Tuesday, November 17, 2009

Where are the Doctors to Implement ObamaCare?

Wall Street Journal editorial "Where are the Doctors to Implement ObamaCare?" (November 17th, 2009) is mistaken in its causal conclusion concerning the need for more minority doctors. Specifically, it drew the conclusion that because (obstensibly) white doctors tend to practice in white communities and minority doctors tend to practice in minority communities, that we need to emphasize more minority doctors because minority communities are more in need of doctors.

Furthermore, the physician workforce does not reflect the ethnicity of the population, underscoring health disparities that result in a higher incidence of chronic diseases and higher mortality in minority and low-income populations. Because minority physicians are more likely than non-minority physicians to practice in ethnically diverse communities, it is vital for medical schools to train a diverse workforce of physicians to practice with a clear emphasis on prevention, and with cultural competency and sensitivity.

Let's imagine a world in which doctors of different races are choosing where to serve. If we imagine a world with the weakest possible racism, where I don't care where/who I serve, but as a tiebreaker, all other things being equal, I use race. I'm not willing to pay one penny to be a racist. In essence, no one is a racist, and only uses race as a tiebreaker. Then we should still see perfect segregation for one race. The figure below indicates our matching model (click to enlarge).

But in this model, if we wanted to serve underserved minority areas, how might we go about doing it? The economic answer appears to be that we can train Ku Klux Klan members just as easily as we could Black Panthers. Why? Because it is only the marginal racist that matters. The KKK members will certainly serve white areas, and doctors who don't care will be pushed to serving minorities. We can see this in our new figure (click to enlarge).

Our "no racism exists" model above doesn't change our conclusion that it doesn't necessarily matter if a new doctor is minority or not--it is the marginal racist that matters, and if, at the margin, we have doctors who aren't racist, then we shouldn't care what race doctor we introduce--teaching Ku Klux Klan members may help minorities as much as teaching Black Panthers.

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