Is it racist to oppose Obamacare?

It is pretty easy to be against Obamacare these days.

The federal government can’t come up with a working website to help people buy health insurance. The president misled people about whether they could hold onto their old insurance plans. And come next tax day, the least popular provision of the Affordable Care Act — the individual mandate — will be implemented for the first time.

Lost amidst all this controversy is the very strong likelihood that once Obamacare is fully implemented, and the disastrous Healthcare.gov website is functioning properly, the law will mean health insurance for millions of previously uninsured Americans.

And the people most likely to benefit from this law, according to a recent study, are blacks and Hispanics who not only have higher rates of uninsurance, but also frequently demonstrate greater need for medical care.

Which raises a question: is it racist to oppose the Obamacare efforts to increase health insurance in the United States?

The authors of the study point out that “not only are Hispanics and Blacks more likely to be uninsured [than whites], they also report worse health at most ages.” This partly explains why African-Americans have shorter life expectancy than Caucasians, and spend more of their adult years in poor health. In fact, the authors have an analysis illustrating the chance of going without health insurance according to age, race and ethnicity, based on data from 2008, before Obamacare was passed into law:

Is it racist to oppose Obamacare?

This picture reminds us that a major goal of Obamacare was to reduce unjust disparities in access to healthcare, access that can mean the difference between pursuing versus not being able to pursue one’s life goals. I understand people’s concerns about creating an expensive new government “entitlement.” I know why many of my politically conservative friends and relatives are suspicious about federal efforts to reform something as massive and complex as the US healthcare system. Indeed, the ridiculously incompetent launch of Healthcare.gov confirms many of these suspicions.

But as a physician, I cannot stand the thought that we allow people to suffer needlessly for lack of access to affordable healthcare. Having practiced medicine in the VA health care system from 20 years, I have seen the benefits of providing decent Americans with solid healthcare coverage.

I also understand the concerns of my politically liberal friends who criticize Obamacare for not pushing us into a single payer system, and instead relying upon private insurance companies to help solve the problem. It is very likely that “Medicare for all” could have been launched much more smoothly than the health insurance exchanges which we are trying to get running now.

But as a political moderate, and also as someone who has read extensively about the history of health reform efforts in the United States, I understand why the Democrats tried to work within the system we have, rather than impose a politically untenable single-payer system that never would have come into being. No politician who values her chance at re-election would vote to eliminate a whole industry, like the health insurance industry. Health care reform must always operate within the possible.

Now back to the question I pose in the title of this post: given that Obamacare will help blacks and Hispanics more than other segments of the American population, is it racist to oppose the law?

The answer is: mainly no, but occasionally yes. There are some racist people who oppose the law because they hate seeing their tax dollars used in ways that benefit blacks and Hispanics. They oppose the law because they believe that black and Hispanic people who lack health insurance simply need to stop being so lazy, and get better educations and better paying jobs so they can buy insurance on their own. But most people who oppose the law do not do so for such explicitly crass reasons. They do so because they are worried about government spending. They do so because they don’t trust the federal government to administer the system effectively and efficiently.

Nevertheless, people who oppose the law for these other, more legitimate, reasons need to at least recognize that efforts to thwart the law, if they succeed, will disproportionately harm blacks and Hispanics. That is what is so disturbing about the many Republican efforts to repeal The Affordable Care Act without coming up with a legitimate alternative that offers all Americans decent and affordable health insurance. I am not saying that alternative plans do not exist. I’m just saying they have not been the focus of most repeal efforts.

To oppose the Affordable Care Act without coming up with a way of benefiting the neediest people among us — I have a hard time respecting that.

Peter Ubel is a physician and behavioral scientist who blogs at his self-titled site, Peter Ubel and can be reached on Twitter @PeterUbel.  He is the author of Critical Decisions: How You and Your Doctor Can Make the Right Medical Choices TogetherThis article originally appeared in Forbes.

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  • Thomas D Guastavino

    If the ACA (Notice I am not calling it Obamacare because apparently that is deemed racist) reimbursements are so low that few providers accept it how are Blacks and Hispanics helped?

    • southerndoc1

      Not defending the ACA, but there are no fee schedules in the legislation. The payments to physicians are determined solely by the capitalist insurers who sell policies on the exchanges and are trying to maximize their profits. If we don’t like the fee schedules they’re offering, we can, as always, chose not to contract with them for those particular products.

      • Thomas D Guastavino

        Do you think we will be called racist if we turn down these ACA policies?

        • guest

          You are racist for even asking the question!

          • Thomas D Guastavino

            How So??

          • guest

            Forgot to turn on my snark font, sorry :)

          • Thomas D Guastavino

            Sarcasm, I love it!

  • PoliticallyIncorrectMD

    Respectfully, measurable inequality between any two groups (racial or otherwise) may have nothing to do with either unconscious bias or intent to discriminate. It may well be rooted in the specific makeup / properties of a group (socioeconomic, cultural, genetic and otherwise), especially when it comes to health disparities. For example, the fact that most of Cystic Fibrosis patients are Caucasian and most Sickle Cell Disease patients are African American is hardly an example of racism. Equating disparities with discrimination (conscious or unconscious) is hardly “scientific” and only convenient to those advocating for certain agenda.

  • PoliticallyIncorrectMD

    Dr. Ubel –

    The devil is in the details. In my opinion, one should not equate disparity (difference between two groups) and discrimination such as racism (unequal treatment of two groups). Similarly, one should see a difference between access to health insurance and access to medical care. It seems that ACA does not discriminate (no pun intended).

  • May Wright

    Does calling someone “racist” even mean anything anymore? It’s been used so liberally as an all-purpose shut-up bomb for the last 5 years, most of the real meaning of the word has been leeched out of it.
    I for one am pretty much over it. I don’t want the US government to take over health care because I think they’ll wreck it. That doesn’t make me a racist.

  • saurabh jha

    I am pleased the author does not think it is racist to oppose the ACA.
    When some victims of racism see the slur “racism” thrown around frivolously, such as when one wishes to prevail in a policy debate, it is actually quite offensive and demeaning, even though that might not be the interlocutor’s intent.

  • http://onhealthtech.blogspot.com Margalit Gur-Arie

    Actually, in absolute numbers, white people (or rather pinkish beige) are overwhelmingly more likely to benefit from what Obamacare is supposed to accomplish (but won’t in its current form), than any other race or ethnicity, seeing that white people including European Hispanics (not what “most people” would refer to as Latino), make about 70% of the US population.

    BTW, I assume there is a zero missing on the vertical axis of that graph….

  • Thomas D Guastavino

    Sarcasm, I love it!

  • Tiredoc

    Are you still beating your wife?

    You fail even in your straw man construction. The reason a disproportionate number of Hispanics are uninsured is they are illegal residents, statutorily excluded from both the benefits and penalties of Obamacare.

    As for the herky-jerky graph, you assume that the African American population’s life expectancy discrepancy would improve with access to insurance. There is no reason to assume this. For an accurate statistical analysis, you need to weight the age as a percentage of life expectancy in order to compare the prevalence of uninsured status.

    Involuntary uninsured status is directly proportional to a specific financial condition, which is unemployed, without assets, with a pre-existing condition that prevents purchase of insurance.

    Your main point is that those of us who oppose Obamacare need to have a plan to address the issue of the uninsured in order to not be contemptible.

    Obamacare was supposed to insure more people than the previous system. It was supposed to cost less than the previous system. It was supposed to not suck.

    Obamacare is going to debut in 2014 insuring less people than before it started. Of the people that gained insurance, most will be Medicaid patients, who aren’t going to bend the cost curve down at all. The illegals still won’t be insured.

    The appropriate response to a bad law is to repeal it.

  • John C. Key MD

    What would the political left do without the straw man?

    Are there really people out there who wish to deny health care to the poor and/or blacks and hispanics? If so it must be a vanishingly small group–I’ve never run into one and I’ve been practicing medicine for 40 years.

    Obamacare in its current incarnation will surely destroy American healthcare. Unless his goal is uniform but poor quality healthcare for all, it is difficult to see how Dr. Ubel and his ilk can support this sham.

    • http://onhealthtech.blogspot.com Margalit Gur-Arie

      This is not the political left, Dr. Keys. The political left wants Medicare for all (all, as in all of us), not just a feel good mass produced and mass inflicted inferior solution that the benevolent elite won’t touch with a ten foot pole for their own needs. The same was true for the mass produced and mass inflicted “food” industry. And the same is true for the emerging mass produced and mass delivered “education”, or rather labor preparation, paradigms for everybody that cannot afford the exclusive private schools of the wealthy.
      Rhetoric not withstanding, this is not about conflict between left and right ideology. This is about huge corporations, and their paid, or captive, advocates vs. the people. The former is actually healthy and good for a free people, but the latter is destroying us.

    • SBornfeld

      People are a bit more discrete now than in the ’60s, when people in some states starved social welfare in the hopes that “those people” would find their way to those pinko states. But it’s very hard for me to escape the feeling that those governors who declined increased federal money for Medicaid were thinking along the same general lines. No way I can prove it, but if you haven’t found people who resent giving the little guy a break, I don’t think you can be looking very hard.

      • John C. Key MD

        I suppose one can find that which one wishes to find. Of course there are many legitimate reasons to avoid the Medicaid uptick (like the fact that it is a “bait-and-switch) but if you want to view it as a way to relocate the poor, that is your business. As Abraham Lincoln said, “Most people are just about as happy as they make up their minds to be”.

    • guest

      “uniform but poor quality healthcare for all”

      This is exactly what the ACA will deliver, and I am fearful for the future.

  • Thomas D Guastavino

    Sarcasm ?

    • May Wright

      Ever since I admitted that my antipathy towards a certain Canadian arts graduate was, indeed, naked racism, Ninguem has been on my case ;)

      • Thomas D Guastavino

        I did notice that several of the replies by Ninguem were deleted but there were 15 likes on the last reply, hence my confusion. Interesting responses

  • fatherhash

    hahaha, nice.

  • Suzi Q 38

    Aren’t there any uninsured Asians?

  • guest

    Incredibly ignorant regarding the concerns about the ACA. Absurd!

  • M.K.C.

    I only ask because I’m not old enough to remember the political repercussions at the time:

    Were all those who opposed Hillarycare shamed, derided, and written off as “racist”?

    Or is dismissing all your political critics as “racist” something new, a bonus feature of having elected the man touted as “our first post-racial President”.

  • Tom Smith

    What is the result of Obamacare?

    Million of those uninsured, before the disastrous implementation of Obamacare, remain uninsured.

    Millions of those insured before the disastrous implementation of Obamacare are now uninsured.

    Those currently insured, face skyrocketing premiums, skyrocketing deductibles, and plummeting quality of care.

    Obama PROMISED, countless times, that, “if you like your plan, you can keep your plan. If you like your doctor, you can keep you doctor.”
    Both statements were LIES. These LIES were known well in advance of the disastrous implementation. If Obama, and his cabal of socialists, had been honest about the European-style socialized medicine that they were pushing, Obama not only would NOT have won the 2009 election, he would have been laughed out of the senate.

    There are many who can NOT afford their existing insurance and the insurance plans offered by “healthcare,org” are unaffordable by most.

    So, in an effort to “equalize” healthcare across the board, Obama, his cabal of socialists, have reduced the quality of the medical care Americans receive, AND have made this “care” unaffordable.

    Who is the racist here?

    I would contend that OBAMA, and his cabal of socialists, are the RACISTS, since more people are destroyed by this abomination, this travesty, this government power-grab, known as Obamacare.

    So, if being against the disaster, the train-wreck, known as Obamacare makes me a racist, so be it. I AM A RACIST!

  • Michael Rack

    “No politician who values her chance at re-election would vote to eliminate a whole industry, like the health insurance industry”.

    The Democrats did do this; but planned the elimination to occur gradually so that most Americans would not notice.

  • John Hunt

    Does it bother you that Black Americans have shorter life expectancies and benefit less from Medicare and Social Security, but have their money taken from them throughout their working life to pay for those programs just as much as white Americans? Talk about racist programs. Oh, Social Security is Sexist too, because males die younger than females.

    It is time to eliminate groupisms altogether. The progressives love to group people into Black, White, Hispanic, Gay, Straight, etc. etc. Progressives love Groupthink. Groupisms dehumanize and allow throughtless judgments against individuals without taking the effort to even know the individual.

    Does an individual child have access to care? That is what I care about.
    The health insurance paradigm and its moral hazard is making access to care horribly unaffordable. The groupthink progressive solution is more of the same insurance that caused the problem in the first place, or outright socialism (the ultimate in moral hazard). I think the solution is to stop thinking in groups and averages and statistics and instead think in terms of individual liberty

  • guest

    “There are some racist people who oppose the law because they hate seeing their tax dollars used in ways that benefit blacks and Hispanics.”

    Are you serious? I do not know a single person who really believes this. Most that I know oppose the ACA because it’s a terrible bill that cuts reimbursements to providers while doing nothing about health care costs. If anything, the ACA will make costs rise because it increases the power of the 3rd party payor.

    Some really ridiculous conclusions drawn here.

  • http://www.waynecaswell.com Wayne Caswell

    Is it “racism” or “classism”? Public health officials have seen average lifespan differences of more than 20 years between affluent and low-income neighborhoods on opposite sides of the same town, and the wealth gap keeps widening.

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