Black Unemployment Driven By White America’s Favors For Friends

There’s a comforting-to-white-people fiction about racism and racial inequality in the United States today: They’re caused by a small, recalcitrant group who cling to their egregiously inaccurate beliefs in the moral, intellectual and economic superiority of white people.

The reality: racism and racial inequality aren’t just supported by old ideas, unfounded group esteem or intentional efforts to mistreat others, said Nancy DiTomaso, author of the new book, The American Non-Dilemma: Racial Inequality Without Racism. They’re also based on privilege, she said — how it is shared, how opportunities are hoarded and how most white Americans think their career and economic advantages have been entirely earned, not passed down or parceled out.

The way that whites, often unconsciously, hoard and distribute advantage inside their almost all white networks of family and friends is one of the driving reasons that in February just 6.8 percent of white workers remained unemployed while 13.8 percent of black workers and 9.6 percent of Hispanic workers were unable to find jobs, DiTomaso said.

This week, the professor of organization management at Rutgers University and her ideas have captured the attention of the business press. There was a blog about her book in The Wall Street Journal and a story in Bloomberg Businessweek. DiTomaso, who is white, has gathered evidence that racism and inequality actively shape the labor market and make it far harder for black workers to find jobs.

“Across all three states where I did my research, I heard over and over again [white] people admitting that they don’t interact very often with nonwhites, not at work, not at home or otherwise,” said DiTomaso about the 246 interviews with working-class and middle-class whites she did over the course of about a decade in Tennessee, Ohio and New Jersey. Her research included detailed job histories and information about the way her study participants obtained jobs over the course of their careers.

“That was true for just about everybody unless they were still in college,” DiTomaso continued. “Others would allude to some college friend or experience. But since then, they had not had much contact with blacks. So how would they pass opportunities and information across race lines?”

DiTomaso concludes, based on her research, that most white Americans engage, at least a few times per year, in the activities that foster inequality. While they may not deliberately discriminate against black and other non-white job seekers, they take actions that make it more likely that white people will be employed — without thinking that what they’re doing amounts to discrimination.

“The vast majority assumed everyone has the same opportunities, and they just somehow tried harder, were smarter,” DiTomaso said of those she interviewed. “Not seeing how whites help other whites as the primary way that inequality gets reproduced today is very helpful. It’s easy on the mind.”

So white Americans tell a neighbor’s son about a job, hire a friend’s daughter, carry the resume of a friend (or, for that matter, a friend’s boyfriend’s sister) into the boss’s office, recommend an old school mate or co-worker for an unadvertised opening, or just say great things about that job applicant whom they happen to know. But since most Americans, white and black, live virtually segregated lives, and since advantages, privileges and economic progress have already accrued in favor of whites, the additional advantages that flow from this help go almost exclusively to whites, DiTomaso said.

DiTomaso’s findings aren’t exactly new, said Algernon Austin, director of the Race, Ethnicity and the Economy program at the Economic Policy Institute, a left-leaning Washington-based think tank.

“Listen, I think it’s an important piece of work to reiterate and clarify the ways in which blacks are disadvantaged in the labor market,” Austin said. “Of course, part of the appeal of this is that there’s no malice. You can say no one is to blame. The Businessweek piece says, well, people just like helping out their friends, which is perfectly natural and normal.”

DiTomaso’s work does confirm that networks — not just the kind you build over awkward conversations, finger foods and watered-down cocktails but the kind you’re born into — matter, Austin said. It also points to just how different forms of inequality feed one another. Family-and-friends segregation feeds job and income inequality. That in turn feeds neighborhood and school segregation. That then leaves some kids less likely to receive a quality education and escape from the cycle, he said.

Austin thinks that increased public awareness of opportunity hoarding, as well as public policies that enhance options for blacks and Hispanics, could make a difference. Bringing more blacks into the labor force would have the immediate effect of reducing black poverty, and quality early-childhood education has been proven to blunt some of the short- and long-term effects of childhood poverty, he said.

“To President Obama’s credit, he’s certainly focused on early childhood education,” Austin said.

It’s not that black workers don’t attempt the same sort of job assists within their own networks, said Deirdre Royster, an economic sociologist at New York University and author of Race and the Invisible Hand: How White Networks Exclude Black Men From Blue Collar Jobs.

African Americans ask neighbors, significant others, the significant others of neighbors, relatives and friends about open jobs, too. But since black unemployment rates were far higher than white rates before, during and after the recession, the number of people in a typical black social network who are in a position to help is far more limited.

According to Royster, there’s an additional twist: When blacks are aware of a job, they describe the job, the boss, the company and its preferences and needs. Then they follow up with a warning.

“They give the person looking for a job all sorts of information and then they say, ‘But don’t tell them I sent you,'” said Royster.

Black workers are aware of something that researchers are still trying to explain: White bosses often worry, lack of statistical evidence aside, that black workers are more likely to sue them or band together in the workplace and try to change things, Royster said. That seems all the more likely if the black workers already know one another, she said. And many white hiring managers still assume, consciously or unconsciously, that black workers bring undesirable workplace habits and qualities, Royster said.

Indeed, a 2003 study by Devah Pager, now a Princeton University sociologist, found that white men with criminal records were more likely to get callbacks for job interviews than black men with the same qualifications and no criminal history.

Black men: Here’s your wake-up call

Date: Tuesday, March 26, 2013 By:

Have you received a wake-up call yet?

For too many of us, it takes a sudden wake-up call — in the form of a major or minor health crisis — to make us realize that we’re not invincible.  And tragically, for some, that call comes too late.

As black men, we often don’t talk about our health or seek help until something goes wrong. We may exercise and eat right. We may know how our habits today affect how we feel. But what about tomorrow? Are we making the right choices to stay healthy as we grow older? Most importantly, are we having the right conversations about health and well-being with our sons and our fathers, with our brothers, our colleagues, our neighbors, and our friends?

According to the Office of Minority Health at the U.S. Department of Health and Human Services, black men are 30 percent more likely to die from heart disease and 60 percent more likely to die from a stroke than white men. And unfortunately, the list goes on — black men still suffer from higher rates of disease and chronic illness such as prostate cancer, diabetes and heart disease.

Unless we act now, these disparities will continue to affect generations to come.  Their existence should be a wake-up call for all black men. It’s time to invest not only in our own health, but in the health of our communities.

That starts by putting ourselves in the driver’s seat when it comes to our own care. The health care law signed by President Obama in 2010 is removing many of the obstacles to health care we’ve faced in the past. It provides access to preventive services – like screenings for blood pressure, cholesterol, and type 2 diabetes – at no cost to us.

It will protect those of us with pre-existing conditions like asthma or heart disease from unfair premium rates or outright denial of coverage. It makes major investments in America’s network of community health centers, where over a quarter of patients served are African-American. And on October 1st, the law will open the door to affordable coverage for millions of African-Americans, through the Health Insurance Marketplace.

That means brothers running their own businesses will have the opportunity to get coverage for themselves, their employees, and their families. That means men working in barber shops, body shops, and construction companies across America will have access to affordable coverage if they don’t have it now. That means when you hit a rough spot and are between jobs, you don’t have to sacrifice the well-being of your loved ones. It means greater peace of mind and financial security for our families and communities.

There’s a lot of great work being done in our community to close gaps in access to quality care. I’m encouraged by the tireless work that our faith- and community-based groups are doing every day to raise awareness and push policies that will make the health care system work for all Americans. They are leading the way – but it’s up to all of us to do our part.

The wake-up call that brings better health to our communities shouldn’t be a private alarm that we hear alone. It should be a chorus of voices that speaks to us, our families and our communities. This year, let’s put our health in our own hands, and create a brighter, more secure future together for all of us.

Physician Independence May Die by a Thousand Tiny Cuts

Blog | March 21, 2013 | ACO, Healthcare Reform By and

The American Medical Group Association’s (AMGA) annual meeting in Orlando can be best summed up with Board Chairman Michael Bukosky saying “This is our time, time to step up and act.”

Bukosky said that integrated systems of coordinated care are working. He urged partnering with patients and encouraging them to be responsible for their health.

A lot said in a sound bite and two short sentences.

Nonetheless, the AMGA seems to get that, with the current diversity (read: lack of readiness) that is existent in the Patient-Centered Medical Home (PCMH), Comprehensive Primary Care Initiative (CPCI) practices (which we have seen proliferating in New Jersey and elsewhere), the results of these programs are likely to be disappointing to some.

Disappointment, while virtually inevitable unless there are fundamental changes, will be unfortunate because the problem is not with the model. It is directly tied to the lack of infrastructure investment, organization, and strategic cost-reduction training being provided by CMS and the other payers in the programs.

There are very smart people in these organizations, and it is confounding that they would work to field thousands of physician teams without data and analytic support, cost-management coaches, and proper training.

If the ultimate goal is to significantly reduce total cost of care, then why is TransforMED (a private company that developed as offshoot of the American Academy of Family Physicians hired by CMS to provide support) focusing all of its efforts on internal practice processes? That area that represents only five percent of the cost of healthcare. Why are they not providing historical cost data, benchmarks, transparent rate information, information on the economic efficiency of specialist providers, and training on managing the cost and utilization of high-cost downstream medical services?

Why are we not taking advantage of the potential alignment of these practices, particularly where they in close proximity to each other, to organize them as cooperatives, collaborative, or an independent practice association (IPA)? A high-performing primary-care network can, with the aid of some price transparency and appropriate coaching, create marketplace pressure on high-cost providers to reduce not only utilization but unit costs as well.

Haven’t we seen enough evidence of the advantage certain institutional providers take by delivering services in a market where the customer doesn’t understand what they are buying? When prices are obscured to the consumer and where the consumer is sheltered from the price impact, the system is not only rigged, it is predatory.

Glass half full, we are dealing with a failure in leadership, but one should wonder who is drinking from that glass to make it that way.

Whatever the cause, wasting this superb opportunity to reform the healthcare system through provider-payer partnerships is a shameful disservice to the American people, taxpayers, and the most vulnerable among us.

The same sort of payer-physician partnerships that fueled the successful prepaid group practice models and gave rise to the Geisingers and the Kaisers of the world are obvious models. Also, today’s technology makes clinical integration equally available to the country doctor and metropolitan practice.

There is hope, though. The private sector is bringing practical solutions that can not only help these programs to be successful in their goal of substantially reducing the total cost of care, but also benefit patients, physicians and payers.

To survive and proliferate, they will require real leadership. Physicians need to step up and take that role. It will require the vision to recognize that we are going about this in the wrong way and to correct the course. The participation and commitment of the health care community, the cooperation of regulatory authorities and the political will to set aside ideology, partisanship and special interests to legislate in the best interest of the country will also play a central role.

Our present course, as characterized by the Doctor Patient Medical Association’s Kathryn Serkes, is disaster in slow motion.

It is one of the greatest and most dangerous threats this country has ever faced, and it is hard to see because it is death by a thousand tiny cuts, festering one by one.



Be Prepared for Change in Reimbursement Models

While fee-for-service reimbursement has been a fairly straightforward business model — the more procedures a physician does, the more money he makes — it is not without its drawbacks. Practices are frustrated and confused when they hear about the annual threat to Medicare reimbursement rates. Both private and public payers are increasingly demanding reporting of quality metrics. And physicians have often been accused of driving up costs by prescribing unnecessary care.

Now, practices are being told that they need to join accountable care organizations (ACOs); merging with hospitals or other physician groups. So what do these changes mean for the future of private practice?

There are many different ideas that have been talked about for reimbursement changes in the future. These include a return to capitation (payment per member, per month — whether or not practices provide service); bundled payment (when services by several providers are paid to one source); and episodic payment (based upon the patient diagnosis — similar to surgery payments but applicable to all disease types).

So how will your practice morph into a new reimbursement/practice model and still ensure that it is paid adequately for services?

First, it is important not to panic. Changes in reimbursement will not occur in 2013 to any great extent. More importantly at this time it is necessary to consider the impact of meaningful use, Stage 1 and Stage 2, PQRS, and e-prescribe incentive payments which will have penalties for noncompliance through reductions in payments from Medicare.

Next, there are many steps that can be taken now to prepare for the future, whichever option is accepted:

• Understand what each reimbursement model means for your practice. Attend educational sessions, read, and learn from any source possible.

• Accept the fact that reimbursement amounts from any fee-for-service source will decrease; many practices have experienced this already and it most likely will get worse.

• Instead of concentrating totally on your revenue cycle, develop a way to understand what it costs your practice to provide services — from a basic office visit to a specialized procedure. This will become very important as options change from fee for service to total payments for a series of services.

• Look into the development of treatment plans for your most common diseases, e.g., diabetes care means quarterly HgbA1C and annual eye and foot exams. Ask yourself “What does it cost our practice to provide this care, and how much reimbursement is necessary to provide this service and maintain our patient population to the standard of care?” This episodic payment option may not cover all associated costs as currently defined.

• Develop a patient satisfaction survey program, which includes not only gathering the data but doing something with it. Medicare and payers may assist in sharing information they have gained from patients over the years.

• Communicate with your payers on what you are doing and how well you are doing it. Transparency and information sharing will assist in preparing for the future.

The key message here is that things will change for your practice. It will require some forward thinking on your part, not panicking today, but becoming aware of and preparing for the future, whatever that may bring.