Evening Exchange; Health Care - Part 1 of 4

Healthcare reform in the African-American community the start of a four part series. Up next an evening Exchange. Good evening and welcome to evening exchange. I'm Kojo Nnamdi. February as you know is Black History Month. It's a time when the nation takes a look back at the history of black Americans here on evening exchange however we are going to use Black History Month as a means of looking forward all month long we're going to explore the future of African America. Everything from politics and economics to medicine and popular culture. Tonight we start a four part series that will explore the many options for health care reform. The White House the Congress the insurance industry and the American Medical Association the National Medicaid medical association to name but a few have their own ideas of what health care reform should look like. But there is a growing concern in the African-American community that the nation will somehow

enact a monumental reform package with limited input from black patients and black health care professionals those who are on the front lines. Each week we'll ask a different question tonight to establish a foundation will ask what are the health care problems in the African-American community. Next week we'll delve into the connection between health care and welfare reform. Joining us tonight to get the ball rolling. Dr. Frieden Lewis Hall. Dr. Hall is a psychiatrist who practices at Howard University Hospital. She is also an associate at the National Institutes of Mental Health. Welcome back. Also joining us Dr. Clyffe calendar Dr. Clive calendar is an internist who runs the organ transplant unit at Howard University Hospital. Like life Dr. Andrea Sullivan is here she is a natural pathic doctor who specializes in preventive medicine. Hi Andrea. Also on our panel Dr. Marilyn quarter to quarter is a Washington pediatrician. Welcome to evening exchange. Also Harvey Raymond avi Raymond is the director of insurance products for the Health Insurance

Association of America hereinafter to be known as h i a a it's a trade association that represents 270 commercial insurance companies across the country. Welcome to all of you. Our first question is not only what are the health problems in the African-American community but precisely what is the African-American community are we talking about the health problems of a race going on. Are we talking about the health problems of a particular segment of that group that part of the black community that happens to live in predominantly black communities whether in the north or the south. Generally poor communities often inner city communities. Are we talking about the health problems that spread across the board because people happen to be African-Americans. Well I feel that when I was there was there was a recent article that asked the question is being black dangerous to your health. And it looked dead. That is exactly the question that you're asking whether or not just plain old being black

despite your socioeconomic status your level of education or whatever seem to land to a greater propensity for this health. I think I just made up a new word and the answer was yes. In many cases despite socio economic level despite educational level despite access to insurance into the health care system in general there were still some problems. Health care for African-Americans. Dr. calland would you care to define what some of those problems are those that we probably know best. Yes. I think that transportation and the availability of sophisticated health care. Is one of the problems and actually what free Lewis Hall dressed actually comes under the scope of the genetic differences which a couple of decades ago became very unpopular. Because somebody said because you're different that means you're

inferior. Actually we as a group homo sapiens exist because of the tremendous differences and those differences are the reason we survive. When we speak of the African-Americans we're talking about the beginning of civilization. And from whence cometh everything else. And therefore African-Americans need to really take pride in the fact that we have some differences that should be looked upon as something that's wonderful and should be encouraged so that diversity is the beginning. All that's creative and good rather than something that marks you as somebody who's inferior. I like to show you back on what fita said. I think it's clear that being African-American does contribute to all health problems. When you look at what I consider to be one of the gravest health problems in our community today which is AIDS I mean that clearly covers a complete. Complete rank of all

people all the diseases I see in my practice. Certainly diabetes cancers AIDS arthritis. It doesn't matter what your socioeconomic status is. So I would say that being of African-American entitles you to a certain amount of discomfort or dis ease if in fact those genetic differences do mean that we have sometimes different kind of health problems than white Americans do. Is the health care system in America at this point responding to our health problems in a satisfactory manner. Well actually that was the point I was about to mention it's for what standard are we talking about as well as. What type of evaluation are we doing as a pediatrician in the area. I look at it when I bring. Let's say for example a newborn exam into the hospital and to see in some of the problems that the mother may have had prenatally not to mention some the types of behavior or activity that may have added some

stress onto that particular individual. Well that new point coming into well we find that you have more increase in infant mortality as well as infant types of problems from developmental as well as medical and you know you talk about well this is the beginning and you want to move that into something that from that point on is ideal. But you also at that time want to evaluate Well where's everybody at the beginning and reference to genetics and where from there do we begin to follow that. And as a brand new new system is organs etc. This began as well as some differences from that point on some of the preventive measures that one would want to do from growth and development that we find very early in the African-American community. There's a lag and a delay due to some of the availability of resources and just some of the lack of

information dispersed and availability. You have already some disadvantages. Let's talk about the insurance industry for a second Mr. Raymond because it has been argued that because in certain areas of the country for instance in black communities people tend to have more and a greater variety of certain types of illnesses that the insurance industry tends to discriminate against the so-called chronically ill against those parts of the population in which there is likely to be a higher degree of illness than other parts of the population. How would you respond. Well I think it depends on really the more the social economic status and the employment status and the linkage that the individuals have to the health insurance system for reimbursement. I think that when you given that 87 percent of the population receives health insurance for example through an employer based system if you don't have a linkage to an employer and we know that there are problems disproportionately with unemployment then you're obviously going to have difficulties

addressing either acute or chronic kinds of needs with and within any segment of society. Who among those who are uninsured. You know there's over 50 percent of those who don't even make more than $10000 a year. I think again that addresses a social economic problem as opposed to perhaps just a class problem or a kind of disease problem. So obviously when you look at things from the church perspective the affordability of being able to purchase health insurance and the availability of health care really is a real crux of the issue and that's what I think needs to be really addressed in the discussion as well. In addition to obviously the comments about the about the genetic side clearly what confronts the nation at this time is one of the lack of an ability to have everyone in the country have some form of adequate health insurance and to the ability to keep costs low. But when we talk about adequate health insurance we're simply not talking about getting your illnesses healed until we also talking about preventive medicine and that

seems to be one of the nation's most difficult problems to cope with at this point because in fact good health doesn't begin with birth. It begins a long time before birth would you care to combine two things. I wasn't suggesting early on that things like AIDS or diabetes end or cancer are always genetic either. Usually not. So I just wanted to straighten that out. I'm just saying that disproportionately we have an inroad in terms of disease as well as everything else on this planet seemingly low socio economic status mental disease physical disease all of that. One of the problems I think and maybe here we're going to start stepping on people's toes but that's OK that's good that's why we are here. I think we have a multi billion dollar conglomerate in the health care system from the insurance companies all the way down to allopathic physicians. That is not to say that they do not do some good things that is just to say that there is a lot of money tied up in the current health care system that has not been working to the best of its ability. It has been

ineffective and very high in costs. However it continues to function so to speak. But you've got insurance companies involved you've got pharmaceutical pharmaceutical companies involved you've got high salaries of physicians involved. They're not easy to get those things up while we have a lot of confidence in the president at least I do I don't think he can do it all because he has got all of those those agencies and those organizations and with lots of financial backing and high powered lobbyists to keep him from doing the kinds of things that he may in his heart really feel are best. So one of the things that I do is certainly preventive medicine and along with doing treating people when they are already ill. And that to me is something that needs to be incorporated in this reform. There's no reason why a naturopath physician who is well trained in a four year medical school cannot work side by side from a physician from Howard University. I recently got a call to ask if someone from their medical school could come and sit in my practice for a day a week or so.

And I'm certainly consenting to do that because I think that's the kind of sharing that needs to go on. And indeed you've allowed us to take off the gloves when we no longer need to be polite. The money is at the basis of a lot of what is going on here. If it can be agreed that those health problems that come from the black community rather we are talking about heart disease whether we're talking about high blood pressure or whether we're talking about AIDS or any of those problems would come from the black community have a great deal to do with access to medical care and have a great deal to do with education about access to medical care. Whatever the administration comes out with in terms of a health reform package is likely to meet the objection of one group or another. Absolutely. If indeed it is more than one or if not more than one group if indeed the interests of the black community are to be met then we're talking about access not only for the poorest of the poor who may have Medicaid but we're talking about access for those working people who do not. On the one hand qualify for Medicaid but on the other hand can't afford

to have the kind of preventive war prenatal care. In the case of a pregnant mother that they might need what needs to be in a health care reform package coming out of this administration that will affect the needs of that particular group of people. That is our concern. I think one of the first things it's got to come out is universal coverage. This nation needs universal access to health care health insurance for everyone regardless of social economic class regardless of physical or mental condition. And regardless of of the rules and the regulations so to speak we really need universal access. We were sort of glad that our industry's really coming around to that point of view. And we're we're not. I think the next thing that we need to address is homelessness because I think that how can you have anything if you don't have a place to sleep or. To be out of the cold like a day today will you be frozen to death. So that those two are the central needs. But you know when you think of us from the cradle and before to the

grave we will die at birth. And towards the end we died 10 years earlier. You know we're affected. We talk about preventive health which is incredibly important but terribly underfunded. Similarly research. Take for example kidney disease. Six billion dollars are spent every year on kidney disease. A third of the patients who have kidney disease are black. Yet less than. One to five million dollars is spent on studying. The black or African-American problems. Now that is a disproportionate and terribly underfunding of a problem that particularly afflicts and affects us and that is truly an ear of kidney disease hypertension and probably almost every other disease. We spend money for the researching the problems of the non-African Americans but the minorities and in particular the African-American we all spend the money for research that we should.

Well the first response you get to that even before we get to universal coverage which we will obviously get into is that look we're facing a major budget deficit here. Everybody is saying that we should put money on the front end for our children and that means a great deal more money into education. We don't know how much more money we can put into health care. President Clinton at this point it is being reported and what he is talking about is 30 billion dollar infusion into the economy that will extend the debt and budget deficit by 30 billion dollars and the first response you're going to hear is research for kidney disease. Given that African-Americans we just don't have the money for one of the things that I think is happening now is that everybody seems to be coming onboard to the fact that perhaps what we're missing is not quantity of money but the quality of the way in which we spend the money. You're absolutely right. I think that we all agree for universal coverage and that might mean some sacrifices from everyone involved in health care. However what we are talking about is if he had X numbers of dollars who are those dollars go to where should they be spent.

Should they be spent at the end at end stage kidney disease or should they be spent at the beginning in education about nutrition and other avenues of health care that would be preventive in nature. And I think I hear a cry for prevention for modification of lifestyle for early education. And one of the things that I always say is that even if we were able to drop. The best health care facility in every neighborhood in this country and made health care access able to everybody unless you made the people in the community. Access. Able. You've done nothing. That's like giving everyone a car but not teaching them how to drive. So I believe that the system is going to have two components the provision of a way to pay for health care for everybody who wants it. The provision of a system that could be accessed by everyone who needs it. And then the third part is a massive education process to teach people how to use this

critter healthcare that is in the best of all possible worlds. Let me say this. I said this before on your show so it's redundant and some reason you actually like to petition doctor means teacher. If you look at what doctor means that means teacher. And for me that means education and as a natural Pethick physician that's a large part of what I do I teach people how to assist themselves in doing the healing because the body has everything it needs so beautifully to do that. Yes clearly there are times when intervention is absolutely critical. I'm not talking about those times the health care system as we know it does that fairly well. But there are other parts of the health care system that are disastrous just absolutely disastrous. You can pay $116 for cold medication from a pharmacy that is absurd. That is absolutely absurd when you can pay $16 for herbs from a pharmacy. Now needless to say that's one hundred dollars that somebody is not getting. No you're right the pharmaceutical companies are not going to like that. But I think his point was well taken that is quality. It's what we're

doing with these dollars and we haven't been doing what we need to be doing to support people in this process. But if in fact what Frita is saying is true and that is that people not only have to have access that we have to have the kind of education that will allow people who may not otherwise use that access to use that access then we're saying Look Clyffe calendar says you have got to put more money for research in specific areas that affect the African-American community even though it affects the population at large. But things like kidney disease you've got to look at Frieda's So we got to put money in not just for access but for education about access. And there are those on the other side who will argue that look we only have limited sums of money we can give you access. You figure out how to educate the people who need that access and who need to employ that access. How are we going to solve that dilemma because it's one of the dilemmas that the administration obviously is going to confront. Where does this money go. Could I argue that anything without education

is is not useless but it certainly diminished. Incredibly so. And I would say if I had to just put my head on one thing and I couldn't put it on anything else I would put it on community education because community empowerment is where the action is. That's where we're going to make changes that are going to make the world better. And so I would I couldn't agree more with the prevention and the education. I would personally factor in also research because I understand that and trying to figure out how to do things the best way. Very often we have to do research and that is where we are underprivileged perhaps the most we've got to take a short break right down when we come back everybody who wants a chance to say something including a few of you in our viewing audience will have a chance to do so so stay with us. We're talking health care reform.

We'll be right back. Other American kids who are just joining us this is the

first in a four part series during the month of February that evening exchange we'll be discussing on the issue of health care reform in general and how it should apply to black Americans in particular. We're talking tonight about the problems the health problems facing the African-American community with Dr. Frieden Lewis Hall of Howard University Hospital. Dr. Clyffe calendar also of Howard Hughes University Hospital Dr. Andrea Sullivan who is in Perth. Dr. Marilyn Porter who is a pediatrician and Harvey Rieman of the health insurance association of America. If we began and we are going to continue by attempting to define the particularity of the problems that face those of us and what we've been calling African-America Friedl. Well one of the things that I think is important for us to understand is that mortality is great. The latest statistics 1987 show that there are 75000 excess deaths per year in the African-American. What does the to us. Those are deaths that would be above what would be considered if we had the same death

rate as white Americans. So those are deaths that are above the projections and those things seem to occur in just six diseases or six disease categories substance abuse homicide cancers cardiovascular disease diabetes and chemical dependencies. And if we look at those disease we are clearly disproportionately affected. So the numbers are awful if we include things like infant mortality and AIDS. The numbers are then staggering. So the the numbers show us that we need to get in and we need to get in early. One of the huge problems that we face is really utilization of the health care system where in emergency rooms for primary care we don't know when to go and we come late in the process instead of treating diabetes early on we're treating it at the point of of amputation or at the point of losing eyesight. The costs are then great. So there are so many things that we need to look at in terms of what actually affects us in how we can better utilize what resources we do have available.

One of the things that Clive mentioned which was Community Empowerment is one of the reasons I became a natural path because for me that's that that's about empowering people to take care of themselves. It's about teaching them to do that and to piggyback on what he said again. Community Resources can have naturopaths working in those community institutions along with Dr. Frieden hall. There's nothing wrong with it. I just found out the Hawken work side by side together again. Well trained from university having taken medical exams all of those things are essential. We don't want to risk any public health problems here. But I'm saying that to say that that's where the front line begins for me in addition to research let's give more research monies to natural medicines. Thank God. NIH has finally understood that there can be an office of alternative medicine. The joke is is it going to be the office of astrology. No problem I can deal with that. But we have it and it is and it is. It is staffed by Ph.D.s and people who researchers to do the work that needs to be done.

Well what happens if there is universal universal health coverage. Will that necessarily mean that those people who are going into emergency rooms to treat common colds are not showing up until the symptoms of whatever else them are so horrible that they have to have an amputation. Well that was universal coverage necessarily means that those black people who use medical facilities in that way will stop doing. Well I'd like to first talk about that the community we talked about in terms of getting into the community even though availability is there. One out of six individuals in the city of Washington who are eligible for Medicaid only one out of six actually apply. So that's one out of six individuals eligible actually apply at Zappy and that was a staggering. Report that I heard this morning. Interesting enough what happens some of the education of knowing that they are eligible doesn't focus on some of the importance and the priority of even taking care of one's health

is not even addressed. It is very important to become as physicians as we are health providers as we are is very important to become community friendly. Another element here I think it underlines education and that really I think addresses the need for all Americans to really somehow get the message from the president or whomever that we all have to become more individually accountable and responsible for our health. We really sort of live in a while I'll do my own thing I'll smoke too much I'll eat too much and drink too much I won't exercise enough and some day if I have trouble I'll go to the doctor in the hospital and get fixed up. That's that's an attitude that we really need to address the nation because it's really very pervasive and prevailing I believe that that's the attitude of the health care system that's what we've been taught to do since the turn of the century that's what we've been told. You feel that the health care system itself fosters a little among this care system that it's a crisis management system that will take care of

sick people try to get sick care system. That's what it does. Insurance companies pay. That's where the doctors obviously practice. And as a result we think we have overlooked preventative and the kinds of education and the accountability issues those are issues that really are very important. I think there's some good news in one respect because some of the things like managed care programs that HMO is good at those kinds of issues might not you know in a good mode let's prevent let's educate but they really don't. That's because they really don't. That's right. All right. The real critical problem which is a basic distrust that we as African-Americans have of black doctors white doctors the health care providers going into that a lot of organ donation in particular when in the African-American community we don't want to donate limbs because of either religious beliefs or just downright suspicion. Right. And I guess recently the Tuskegee scientific experiment on us was viewed and put into perspective.

You can appreciate the reason for the distrust of the African-Americans and so whatever we do with the community empowering efforts we have to bring back the perception of sincerity and trust otherwise whatever we do is not going to reach the areas we wanted to reach. But I think the community also has to take some of the responsibility. I mean we know that one form of racism in our communities in grocery stores for example is that if you come if you go down the street you know the vegetables aren't so high and they may be a little bit rancid in the cans are dented don't start to talk. About. But I think the point here is that we fight that economically we fight it politically we're offended by it and we're doing our best to get it changed. Meanwhile though we know what a rotten head of lettuce looks like. We know rancid meat smells like so that we are empowered to protect ourselves in that environment. We don't know what a rotten head of lettuce looks like in medicine. We don't know what

rancid meat smells like there so that we get duped over and over by the system. We don't just need a historical backdrop for this. We can look at recent data and how differentially were given treatment and almost all treatment settings. So you know our distrust is old and it's also new. And part of it is that we're not informed consumers and we have to take responsibility for that. Nobody else is going to give that to us I just want to say a couple of things. One of the biggest diseases on the planet is racism. That's a given. OK. And I say that seriously. I don't know how to deal with it except in the ways that we are month by month day by day in our own individual and cumulative ways. But I say that because it is so pervasive and it does so much. I mean it does things like it doesn't allow a person to think that they're worthy to go to sign up for Medicare or Medicaid. It's like I'm not worth going to the doctor until my arm falls off until I can't see what kind of attitude is that a human being.

Are we in fact the victims of racism in that way or are we using racism as a crutch and an excuse for not to accept those responsible. Absolutely because we do need to be more accountable. And again that's what empowerment is about. Teach to teach and when we are victims because we have been barraged by this brainwashing campaign from the time we're little kids till before you die. And I did not raise that question after we have itemized the kinds of problems health problems that we have in the African-American community and the White House to start to look at this health care reform package. And we expressed some degree of dissatisfaction with what's in there for us. You can reasonably expect that somebody will say well wait a minute we can't solve all of your problems. A health care reform package can only address some of the more urgent problems in a lot of ways. I get the impression that the health care reform package is going to take the same approach that the health care system has taken. Look we have some people here who are not insured we got to get to insure that we have some

costs here that have to be brought down. We have to get them brought down. What are you talking about here. Collectively it seems is a completely different approach to the whole issue of health care. If in fact the problems of the African-American community are to be solved that is the only realistic about it for me. I don't I don't know anything less but clearly I'm talking about you know my words about this. I said the same thing but they're all saying the same thing. Yeah they just say well let's see if we can extend coverage over here and a little coverage over there. They might as well spit in the ocean and see if they can make away with it. If if the health care system is honestly going to change then then we're going to have to do what we're doing now and that is sit down at the table and figure out with the community honestly needs not in dollars and cents but to figure out what the community needs and then apply what dollars are available to making sense of that. It certainly sounds like you're adding an additional dimension to the whole health care

discussion and debate because frankly it focuses all of you know primarily on availability and cost and those kinds of issues. And I don't know to what degree the kinds of comments here would be appropriate to another minority group etc. but it certainly sounds to me like you know here's a here's a set of issues that are not out on the table. Any of the kinds of things that I hear and read about. You have hit on precisely the point that we are having this discussion because it would appear that whenever the African-American voice enters the discussion it adds another dimension to the discussion when the argument is that that dimension should have been included in that discussion in the very first place. We don't need to be adding another dimension to the discussion which unfortunately we find ourselves in the position of always doing we one would have thought that when the country sat down to discuss the issue of health care reform the considerations that are being discussed right now would have been at the top of the agenda. Instead it appears as you point out that they add another dimension to the discussion when these people seem to be saying that should be the focus of the

discussion. This isn't unique to right. I mean the added Amendment new here. I mean we exaggerate the point but I don't think that anything that we've said here you couldn't sit Hispanics around the table Asians around the table the majority with a now majority population around the table. This applies to every single American. It applies in different degrees but I honestly believe that just handing out money is not going to solve the healthcare problem nor is nearly redistributing it unless you redistribute it in a way that is meaningful in terms of Honestly bringing reformation to the system. I want to go back I wanted to get back to your point that you were making earlier about one in six apply now. The other thing that we found out in this particular meeting which happened to be with and there for a school based clinic in the district and in that particular setting that discussion came up as to why this individual parent had not involved him in Medicare. Now what happened on Medicaid what happened was they were eligible. Father was working all day.

Didn't you know at the time knew it was important that the actual place that this young person would go before this. School based clinic was established over the past two years which is now his school that. Now his health home his medical home was only the emergency room. When was the last time this fella had a physical exam from a private doctor or even a clinic. He didn't remember. So it was utilization of the emergency room that for a cold or for a rash 200 to $300. And from insurance money on bail it turned out that what that would cause was an astronomical an increase in cost. Lack of education because at that time it's the acute care being lack of follow up lack of continuity. Not to mention lack of immunizations. So it may have been three blocks down the street a clinic. But it was just not at the time important or available. Now what we have found was even in the past year or two individuals who would not use services around the corner that they knew it was

available. Now they use it within the community because it's now within their domain in the school and the Church that's in the neighborhood. So that didn't go there. That's one end of the spectrum of the other end of the spectrum is Commines the Frita had been making earlier about even if there was the coverage even if there was access there was now an increasing body of evidence indicating that African-Americans do not get certain kinds of sophisticated tests when they go in for treatment. Tell us about rancid meat bad here. Lettuce I mean it's really the same analogy. We're not sure why it happens. Some of it may be the perception of the person providing the care. It is the perception that the person is not necessarily worth saving. With these extraordinary means it may be that a person seems so unsophisticated whatever that means that they wouldn't understand these procedures. There's also a perception that African-Americans as a whole group of folks are non-compliant. They come here. They ask Basam we give them the pills we give them the medicine and they go home then

and don't take it or don't do whatever. So there's there's just this gap that you can walk through between the the healthcare system there perception of African-Americans and the care that they're willing or able to provide. What does the insurance industry maybe have to do with this you read about famous people having open heart surgery all the time. You really read about Medicaid patients having open heart surgery lives there. Well there are various procedures of course that are paid for by Medicaid and Medicare but I doubt it's to the extent that they're available under the under the Private reimbursement system. I guess the question that comes to my mind is perhaps would it change if if an individual could go to any doctor in any hospital anywhere and that payer or that provider of care knew that there would be full reimbursement are adequate not just because the house is wisely absent in a delegate it doesn't suggest that that happen.

The data suggest that despite how much someone would get paid for the services that they are about to render that in many cases differentially African-Americans do not receive that the best level of care. So in part it has to do with education again but this time educating the physicians and the health care system about its own perceptions or misperceptions. And to bring them up to speed on making correct diagnosis and giving the full extent of care and you'll get your money back and it goes back to her diagnosis that she made before races because that is the underpinning of all of it including our own self dislikes along with the built in unperceived racisms of those who are not a minority because they don't even recognize that their race is to what extent do you have to do organ transplants because people did not come in at an earlier date for

treatment of what at the time may have been a lesser illness. I would say that we have for example blacks cost to 12 percent of the American population and 30 percent of the patients who need transplants. And I would say that 65 percent of those are related to untreated improperly diagnosed high blood pressure or diabetes. The consumer is very important all the way around. And some of the lack of expectations or the the education that that particular. Patient comes with is going to also dictate what services that they receive. And it's very important as. Educators in the community physicians teachers parents church leaders we have to make sure that our people the expectations that they come to that particular medical facility which. Is correct is adequate and is thorough. And from that point some of the monitoring and some of these facts that we got to

take a short break. When we come back we're going to hear from you those people who patronize our health care services here in the Washington area. So stay with us. We'll be right back. Welcome back. We're talking about health care in the African-American community the problems that need to be solved

with Dr. Frieden Lewis Hall Dr. Clive Keller Dr. Andreas Sullivan Dr. Marilyn Carter and Harvey Reymond of H. I a it. By now you should know what that means Andrea your turn. And I just wanted to say a couple of things. One was about the child going to the emergency room for a common cold or anyone going to emerge from comical using the emergency room as a primary care physician. That's a poor waste of resources when in fact there are herbs there are foods taking a child sometimes off of dairy products can stop IRIX but yet we give repeated rounds of antibiotics repeatedly to children that are just on maintenance antibiotics at 5 and 6 and 4 years old. It's just unheard of. And it continues to depress the immune system. That's number one. Number two the attitudes of Caucasian physicians especially as it relates to African-American patients. We need a whole education in that field in and of itself and that is a lot of the reason why African-Americans until we ourselves became doctors didn't want to go to doctors because they

couldn't trust them or we weren't understood or we would use our English and they would think we were saying something else or there was no communication whatsoever. I mean you know many stories like that. So I think it's important to to again understand how racism and perceptions fit into this whole system. There has to be a degree of multiculturalism taught in the in the medical profession as well which is more like that. No. Yes. I also recently have had some Malani statistics over the past two to three years we have had an increase in those individuals who lack immunizations and because of that that puts that particular population certainly at risk. Self-breast as well as risk to the community and that's alarming because when you talk about modern medicine when we talk about all of the audience we can now transplant all of the things we can now do basic immunisations has always been one of the first and primal importance of just preventive health maintenance. And we are going backwards and we have a new record.

I don't know that I agree with that. OK we'll discuss that at a later date but nobody will be surprised to know that the issue of universal immunization for young people is before the health care reform task force and one of the proposals is that the government the government does it all in the pharmaceutical industry doesn't like that. Everybody says that means the government will set the price and we won't be able to charge what we would like to charge so. Right. That's a controversial issue which is now your turn and you're under your caller. Go ahead please. Caller are you there. A little can you hear me. Let us try another telephone call. It is your turn to call you on the air. Go on. Go ahead please. We don't seem to be getting the telephone at all. Let's work on that for a while as we continue our discussion. But as I was pointing out that the issue of immunization has become a hot political issue at this point. Even though it's something that everybody wants. They say no the government shouldn't be the only person who takes care of. Well I think a reflection upon the lack of providing through traditional plans of insurance over the past term's

reimbursement for immunizations. I think there are some changes that are taking place like there is a renewed interest in really preventative kinds of programs. And I think that those kinds of treatment processes will will will stand a good stead on the long term. But you know it's we're slipping. You know tuberculosis is another disease that obviously has started to have an increased incidence rate. And and that is something that perhaps a few years ago could have been cured with a modest level of expenditure but it wasn't made. And now we're paying a higher price for it. There seems to be some general agreement here that one there has to be access that is universal coverage. One can assume that there needs to be some form of cost control is that in agreement here also there needs to be some form of cost control in the black community. There also seems to be a general agreement that there needs to be education. But people will say because as Frida's pointed out it's like spitting in the woods. If you have access that people do not understand how to use that access so people not only have to use the access but you also seem to be making the point that this access has to

be used in a particular way it has to be used first to prevent illness so that people do not come in at the last minute. You are talking here about a massive educational program here. Yes we know we are. We are. You know I feel that the analogy is that the health care system is trying to climb over a very high wall and people keep coming on board to give us a boost to try to get over the wall someone needs to say when I go around you know why not take a completely different approach. Why not try an outpatient instead of trying to outpace this with money. Try and outpace it with modifying the way that we approach health care altogether. Shocking. An alarming thought but I honestly cannot imagine fixing our health care system without developing a health care system and making it owners manual for it that every American then has so that we can figure out how to use whatever this new thing is that we.

Let me try to point out how difficult I think this is because we do want to focus on the problems here and this is a problem. We know that there has been a massive education program aimed at getting America to stop smoking cigarettes. Then all of a sudden all of the billboards start showing up in the black community all of a sudden the tobacco industry starts targeting its advertising at young black males or young black females Eyebeam. That's the kind of problem we're talking about here we have the problem with heart disease. So what we're being encouraged to smoke more. What can we expect realistically and more empowerment. Because when the billboards started coming up in empowered communities they very quickly came down. Absolutely. I mean the community was on target with the idea that oh yes well that looks very sexy and it looks wonderful and our kids are beginning to smoke again. But by and large if you start asking children especially now. You know what do you think about smoking. They have some very significant ideas. Many children now are anti-smoking because communities have come on board and said

we're going to reeducate you they can throw up as many billboards will pair them down. We'll do whatever. But you will not that's why I understand we have a telephone caller on the line. Welcome. Thank you for patience. Go ahead please. Hello. Go right ahead. With respect to race and in deference to those who may feel that the notion of racism is a small factor in how urban planners in the medical community are about. Studies show that the urban areas are which are largely black or inherently unhealthy. All the studies show that the distribution of high incidence health is concentrated in the city. A more recent study in U.S. News and World Report by Dr. Paul Jaworski concurs. And of this individual attitude a rising economic tide will lift the boats the ghetto and also the fact that Hurghada hurry up quit and maybe change the trigger. Age rate for Social Security. What do we do if there there's no asymmetrical application to blackout. What do we do. My my feeling that we have to

rise up and try to get the community to speak loud enough so that the new president and the new regime will be sensitive and recognize that a a cheaper way of accomplishing the goal is to enlist the community become part of the solution to the problem. Back to the telephone it's your turn call you on the air go ahead please. Hi. Hi. I have to say three three three things. The question. One I see on the side of truth we do have universal health care and also agreed that education should be on a part of the patient and the behove giver. Secondly quickly myself is a coterie co-pay person to medical insurance through my job. I find it very difficult because most extreme so-called low cost to me when I'm being a full charge kind of in my pocket when I'm visiting a doctor. We have a

problem there you know with verses that you scared take time off work because the vet's job growth and so forth. And also the employees are invested much in your health care. But really I think just some Doesn't escapism. The biggest problem we have is that on the high end of it is the profiteers on profit from it. The issue is companies pharmaceuticals hospitals so forth and so on. I think once we eliminate the properties from this service is really supposed be for the betterment of human beings. Obviously there's more than enough blame to go around. When it comes to profiteering and medical. I would like to make two comments though one about co-pay very quickly. That is a difficult scenario that every week you're getting your check every other week you get your check you've paid very high premiums. And then in addition you have to pay out of your pocket when you go to the doctor. And this

really is a barrier to many patients who if you have four children and you have to go to a pediatrician and pay the co-pay. That could add up if someone has a little ear ache or a little belly ache then it may have to go a little while because you do have to come out of your pocket. In addition I cannot sit here as a health care professional that deals with mental health issues and not talk about the differential treatment of people with mental illnesses. I was wondering when that would come out. At the very last moment. I want it to stick. And that is we know now that most people who have mental illnesses or disorders of any kind that would go on that spectrum are not the walking wounded as many people think. We're not talking about getting patted on the back or patted on the head by someone. These are people who are honestly suffering who are disabled in many ways and to discriminate against them differentially by not paying for substance abuse disorders depressions and other kinds of mental health disorders is really

abysmal. And I cannot see that going through in this next round of reform. Got to get back to the telephone. You're on the air. Caller go ahead please. Hello. Yes good evening. Good evening. I like to say with all that the the lack of the African-American community have done to enhance the health care from birth control to open heart surgery to all types of medication that we have contributed seem like we educate the wrong people should it not. Why are we still waiting to be input. Well we have put so much in that when I see what you're saying you're saying that instead of educating the African-American community which we should be educating the white community about not only what our needs are but exactly how we have contributed to the system I guess is what our caller was saying is that what we're doing today. I think that we're talking about. That is the purpose of our gathering here this evening.

Indeed I had another thing I wanted to introduce and that is the problem of homelessness and how that affects our healthcare of all peoples lives. Talk about that please. Well I feel very strongly that those people who have no homes certainly can have no access to health care and when they do it can only be on a very transitory transitional nature. Therefore any curative effort is dissipated. So whatever efforts we do to improve our health care without addressing that terrible disease homelessness is going to be in vain. You're about to say how well I had a couple of comments one backing away from one of the things we do do is track profitability and I would suggest that the wreckage would show that the profitability at least of the commercial health insurance industry is probably less than your Friendly Giant grocery store over the long term. Second I think the education really of the insured individuals is is enhanced by an awful lot. If there is an employer involvement because employers are

concerned about health care and they're concerned about their color and lot of employers do spend a lot of time money and resources and try to help that education process come to place. So I think that employer linkages is a real plus in the delivery and also the education as you know Harvey of the insurance industry will say it's not making a great deal of money. The American Medical Association will say doctors are not making a great deal of money by the legal practice of say we are not making big money off of filing their practice lawsuits. Everybody who is involved in the provision of health care will claim during this process that we are already hurting and we cannot hurt them anymore. We are hurting for time and we do have to take a short break. I'm sorry about that. We'll be right back. Well that's it. That's all the time we have for tonight. Next Tuesday we'll continue our four part series with an

exploration of the connection between health care reform and the need for welfare reform. Our thanks to all of our guests for participating with us some of them will be joining us for our future discussions and our thanks to you of course our viewers for participating not only in this evening exchange that we look forward to your participation in the rest of the Su's you notice the new set take step on the set. Our thanks to Mr. Card Alperstein furniture on Seventh Street Northwest for that night. When