No. You can't just jury this away. Any American single payer system will be racist

[Recursion]

I'll take as many hides as this requires, because if you don't get this, you aren't helping.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3983362/

That's an article about racial disparities in kidney failure survival rates in the US. Everyone with kidney failure in the US is put on Medicare. Medicare does not solve the problem: the problem is that Americans are racist as fuck.

Any American social healthcare plan that actually comes into existence will have as its first mission reassuring white voters. And that means they will deny black and brown patients the same opportunities white patients have.

This isn't a theory; this is what we have seen happen with Medicare. The system is not the problem. The people are.

We pretty much have word-for-word the Dutch healthcare system. The difference is that the Dutch jurisdictions are not actively sabotaging their system, and our jurisdictions are. That will remain true.

We cannot have universal healthcare in the US until we end racism. It is not possible.

[FBaggins]

1. No need to jury it away... but it's a ridiculous theory

You haven't even provided a thesis claiming that theoretical single-payer system would be more racist than the existing system.

I'm not a fan of single-payer... but this isn't a valid reason to oppose it.

[WhiskeyGrinder]

2. Did you see the article in the 1619 Project that talked about this very issue?

https://www.nytimes.com/interactive/2019/08/14/magazine/universal-health-care-racism.html

Why doesn't the United States have universal health care? The answer has everything to do with race.

The smallpox virus hopscotched across the post-Civil War South, invading the makeshift camps where many thousands of newly freed African-Americans had taken refuge but leaving surrounding white communities comparatively unscathed. This pattern of affliction was no mystery: In the late 1860s, doctors had yet to discover viruses, but they knew that poor nutrition made people more susceptible to illness and that poor sanitation contributed to the spread of disease. They also knew that quarantine and vaccination could stop an outbreak in its tracks; they had used those very tools to prevent a smallpox outbreak from ravaging the Union Army.

Smallpox was not the only health disparity facing the newly emancipated, who at the close of the Civil War faced a considerably higher mortality rate than that of whites. Despite their urgent pleas for assistance, white leaders were deeply ambivalent about intervening. They worried about black epidemics spilling into their own communities and wanted the formerly enslaved to be healthy enough to return to plantation work. But they also feared that free and healthy African-Americans would upend the racial hierarchy, the historian Jim Downs writes in his 2012 book, “Sick From Freedom.”

Federal policy, he notes, reflected white ambivalence at every turn. Congress established the medical division of the Freedmen’s Bureau — the nation’s first federal health care program — to address the health crisis, but officials deployed just 120 or so doctors across the war-torn South, then ignored those doctors’ pleas for personnel and equipment. They erected more than 40 hospitals but prematurely shuttered most of them.

White legislators argued that free assistance of any kind would breed dependence and that when it came to black infirmity, hard labor was a better salve than white medicine. As the death toll rose, they developed a new theory: Blacks were so ill suited to freedom that the entire race was going extinct. “No charitable black scheme can wash out the color of the Negro, change his inferior nature or save him from his inevitable fate,” an Ohio congressman said.

All of our institutions are built on white supremacy. We must dismantle it before we can move forward.

[pnwmom]

3. This doesn't prove what you think it does. One of the biggest causes of kidney failure

is diabetes, and most of the people who develop kidney failure developed diabetes LONG before they went on Medicare. And many of these people had no insurance or inadequate insurance before they went on Medicare.

It makes no sense to blame Medicare on the problem that developed long before.

And the expansion of Medicaid -- which is single payer -- has already improved the health outcomes of the people on it.

https://www.washingtonpost.com/health/i-would-be-dead-or-i-would-be-financially-ruined/2019/09/29/e697149c-c80e-11e9-be05-f76ac4ec618c_story.html?fbclid=IwAR2G5GkOX1nnR1jjxBxJ7YSxGyVrZyb1oyD6Nwh6WcbXrPsxzAIM_aT06HQ

DETROIT — Poor people in Michigan with asthma and diabetes were admitted to the hospital less often after they joined Medicaid under the Affordable Care Act. More than 25,000 Ohio smokers got help through the state’s Medicaid expansion that led them to quit. And around the country, patients with advanced kidney disease who went on dialysis were more likely to be alive a year later if they lived in a Medicaid-expansion state.

Such findings are part of an emerging mosaic of evidence that, nearly a decade after it became one of the most polarizing health-care laws in U.S. history, the ACA is making some Americans healthier — and less likely to die.

SNIP

It is difficult to prove conclusively that the law has made a difference in people’s health, but some strong evidence has emerged in the past few years. Compared with similar people who have stable coverage through their jobs, previously uninsured people who bought ACA health plans with federal subsidies had a big jump in detection of high blood pressure and in the number of prescriptions they had filled, according to a 2018 study in the journal Health Affairs.

[TheRealNorth]

9. Pnwmom nailed it

[brush]

4. Eliminating racism in America is like trying to eliminated breahing. It won't happened but we...

can't let that stop us from deploying improved services. As we have done for centuries we've learned, some more successfully than others, to work around racism as we go about our lives.

It would be the same with single payer health care.

[Recursion]

5. "Improved" services that are racially biased are not interesting to me

I don't want them. I don't want to benefit from them. I don't want to pay for them. I don't want to give Mitch McConnell the power to decide if sickle cell is a "real" disease or not.

[brush]

8. You're paying for them now. Single payer is better than what we have now. Racism is not...

going anywhere. Moscow Mitch won't be working in your health care office. Be smart and learn to work around it like we've always had to do while trying to eliminate racism and rid the system of the racists.

[TidalWave46]

6. I attempted to reply to your original op and it went "poof" as I was replying.

You make one point that is excellent and follow it up with a point that is truly ignorant. Racial disparity within healthcare is real. In your other op, you literally said that is a reason we cannot do single payer. That is just nonsense and completely ignorant. There are other words that could be used but I don't want a hide. Your thought experiment is so foolish it isn't worth discussion. It should be hidden.

[Recursion]

7. Why should we grant Mitch McConnell the power to deny black people healthcare?

That's the barest way of stating the issue. And I'm happy to stand by it.

[TidalWave46]

10. If that is the best way to state the issue then you have no issue.

You are conflating two things that should not be conflated.

Why achieve 100% insurance coverage for people of color when there is disparity services in place? Do you see how mind-numbingly foolish that is? Why make sure someone has a general primary physician? Why make sure every person of color has affordable access to cholesterol meds? Why make sure people of color can have access to affordable blood tests twice a year? Why make sure people of color won't go into insurmountable debt because of a necessary surgery?

Your thought experiment is frightening.

Talk about the disparity in services provided among races. Talk about how that won't disappear with single payer. Both of those aspects are as real as could be. Don't then follow it up with how we shouldn't move on single payer because of it. That is a level of dumb that cannot be entertained for obvious reasons.

To be fair, you have changed your wording for this op. This op is much less foolish that the other one.

[edhopper]

12. What makes you think the Republicans will have

any part in a Single Payer system?

[Recursion]

17. Because they vote, particularly in mid-terms

If we give them power they will use it.

[Act_of_Reparation]

11. "Until we end racism"

Yeah, ok. BRB while I end racism.

[muriel_volestrangler]

13. Huh? Your link says:

Overcoming barriers to quality health care is crucial for optimizing health outcomes (Figure 5)7. A single payer system has been proposed as a powerful approach to reducing disparities in access to care, delivery of care and associated health outcomes. Tarver-Carr et al. reported much lower rates of cardiovascular procedures among women and minorities with CKD not on dialysis when coverage was dispersed among multiple providers. However, after the onset of ESRD and transition to Medicare, a single payer system, the rate of cardiovascular procedures was similar for all ESRD patients27. A single payer system has also been associated with racial/ethnic equity for KDOQI CKD recommended targets28. A pooled analysis of four community-based studies where coverage was dispersed among multiple providers, suggested a survival disadvantage (composite end points of death and nonfatal myocardial infarction) for blacks with CKD,29 whereas, a survival advantage was noted for blacks with diabetic nephropathy seen at the Veterans Administration, also a single payer system30. In addition to strategies such as a single payer system, an integrated team approach (Figure 6) can help to better coordinate the complicated needs of many patients31. This may be particularly important for patients with multiple health care needs such as those with CKD. An integrated approach can help to coordinate care and improve health care delivery across the existing multiple payer system, leverage a team of health professionals (physicians, nurses, social workers, dietitians, pharmacists) and provide system level support for patient self-monitoring of key co-morbid health conditions such as diabetes and hypertension32.

So your link disagrees with you. What is your case?

[Recursion]

18. Everyone in the US with kidney failure is on Medicare

Medicare is a single-payer system.

[muriel_volestrangler]

19. Please read the paper you linked to, especially the section I quoted for you.

Then you can consider whether to self-delete your OP:

Tarver-Carr et al. reported much lower rates of cardiovascular procedures among women and minorities with CKD not on dialysis when coverage was dispersed among multiple providers. However, after the onset of ESRD and transition to Medicare, a single payer system, the rate of cardiovascular procedures was similar for all ESRD patients27. A single payer system has also been associated with racial/ethnic equity for KDOQI CKD recommended targets28. A pooled analysis of four community-based studies where coverage was dispersed among multiple providers, suggested a survival disadvantage (composite end points of death and nonfatal myocardial infarction) for blacks with CKD,29 whereas, a survival advantage was noted for blacks with diabetic nephropathy seen at the Veterans Administration, also a single payer system30.

The problems with minority care are before they get onto single payer systems. After they're on Medicare or the Veterans Administration, the treatment is equal.

Your OP has got it completely wrong.

[Midnightwalk]

14. The article seems to argue for universal healthcare

There’s a lot to digest there so apologies if I get some wrong.

The abstract says minorities tend to have worse progression of disease but have better outcomes once on dialysis.

Chronic kidney disease (CKD) is a national public health problem. While the prevalence of early stages of CKD is similar across different racial/ethnic and socioeconomic groups, the prevalence of end-stage renal disease (ESRD) is greater for minorities than their non-Hispanic white peers. Paradoxically, once on dialysis minorities experience survival rates that exceed their non-Hispanic white peers.

The authors seem to think universal healthcare is a way to improve outcomes for minorities and in general.

In addition, the promotion of universal forms of health care and/or more structured medical care systems7 may be vital prospects to advance our knowledge. These approaches can ensure that all persons can receive timely quality care.

Also

A pooled analysis of four community-based studies where coverage was dispersed among multiple providers, suggested a survival disadvantage (composite end points of death and nonfatal myocardial infarction) for blacks with CKD,29 whereas, a survival advantage was noted for blacks with diabetic nephropathy seen at the Veterans Administration, also a single payer system30.

I am not trying to argue there isn’t way too much racism in America and in the healthcare system in particular. There is. I’m just questioning your conclusion that single payer would make it worse. The article seems to argue that universal healthcare would help.

[Mosby]

15. The linked article doesn't say that americans are racist AF

It says that long term outcomes for kidney disease seem to vary based on socioeconomic status, race, and education, and these variables are interrelated.

Educated people are more healthy and live longer:

Higher educational attainment (college graduates compared to persons not completing high school) was associated with significantly lower adjusted odds of having hypertension, 0.71 (95% confidence interval [CI], 0.66-0.76); diabetes, 0.77 (95% CI, 0.72-0.81); cardiovascular disease, 0.62 (95% CI, 0.57-0.68); current or previous smoking, 0.57 (95% CI, 0.54-0.60); obesity, 0.83 (95% CI, 0.79-0.88); decreased kidney function, 0.89 (95% CI, 0.82-0.96); and albuminuria, 0.72 (95% CI, 0.67- 0.78). Importantly, during a mean follow-up of 3.9 years those who had completed college had 24% lower mortality compared with participants who had completed at least some high school (p<0.001) (Figure 7)37.

The health disparities are a lot more about knowledge and behavior but are influenced by poverty, family makeup and the legacy of slavery.

I think single payer/universal HC should mitigate these issues, not make them worse.

ETA those numbers (.71, .77, .62) are correlation coefficients where 1 is a perfect correlation. r = .7 for example is considered extremely high.

http://sites.utexas.edu/sos/guided/inferential/numeric/bivariate/cor/

[ismnotwasm]

16. Well.

Imma certified Med surg RN who also does in-patient dialysis. Racial disparities are very apparent in real time.

I think we can work toward Universal health care while simultaneously work toward racial justice.

Medicare for all is not going to work for a variety of reasons.

My last shift, our ICUs were 9 nurses down, and they were begging us to dialyize patients almost ready for floor care. Our dialysis list was also out of control. We work very long shift to provide care. Management hates the overtime we work.

We are short clinics. We are short providers. We are short nurses. We are short healthcare workers all across the county. Medicare chronically under reimburses healthcare services. Chronic Kidney disease is the only condition full covered (the history of why is interesting)

So while I agree in part, I also want to see forward momentum on universal healthcare.

[ecstatic]

20. But is the problem due to delay in detection of kidney disease?

And is the delay of detection due to not having any insurance, or not having regular checkups, or not going to the doctor at the first sign of an illness?

The reason I ask is because of this line:

Paradoxically, once on dialysis minorities experience survival rates that exceed their non-Hispanic white peers.

I don't have time to read the entire article right now, but it sounds like they're saying that once the disease is detected, minorities recover even better than their white peers.

I'm not advocating for single payer, I'm just saying that this article doesn't appear to support your OP.

[ismnotwasm]

21. You don't recover from ESRD

The average life span on HD is five years.

I’m not going to get into this, but our healthcare system is part and parcel of institutional racism, as is all American systems.


That doesn’t mean we can’t move forward with universal healthcare, it means there isn’t a simple fix.

[Recursion]

22. You said it much better than I did

Single payer would be great, and it would still leave us with a ton of work to do. Just like we have now. But we could also make our current system work, if we fixed the same problems.