Advocacy and Policy
Empire State Medical Association (ESMA) Recommendations to Reduce Health Disparities
Rationale: Health maintenance organizations (HMOs) are the middle men of medicine. HMOs deliver no health care and value interests of investors, shareholders, and executive compensation more disproportionately than those of patients. Revenues that could be directed to health care infrastructure is often used for corporate profit.
Legislation must be passed to make healthcare a basic human right – not a privilege. Over 45 million Americans have no health insurance. Countless millions more are incompletely insured and one catastrophic illness away from bankruptcy.
The concepts of referral use and capitation by HMOs discourage the physician patient encounter which delays access to health care. Health care delays increase costs by increasing expensive emergency room visits and hospital admissions for serious illness, leading to the closure of many hospitals.
In New York hospitals have lost approximately $750 million in the same year HMOs in the city have demonstrated over $750 million in profits. HMOs frequently cherry pick profitable healthy patients but leave millions – including the elderly and those with pre-existing conditions – uninsured. HMOs also often have prohibitive deductibles and patient out of pocket expenses, further taking money from patients to protect profits. Tighter regulation of HMOs and centralizing care to a few would contain costs spent on administration and allow patients and hospitals to thrive.
Existing government insurances should be expanded to allow New Yorkers to buy in. Expanding Medicaid, Child Health Plus, Healthy NY program and Medicare to insure all New Yorkers would be the ideal prototype for universal access to quality health care.
Legislation must be enacted to ensure mandatory cultural competency for all physicians and healthcare workers in New York State. Healthcare workers in New York must be made aware of the terminal effects of prejudice in healthcare on ethnic minority groups in New York State. David Satcher M.D., the former U.S. Surgeon General, estimates 83,570 annual premature deaths are due to social assumptions, misunderstandings and prejudices in healthcare.
Dr. Nelson Adams, the 111th President of the National Medical Association, states: “Cultural competency education is urgently needed. Racial inequities in healthcare will never be scientifically justified, politically excusable, or morally acceptable”.
Contact all local New York medical schools and hospitals to immediately enforce nondiscriminatory laws by recruiting underrepresented Black and Hispanic physicians, medical students, residents and allied health personnel. Currently New York City is 65% Black and Hispanic. The percentage of Black and Hispanic medical students in the city is 5-10%. Leadership in medical schools and hospitals has failed to diversify medical staff to address current healthcare disparities.
Curriculums and entrance requirements must be reviewed and adjusted to reduce barriers which prevent staff diversification. Of note, in 2042, ½ of all Americans will be people of color.
Repeal the New York Medicaid cuts for health care for those patients with dual Medicare eligibility. Rationale: These cutbacks have reduced Medicaid patients’ access to private physicians in underserved neighborhoods.
Because physicians will receive less reimbursement than physicians who practice in wealthier communities, Medicaid cutbacks discourage physicians from setting up practices in poor communities.
Physicians who open primary practices (greater than part-time) in underserved neighborhoods in designated zip codes in central Brooklyn, southeast Queens, south Bronx, and Harlem should receive special tax breaks, such as paying no property tax on home or office and/or a 50% discount on state and city taxes.
Medicaid reimbursements must be increased to increase the number of physicians who accept Medicaid and provide more patients with a medical home. Reimbursements to dentists must also increase so that patients can obtain care from local dentists in their community. This will reduce delayed care complications, emergency room visits and hospitalizations, which are more costly. Delayed health care is expensive health care.
Failure to increase physician reimbursement will lead to a shortage of outpatient locations to access preventive and therapeutic care. Of note, costs for physician practice operating expenses continue to rise: a recent federal mandate to convert all patient records to electronic medical records will cost each practice an average of $30,000 to $40,000. With ongoing support costs ranging from $4,000-$8,000 per year.
Design and implement policies that include access to nutritionists and comprehensive nutritional reform in all schools and government agencies and communities. Poor nutrition in many inner city zip codes contributes to obesity rates as high as 70%, leading to increased morbidity, mortality and health care costs. No number of physicians or amount of money spent on health care treatment can solve the health care crises due to obesity, poor nutrition and lack of exercise without complementary policies, including tax incentives for those with BMI (body mass index) within normal range, that encourage health and reduce health care costs.
Create and enhance preventive public service announcements and public health education protocols.
Rationale: Educational advertisements regarding diet, exercise, substance use, smoking, sexually transmitted diseases will help prevent premature death from cardiovascular disease, cancer, homicide, HIV and diabetes as the leading causes of death.
Increased numbers and frequency of public service announcements will also help reduce health care expenditures on many preventable diseases, including tuberculosis and Hepatitis B. Advertisements via radio, television, billboard posters and press conferences are very effective in providing awareness about the latest health alerts, issues and action initiatives.
To increase public education, health information DVDs should be made for all public school 8th graders, Medicaid applicants, and public hospital emergency and waiting room visitors to view.
Implement tort reform, including malpractice award capitation. Rationale: Tort reform with award capitation will ensure more funds available for health care by discouraging trial lawyers from filing frivolous lawsuits, which cost health care providers and institutions millions of dollars. Legislation must mandate that cases in which plaintiffs lose due to a suit’s frivolous nature, the plaintiff is responsible to pay punitive damages as well as the defendant’s legal expenses.
Create violence reduction, conflict resolution and preventive law education protocols for public junior high and high school students. Rationale: Conflict resolution education will help reduce and prevent incarceration and disenfranchisement. Because of church and state separation laws, religion is not taught in public schools, which can leave a void in ethics and moral education. Children coming from poorer families often have parents working long hours away from the home and may be deprived of this nurturing. The public educational system must participate in educating students about the consequences of criminal activity. We must also have funding for research which identifies the most common zip codes with incarcerated youth, identify the causes/reasons for incarceration and create programs to prevent this adverse outcome in those zip codes.
Improve educational protocols in the zip codes with the highest health disparities. Rationale: Charter schools, such as the Harlem Village Academy Charter School, should be a model for all NYC public school education. Harlem Village Academy takes 5th graders performing in the bottom 25% of test scores and turn them into the top 5% performing 7th graders in test scores city wide. The school has a rigorous curriculum grounded in a caring and nurturing environment with the highest expectations for all students. Students are taught to think deeply, independently and critically. The school day is long, starting at 7:30 am and ending at 5:30 pm, with Saturday school and study hall for students who need extra help and attention. The Academy has a culture of accountability for academic achievement, a clear strict code of conduct consistent throughout the school and school uniforms that contribute to a culture of respect, scholarship, and community. Make first aid training a mandatory component of high school education to help expose children to healthcare and empower them to assist in a health crisis.
Develop job-training programs for unemployed New York City residents. Unemployment leads to poverty, substance abuse, and crime. In NYC, for example, 51% of Black men are unemployed, which also affects the families and children of these men. This should be considered a catastrophe requiring city, state, and federal emergency aid.
Globally, U.S. drug companies make 50% of their profits from the American consumer alone. Pharmaceutical cost reduction protocols such as those used in Canada and other countries will reduce the cost of medications for those who are the most sick, poor and least likely to be able to afford them. Legislation must be enacted to reduce the degree of medication mark ups. Parallel importation of drugs may also stimulate free enterprise and reduce medication costs. Reduction of prescription drug costs will contribute significantly to reducing health disparities.
Prosecute white collar criminals whom conduct financial fraud in all communities, particularly heavily hit African American communities. Predatory lenders, mortgage brokers and financial advisors have given false information and signed off on fraudulent documents to profit from loan transactions, leaving individuals with large loans on overinflated property values. Prosecute corporate CEOs who file false earnings and guidance projects to manipulate stock prices, creating victims of the common stockholding public. Such fraud leads to trillions of dollars of loss of the American public’s wealth, originating from criminal behavior right here in New York state. This loss of wealth leads to increased stress, depression, decreased access to health care, reduced ability to afford medications and an overall poorer state of health for all New Yorkers.
Mandate HIV testing for those who are incarcerated or in federal institutions. This population is at increased risk for infection with and transmission of the HIV virus.
Ban alcohol and tobacco billboard advertisements in New York City. Rationale: Alcohol and tobacco are heavily advertised on billboards in Black and Latino communities in New York City. Disproportionate advertising and subsequent use of these substances lead to increased disease and health disparities in Southeast Queens, Central Brooklyn, South Bronx and Harlem. Banning these ads will help reduce the glamorization of these dangerous products.
- Improve the self-esteem of Black youth and educate all public school children about the significant historical contributions by Blacks to modern society. The current educational system fails to teach the original contributions of Blacks to civilization, science and technology. For example, the first physician, Imhotep, was a Black African physician. The teaching of the accomplishments of Blacks both ancient and modern in the New York City public school system would improve the self-esteem and psychological well-being of Black children.
Address expulsion of pre-school children. Statistics demonstrate that 6.67 pre-school children are expelled per 1000 students. This is 3.2x the rate for K-12 students. Rates of expulsion for African American boys are 4x that of girls. Black girls were the least likely to be expelled. Smaller class sizes with less than 10:1 student/teacher ratio will reduce teacher stress and burnout. Provide behavior consultants for those children in need and comprehensive student assessments for those having difficulty.
Improve teacher training and tie teacher benefits to academic improvement in test scores.
Address the disproportionately high placement of Black students into special education and slower tract educational programs.
Strengthen and expand health care programs for children. Investment in early childhood health and development is powerful. Average Medicaid costs per child is $1500/year, compared to the average annual costs for a Medicare patient at $12,000. Many poor children go to school with dental pain, and many have mental illness. Expanding SCHIP poses no threat to private insurance companies who have been opposing the program. Children visit a physician on average 8 times within the first year of life. Access to doctors is important for health and development and prevents these children from becoming future Medicare patients due to disability.
Prevent the incarceration of Black men. Improve education. Invest in increased numbers of and programs for after school programs and community youth centers. Address the myths in inner city communities that being well educated is inconsistent with Black American culture. Re-educate and provide job training and transition programs for the incarcerated. Provide mental health to those in need. Eradicate arbitrary law enforcement arrest quotas. All of the above recommendations should target the NYC zip codes known to have these disparities in health, education and unemployment, particularly central Brooklyn, upper Manhattan, South Bronx and southeast Queens.