Dr. Michael Poulson’s strong comments about structural racism associated with housing and communities and the services (education, jobs, etc.) provided there are right on target and need to be addressed by government policy and programs (“Biden’s infrastructure plan must curb structural racism,” Opinion, April 27). As a fellow physician, I hope that Poulson and others in our field will also address the structural racism in how we pay for health care for children and youth (and older people) in many of these communities.
Medicaid serves as a major and often critical source of health insurance for Black and brown households. Medicaid coverage for children has many demonstrated benefits, including reduced teen mortality and disability and higher earnings in adulthood. Yet Medicaid also supports ongoing structural racism by paying about two-thirds of what Medicare pays for the same services, framing Medicaid recipients as worth about two-thirds of other people. Medicaid-insured people face discrimination in who provides their care and where they can get care, with many physicians and hospitals encouraging care from providers who mainly treat low-income patients. This structural problem also should be addressed.
Dr. James M. Perrin
Boston
The writer is affiliated with MassGeneral Hospital for Children and Harvard Medical School.