Insight News

Feb 11th

Black elderly warehoused with worst facilities with worst health care services

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For the last two months, I have gone through the painful but enlightening experience of visiting perhaps 25 nursing homes in two states. And in that process I have gained an even more acute appreciation of ... For the last two months, I have gone through the painful but enlightening experience of visiting perhaps 25 nursing homes in two states. And in that process I have gained an even more acute appreciation of the need for adequate health care for the elderly and for all Americans.

This is particularly urgent in that the rules which govern Medicare are shaped to assist those who have a chance for recovery in 20 days to sometimes as much as three months. After that, if they are indigent and have Medicaid, it will cover the cost. If they are not indigent, nursing home care for elderly sick persons must be borne by the family and can cost as much as $3,000 per month or whatever they can afford. Medicaid now covers 40 percent of all medical costs for the poor.

The Black elderly, disproportionately poor, are also disproportionately warehoused in some of the worst facilities, with some of the worst medical care. A study by the Harvard School of Public Health found that because of racial bias and cultural differences, Blacks face a poorer quality of care under Medicare managed plans. Walking through these nursing homes and asking hundreds of questions, I found that in most cases these facilities are the last homes for the dying or otherwise infirm. While some of them are excellent in maintaining the health and dignity of the elderly, others stink of urine and exhibit neglect in the cleanliness of the facility and the residents. More urgent is the fact that in the current economic climate, state financial contributions to nursing homes is being cut.

Given this environment, something is happening to cause insurance executives to suddenly begin to call for universal health care. For decades now, those who have promoted universal health care have been regarded as "pinko lefties," socialists and down right silly for recommending something that was not about to be taken seriously. Now we find Blue Cross of Montana, Blue Cross of California and the head of United Health Group, the largest private insurer in the country, urging Congress to reexamine the issue.

One fear is that the magnitude of the uninsured, which stands currently at 41 million and growing since the dive in the economy two years ago, will drag down the entire health care system. Unemployment drives down the system because employers are the main source of insurance premiums and when firms cut workers, insurance premiums go. The number of uninsured in 2000 amounted to 14 percent of all Americans, 21 percent of Blacks (probably 24 percent of Blacks in this recession) and 24 percent of all poor Blacks. Hispanics in particular face a heath crisis, as nearly 40 percent had no health insurance, while only 13 percent of Whites were uninsured. The problem seems to be growing by the minute. The U.S. Department of Labor says that in November 2002, unemployment grew from 5.7 percent to 6 percent, adding 40,000 to the jobless rolls.

Nevertheless, the pool of those currently insured is costly to insurers, as many HMOs around the country are throwing out the elderly, and the working poor and young cannot afford to pay high premiums for insurance. Essentially the problem is that insurance companies want more young people in their pool of the insured; they are less ill and, therefore, subsidize those with more serious ailments. Among the employed, about 90 percent of non-Hispanic Whites have insurance, while 81 percent of Blacks and only 66 percent of Hispanics are covered. At the same time, insurance companies are adjusting to the loss of customers by raising premiums. However, there is a limit to how far this can go.

In any case, since one-quarter of Blacks and one-third of Hispanics are affected by the lack of health insurance, their political representatives may now be free to strongly advocate for universal health insurance, given that some of the big insurance companies have opene

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