Dialogue on Health Care

Dialogue on Diversity, an organization of women entrepreneurs and professionals based in Washington, DC but with nationwide reach in its programming, presents a yearly cycle of programs on public policy issues and entrepreneurship, aimed specially for women and designed to stimulate constructive conversation among the country’s Latino and other ethnic communities. Its annual Health Care Symposium was held May 11 and dealt with issues in U.S. health care.

The Symposium opened with remarks by Lucille Roybal-Allard, Chair of the Health Task Force of the Congressional Hispanic Caucus, who cautioned that voices of concern should be directed to the Congress urging members to think clearly and responsibly, to explain and educate, not join in a stampede to gut the still scarcely implemented new health care legislation.

The agenda began with a panel on the PPACA Patient Protection and Affordable Care Act of 2010 (PPACA). The debate culminating in enactment was the climax of a campaign to recast important parts of the contemporary health care system, one that has grown with demographics, economic advance, and technological innovation, yet lacks in its accessibility for persons isolated in ethnic ghettos and economic backwaters. A social system whose legal and economic structures have less than successfully managed to produce a broad and equitable provision of health care must be turned around to form a population that is the subject of a rich country’s studied investment.

The subject of the Symposium’s second panel was the preventive phase of health care. A society’s aggregate health care costs will doubtless be lessened through the reduction in advanced-stage illness and of sickness generally. It is perhaps difficult to assign a precise measure to the effects of the “lifestyle” strategies such as exercise, diet, and the like. There is serious debate whether the costs of screening are justified by the uncovering of only a few conditions whose treatment at just that point will save future costs. There must be, it was believed, a certain presumption in favor of the screening strategy, even if the hits are few and far between.

The subject of an afternoon panel was the much-heard term “cultural competency.” This designates those multiple blockage phenomena by which effective health care is impeded in the delivery phase to those many communities and classes of persons marginalized by language, income levels, cultural mores, and other factors. The Latino communities of the country are the most conspicuous example of a barrier of language and culture and income. It is easier by a long shot to describe these barriers than to lay out a workable roadmap to get past them. Several provisions in the PPACA seek to make care, preventive care included, an economically manageable possibility for the low income reaches of the population, ethnic minority communities among them. The other elements of a cultural competency program deal with the familiar problems of linguistic obstacles, the task of ensuring that the physician grasps the nuances of what the patient is relating, while the patient in turn must be made to understand the instructions of the physician or nurse. Since there are always new patients coming on, and new nurse practitioners and physicians to receive them, these problems will not be solved once and for all, but must be viewed as a continuing maintenance function for a cultural competency crew as an integral organ of a well articulated health care system.

The hugely important topic of electronic health records and the adoption of information technology in the health care industries occupied a later panel at the Symposium. The project now gathering speed in the U.S. should make a sober assessment of the administrative and cost aspects of the project. A similar, not very successful program in England appears to have cost to date around $12-15 billion. The corresponding project in the U.S. would be six times as expensive (if one goes by the ratio of populations), or $50-75 billion. Medical IT is a seductive dream, but the work must be done now. Again, political discussion should fasten laser-like on the questions of funding for the system, and the possibility of an off-the-budget corporation to carry out the work.

Maria Cristina Caballero is President of the Dialogue on Diversity.