American Health Care and the Unconscious Bias Bogeyman

Over the 2021 holiday season, Kaiser Permanente, the largest managed care organization in the United States, quietly conducted a mandatory training targeting its California employees in the name of “Providing Culturally and Linguistically Appropriate Services in California.” Filled with boilerplate progressive jargon including “unconscious bias,” “diversity and equity,” “racial disparities,” and “systemic barriers,” the training program advocates for so-called “racially equitable care.” To mitigate unconscious bias, Kaiser wants its practitioners to adopt a “Stop. Challenge. Choose.” model to accept that they have bias in every situation, to challenge biased assumptions, and to mindfully respond to patients through culturally and racially sensitive lenses.

The training’s overarching flavor tastes more like a spiritual fellowship program than a health care manual. Worse, it quickly veers off track from feel-good counseling to race-based stereotypes. To make the case for unconscious bias (UB) as a negative factor impacting health care, Kaiser invokes prejudice in hiring: “A person with an unconscious bias toward Asians (believing they are good at math), may hire only Asians in their accounting department.”

From biased hiring, Kaiser leaps forward to caution its employees against associating certain racial groups with certain diseases, which it claims is another sign of UB. Then, in a bizarre twist of reasoning, the company refers to health disparities through the arbitrary prism of race:

Some examples, according to various national studies, include: Asians had higher rates of inpatient heart attack mortality than whites; Mortality was higher for Black males than white males treated for colorectal cancer despite similar surgical, chemotherapy, and radiation rates; The incidence rate for cervical cancer was more than five times as high for Vietnamese women than for white women; The prevalence of diabetes in Hispanics and American Indians/Alaska Natives is approximately double that of whites; Black mothers and birthing people are more likely to die in childbirth compared to White mothers and birthing people.

Instead of demonstrating an array of possible contributing factors to these observed discrepancies such as lifestyle, culture, acculturation, community-level care, and insurance coverage, Kaiser points the finger at systemic racial inequalities. Notably, the “various national studies” are not referenced.

Embracing critical race theory and social justice is nothing new for corporate America. Neither is the tendency to marry medicine with ideology in academia. From over-the-top diversity quotas for corporate boards to race-based considerations in the distribution of lifesaving COVID treatments to cash incentives for professors to infuse social justice into classes, every fiber of American society is undergoing feverish thought transformations, which some dramatize as a mass hysteria or mass psychosis.

But commanding medical students and haunting health care practitioners take the woke experiment up a notch. The American health care system, once the envy of the world, has been plagued by high cost and poor outcomes, attributed to such complex, structural issues as overspecialization, lack of competition, over-commercialization, and broader sociocultural changes. Compared to ten other high-income countries, the U.S. spent nearly twice as much on medical care in 2016, and yet its performance lagged behind. According to the Robert Wood Johnson Foundation, 75 million Americans with multi-morbidity represent 25% of the population and account for 65% of health expenditure.

Can we wave a magic wand and wish away the ills of the U.S. health care system by focusing on anti-racism? If Kaiser’s 304,220 employees all sign up, voluntarily or with coercion, to the “Stop. Challenge. Choose.” model, will their patients, regardless of their immutable characteristics, receive better care, develop more meaningful relationships with their care providers, have their hospital bills lowered, or gain a better bargaining position vis-à-vis the opaque billing bureaucracy? Will culturally and linguistically appropriate care improve patient experience to the extent that the uninsured or insufficiently insured would want to seek care just because the doctor affirms their cultural, racial, ethnic, and gender identities?

To put icing on the cake, the managed care market giant also takes up the role of a psychologist by attempting to explain the importance of embracing diversity. By diversity, Kaiser focuses on its “internal dimensions,” characteristics assigned to an individual at birth, including race, age, ethnicity, gender, sexual orientation, and physical ability. Against scientific evidence on acquired sexual orientation as well as a growing body of literature on gender grooming, Kaiser argues that these characteristics are beyond individual control. But in the same training slide, it also contends that “modern technology has helped correct characteristics such as the gender assigned at birth.”

Circular logical fallacies are perfectly manifested through such medical Lysenkoism, in which dogmatic goals dangerously overtake a primary focus on the truth and on quality of care. Are we better or worse off?

Image: Clay Banks, Public Domain