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Almost a week has passed since the Supreme Court positive action terminated in university admissions, and I’m still pondering a key argument that Judge Clarence Thomas made in his ruling consensus opinion.
It wasn’t about legal doctrine. It was about the role that race plays – and should play – in American society today.
“Racism,” wrote Thomas, “simply cannot be reversed by another or stronger racism.”
When Thomas wrote this, he wasn’t just attacking affirmative action. He was also responding to Justice Ketanji Brown Jackson, who spent a significant portion of his dissent detailing the vast racial disparities in the United States and arguing for the use of racially conscious remedies to eliminate them.
Health care differences were an important part of Jackson’s discussion. And by the way, she dramatically overestimated a statistical result, which was reported in right-wing media such as e.g National review and the Daily signal (Headline: “Justice Jackson’s Trifecta of Wrong on ‘Research’ into Racial Preferences”). It appears that the judge and her clerks merely cited a brief from a friend of the court that contained the same error.
That doesn’t excuse the error. Nor does it mean that their general point of view is wrong. There is a great deal of research on race and its role in health inequalities, and the vast majority agrees that race absolutely matters, for exactly the reasons Jackson suggested.
In fact, the most blatant misrepresentation about race and health care that I’ve discovered in last week’s opinions didn’t come from Jackson. It came from Thomas. And his mistake actually seemed to weaken his larger argument, in a way that is still relevant today, even though affirmative action is officially off the table.
What the research says about race and health care
Jackson’s discussion of racial differences included a long, well-documented list of reasons black Americans are worse off than white Americans. When it comes to health care, the list of poorer outcomes for blacks ranges from a higher likelihood of having babies born with low birth weight to a higher incidence of death from certain types of cancer.
Thomas has not denied that such differences exist. However, he stated, “None of these statistics are able to establish a direct causal relationship between race — rather than socioeconomic status or some other factor — and individual outcomes,” Thomas wrote.
This would come as a shock to researchers who have studied racial disparities in health and have made every effort to account for factors such as income, education, or predisposition to certain diseases. You’ve found time and time again that race still matters.
You don’t have to take my word for it. Here is the Institute of Medicineafter a comprehensive review of the literature in 2003: “A large body of published research indicates that racial and ethnic minorities have poorer quality of health services and are less likely to seek even routine medical procedures than white Americans.” … albeit differences with factors such as insurance status, income, age, comorbidities and symptom expression.”
Jackson wasn’t just arguing that people from minority ethnic groups are somehow sicker, to be clear. She made it clear how important it is to train enough minority doctors and especially black doctors – given Proof that black patients often receive better care when they have doctors of the same race.
Here, too, Jackson was able to draw on a large stack of research results. Among the most well-known works are some relatively recent studies dealing with it Cardiovascular Care in Oakland, California, And Hospital Mortality in Florida. In each case, the race of the doctors made a significant difference in the type of health care black patients received.
Researchers aren’t exactly sure why this effect keeps occurring. It could be that black patients receive more attentive and compassionate care from black doctors, for example, or that they do They are less likely to trust white doctors given the legacy of the infamous Tuskegee Syphilis Study and first-hand experience in American hospitals. Or it could be a combination of these and other factors.
But there is a fairly broad consensus that this effect exists, and it was bolstered even further last December – unfortunately too late for oral argument – when Duke’s Michael Frakes and Massachusetts Institute of Technology’s Jonathan Gruber published a working paper based on it health care in the military.
Using the extensive, thorough data the government maintains on military personnel, the two scientists found “impressive evidence of racial identity.” [i.e., Black patients getting care from Black doctors] leads to improved maintenance of care – and ultimately to lower patient mortality.”
Why race matters and what to do about it
Whether all of this adds up to an affirmative action argument is obviously a separate, more complex question – and, from a practical point of view, an irrelevant question after the Supreme Court ruled that universities cannot consider race as a factor in admissions. That doesn’t mean, however, that universities don’t have opportunities to tackle problems tied to race or increasing the supply of minority doctors, especially black doctors.
An interesting opportunity comes from the University of California, Davis School of Medicine. After the state banned affirmative action in 1996, the school sought to identify and promote applicants from low-income backgrounds by developing a “disadvantage” index that included nonracial factors such as parental education, family income, and neighborhood affluence considered.
According to a recent profile, UC-Davis now has “one of the most diverse medical schools in the country.” in the New York Times. And the idea of rewarding students who have overcome adversity has clear logic, for reasons President Joe Biden and a Princeton sociologist laid out in his remarks last week Paul Starr summarized in a new article by American Prospect: ““Overcoming adversity is a demonstration of ability,” Starr wrote.
And it’s not just individual universities that can act. The government could invest in racially neutral programs that nonetheless reduce racial disparities in practice, whether by improving access to health care for minorities or by investing in programs that address the causes of racial inequality.
That could mean a boost SNAP or invest more money in high-quality products early childhood education or, shall we say, expand Medicaid in states that have not yet done so. Research has demonstrated all three interventions to reduce racial differences in various measures from wellbeing.
Of course, the conservative political forces that have undone affirmative action by putting judges like Thomas on trial tend to resist also these initiatives. And they have their reasons. These guidelines, like all guidelines, involve compromises.
But when the conservatives, who don’t support race-conscious responses to racial differences, also don’t support race-neutral responses, one has to wonder how many of them really care about addressing those differences — and whether some don’t care at all.