My critics—and those who just plain dislike me—often accuse me of being “obsessed with race.” The truth is that they are both right and wrong.
You see, racism factors into our lives on a daily level, in both macro and micro ways. Also, most people confuse personal prejudice for racism and don’t know the difference. I wish race didn’t matter and didn’t infect so many systems and interactions. But it does.
Another of my “favorites” is people telling me that I hate white people. I do? I don’t know; I was married to a white guy, and my current squeeze is a white guy. No, I don’t hate individual white people, I hate the system of whiteness and white supremacy which is our current operating framework for society. I hate that both white supremacy and whiteness seek to destroy Black and brown lives, not to mention the chaos it actually unleashes for white-bodied people, too, including those I personally care about. I hate when white people just plain ignore all this.
So, I was minding my business today, with no intention of writing a post like this, when I was reminded once again of the insidious nature of white supremacy culture and its impact on Black lives.
Back in early fall, I went to my primary care physician for my annual check-up, including an appraisal of the lady bits. Several weeks later, my primary care doc reached out to say that something a little concerning came back in the results and she wanted to refer me to a specialist for a biopsy. My doctor walked me through the test results and said while nothing indicated that I needed to prepare to wind down my journey on this dusty rock, we did need to err on the side of caution.
Yes, the worst-case scenario was the big C—but if so, this should be in the earliest stages where my life won’t be shortened or impacted in any major way.
OK. Cool beans. Not the news you want to hear before the holiday season, but knowing that I probably am not in my last days helps a great deal. After giving me a choice of three possible providers for the procedure, I went with the one I heard was the best choice. Several weeks later, they called and scheduled my procedure for late February.
Being filled with low-end worry was not exactly how I wanted to spend the holidays or the lead-up to my 50th birthday, but I put the date on my calendar and figured I should enjoy life to the fullest in case my doctor was wrong, Yeah, I am a weirdo—or maybe just realistic with the legacy of both my parents dying early. But I really hadn’t been thinking much about this impending appointment lately, other than making sure my partner could accompany me.
At least I wasn’t until yesterday, which is why I’m writing this.
The mail brought a letter from the specialist’s office. I expected the letter would be a list of preparations or forms to complete. Nope! It was a letter telling me what portion of the procedure my insurance would cover and telling me that I had to prepay the remaining balance of $302.26.
By the way, as I write this, the procedure is scheduled in five days. Five days.
At first, I was just taken aback. I have had a number of procedures over the years and I have never been asked to prepay for anything. I do have $302.26 to spare, so taking care of it is not a problem.
But a few years ago, I would have been hard-pressed to come up with an unexpected few hundred dollars at the end of the month. In the immediate years after my ex-husband and I separated, while I was building up this site and my consulting work, money was tight. Very tight. One of the reasons I never could visit my Dad or family back in the MIdwest was a lack of money. While I am not exactly “rolling in it” now, at least I do now have the ability to cover unexpected costs. Or at least this one.
However, the more I sat with this letter, it dawned on me: I am receiving a biopsy for suspicion of a cancer that disproportionately kills Black women. When this cancer is caught early through regular screenings and biopsies like the one that I am having, survival rates at five years are 92%—and this is considered a slow-growing cancer. However, if one can’t get regular screenings and doesn’t know they have it until they are symptomatic, survival rates drop significantly.
Then it hit me: Do Black women die of this cancer at higher rates than other women due to a lack of ability to access the more advanced screenings and possibly treatment? If so, what is the barrier?
Obviously, I cannot speak for Black women as a whole, but if the specialist who does the biopsy requires prepayment, that strikes me as a significant barrier. Especially in a state where in our most populous region, there are only three providers who can do this procedure. Particularly in a world where, according to the data, Black women earn between 58 and 64 cents for every dollar a white man earns.
So in a world where inflation has us all talking about the price of eggs, how many Black women really have a spare $300 lying around at the end of the month with rent and bills to pay? Honestly, not as many as we might like to think—especially when I think of who I see doing the majority of crowdfunding for critical needs. It is Black women and other marginalized people.
Now, I am sure this nice practice has no idea that I am a Black woman. I highly doubt they wrote this letter specifically to me. But I also see how someone else with fewer resources, who is not nearly as neurotic about physical well-being as me and struggling financially, could easily end up canceling the appointment due to a lack of ability to pay.
Maybe they figure they would get to it later. But as someone who grew up rarely seeing a dentist because my parents didn’t have dentist money, I know the impact of putting things off. In my early 20s, back in the 1990s, I had to have five figures worth of dental work done to make up for all the missed visits and dental work. To this day, I am thankful that I mostly have all my teeth—I have only lost two due to lack of money. For those of us who grew up struggling financially, teeth were optional.
By the same token, health issues that don’t cause immediate problems grow into large problems that can possibly take your life. As a teenager, I watched my father deal with what he thought was a minor problem that eventually became late-stage throat cancer. To this day, it is still a miracle that my father eventually lived 30 years post-diagnosis when his initial diagnosis gave him less than a year. The barrier to my Dad getting early treatment: lack of both insurance and cash.
When we look at why certain people are disproportionately affected by certain ailments, we need to look at the systemic barriers. There are probably a host of reasons, but I see access to care, even down to being able to take a day off work if paid time off is a barrier.
The thing about racism is that it’s not always a racial slur or a guy with a sign on a street corner. It is how systems are structured that can provide barriers that create certain outcomes. Inability to access care in a timely fashion at a stage where a cancer diagnosis is nothing more than an inconvenience is part of why Black women die of this particular cancer so much more than anyone else.
And yes, white people can suffer financial limitations and face the same thing, but remember they survive more often—from this and other conditions that hit Black people hard. Why is that? Part of it is that white people are more likely to know someone who can help them out. They are more likely to be tested and treated more carefully by the medical system to begin with. The system is stacked in their favor.
If we are going to be honest about problems, we need to look at who has resources and access—and who doesn’t. We all play a role when—for example—we undervalue the labor of Black women, don’t pay them enough, steal their labor, etc. It doesn’t take an openly racist doctor to cause the problem. Most of the problems are farther up the pipeline in people’s lives. Way farther up. A society that treats people’s worth differently based on race starts setting up failure early and that influence creeps into every corner of life later on—so that an unexpected co-pay becomes a barrier to much-needed care. So that something highly treatable can end up a death sentence.
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