Racial Justice and Medicare for All

This week we chat with Dr. Bita Amani, an epidemiologist and Associate Professor for Charles R. Drew University of Medicine and Science and Lead Co-Chair of the COVID-19 Taskforce on Racism and Equity which is housed in the UCLA Center for the Study of Racism, Social Justice, and Health. We talk about how health played a role in the invention of race, and what structural racism in our healthcare system looks like right now. We also talk about health inequities and what Medicare for All will fix (and also what it won’t fix!)

Show Notes

We start with the basics: Dr. Amani is an epidemiologist. What IS epidemiology? It’s the study of the distribution and patterns of disease – meaning: who gets sick, and what causes some groups to get sick while others don’t? Specifically, she’s a “social epidemiologist,” which focuses on how major structures – like housing, the workplace, and HEALTH CARE – impact the distribution of disease. She is exactly the expert you’d want to ask about the COVID-19 epidemic, and it turns out that race and racism plays a major role in who gets sick and who doesn’t.

To understand how racism impacts health, it’s important to understand that we’re talking primarily about “structural racism” – such as the systems of mass incarceration and policing in the United States, systems where you’ll be treated differently based on your race. This is different from defining racism as the things that bigoted, racist people say and do. Although there are plenty of bigots, and people with explicitly racist ideas out there, a system of structural racism doesn’t need them to create different outcomes based on your race (in criminal justice, in housing, in healthcare, etc).

As it turns out, medicine played a crucial role in creating the concept of “race” – which has no biological basis – and convincing the U.S. population that people belonged to different races characterized by fundamentally different bodies and mental facilities. This role of early medicine was particularly important for maintaining slavery, and formed the basis of white supremacy.

So how has this legacy of our healthcare system supporting structural racism carried over into the present day? The geography has carried over for one, leaving communities of color in “medical deserts” – areas without enough access to care. This problem has been getting worse with the closing of hospitals that serve communities of color, which is even happening during the pandemic. Or look at health insurance coverage – which is linked to employment and the racial inequities in access to good jobs – where black people are twice as likely to be uninsured as white people.

If we won Medicare for All in the United States – which would guarantee at least universal access to health insurance – what impact would that have on racial inequities in healthcare? It would obviously de-link your healthcare from your job, which would be a major victory for insulating healthcare from one major system of structural racism. A victory like this in healthcare coverage could also be a real tipping point for addressing broader systems of structural racism, if we don’t have to worry about our healthcare.

However, Medicare for All would not end – or even possibly make a big dent – in racial inequities in health outcomes. That’s because our health outcomes (whether and how often we get sick, how long we live, etc) are impacted not just by our access to healthcare, but by housing, education, our access to social supports, etc. M4A wouldn’t even necessarily end racial inequities at hospitals and physicians offices themselves, where we know that people of color are treated differently (worse). So Medicare for All can’t be an end-goal for a movement for health equity, it has to be just a beginning.

What about the intersection of COVID-19 and structural racism? Sadly, Dr. Amani knew right away that there would be vast inequities in how communities of color were impacted by the pandemic. The COVID-19 Taskforce on Racism and Equity that Dr. Amani co-chairs has had to fight to even get accurate data collected on COVID-19 outcomes in many states. The fact that we’re even debating Medicare for All during a pandemic is shocking, though.

We will not educate our way out of this racist healthcare system, though – we have to organize our way out of it!

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