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More Evidence Obamacare is Good For White People | The Health Care Blog

More Evidence Obamacare is Good For White People | The Health Care Blog | Healthcare and Technology news |

The latest Gallup and Healthways poll doesn’t phrase it this way, but its findings that the Affordable Care Act “appears to be meeting its goal of reducing the percentage of Americans without health insurance” is more evidence Obamacare is good for white people.

In an interview with National Public Radio at the end of last year, President Obama was asked whether he and the Democrats had lost support among white voters. He denied it, comparing his share of the white vote favorably to that John Kerry in 2004 and pointing to the Affordable Care Act (ACA) as a program that benefited working-class white voters without many realizing it. I’d written much the same thing about Obamacare in a THCB blog post a couple of weeks before the 2012 presidential election. But as with other issues related to race, it’s a topic that the president has only reluctantly discussed, even when good policy is also good politics.

In response to NPR questions about race, Obama noted that some of the biggest beneficiaries of the ACA live in places like “Mitch McConnell’s state,” home to relatively few blacks or Hispanics. Coincidentally, a front page story in the print New York Times documented Kentucky’s experience with the law – which, the president wryly noted, Kentuckians do not call “Obamacare” – the same day the NPR interview aired.

And now Gallup, in a poll designed to mimic the national demographics on race, gender and ethnicity, has found that the national rate of uninsurance has dropped significantly. The regions with the largest decline in the rate of uninsurance were the Midwest and the South. The latter, of course, is the GOP’s stronghold region.

A large gain in the number of number of whites with health insurance was exactly what an Urban Institute analysis was predicting nearly three years ago. It suggested full implementation of the ACA would mean that 12.3 million more white people would gain health insurance.

“Based on the income levels involved, these newly insured will be working-class Americans more familiar with NASCAR than NPR, and, in rural areas, with grain elevators more than car elevators,” I wrote, drawing on several analyses. Fifty-three percent would be male. On the other hand, if Obamacare were repealed and replaced by the plan endorsed by the GOP’s Romney-Ryan ticket, I calculated nearly 25 million fewer whites would have health insurance.

So why is there a perception that minorities are the big Obamacare beneficiaries? While there are many more uninsured whites than blacks, a higher percentage of blacks and Hispanics are likely to be uninsured. On a proportional basis, then, the insurance coverage aspects of Obamacare have a larger effect on minority individuals. That, in turn, allows Obama opponents to play into the perceived victimization of whites.

The Public Religion Research Institute’s 2012 Race, Class and Culture Survey (not mentioned by Obama or NPR) found that 60 percent of non-college educated whites believe that blacks and other minorities get too good a deal from the government. A Fall, 2014 poll by the same group found that 58 percent of working-class whites believe that discrimination against whites has become as big a problem as discrimination against blacks and other minorities.

I closed my blog post in 2012 with a blunt assessment of the perception problem:

The numbers show that the [ACA] is a good deal for white folks, particularly those who are working class. But it’s also very good for many other Americans that too many of their fellow countrymen still view largely as “other” and less as “American.” The larger question is whether coloring in the facts about Obamacare will do anything to override white voter questions about the color of the man who made it possible.

As we now know, the Obama administration’s defense of all aspects of the ACA was be less than robust. Public support has slipped, according to the latest Kaiser Family Foundation poll, even as the law’s positive impact continues to grow. The new GOP majority in the Senate and swollen majority in the House will face little political blowback from the stepped-up attacks on the Obamacare bogeyman that can be expected in the weeks to come.

A newly released report by the Urban Institute updating its 2012 analysis of the racial and ethnic impact of the ACA emphasizes what Obama could have said. The ACA will narrow the uninsurance gap between whites and minorities such as Latinos and American Indians/Alaska Natives. However, since a “disproportionately large share of blacks” live in states that took advantage of the Supreme Court ruling permitting them to not expand Medicaid, the gap between black and white uninsurance rates remains.

If just five “non-expansion” states (Florida, Texas, Georgia, North Carolina and Indiana) were to expand their Medicaid program, the number of blacks with health insurance nationwide would jump by 30 percent, or 900,000 individuals. But those same five states expanding Medicaid would also cause the number of insured whites nationwide to increase by 25 percent, researchers say, or 3.3 million people. That’s more than three and a half times more whites than blacks gaining better access to care.

Although the report doesn’t mention it, three of those five states (Florida, Texas and Indiana) are home to politicians mentioned as potential 2016 GOP presidential candidates. (Florida’s GOP Sen. Marco Rubio might want to examine the breakdown among Hispanic beneficiaries of the ACA for Cuban-Americans.)

Those who oppose “give-away(s) to a selective group based on race,” as a white supremacist group Majority Whip Steve Scalise addressed in 2002 put it (he says he didn’t know their beliefs) will never be fans of the first black president. But when you color in the facts, they show today, as they did in 2012, that Obamacare is a clear win for working-class white people.

Unfortunately, unless those individuals listen to NPR or read health policy journals, most may never know it.

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What if the president worked like doctors today?

What if the president worked like doctors today? | Healthcare and Technology news |

Perhaps doctors should be more like the president.

After all, we also carry the ultimate responsibility for our constituents, even though we, too, have team members who do part of that work.

The way I understand things to work at the White House, those other team members collect, review and prioritize the information the president needs in order to manage his, and all our, business.

That is how things used to work in medicine, too, before computerization revolutionized our workflows. Nurses, medical assistants or secretaries would open the mail, gather the faxes, look over the lab and x-ray reports and put them on physicians’ desks in a certain order. Highly abnormal or time-sensitive information would be prioritized over routine “signature needed” forms, and in my case, essentially normal reports on patients already scheduled to be seen within a few days wouldn’t even reach my eyes until the patient appointment.

Computers changed all that.

Now, most of the information goes straight to the doctors’ inboxes, unseen by other human eyes in the office. This is said to be faster. It is, to a degree, in the sense that the information leaves the laboratory or the x-ray department faster via their Internet-connected computers. But in the typical medical office, we have now turned decision-making doctors into frontline mail sorters and de facto bottlenecks of routine information.

The average doctor sees a different patient every fifteen minutes and the medical assistant rooms patients, takes vital signs, inputs visit information into the EMR and listens to voicemails, which are turned into physician emails. At the same time, the doctor’s electronic inbox is continually filling up with lab reports, x-ray results, consultation reports, electronic prescription refill requests, emails from case managers, and messages from counsellors and other care team members to please read and respond to their issues.

So when does the doctor check his or her inbox?

Between patients is the way many people imagined this system to work. But, how much time do we have between all those back to back fifteen-minute patient encounters? And how do we prioritize in those precious moments between the various types of new information waiting for our review?

Most EMRs color code urgent or abnormal reports, but when it comes to standard laboratory panels, normal patients statistically have 5 percent of their results outside the normal range without being sick, so the majority of complete blood counts and comprehensive metabolic profiles show up red, whether they contain panic values or just statistical noise.

Where does a doctor even begin a two-minute dash through their overflowing virtual inbox?

By lunchtime, or after the last patient visit is over, we dive into the information that has been waiting all day, speedily delivered but bottle-necked for hours while we have been seeing patients.

Imagine if the White House IT department instituted a similar workflow for the president: After a day of speeches, audiences with foreign dignitaries, ribbon cuttings and baby kissing, he has a few minutes before the state dinner, and hastily types in his multiple passwords on the executive computer.

A hundred messages await. One of them contains information about hostile troop movements on our border, another a ransom demand from extremists threatening to blow up our embassy in a faraway land, but most of them are routine missives, reports and requests marked “urgent” in hopes of grabbing the president’s attention.

Is that any way to run a country? No, and any such proposal would surely be vetoed by the commander in chief. But that is exactly how information is managed in today’s medical office, on the front lines of primary care.

Tick-tock, doc! Three patients are waiting, no more time for refills, emails or test results, urgent or not.

And stop reminiscing about having a secretary. Who do you think you are? The president?

Gilbert C FAURE's curator insight, January 14, 2015 8:52 AM

Most EMRs color code urgent or abnormal reports, but when it comes to standard laboratory panels, normal patients statistically have 5 percent of their results outside the normal range without being sick, so the majority of complete blood counts and comprehensive metabolic profiles show up red, whether they contain panic values or just statistical noise.