Reader mail: Racial disparities, high-deductible plans

Hi folks: 

Every now and then it's my privilege to stop opining all of the time and share some of the interesting feedback I get from you. This week I've got a few notes to share on columns that seem to have struck a chord.

On the need for building trust [1] to address racial disparities in care, I received this thoughtful response from a specialist physician:

"It is easy to try to see this issue as simple bias. It is more difficult than that. If you could segment each ethnocentric group regardless of race I believe you will find that there is a huge variation in both acceptance of traditional healthcare delivery professionals and trust in advice. Flipping it around is to ask the individuals in question to list their daily priorities. Healthcare is not on the list at least very high up. Next meal, finding work, getting a ride, taking care of the baby, avoiding being shot or hurt are somewhere above getting my meds. If we are to move beyond an acute response healthcare system to one that can prevent and manage chronic health conditions it is clear that engaging individuals in long term relationship with the system is required."

My column attempting to shoot down the notion of a "moral hazard" in healthcare [2] consumption brought a few responses, including some who agreed, and some who thought I was full o' beans. This reader, a health policy analyst, shared my concerns:

"It's amazing how difficult it is to rid certain elements of the notion that health care is just another commodity, like toasters or washing machines. Consumers don't have the level of information necessary to make health care markets operate like the Econ 101 textbooks say they should.  And posting prices in the waiting room isn't going to change that. When the supply [providers] largely controls the demand [services], it's easy to see that the textbooks don't apply."

I'd love to hear from you folks again on this or other issues which concern you. Please, whether you share my viewpoint or think I'm way off-base, please write. We're always delighted to hear from you. - Anne [3]