Tempering Systemic Racism in Healthcare

Systemic racism (a.k.a., “institutional racism” or “structural racism”) is the notion that overt racial discrimination in the past (e.g., slavery and Jim Crow laws), has left a residue on the structure of American institutions that yields ongoing inertial patterns of discrimination. The Center for Health Care Strategies says, “Racism is embedded in society and we don’t need racists to perpetuate it.”[1] This is a reasonable and legitimate concern—and certainly true in some respects. Unfortunately, many of the policy prescriptions aimed at rectifying these patterns fail to consider the magnitude of their present-day impact, the efficacy of proposed solutions, or the tradeoffs with other societal concerns. 

• An assumption that any health disparities between racial groups are primarily, or even exclusively, the result of racism–to the exclusion of genetics, measurement errors, etc.
•  The encouragement of victimization and discouragement of personal responsibility. A 2021 publication of the American Medical Association (AMA) and the Association of American Medical Colleges (AAMC)[11] said, “People are not vulnerable; they are made vulnerable.” That publication repeatedly suggests that disparities are the result of intentional acts of malevolent parties. At times, the tract descends into quasi-Marxian gibberish. Doctors, it says, should not say, “Low-income people have the highest level of coronary artery disease in the United States.” Rather, the doctor should say: “People underpaid and forced into poverty as a result of banking policies, real estate developers gentrifying neighborhoods, and corporations weakening the power of labor movements, among others, have the highest level of coronary artery disease in the United States.”  
•  An absolutism and intolerance for debate and investigation. As journalist Bari Weiss notes, “In this revolution, skeptics of any part of this radical ideology are recast as heretics. Those who do not abide by every single aspect of its creed are tarnished as bigots, subjected to boycotts and their work to political litmus tests.”[12]  
• An inclination toward speech control. The AMA/AAMC document consists largely of 54 pages of mandated speech patterns. One must not say, for example “minority” Rather, one should speak of those “historically marginalized” or “minoritized” or “BIPOC.” “The obese” and “the homeless” must become “people with obesity” or “persons experiencing homelessness.” As with those re-dubbed “Latinx” and “womxn,” one might question whether those previously known as minorities, obese, or homeless consider the ponderous neologisms to be desirable.
•  For some advocates, the philosophy underlying systemic racism is not subject to refutation by logic or evidence. Its tautological, Orwellian nature is beautifully crystallized in a statement by psychology professor Angela Bell: “If you have to ask if you are a racist, you are … And if you are not asking if you are a racist, you are.”[13] This makes sense when one considers the Frankfurt School origins of a good deal of thought in the sphere of systemic racism. For example, the editors of Critical Race Theory: The Key Writings That Formed the Movement,[14]  wrote: “[S]cholarship about race in America can never be written from a distance of detachment or with an attitude of objectivity. … Scholarship … is inevitably political.”  
•  A tendency toward a permanent regime of authoritarianism. Antiracism guru Ibram X. Kendi famously wrote: “The only remedy to racist discrimination is antiracist discrimination. The only remedy to past discrimination is present discrimination. The only remedy to present discrimination is future discrimination.”[15] Kendi has proposed a profoundly illiberal “antiracist constitutional amendment”[16]: 

The amendment would make unconstitutional racial inequity over a certain threshold, as well as racist ideas by public officials (with “racist ideas” and “public official” clearly defined). It would establish and permanently fund the Department of Anti-racism (DOA) comprised of formally trained experts on racism and no political appointees. The DOA would be responsible for preclearing all local, state and federal public policies to ensure they won’t yield racial inequity, monitor those policies, investigate private racist policies when racial inequity surfaces, and monitor public officials for expressions of racist ideas. The DOA would be empowered with disciplinary tools to wield over and against policymakers and public officials who do not voluntarily change their racist policy and ideas.