DEI is coming when it comes to your health care, and maybe even your health. In the name of “equity,” America’s leading health systems are now separating or excluding some patients from life-saving programs based on their race. These new programs mark a dangerous turn for American health care, where selection among preferred racial groups is the new standard of care.
Take the Cleveland Clinic, for example. This premier health system operates a Minority Men’s Health Center and a Minority Stroke Program to treat a variety of conditions, including stroke, diabetes and other risk factors for stroke, men’s diseases, and various mental illnesses. These programs offer a range of benefits, from disease prevention and treatment to specialized providers, transportation assistance, prescription assistance, support groups, and educational events.
These are world-class programs. But they are “tailored” for minorities. For example, the Minority Stroke Program’s stated focus and goal is “the prevention and treatment of stroke in racial and ethnic minorities.” Therefore, minorities (and only minorities) are encouraged to contact the Minority Stroke Program Team to schedule an appointment.
While a recent challenge to these race-based programs apparently prompted the Cleveland Clinic to quietly remove all traces of the Minority Men’s Health Center from its website, the clinic’s Minority Stroke Program otherwise appears to remain unchanged at this time.
The Cleveland Clinic defends its racially differentiated stroke program by saying it helps patients “who need it most” and the programs are necessary to combat racial disparities. Black and Latino patients, for example, have worse stroke outcomes on average.
But if addressing these racial disparities is a legitimate goal, why not other disparities? White people suffer more from Parkinson’s disease, macular degeneration, type 1 diabetes, COPD, skin cancer, cystic fibrosis, osteoporosis, and MS, to name a few. Should the Cleveland Clinic open an MS clinic for whites? Of course not.
The problem with such interracial health equity models is that they use race as a proxy for real health risks. A higher rate of stroke in a particular race does not necessarily mean that race itself causes strokes. A leading study of racial disparities in stroke outcomes identifies several risk and potential factors: diabetes, high blood pressure, heart disease or other cardiovascular disease, 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, such as those at the Cleveland Clinic (among others, Mayo Clinic and other leading systems), address disparities, not patients. These programs aim to filter and view health outcomes through a racial lens and assume that a person’s race tells them all the doctor needs to know about who needs health care most.
But beyond race, any number of demographic filters could be applied to almost any characteristic to compare and evaluate health outcomes – to name a few: height, eye color, birth order, handedness, place of residence, etc. The mere availability of a particular demographic factor not Make it a relevant or legitimate standard for evaluating health outcomes.
In fact, studies have shown that the occurrence of racial differences is explained not by race, but also by other factors related to social support systems, neighborhood factors, education, employment, and other new variables that need to be understood and taken into account – barriers that transcend racial boundaries and may account for health disparities.
Ignoring relevant and legitimate factors and variables of health risks and consequences in favor of a simple, blind consideration of skin pigmentation that serves no purpose other than to compensate for broad racial differences. not help those who need help most. This approach is more likely to lead to assumptions that are the product of widespread racist stereotypes.
Programs that seek to equalize health care for people of color are not only wrong, they are illegal. Under the broad protections of the Affordable Care Act and Title VI of the Civil Rights Act of 1964, health care facilities that receive federal health care funds cannot discriminate on the basis of color. This means that health care providers cannot segregate care, enforce racial preferences, or implement programs that are racially motivated and designed to provide different services to some people than to others.
Not surprisingly, the Biden-Harris administration jumped on this bandwagon from the start. On his first day in office, President Biden signed several executive orders mandating race-based initiatives. In line with this racial equity agenda, the Centers for Medicare and Medicaid Services (CMS) recently released a bill that would allow and promote a racially discriminatory system for allocating kidney transplants and related services. We condemned this bill in public comment.
Unfortunately, however, the last decade has seen an attempt to reduce racial disparities in organ transplants with the race-conscious Kidney Allocation System of 2014. And studies show that this system has worked exactly as intended: It has increased transplant rates for certain racial minorities and decreased them for whites.
Some may call these efforts “progress,” but in reality, race-based equity initiatives are nothing more than an illegal attempt to equalize mortality and morbidity based on an individual’s skin pigmentation. Patients are treated not 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 given preferential treatment or inclusion in medical care does not change simply because a patient has the wrong skin color. Empty balancing efforts that result from identity politics have no place in medicine.
Patients and their families should be aware of these programs and reject programs that undermine individualized medicine in favor of racially equitable outcomes. Health systems cannot be accessible, robust, and effective without the basic guarantee of equity for all.
Dan Lennington and Cara Tolliver are attorneys at the Wisconsin Institute for Law & Liberty.
