Medicare, due to become insolvent in just five years, already comprises one-eighth of the federal budget. By 2050, it will constitute 25% of federal spending, crucially driving the share of interest owed on the national debt to triple from 2031 to 2051.
But the Biden administration’s attention seems focused elsewhere. Buried in the Department of Health and Human Services’s fiscal planning for next year is a proposal to establish bonuses for physicians who “create and implement an anti-racism plan.”
“The plan should include a clinic-wide review of existing tools and policies, such as value statements or clinical practice guidelines, to ensure that they include and are aligned with a commitment to anti-racism and an understanding of race as a political and social construct, not a physiological one,” the HHS writes. “The plan should also identify ways in which issues and gaps identified in the review can be addressed and should include target goals and milestones for addressing prioritized issues and gaps. This may also include an assessment and drafting of an organization’s plan to prevent and address racism and/or improve language access and accessibility to ensure services are accessible and understandable for those seeking care.”
The CDC under the Biden presidency has already diverted time and attention away from the pandemic to craft its own Orwellian “Preferred Terms for Select Population Groups & Communities,” so it is little surprise that the “Great Wokening” has continued apace for Medicare. Healthcare expert Chris Pope of the Manhattan Institute notes that Congress already authorized the HHS to make such changes in the name of “health equity” with a 2015 bill, and Pope predicts that in practice, this will likely be a weak incentive for physicians. Nonetheless, it’s a rather telling move from the HHS and the White House more broadly.
Racial disparities of outcome are a very real tragedy across categories of healthcare. Our maternal mortality rate is one of the highest among OECD nations, in no small part due to the fact that black mothers are three times more likely than their white counterparts to die of pregnancy-related causes. More than 4 in 10 black adults suffer from obesity, compared to 3 in 10 white ones, resulting in greater risk of death from COVID.
These are preventable crises. We could ameliorate them by enhancing our suboptimal methods of screening for preeclampsia, the leading cause of black maternal deaths, and shifting the nutritional standards of SNAP coverage to those of WIC, which has proven successful at reducing obesity rates.
Yet these aren’t the solutions HHS is pointing to. Instead, the CMS’s framework to create an “anti-racism plan” looks like it will only promote some silly jargon games like implementing a “language access plan.” If college campuses have provided any indication, doctors fishing for bonuses will likely be better off in the eyes of the bureaucracy by sending Ibram X. Kendi a few grand rather than taking substantive measures to improve disparities of outcome.
Not that any of this matters should Biden (and Republicans, for that matter) continue to blow out the budget. Major healthcare spending — first and foremost, Medicare — is driving our debt into uncharted waters. Should the spending continue apace, we’ll all be equal, packed in the waiting room and lacking care.
