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Health Disparities



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There’s a very good piece by Sally Satel in today’s Wall Street Journal (page W13). The bottom line is that a recent study in the New England Journal of Medicine on racial disparities in health care is flatly at odds with those who claim doctors are biased and who would use a variety of preferences to ensure “cultural competence” among them. The problem is poverty and access, not race per se. (See also my piece for NRO this spring .)
Additional points that I’d make: (1) even the study’s correlation between wealth and race may be exaggerated, since the study is limited to Medicare beneficiaries, and patients over 65 are less likely to have fully reaped the economic rewards of the end of Jim Crow; (2) the accompanying editorial by Arnold Epstein in the same issue of the NEJM is worth reading, and notes that the study “point[s] away from interpersonal discrimination” and indicates that the problem is not really race qua race, since “efforts to improve the quality of health care in general might reduce racial disparities …”; (3) not much support in the study for racial preferences in medical schools, since there is no evidence of a problem with a lack of cultural competence, and the last thing the study indicates we need is more second-rate doctors in minority communities; and (4) regarding a cultural competence “problem,” it makes no sense as an a priori matter nor is there any empirical evidence to support it, blacks themselves don’t believe in it since they generally don’t indicate a preference for black doctors (as Satel discusses in her book, PC, M.D.: How Political Correctness Is Corrupting Medicine), and this study indicates that they tend to have plenty of access to black doctors and/or doctors who work frequently with African Americans anyway!



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