DEI is coming for your health care, and maybe even your health. In the name of “equity,” America’s top health care systems are now segregating or excluding some patients from life-saving programs based on race. These new programs mark a dangerous turn for American health care, where picking and choosing among preferred racial groups is the new standard of care.
Take Cleveland Clinic, for instance. This world-class health care system runs a “Minority Men’s Health Center” and a “Minority Stroke Program” for addressing numerous medical conditions, including stroke, diabetes, and other stroke risk factors; men’s health conditions; and various mental health issues. These programs tout a range of benefits from disease prevention and treatment to specialized providers, transportation assistance, prescription assistance, support groups, and education events.
These are top-notch programs. But they’re “tailored” to minorities. For example, the Minority Stroke Program’s stated focus and goal is “preventing and treating stroke in racial and ethnic minorities.” And so minorities (and only minorities) are encouraged to reach out to the “Minority Stroke Program team” to set up an appointment.
While a recent challenge to these race-based programs apparently prompted Cleveland Clinic to quietly remove all traces of the Minority Men’s Health Center from its website, the clinic’s Minority Stroke Program appears to remain otherwise intact at this time.
Cleveland Clinic defends its racially distinctive stroke program by saying that it helps patients “who need it most” and that the programs are necessary to combat racial disparities. Black and Latino patients, for example, see worse stroke outcomes on average.
But if treating these racial disparities is a valid goal, then why not other disparities? Whites are more likely to suffer from Parkinson’s, macular degeneration, Type 1 diabetes, COPD, skin cancer, cystic fibrosis, osteoporosis, and MS, just to name a few. Should Cleveland Clinic open an MS clinic for white persons? Of course not.
The problem with such racial health equity models is that they use race as a proxy for legitimate health risks. A higher incidence of stroke in a given race does not necessarily mean that race itself is causing strokes. A leading study of racial disparities in stroke outcomes identifies various risk and potential factors: diabetes; hypertension; heart disease or other cardiovascular-related conditions; smoking; low socioeconomic status (such as education level); obesity or physical inactivity; inflammation; vascular factors; sleep apnea; and mental health. Race is not on the list.
Race-based health equity initiatives, like Cleveland Clinic’s programs (among others at Mayo Clinic, and other leading systems), treat disparities, not patients. These programs aim to filter and view health outcomes through a racial lens and assume that one’s race says all the doctor needs to know about who needs medical care the most.
But beyond race, any number of demographic filters could be applied concerning almost any characteristic to compare and address health outcomes — to name a few, height, eye color, birth order, handedness, where one lives, and so forth. The mere availability of any given demographic factor does not make it a relevant or lawful standard for evaluating health outcomes.
Indeed, studies have indicated that the appearance of racial disparities is explained not by race, but by other factors relating to social support systems, neighborhood factors, education, employment, and other novel variables that must be understood and accounted for — barriers that can transcend racial lines and be responsible for causing disparities in health outcomes.
Discounting relevant and legitimate factors and variables for health risks and outcomes in exchange for simple, blind deference to skin pigmentation for no other purpose than balancing broad racial disparities does not help those who need care most. Rather, this approach invokes guesswork that is the product of broad racial stereotyping.
Racial health equity schemes are not only wrongheaded, but also illegal. Under the broad protections of the Affordable Care Act and Title VI of the Civil Rights Act of 1964, health care entities receiving federal health care dollars may not discriminate based on race. This means that health care providers may not segregate care, impose racial preferences, or implement programs that are racially motivated to provide services to some in a different manner from those provided to others.
Unsurprisingly, the Biden-Harris administration has been on this bandwagon from the get-go. On his first day in office, President Biden signed several executive orders mandating race-based initiatives. In alignment with this racial equity agenda, recently, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule that would permit and incentivize a racially discriminatory system for allocating kidney transplants and related services. We’ve condemned this proposed rule in a public comment.
Unfortunately, however, for the last decade, the race-conscious 2014 Kidney Allocation System has been working to reduce racial disparities in organ transplantation. And according to studies, this system has worked exactly as intended — increasing transplant rates for certain racial minorities while reducing them for whites.
While some may call these efforts “progress,” in truth, race-based equity initiatives are nothing more than an illegal endeavor to balance mortality and morbidity according to an individual’s skin pigmentation. Patients are not treated as individuals, but as mere representatives of their race.
No matter how well-intentioned, racial balancing in health care is not medicine — it is politics. Whether a particular patient should be prioritized or included for medical treatment and care does not change simply because a patient is the wrong color. Empty balancing efforts resulting from identity politics have no place in medicine.
Patients and their families should be on alert for these programs, and reject programs that undermine individualized medicine in favor of racially balanced outcomes. Health care systems cannot be accessible, robust, and effective, without the fundamental guarantee of equality for all.
