Making Health Carae Accessible


May 02, 1993|By WILEY A. HALL III

We did not lose the war against poverty, we just got picky

about who we helped and how much we helped them.

Similarly, there is a great rising fear that we will get equally finicky when it comes down to the crunch on health care reform.

A couple of recent studies illustrate what I mean about the war on poverty.

In a 1991 report, "Child Poverty in America", the Children's Defense Fund noted that while federal programs had cut poverty among the elderly from 30 to 11 percent since the 1960s, children in poverty had grown steadily over the same period. Not only were more children living in poverty, researchers found, but they tended to live in families that were deeper in poverty than in the past.

Last fall, the Center on Budget and Policy Priorities reported similar findings in a study of whites on welfare. That report found that while there were more white Americans living in poverty than any other racial or ethnic group, the nation's anti-poverty programs were far more likely to lift whites out of poverty.

As a group, whites living in poverty are more likely to be elderly and are more likely to have had work experience than say, blacks, Hispanics or Native Americans. And government programs that benefit the elderly and working poor tend to be the best funded, pay out the highest benefits and they enjoy the greatest political support. Programs perceived as benefiting minority groups are not only under-funded, they carry considerable stigma.

No one alleges that there is a political conspiracy to hold blacks and other minorities back, although European nations have been far more willing to devote the resources to make anti-poverty programs work. Researchers say that American distinguish between a "deserving poor" whom we are willing to help and an "undeserving poor" for whom we do the least we can and then only with the greatest reluctance.

What these studies illustrate is simple common sense: In a democracy governed by majority rule, the majority population fashions programs that benefit their needs.

The same thing might well occur after the smoke clears on health care reform.

Hillary Rodham Clinton, the president's health czar, has reassured both Hispanic and black legislators that the health care needs of their constituents will not be forgotten. But as with welfare, programs aimed at minority needs often are endorsed by commissions and planning committees only to get under-funded or eliminated outright by Congress.

Indeed, the current push for health care reform appears to be driven by the needs and fears of the middle class. Four out of five Americans have some form of health insurance, but insurance rates continue to rise, and the recession has aggravated the average American's fear of losing coverage altogether.

Many of the proposals floated by Mrs. Clinton's task force on health reform appear designed to address these fears: Costs may be controlled through greater reliance on a managed care system. Taxes may be raised to pay for a guaranteed basic coverage for all Americans not currently insured.

But the 35.7 million Americans living in poverty have specific needs that may not be addressed by the reforms being considered. They are most likely to be uninsured. Their health problems are more acute. They live in areas that are under-served by health professionals.

Many are covered by Medicaid, the government's 28-year-old health care program for the poor. But study after study has documented that Medicaid patients often receive inferior care while the majority of the nation's health care providers are reluctant to treat them at all.

Care for the Hispanic and Asian communities is hampered by language barriers. Native American communities are severely under-served, as are black and Hispanic communities in rural areas and the inner cities.

To meet these needs, experts say the government will have to provide money to increase the numbers of minority health care providers. They will have to provide money to increase health care services to inner city and rural communities. They will have to provide money to intensify preventive care efforts. And they will have to devote larger proportions of the public's health care resources to the acute health problems of the poor.

All of these proposals reportedly are on Mrs. Clinton's health reform task force agenda. But that does not mean they will be enacted.

Surveys indicate that most Americans are willing to consider higher taxes to underwrite improved health coverage. But how much, if any, of those tax dollars are they prepared to see devoted to the "undeserving" poor?

A5 Experience suggests that the answer is, not much.

Wiley Hall is a columnist for The Evening Sun.

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