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The following column is by The Goldwater Institute's Visiting Fellow Dr. Murray Feldstein.
I was a surgeon for over 50 years. I challenge anyone to come into an operating room after the patient’s entire body has been surgically draped so that only the gaping open wound is exposed. Look deep inside the body. Take note of the tan kidneys, brown liver, greenish gall bladder, and glistening pale intestines. Marvel as the mighty aorta pulsates down the length of the abdomen, carrying gallons of life-sustaining bright red blood to the pelvis and the legs.
Now…can you tell me the race of the patient?
Trick question. You cannot—because we are all colored the same inside.
As a surgeon, I did not ignore genetic, cultural, or socioeconomic factors associated with race when they related to the patient’s disease, but I never wavered in attempting to treat each patient as an individual. After all, while science instructs us as to what might occur if we treat a disease in a particular way, the art of medicine involves applying the most appropriate treatment for one particular person.
But today, a growing movement casts aside our civilization’s strides toward respect for the intrinsic value of each human as a unique individual. It ignores the real progress we’ve made toward true racial equality, instead demanding that a patient’s group identity—his or her “community”—take precedence over the individual.
Of course, there have always been significant disparities in health outcomes for various population groups. Only women die in childbirth. Only men die of testicular cancer. More people living in hot climates die of heat stroke. The children of Ashkenazy Jews are more likely to die of Tay-Sachs Disease. Black people are more likely to suffer the complications of Sickle Cell Disease.
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But these group disparities aren’t a result of racism; they’re related to sex, geography, religion, and specific genetic traits. Their causes are easily discernable, and progressive activists can’t wish them away by proposing “reforms” aimed at achieving outcome “equity.” Yet these activists want to take the serious and numerous disparities and blame racism rather than doing the more complicated work of diving into the numerous and complex factors, which are often not easily discernable, and where there is scant evidence backing up these flimsy claims.
No one denies that racism has been a major source of injustice throughout history. But progressives assume that racism is a major cause of current unfavorable disparities in healthcare outcomes, using evidence largely derived from retrospective studies associating outcomes with demographic data. Importantly, these studies suffer from the presence of confounding variables that are unevenly distributed across different groups—factors like educational level, income, place of residence, family dynamics, and cultural practices. Tricky statistical manipulation can be conducted to better understand the role each of these variables plays, but there is no way to justify the assumption that racism is the most important cause of the disparities.
In claiming that racism is to blame for disparities in healthcare outcomes, progressives also use evidence derived from aggregate studies. In other words, they lump together people from all types of backgrounds (age, income, education, rurality, nationality) and use those findings to inform healthcare decisions for entire populations, which is highly misleading.
When federal health organizations communicate their health outcome data for each race group, they group together people living in rural and low-income areas, high-income professionals in large metropolitan cities, and even those who have recently been resettled from war-torn countries—despite the fact that these subgroups have very different health outcomes and pre-existing conditions.
This misuse of aggregate and retrospective studies has created sweeping narratives and assumptions about white Americans and minorities. White people actually make up the largest proportion of Americans who reside in poverty (42%, followed by black Americans at 28%), but their struggles and poorer health outcomes have become a mirage, particularly in rural areas, where white individuals make up 76% of the population.
Consider that the infant mortality rate is 16% higher in Appalachia than in the rest of the nation. But it’s not because of racism, it’s because of factors like high poverty and uninsured rates, a lack of physician availability, and pre-existing health conditions.
Progressive reformers also believe mistrust of the established medical system is one important cause of a lack of minority access to competent healthcare. The infamous Tuskegee Syphilis Experiments, which treated black men as guinea pigs and led to hundreds of unnecessary deaths in the 20th century, is one of many reasons cited for this mistrust.
But now in the 21st century, a multitude of published articles promote the notion that patients are reluctant to see healthcare providers who don’t look like them. Patients are advised to seek out practitioners who belong to their own racial, ethnic, or gender-preference groups—and group identity is emphasized over individual professional competence. It’s true that associating with people with whom we have things in common is often easier and more convenient, whether we’re choosing physicians to treat us or neighborhoods to live in. But making blanket assumptions about wide swaths of people—like saying that all heterosexual white male physicians are too insensitive to meet the needs of all black or LGBTQ patients—ignores each person’s individuality. In other words, this progressive vision of diversity and equity treats Americans with unique needs and differences as if they’re nothing more than faceless, identical members of a given group.
I was born into a family of immigrants. I have been a physician for nearly sixty years and have practiced in extremely diverse environments, including the military, veterans hospitals, Native American reservations, rural areas, underserved inner city communities, and some of the finest academic institutions in the country. I had the privilege of training several generations of medical students and residents. I am optimistic that this period of progressive intolerance is a temporary phase, because I know from experience that intelligent, hardworking men and women of talent and goodwill are found in all races, ethnic groups, and economic classes. Most people still agree with Dr. Martin Luther King’s dream that the content of one’s character will count for more than the color of their skin. Hopefully his dream of the melting pot will triumph over the nightmare of neo-segregationist identity politics—because, in the end, we are all colored the same inside.
Dr. Murray Feldstein is a Visiting Fellow at the Goldwater Institute.
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