With Liberty, Justice, and Health Care for All: A Conversation with Pulitzer Prize- Winning Journalist Eugene Robinson

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Eugene Robinson has been championing human rights and social justice as a journalist for four decades. His columns on politics and culture are syndicated by the Washington Post where he has worked since 1980 after four years at the San Francisco Chronicle.

While at the Post, Robinson has been a city editor, assistant managing editor of the Style section, and a foreign correspondent in Buenos Aires and London. He won a Pulitzer Prize for Commentary for his columns on the 2008 presidential campaign. In addition to his newspaper work, Robinson is an MSNBC analyst, frequent panelist on TV news shows, and the author of three books, most recently, Disintegration: The Splintering of Black America, which was published in 2010.

Robinson will be the plenary speaker on Nov. 7, at 8:30 a.m., at Learn Serve Lead 2015: The AAMC Annual Meeting in Baltimore. He will discuss the socioeconomic disparities in our country that impact health and health care delivery.

In one of your columns supporting the Affordable Care Act (ACA), you said health care should be considered a right, not a privilege. Now that the ACA is law, where do we need to turn our attention to improve health care in this county?

We still have millions of Americans who don’t have coverage. Everyone recognizes that we still have imbalances in [health care] cost and access in all sorts of ways. The ACA was an important start. It established a principle of moving in the direction of truly universal coverage. But I don’t think anybody really knows what the next step is. It might look like Medicaid for all. The expansion of Medicaid has been a big factor in getting [health care] access for more people and is taking another big bite out of the apple. Now it is important to find a way to incentivize the kind of care that tries to prevent disease by encouraging people to have checkups and preinterventions—and basically mandate that insurance pay for this. If you start taking care of people that way early enough, you don’t get into as much debilitating and enormously expensive care at the end of life.

A recent AAMC report, Altering the Course: Black Males in Medicine, brought to light that the number of black males applying to and attending medical school in the United States has declined since 1978. How do we turn that around?

Talk to any education official in the country, and you will hear about the need to focus on STEM education. In Baltimore, for example, if you ask university or city officials if [minority students] are prepared to work for Johns Hopkins University, the city’s biggest employer, the answer is no. We have lots of programs designed both to improve the quality of STEM education and increase the flow of kids going into those fields. If you look at test scores in some places, education reform is starting to show results, but this doesn’t happen overnight. And while we need to start with education, education doesn’t happen in a vacuum. There are other critical problems to solve: Neighborhoods blighted with abandoned housing. Transportation issues. Lack of jobs. My Brother’s Keeper [the Obama administration initiative] addressed some of these issues with success. Foundations are trying to do what they can. To really move the needle, we need a holistic approach that is very ambitious and, frankly, expensive. All of what we are doing now is not enough.

An election year is ahead. Do medical schools and teaching hospitals have important stakes in this election?

I’m a big booster for spending on medical and basic science research. If we don’t do that, we won’t reach the breakthroughs that are really needed. A lot of the money for research comes in one way or another from the federal government. It has become fashionable to talk about research as a good, but when it comes down to actually doing a budget, those are dollars for future gain, and sometimes dollars need to be spent for immediate, pressing needs. That gets into the whole question of how we structure our spending, and it gets complicated. So, there is theoretical bipartisan consensus on more research spending, but no practical bipartisan consensus. [In an election year], this is something to watch for.

The news industry has changed dramatically during your career, from print to the digital age, and with massive layoffs at newspapers. How has this affected medical and health care reporting?

There are fewer newspapers today with dedicated health reporters on staff. Health coverage is probably less in-depth and less sophisticated in some ways. Papers used to have experienced writers who knew how to read a study and had sources across the industry. There are good [reporters] out there, but they are not always easy to find. Instead, we’re seeing blogs about health by health professionals themselves. Newspapers aren’t the gatekeepers in the way that they were in the past.

In medicine, we’ve seen that unconscious bias can influence a doctor’s perceptions, decisions, and patient care, which can adversely affect health outcomes. Is it possible to overcome deep-seated attitudes?

Unconscious bias is the new frontier. We’re just trying to get our arms around it. I think that’s very important and can have a big impact. The first step is learning about it and acknowledging it is real, and to the extent that we can, quantify it. Then we have to find ways to get around it or avoid it—to trace back through the system to see where we’re going off the rails. It may get back to metrics and looking at the numbers, the outcomes, and the disparities in a different way.

There is hard data showing that poverty, racism, lack of educational access, and other social determinants lead to poorer health outcomes. What role can medical schools and teaching hospitals play in eliminating health disparities?

Hospitals are among the largest employers in many cities. It would be in everyone’s interests—altruistic and practical—for big medical institutions to do everything they can to lift up the communities around them. [Academic medical centers] have a duty of citizenship that can be exercised and applied close to home. I would hope that big institutions would feel a certain obligation and take a leading role in helping to redevelop their communities.

 

This article originally appeared in print in the October 2015 issue of the AAMC Reporter.