GRIM PROGNOSIS

The grim consequences of racial and economic inequality in the United States are especially visible in our health care system. By every measure, the health gaps between blacks and whites are stark. And to a great extent in the United States, where you live determines your access to goods and resources, the quality of social services, and the accessibility of affordable and decent health care. That America is still balkanized by race, despite the gains of the long struggle for civil rights, plays an important role in the maldistribution of resources by place. But just as important are wide disparaties in health, social services, and education by state and, within states, by locality, the long term consequence of America's distinctive form of governance that relies on the states to bear much of the cost of social provision.

As for the impact of place on health care, George Washington University researcher Bruce Siegel has it just right: “health care is local, just like politics, so you’re going to see a lot of differences in what communities do.”

Two pieces in today's NY Times make clear the high costs that being born the wrong color or being born or living in the wrong place have for health care. One reports on a Dartmouth medical school study of medical disparities found that "blacks typically were less likely to receive recommended care than whites within a given region" and also that health care outcomes ranged widely from state to state. Not surprisingly, some of the grimmest outcomes are in those Southern states that have spent relatively little on medical care. For you real wonks, the 2008 Dartmouth Atlas is available here.

The other Times piece offers a bleak report from California--a stark reminder that health care opportunities vary widely from place to place. LA hospitals, like USC, Cedars-Sinai, and UCLA, offer some of the best medical care in the world. But for residents of the mostly black and Hispanic South Central neighborhood, health care has gotten worse. Since 2000, 15 hospitals have closed, most of which serve the city's poorest and sickest residents. The result is that sick and often uninsured people have flooded local health clinics. Adding insult to injury, Governor Arnold Schwarznegger is threatening to cut state Medicaid funding, which will both limit health care options for the poor and cut revenue into the dwindling number of hospitals that serve them. California's Medicaid payments are already low.

These stories highlight the need for universal health care. One difference between the Obama and Clinton campaigns was that her health care reform proposals were more far reaching than his. I'm hoping that candidate Obama visits an inner-city hospital or two, talks to some of the doctors and nurses serving impoverished communities, and puts forth a set of reforms that looks more like Clinton's. It's the least he and we can do for places like Mississippi and South LA.