WASHINGTON -- Health care reform was described yesterday as a "life and death" issue for black Americans, but members of the Congressional Black Caucus are not convinced that President Clinton's proposal is the best approach.
The proposed new system of guaranteed access to a standard package of basic health benefits, emphasizing primary and preventive care, could potentially rescue millions of uninsured African-Americans from needless disease and premature death, supporters of the plan say.
At a meeting with first lady Hillary Rodham Clinton yesterday, key black legislators questioned whether the administration plan blend a private system of managed competition with an
overlay of government regulation might continue or even aggravate discrimination against the poor.
"There are cultural, linguistic, racial, educational and attitudinal differences that impose special barriers to effective delivery of care to our community," said Rep. Louis Stokes, the Ohio Democrat who chairs the Black Caucus Health Braintrust. "We must be assured that any new system does not continue to differentiate between the haves and the have-nots, the unemployed and the working, minorities and whites."
The Clinton program would allow people to pay more to purchase a traditional health care plan allowing them to see any doctor. Most people, however, will be forced by cost to select a cheaper health maintenance organization, which provides the same benefits but does not permit as much choice of physicians or hospitals.
Fear for inner-city centers
Black lawmakers warned that the intense competition between health care providers would squeeze out inner-city health centers that for years have catered to black communities for little or no profit.
Risa Lavizzo-Maurey, deputy administrator of the agency for health care policy and research of the U.S. Public Health Service, noted that the administration's proposal includes a provision that would forbid discrimination by health care providers or the alliances that provide insurance.
But many black lawmakers favor an alternative proposal, sponsored by Democratic Rep. John Conyers of Michigan, to establish a single, government-run health insurance program, because they believe it would screen out more subtle racism that might otherwise creep into a blended system.
Mrs. Clinton observed that the Conyers proposal would require a major new tax increase to pay for it, which would probably be impossible to pass. But she assured the caucus members that the administration shares their goals.
"We're all trying to get to the same place," Mrs. Clinton said. Mr. Stokes called health care reform a "life and death" issue for black people because they are most likely to fall through holes in the current health care system, which has left between 35 million and 37 million Americans without any health coverage at all.
Twenty-one percent of black Americans currently fall into that category, compared with 11 percent of whites, according to government figures released earlier this week. They are mostly working poor who neither have private insurance nor qualify for care through the federal programs of Medicare for the elderly and Medicaid for the poor.
High death rates
The lack of primary care and preventive care, which is not even available to those who have Medicaid, is believed to be directly responsible for the disproportionately high death rate among black people.
Rep. Robert C. Scott, a Virginia Democrat, noted that 1.58 black adults die of heart disease, cancer and strokes for every white adult who dies from those causes. Life expectancy for blacks is 70 years, compared with 76 for whites.
The infant mortality rate for black babies is twice as high as that of the population at large, he said.
With its new emphasis on preventive and primary care, the Clinton program would provide for prenatal care, immunizations and routine checkups for children and teen-agers as well as glasses and dental care.
Those suffering from sickle cell anemia, a blood disease that primarily strikes black people, would benefit from early and more comprehensive care.
The Clinton program would also represent a major improvement in the health care of AIDS patients, who also include a disproportionately high number from the black community.
Rep. Albert Wynn, a Democrat from Prince George's County, said yesterday that assuring universal access to health care has to be first concern of black legislators, with issues of choice coming later.