The Large Factor Justice Jackson Were given Proper And Justice Thomas Were given Improper Remaining Week

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Nearly a week has passed since the Supreme Court ended affirmative action in university admissions, and I’m still thinking about a key argument that Justice Clarence Thomas made in his concurring opinion.

It wasn’t about legal doctrine. It was about the role race now plays ― and ought to play ― in American society.

“Racialism,” Thomas wrote, ”simply cannot be undone by different or more racialism.”

When Thomas wrote this, he wasn’t simply attacking affirmative action. He was also responding to Justice Ketanji Brown Jackson, who spent a significant portion of her dissent detailing the vast racial disparities that exist in the U.S. and making the case for using race-conscious remedies to address them.

Disparities in health care were a big part of Jackson’s discussion. And along the way, she dramatically overstated one statistical finding, drawing snarky rejoinders in right-wing outlets like National Review and the Daily Signal (headline: “Justice Jackson’s Trifecta of Wrong on ‘Research’ on Racial Preferences”). From the looks of things, the justice and her clerks were simply citing a friend-of-the-court brief that contained the same error.

That doesn’t excuse the mistake. It also doesn’t mean her broader point is wrong. There’s a lot of research about race and its role in health disparities, and the overwhelming consensus is that race absolutely matters, for precisely the reasons Jackson suggests.

In fact, the most egregious misstatement about race and health care I spotted in last week’s opinions didn’t come from Jackson. It came from Thomas. And his mistake really did seem to weaken his larger argument, in ways that remain relevant today even though affirmative action is officially off the table.

What The Research Says About Race And Health Care

Jackson’s discussion of racial disparities included a long, well-documented list of ways in which Black Americans fare worse than white Americans. When it comes to health care, the list of worse outcomes for Black people includes everything from a higher likelihood of babies born at low birth weights to a higher incidence of deaths from certain cancers.

Thomas didn’t dispute that such differences exist. But, he stated, “None of those statistics are capable of drawing a direct causal link between race—rather than socioeconomic status or any other factor—and individual outcomes,” Thomas wrote.

This would come as a shock to the researchers who have studied racial disparities in health and gone way out of their way to adjust for factors like income, education or predispositions to certain medical conditions. Over and over again, they’ve found race still matters.

You don’t need to take my word for this. Here’s the Institute of Medicine, following a sweeping review of the literature in 2003: “A large body of published research reveals that racial and ethnic minorities experience a lower quality of health services, and are less likely to receive even routine medical procedures than are white Americans. … even when variations in such factors as insurance status, income, age, co-morbid conditions, and symptom expression are taken into account.”

Jackson wasn’t simply arguing that people from racial minority groups are somehow sicker, to be clear. She was making a point about the importance of training enough minority physicians and, in particular, Black physicians ― given evidence that Black patients frequently get better care when they have doctors of the same race.

Here, too, Jackson could lean on a large stack of research. Among the best-known papers are some relatively recent studies looking at cardiovascular care in Oakland, California, and in-hospital mortality in Florida. In each case, physician race made a significant difference in the kind of health care that Black patients received.

Researchers aren’t sure exactly why this effect keeps showing up. It could be that Black patients get more attentive and compassionate care from Black doctors, for example, or that they are less likely to trust white doctors given the legacy of the infamous Tuskegee syphilis study and first-hand experiences in American hospitals. Or it could be a combination of these and other factors.

But there’s a pretty broad consensus that the effect exists, and it got even more powerful grounding this past December — too late for oral arguments, alas — when Michael Frakes from Duke and Jonathan Gruber from the Massachusetts Institute of Technology published a working paper based on health care in the military.

Taking advantage of the large, thorough data that the government keeps about service members, the two scholars found “striking evidence that racial concordance [i.e., Black patients getting care from Black doctors] leads to improved maintenance of preventive care – and ultimately lower patient mortality.”

Why Race Matters, And What To Do About It

Whether all of this adds up to an argument for affirmative action is obviously a separate, more complex question ― and, as a practical matter, an irrelevant one now that the Supreme Court has said universities can’t consider race as a factor in admissions. But that doesn’t mean institutions of higher learning have no options for addressing issues tied to race or increasing the supply of minority physicians, especially Black physicians.

One intriguing possibility comes from the University of California, Davis medical school. After the state banned affirmative action in 1996, the school sought to identify and boost applicants from low-income backgrounds by developing an “adversity” index that took into account non-racial factors like parental education levels, family income and neighborhood affluence.

Today, UC-Davis has “one of the most diverse medical schools in the country,” according to a recent profile in the New York Times. And the idea of rewarding students who overcame adversity has a clear logic to it, for reasons President Joe Biden mentioned in remarks last week and Princeton sociologist Paul Starr summed up in a new American Prospect article: “Overcoming adversity is a demonstration of ability,” Starr wrote.

And it’s not just individual institutions of higher education that can act. Government could invest in race-neutral programs that nevertheless reduce racial disparities in practice, whether by improving health care access for minority populations or investing in programs that get at the root causes of racial inequity.

That could mean bolstering SNAP or putting more money into high-quality early childhood education or, say, expanding Medicaid in states that still haven’t. Research has shown all three interventions reduce racial disparities in various measures of well-being.

Of course, the conservative political forces that killed affirmative action by putting justices like Thomas on the Court tend to oppose these initiatives as well. And they have their reasons. These policies, like all policies, come with tradeoffs.

But if the conservatives who won’t support race-conscious responses to racial disparities won’t support race-neutral ones either, you have to wonder how many of them really care about addressing those disparities — and whether some don’t even care at all.