Welcome to Stairway to Healthcare, a blog about achieving health equity through changes in healthcare policy. I conceived of this blog as a way to help myself, and hopefully others, to process the extraordinary amounts of information coming at us every day in the debate over healthcare reform.
Then white supremacists marched on Charlottesville, VA.
My mission hasn’t changed, but watching events unfold over the last week has crystallized for me the importance of making equity the consistent bottom line in my conversations about healthcare. You see, the people who marched with torches across the University of Virginia campus have bought into a myth of scarcity. They believe there cannot be equity, there can only be those who have more and those who have less. More for you means less for me.
Health equity means the attainment of the highest level of health for all people. It requires, among other things, that people have equal access to quality healthcare services. Having access to healthcare means more than just having an emergency room near where you live. You only truly have access to care if that care is affordable (which usually requires that you have health insurance); if the type of care you need is available where you are geographically; and if the provider is someone you can communicate with and trust—someone who honors your cultural identity, speaks your language, respects your sexual orientation.
Unfortunately, the healthcare system is subject to the same systemic racism that is ingrained throughout our country. For example:
- Black, Latinx and Native American populations are more likely than whites to delay or forgo healthcare due to cost or other reasons.
- Blacks, Latinx and Native American populations fare worse than whites on the majority of health outcomes.
- Black, Latinx and Native American populations are significantly more likely than whites to be uninsured—in fact, in 2014 (before full implementation of the ACA), 55% of the nonelderly uninsured (under 65 years old) were people of color.
- Latinx and Native American children are twice as likely as white children to be uninsured.
It’s not only people of color who suffer. All of the biases that exist in the larger society exist in the healthcare system. Poor people, immigrants, LGBTQ people, and people who are disabled and/or have special health needs are also more likely to encounter obstacles to accessing high-quality healthcare and more likely to experience poor health outcomes than people who do not fall into one of those groups.
The conversation about health equity needs to be brought to the fore in the debate over healthcare reform. . . . Resources are finite, but there is no scarcity, only choices to be made about how we prioritize those resources.
The legal historian F.W. Maitland wrote, “Such is the unity of all history that anyone who endeavors to tell a piece of it must feel that his first sentence tears a seamless web.” Maitland was talking about our system of laws. But when we talk openly about disparities in health outcomes and healthcare, we tear into another seamless web: that of institutional racism and discrimination; of the ever-growing gap between rich and poor; of ableism; of homophobia and prejudice against transgender people; of the ways socioeconomic status connects directly with inequality in access to a good education, to nutritious food, to affordable transportation. When we talk about disparities in health and healthcare, we put aside the myth that more for you means less for me and say, We cannot live any longer amidst this injustice. We must and will change. We can do better.
Yet, on the political stage, health equity is not often discussed as a core goal of healthcare reform. Most often, the focus is on cutting costs. Reducing cost is important, but too often this is accomplished by limiting access, not by finding ways to deliver the best care to the most people in the most efficient way. And, yes, lawmakers do talk about giving “all Americans” access to care, but with insufficient attention to the disparities in health outcomes and healthcare access that are linked to race, socioeconomic status and other social determinants.
The conversation about health equity needs to be brought to the fore in the debate over healthcare reform, and equity should be a non-negotiable goal of any healthcare reform strategy. There are people delivering this message, speaking up from community health centers, advocacy organizations, and population health programs at universities and academic medical centers. But it shouldn’t just be up to them to carry this message. All of us who care about healthcare reform must pick up the banner of health equity to make sure this message is heard.
It is fully possible to give everyone the opportunity to thrive. Resources are finite, but there is no scarcity, only choices to be made about how we prioritize those resources.
I hope this blog will be a reference for those who want to better understand how healthcare policy connects with the day-to-day lives of real people as well as what sorts of changes can get us closer to achieving health equity. (You can learn more about health equity and health disparities here.) Disparities in access to healthcare and in health outcomes existed long before now. The Affordable Care Act began to take steps toward remedying these disparities—for example, between 2010 and 2016 the uninsured rate for nonelderly, lower-income Black and Latinx adults dropped at least 10 percentage points. But for a number of reasons the ACA has not achieved its full potential, and now its successes are under threat.
I believe that together we can influence the course of this debate and put this country back on the right path when it comes to healthcare. Positive change will not happen overnight, but the threat of moving backward is real and present. It is imperative that we stay engaged and act right now.
Finally, I hope you’ll not just take in what I have to say but that you’ll share your own thoughts with me, by commenting directly on posts or on the Stairway to Healthcare Facebook page, Tweeting at me @StrwyToHlthcre, or emailing me at firstname.lastname@example.org. More than anything, I hope you’ll use what we learn together to have the hard conversations and advocate for change, so that someday in the not-so-distant future every person in this country has equal access to high-quality, affordable healthcare—and a chance at a full and healthy life.
Join me on the #stairwaytohealthcare. Let’s climb.