Reparations in healthcare? Yes, it’s a thing. Throughout the nation, leading healthcare systems have been implementing programs that look to race to determine how to care for patients.
Physicians at Brigham and Women’s Hospital and elsewhere have described this approach as being based on a “reparations framework,” which they say is needed to redress “institutional racism” in healthcare. Consequently, Brigham patients presenting with chest pain, for example, may be treated differently depending on their race.
Brigham has touted a race-based program for addressing disparities in heart failure for certain minority patients. While the type of care needed to address heart failure depends on severity and not every case requires specialized cardiology services, Brigham’s program aims to use a patient’s race to determine what level of care is needed.
Under the program, after an emergency department physician has determined a patient presenting with heart failure does not require a specialized admission for cardiology services, the physician receives an automated prompt instructing them to reconsider their professional judgment if the patient is “black” or “Latinx.”
Brigham justifies its program with a study, which purported to find that “black” and “Latinx” patients were less likely to be admitted to the hospital’s specialized cardiology service. According to Brigham, any racial disparity that remains after adjusting for a few factors mandates the conclusion that the disparity is due to provider racism. The notification prompt regarding black and Hispanic patients thus serves as a reminder to Brigham’s providers to restrain their racist selves.
However, according to some experts, Brigham’s assumption that health disparities are driven by hidden provider racism is medically unsound and unwarranted. Dr. Jared Ross, senior fellow at Do No Harm and a practicing emergency medicine physician, said: “A provider’s professional judgment should not be questioned based on broad assertions that he or she is harboring and applying discriminatory biases. It is dangerous to use skin color rather than acuity of disease to make decisions about patient care.”
As Dr. Ian Kingsbury, director of research at Do No Harm, explained, “Environmental and behavioral factors and patterns, as opposed to bias or racism, may be more likely to explain Brigham’s racial disparities in cardiology referrals.”
Given findings that black and Hispanic patients are more likely to use the emergency department for visits better suited for primary care, Kingsbury noted that certain minority groups may be less likely to receive cardiology referrals because they are in overall better shape when arriving at an emergency department. This notion finds support in Brigham’s own study, which observed that black patients had higher 30-day survival rates than white patients following discharge. “These indications do not point to provider bias,” Kingsbury stated.
Kingsbury’s rationale parallels the Mayo Clinic’s acknowledgment that health disparities, while “most often identified along racial and ethnic lines, may also involve biological, environmental, and behavioral factors,” among other things. Simply put, health disparities, while identified in terms of race, are the result of much more than race itself, if race plays any role at all.
As Kingsbury warned, “The factors driving health disparities are multifactorial and complex. It is irresponsible and unscientific to default to an orthodoxy that disparities must be a result of discrimination or bias.”
Indeed, attributing speculation about discrimination to a disparity not only ignores various root causes for an observed racial disparity but also assumes that healthcare providers are white. In reality, physician demographic data show that white people are far from the only racial group practicing medicine. In 2018, 56.2% of active physicians in the United States were white, with minority racial groups comprising a substantial remaining fraction. Likewise, medical school enrollment for racial minorities has been on a general increase for years.
While instances of intentional discrimination can and do occur, it is hard to believe that an already racially diverse body of practitioners is all consumed by racial bias and without hope, if not for groups of bureaucrats and social scholars to help save them. Really?
Nevertheless, Brigham is not the only health system that has jumped on the everyone-is-racist bandwagon and responded with race-conscious patient programming to balance perceived disparities. For its part, the Mayo Clinic has implemented various race-based programs for minorities, including its “Live Well. Be Well.” cancer prevention program, “SomaliCARES” prenatal care program, and “Live Well. Think Well.” program for “healthy brain aging.”
Other healthcare systems with similar racial balancing schemes include Children’s Hospital Colorado and the Cleveland Clinic, which is now under federal investigation following our recent challenge on behalf of Do No Harm.
These healthcare systems are determined to focus on disparities for certain races. But health disparities are not unique to any one race. On the other side of the black-white disparity, white people are at a higher risk than other racial groups for a variety of conditions — multiple sclerosis, Type 1 diabetes, and osteoporosis, to name only a few.
Indeed, white women are fracturing bones left and right and lead disparities for osteoporosis. Research has indicated that black people tend to have heartier bones than white people. But while osteoporotic fractures have been described as a “major public health issue,” the thought of an osteoporosis program for assisting white women in managing the various risk factors is unfathomable, as it should be. That is because treatment and prevention should target all people, regardless of race — especially if a person has multiple risk factors.
And, in fact, that is the law. Under Obamacare and Title VI of the Civil Rights Act of 1964, healthcare entities receiving federal funding are forbidden from implementing racial preferences and providing separate, racially segregated tracks of care.
And yet, in striving for equity, some of America’s most renowned healthcare systems have forgotten that the product of race-based initiatives is racial discrimination. No matter how well intentioned, these efforts are illegal and will have serious repercussions if they are allowed to continue.
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Cara Tolliver and Nathalie Burmeister are attorneys with the Wisconsin Institute for Law and Liberty and have appreciable healthcare backgrounds and experiences.