Statists and the Racial 'Health Gap'

I often speculate that deep in the bowels of the Obama administration there exists an obscure office charged with inventing egalitarian schemes to increase American dependency on government.  Ignore the high-sounding "fairness" and "equality" rhetoric.  The President's minions just cannot stop pushing, even boldly lying until the last vestiges of limited government and individual initiative are history.

The latest eruption of this endeavor was recently announced by Dr. Howard Koh, Assistant Secretary of Health and Human Services: the federal government would close the health gap between "minorities" and whites.  These health disparities, he added, have burdened our country for too long (go here for the official statement).

This is a remarkably slapdash proposal that would make a hardcore Stalinist blush.  It will probably never fully get off the ground, but as a window to what passes as "policy" in the statist Obama administration, it is invaluable.

The proposal makes race/ethnic differences central.  This is unlike Marxist egalitarianism that stressed economic inequalities.  Now, however, race and ethnicity trump economics, so rich African Americans, but not poor whites, are "disadvantaged."  This is tribalism and, pray tell, how do racial/ethnic differences, not the actual level of illness, "burden" the US?  What if all whites were struck with a plague?  Would this lessen our "burden"?  Would health care now be more "fair"?  Might liberal whites volunteer to become sick so as to reduce inequality?   Moreover, given the murkiness of racial and ethnic distinctions, proper implementation will require Nazi-style Nuremburg-like laws to certify racial/ethnic identity.       

Second, how will this venture be financed in today's tough economic times?  No problem, according to program advocates since: (a) we don't know how much the program will cost; and (b) the money is already there and not subject to congressional review.  So, a program lacking a price tag is being proposed but whatever the cost, no congressional approval is needed.  The need for compulsory remedial Political Science 101 is obvious.

Let's consider the actual crusade.  Minorities are clearly less healthy than whites as indicated by incidences of heart disease, diabetes, infant mortality, certain cancers, asthma, and kidney disease (see here).  But, disentangling this race/ethnicity/income/health relationship is a nightmare and entails some awkward unspeakable PC issues that warrant attention (see here).  For example, certain racial groups may be genetically pre-disposed toward some illnesses (e.g., Hispanics and asthma, blacks and hypertension).  Perhaps only genetic engineering can close these gaps so why waste millions better spent elsewhere?  And, how do we address health problems like osteoporosis that disproportionally afflict whites?

Even more awkward, some minority group members may prefer shopping to annual checkups, even low-cost insurance, and why should government dictate these personal priorities?  Surely the risks of AIDS and sexually transmitted diseases (both of which affect minorities) are known and perhaps these illnesses just reflect poor judgment, not equal access to health care.  Alas, all these complicated issues are swept aside to level healthiness.

Nevertheless, how can gaps be closed?  Proposed measures are a grab bag of half-baked ideas that all rest on the supposition that those disproportionally prone to illness really want to be healthy but, for some inexplicable reasons, just cannot secure the required medical benefits.  There is the predictable call for recruiting more "under-represented populations" to the health profession (i.e., affirmative action).  In fact, a 2009 Report on this health gap made diversifying the health profession central to improving minority health, as if black doctors could better treat black patients.  The government will also collect more health data sub-divided according to race and ethnicity, a tactic that guarantees uncovering even more "unfairness."

The solution also includes hiring armies of busy-body scolds.  For example, since Hispanic youngsters fail to get adequate dental care, the government will employ Spanish-speaking promotoras to "guide" their neighbors to regular dental check-ups.  Similarly, local community health workers will be paid to teach neighbors about diabetes and the importance of following doctor recommendations, while Head Start programs will now also target parents needing medically-related prodding.  Add an incentive program to entice minorities to seek better medical treatment, increased funding for asthma care, a national registry of interpreters to help non-English speakers when visiting doctors and hospitals, more research funds for studies on illness that unequally affect minorities and more community meetings to solicit advice on how to help minorities be healthier.  How all of this can be accomplished with already available funds remains to be seen.

The tip-off to the underlying paternalism is the assumption that poor health reflects a lack of access to fresh fruits and vegetables plus barriers to physical activity.  This is a familiar refrain from America's egalitarian Mandarins -- without government intercession broccoli and apples are beyond reach, and so minorities will naturally (and foolishly) choose double bacon cheeseburgers.  Similarly, without Washington's counsel, minorities are incapable of walking, jogging, or doing sit-ups in their living room.  In a sense, minorities are viewed as young children unable to help themselves, and, furthermore, capitalist markets just refuse to satisfy minority customer demand for fresh produce or gyms.  Where is capitalist greed when we need it?

But, mere foolishness disguises the real agenda.  If one digs a little deeper than upbeat media news accounts the program's real purpose emerges -- promoting statism (see here).  The aim is not just helping African Americans get cheaper, more convenient colonoscopies.  In particular, since all this haranguing to eat better, stop smoking, have safe sex, etc., etc. will probably not reduce the healthcare gap (consider all the past failed public health PR campaigns), the only sure outcome is more bloated government as efforts are multiplied.  HHS openly links the initiative to ObamaCare and explicitly hopes to "transform" health care, hardly the type of program that could be funded without recourse to congressional approval.  

This will be a gigantic make-work boondoggle and highly invasive, to boot.  I can already visualize the federal food police raiding local "snack houses" where obese teenagers secretly devour Ho-Hos and Ding Dongs.  Tens of thousands of promotoras will have to hired (and trained) to pester fellow Hispanics to get annual check-ups and good luck to all those community organizers going door-to-door waging war on Kentucky Fried Chicken.  Expand the definition of "health" to include some criminal behaviors and parental neglect of children and this "modest" program may soon rival Medicaid.

Unfortunately, this latest Obama state-expanding scheme is not unique.  Michelle Obama's effort to cut childhood obesity is just as bad if one peeks behind the curtain (see Meghan Clyne, "Michelle's Machine," The Weekly Standard, April 11, 2011).  Working through the White House Office of Faith Based and Neighborhood Partnership the Obama administration has enlisted churches to snarl millions more into state dependency.  For example, congregations are now implored to push as many parishioner children as possible into government subsidized school meal programs, and if that option is unavailable, get their meals and snacks reimbursed through Washington's Child Adult Care Food Program.  Meanwhile, the churches themselves are encouraged to serve as feeding sites for the Summer Food Service Program, among other government-funded social welfare programs.  In sum, religion and "improved childhood nutrition" are being twisted into bloating the deficit while building habits of dependency.  This "faith-based" initiative is nothing more than re-packaging the infamous late 1960s Cloward-Piven strategy of sharply expanding the welfare rolls to bankrupt government so as to usher in socialism.   

No doubt, these particular state-expanding programs will soon expire from fiscal starvation and, hopefully, a regime change.  Nevertheless, it is critical to sound the clarion call about what's occurring, sometimes almost invisibly, deep within the Obama administration.  This is more than fiscal wastefulness or inept policy-making; these programs are deeply antithetical to limited government and individualism and thus deserve an appellation not lightly applied in today's policy debates -- they are evil.

Robert Weissberg is professor of political science-emeritus, University of Illinois-Urbana.  His latest book is Bad Students Not Bad Schools.