Unhealthy Choice

With the exception of U.S. Solicitor General Ted Olson's appearance before the Supreme Court on Tuesday -- to argue against affirmative action in the University of Michigan cases -- few within the Republican Party seem to have much to say these days about racial reconciliation. It's a far cry from the way things were last December, when Sen. Trent Lott's (R-Miss.) nostalgia for the Old South transformed the once-mighty Republican leader into so much political roadkill. At the time, it was hardly surprising when Sen. Bill Frist (R-Tenn.) used his first major press event as Lott's replacement to talk about the state of race relations in America. The soft-spoken Tennessee doctor could have chosen to offer up mere platitudes about racial healing -- but he went one step further, saying:

For reasons we don't fully understand, but we've got to face and we've got to elevate, we know that African Americans today do not live as long. They don't have the same access, and the doctor-patient relationship in some way is colored by the medical training. And that's something I began to address a long time ago and will continue to address.

Frist's willingness to speak out about the racial divide in American health care briefly raised hopes that the new majority leader would make the issue a priority. But if Frist was serious about challenging health disparities between whites and minorities, it didn't take him long to realize that his president and his party had a higher priority: the continued demonization of affirmative action.

The relationship between minority health and affirmative action may not be obvious at first glance, but the two are inextricably linked. As Frist and others well understand, there's an amalgam of reasons why blacks suffer far higher rates of heart disease, cancer, stroke and infant mortality than whites. An obvious factor is the lack of adequate health-insurance coverage. But another is the chronic lack of black physicians.

One of the legacies of slavery and segregation is that black families still depend largely on black doctors for their medical care: Black physicians are nearly six times more likely to treat black patients than doctors who aren't black. In addition, black doctors have a history of being far more willing to practice in minority communities and to care for Medicaid recipients and the uninsured. Yet today only three out of every 100 doctors in the United States are black.

The medical profession -- which was once able to rationalize conducting medical experiments on black men in Tuskegee, Ala. -- has had, until relatively recently, few qualms about excluding black students from its medical schools. With the exception of students attending historically black medical colleges, as recently as 35 years ago, 99 percent of all U.S. medical school students were white. Significant gains have been made since then, but there is still a long way to go. Despite the fact that there are 126 medical schools in the United States today, roughly half of all black physicians still receive their medical training at one of America's four historically black medical schools.

Now, with affirmative action under legal assault, there is reason to worry that much of the access to medical schools won by minorities over the years could be in jeopardy.

"It will have a definite impact," says Rudolph Williams, former executive director of the National Medical Association (the 30,000-member organization of black physicians), of the chilling effect that the anti-affirmative-action crusade could have on black students' decisions about where to apply to med school. Williams, who served as associate dean of the College of Medicine at the State University of New York's Health Science Center in Brooklyn, believes that with each successive assault on affirmative action, minority access to medical school has suffered.

There is evidence to support this contention. Writing in the September 1998 American Journal of Public Health, David Carlisle of UCLA's School of Medicine documented how the gains blacks made at U.S. medical schools were cut short by the 5th U.S. Circuit Court of Appeals' ruling in Hopwood v. Texas (which found the consideration of race in admissions to be unconstitutional) and passage of California's Proposition 209 (which banned the consideration of race in admissions in the state's public universities). A 1999 study by the University of California, San Francisco found that the measure's passage was partially responsible for a 32 percent reduction in minority enrollment to California medical schools between 1995 and 1998.

The Association of American Medical Colleges has made clear that it believes there is a link between affirmative action and health care for minorities. Jordan Cohen, the group's president, has stated that "the drop in minority applicants reflects the fact that many young people are being discouraged from even considering a career in medicine because of the anti-affirmative-action mood in certain parts of the country." He also noted that the "longer we delay in getting medical schools to reflect the country's diversity, the longer minority Americans will wait to get medical care that minority physicians can supply."

Against this backdrop, President Bush's announcement earlier this year of a plan to boost funding by $371 million for historically black colleges and Hispanic institutions amounts to little more than a variant of the "separate but equal" approach championed by Sen. Strom Thurmond (R-S.C.) and an earlier generation of segregationist politicians. Though no advocate would dispute the need to better fund minority institutions, neither do any suggest that such schools could ever come close to creating the medical training opportunities affirmative action would. "There's just no way Howard and other schools could pick up the slack," says Williams, himself a Howard graduate.

And where does Frist weigh in? Some familiar with his medical career, particularly his work at Vanderbilt University, say it's inconceivable that he doesn't appreciate the value of affirmative action. But even though Frist had the courage in 1995 to stand up to his own party and support Bill Clinton's ill-fated nomination of Henry Foster for surgeon general -- and even though he later joined with Sen. Edward Kennedy (D-Mass.) to win new funds for minority health research -- when it comes to affirmative action, it seems Frist has put his commitment to closing health disparities into a blind trust.

In saying that the White House ought to get involved in the Supreme Court challenge to the University of Michigan's admissions process, Frist on Jan. 12 told FOX News, "In the minds of, I'd say, even most people today, strict racial quotas mean that you're going to be discriminating against the party you did not discriminate in the past, trying to overcompensate." That same day, on NBC's Meet the Press, Frist conceded that he knew "nothing about" the Michigan program, which offers minorities and various other applicants a limited number of additional points in the admissions process. However, such lack of knowledge did not prevent him from once blasting "strict racial quotas and racial set-asides."

It's always possible that Frist is convinced that racial health disparities can be closed without affirmative action. But if that's what he believes, he doesn't have much company.

Jim Grossfeld was chief speechwriter for Health and Human Services Secretary Donna Shalala. He is now a public-affairs consultant based in Bethesda, Md.

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