Equity in our healthcare system

Millions of dollars are spent seeking “fairness” in our healthcare system while insisting that we have no “equity” because our entire medical organization is systematically racist. To get there, some suggest that we should prioritize care delivery by skin tone.

This approach is problematic. It creates racial division. It also goes against the overarching goal of medicine, which is to provide the right care in the right place at the right time when a patient suffers from illness or injury, focusing on the prevention of illness or injury whenever possible.

In an age when we already have so much division and hatred, here’s an idea: Why not just agree to focus on providing the highest level of medical care to every patient, regardless of race, ethnicity, or other characteristics?

The terms fairness, equality, and parity mean different things to different people. However, the three share a common goal: justice. Instead of promoting divisive and discriminatory demands, wouldn’t we do better to turn around and focus on fairness? In healthcare, simple fairness and color blindness are both desirable and realistic.

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Rather than exploiting racial division, the patient-centered approach is ambitious and seeks true justice by creating unity of purpose. The advantages are many, and the negative aspects are almost non-existent.

The relationships most important to health system equity are the patient-physician relationship, the group relationship between physicians and other members of the health care team, and the relationship between the patient and the health care system.

The patient-centered approach avoids divisive ideology. It is a positive and ambitious approach that seeks true justice through building, not diminishing.

The three pillars of a patient-centered approach to providing access to high-quality care at a sustainable cost are 1) expanded personal choice, 2) personal choice of health care arrangements and ownership of health insurance policies, and 3) fairness in providing any government subsidies for health coverage and federal tax treatment for health insurance .

Rather than assuming that patients are unable to make informed decisions about health care for themselves, a patient-centred approach assumes that they are able to. There are many possible ways to fund and provide quality care. Why not put them in competition with each other and let the patient choose the method that works best for them?

Giving individuals the opportunity and responsibility to choose and own their own health care and insurance arrangements—with periodic opportunity to change if they become dissatisfied with their choices—ensures personal control and portability. By definition, health plans and others in the healthcare sector will be directly accountable to the patient.

When purchasing health insurance, nearly all Americans receive some financial assistance, whether it’s tax-free coverage in the workplace, some level of government support or some charitable giving. This assistance must be the same regardless of racial, ethnic or other characteristics. This is justice.

Many factors not related to health, including housing and transportation, but especially education, can contribute to disparities in access to health care. These factors are very real, and specific treatments must be implemented through sound social and economic policies.

For example, getting students of all backgrounds out of failing schools through school choice should be a top priority for state and local policy makers interested in promoting equity.

A high-quality K-12 education geared to giving graduates the knowledge to find and fill a job or pursue higher education will enable students to thrive rather than live in poverty and reduce socioeconomic expectations and achievements.

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In the practice of medicine, to achieve a sustainable health system, medical professionals must focus on identifying health disparities and support research on how to eliminate them.

Medical education is justifiably focused on excellence. No one wants their doctor to have an MD or DO degree as a “participation award.” Your physician should continue to be motivated to obtain the best lifelong CME training and education for the type of practice chosen. Merit in medicine is not a myth.

Likewise, the provision of care must be of the highest possible quality for the medical condition at hand. And the doctor is morally responsible for seeing this happen. It is not a zero-sum game with winners and losers.

Education and healthcare are intertwined. Enhanced personal choice and defined contribution financing offer the same benefits in education reform as in health system reform. When accountability flows to the student and beneficiary, cost goes down, quality goes up, variances are reduced, and healthcare is improved.

Equity: Everyone benefits.

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