Amid a resurgence of the coronavirus pandemic in the United States and internationally, an explicitly racially-based health care program will be implemented later this spring at Brigham and Women’s Hospital, a globally known medical center in Boston. The currently unnamed program is discussed at length in a March 17 article (“An Antiracist Agenda for Medicine”) authored by Bram Wispelwey and Michelle Morse and published in the Boston Review.
According to the article, the new “pilot initiative” uses a “reparations framework” that focuses on “Black and Latinx patients and community members,” who, according to the authors, have been “most impacted by unjust heart failure management and under whose direction appropriate restitution can begin to take shape.” They insist, moreover, that the Boston initiative be a “replicable pilot program” to be launched in hospitals across the country.
The program would offer “preferential care based on race” and “race-explicit interventions,” according to Wispelwey and Morse.
It must be stated from the outset that not only is such a racially-based program medically unethical, it is illegal. According to Title VI of the Civil Rights Act of 1964, “No person in the United States shall, on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity,” including “education, health care, housing, social services.” The bill was passed during an upsurge of the working class in the US in the 1960s, which had as one of its principles the ending of official discrimination along racial lines, including in health care.
Both authors are aware of the illegality of their proposal. “Offering preferential care based on race or ethnicity may elicit legal challenges from our system of colorblind law,” they write. They then attempt to justify their attack on the Civil Rights Act by asserting the existence of “ample current evidence that our health, judicial, and other systems already unfairly preference people who are white,” and that “our approach is corrective and therefore mandated.”
As evidence, Wispelwey and Morse present their observation that “white patients at Brigham and Women’s Hospital … were indeed more likely to be admitted to the cardiology service” than black patients. More broadly, they assert that the disparities they observed, so-called “health inequities,” were not “fully accounted for by insurance status, established links to care, other medical conditions, or an index reflecting the socioeconomic status of a patient’s neighborhood.”
In fact, the data linked by the authors to their article does not support their argument. One linked article is misleadingly titled “Heart Failure Admission Service Triage (H-FAST) Study: Racialized Differences in Perceived Patient Self-Advocacy as a Driver of Admission Inequities.” Its concluding section begins by noting: “Theorized drivers of racial inequities in admission service did not reach statistical significance.” In other words, the article linked by the authors does not provide significant statistical evidence of racial differences in treatment.
The underlying ideology behind the attempt to impose race-based health care is known as “critical race theory,” which holds that social inequality is caused by white racism against “people of color.” Critical race theory obscures the basic source of inequality—class society. The so-called “Public Health Critical Race Framework” has emerged in direct opposition to modern medical practice.
The basic tenet of this theory is that if one is the correct “color,” one is entitled to preferential treatment. This is a right-wing position, which explicitly denounces calls for unity across racial lines in a struggle for quality health care for all. It is a position with which white supremacists can agree, differing only on which “color” receives preferential treatment. And if race can be used to determine care for heart disease, what about other medical procedures, i.e., bypass surgery or dialysis? What about vaccinations for COVID-19?
From this “framework” flows the claim that the underlying problem in health care is “structural racism,” and the only solution is for Brigham’s and other hospitals to carry out reparations, termed “medical restitution,” to those deemed to have suffered from the hospital’s supposed unjust practices. According to the Boston Review authors, such restitution would involve at the very least “cash transfers and discounted or free care,” and be expanded to the federal level to include “taxes on nonprofit hospitals that exclude patients of color and race-explicit protocol changes.”
Using this outlook, representatives of the ruling class, and particularly those in and around the Democratic Party, are creating the fiction that the catastrophic health care situation facing the working population is not due to the decades of bipartisan social counterrevolution at the behest of Wall Street, including the mass defunding and privatization of public health care networks, but to inherent racial prejudices against all African Americans.
Such a perspective has long been pushed by figures such as Ta-Nehisi Coates, who in 2014 argued that African Americans should receive compensation from “white America” for slavery, Jim Crow segregation and urban ghettos. Class oppression is presented as secondary to violence against “the black body.”
These conceptions are promoted at the highest levels of the Democratic Party. Wispelwey and Morse note that they were encouraged by “other institutions to proceed confidently on behalf of equity and racial justice, with backing provided by recent White House executive orders.” One of the orders to which the authors allude was signed by President Biden on his first day in office, calling for “advancing racial equity” in the face of “systemic racism.”
Like many other Democratic Party initiatives, Biden’s executive order has nothing to do with genuine social equality. “Equity” is a term that has been developed in recent years by representatives of the black upper middle class and the black bourgeoisie to sound like “equality,” which has deep resonance in the working class, while in reality denoting something very different. It is a coded appeal to the narrow layers of African Americans who have grown wealthy by utilizing racial politics to carve out a bigger slice of the wealth of the top 10 percent but envy those richer than themselves. It is Richard Nixon’s right-wing call for “black capitalism” in a somewhat less discredited and more deceptive packaging.
With this order, Biden sent a message to these reactionary elements within minority populations that he would look after their interests and shield them from the anger of the working class of all races, whose living standards have declined as a result of the same social and economic policies that have led to a vast concentration of income and wealth among the top 10 percent, and especially the top five percent and one percent on the economic ladder.
It is an attempt to cover up, in particular, the massive growth of inequality among African Americans. From 2007 to 2016, the period of the Obama presidency, average family health care costs rose from roughly $13,000 to $19,000. More than 20 million Americans were without health care when he left office.
Wispelwey, Morse and colleagues who helped write the studies referenced are not oriented to improving the lives of this layer of the population. They hail Joe Biden as a figure who will fight for “equity, civil rights [and] racial justice.” They are willing to overlook Biden’s responsibility for the mass incarceration of millions of impoverished African American men, as well as Kamala Harris’ role in keeping them imprisoned in California, provided their class position and guarantees of special access to political and business perks are protected.
Above all, calls for race-based health care are aimed at blocking the emergence of a unified movement of the working class against corporate profits and the capitalist system that is the source of inequality, poverty and racial discrimination. Genuine progressive movements have always fought for unity across racial lines, not the stratification and division of the working class.