The "Colorblind" Attack on Your Health

The story seemed to be yet another tale about the battle between science and politics in the Bush era. The facts certainly fit the mold: Federal technocrats examine a grave challenge facing America, and political hacks obstruct, censor or otherwise alter their research. But this time it didn't make sense. There was no political payoff; everyone already knew colored folks weren't healthy. So why bother?

Because the cornerstone of post-civil rights conservative thought was under assault. Few concepts are less malleable than mortality. And thus, few measurements pose a greater threat to the modern right's core supposition of equality than a tally of who lives and dies from preventable and treatable diseases.

In 1999, Congress ordered the federal Agency for Healthcare Research and Quality to begin preparing annual reports on whatever racial and economic disparities may exist in the national healthcare system. The request was a sign of the times. In the previous decade, everybody from Beltway politicos to Ivory Tower academics had reached rare agreement on the idea that Americans' wellness differs greatly according to race.

The resulting document, completed in 2003 and grandly named the National Healthcare Disparities Report, confirmed what was by then a hardening conventional wisdom. "This first report clearly demonstrates that racial, ethnic and socioeconomic disparities are national problems," the authors unflinchingly concluded, "that affect healthcare at all points in the process, at all sites of care, and for all medical conditions." The executive summary further delineated the key findings that "inequality persists," that Americans pay "a personal and societal price" for this unevenness and that more research is needed to figure out how to fix it. That June, the technocrats submitted this draft for the standard approval process to then-Secretary of Health and Human Services Tommy Thompson (who, as governor of Wisconsin, pioneered "welfare-to-work" programs).

Thompson's office released a strikingly different document six months later -- just three days before Christmas, a timing that helped it get lost in the holiday shuffle. The data itself was unaltered, but the executive summary that put the data into perspective for busy lawmakers drew starkly different conclusions than those of the draft. It omitted references to "disparities," instead calling them "differences." And it tepidly summarized the technocrats' research by stating, "This report finds that, while most Americans receive exceptional quality of healthcare and have excellent access to needed services, some socioeconomic, racial and ethnic differences exist."

The new version further reshaped the key findings for Congress by bizarrely adding examples of areas in which people of color fare better than everybody else -- examples that the report's own data undermined. It cited lower cancer death rates among Asian/Pacific Islanders and Native Americans -- it turns out Native Americans die less from cancer because their life expectancy is already dramatically shortened by a host of other preventable illnesses. It noted that blacks and Latinos are more likely to report that their doctors ask about previous medication before prescribing new ones. But that's because blacks and Latinos are far less likely to have regular physicians who would already know their health histories.

Someone leaked the report's draft version to California Rep. Henry Waxman's office, and Waxman led an outraged coalition of congressional members in calling the administration to task over the edits. Secretary Thompson ultimately told a House hearing that "some individuals took it upon themselves" to make well-meaning edits, but he promised the original version would be published unaltered. And with that, another chapter in the science vs. politics debate was closed, leaving observers wondering why Thompson's staffers had caused all the fuss in the first place.