Race and Discretion in American Medicine

Abstract:     
Providing health care is an endeavor replete with hidden opportunities for exercising discretion. Hard science answers few of the questions that physicians face daily, and the resulting space for discretion opens a myriad of possibilities for racial bias at the bedside, and in the administration and design of health plans. This article explores the connections between hidden discretion and racial disparities in health care provision. It highlights the influence of market and cost pressures, countervailing regulatory and liability concerns, and the changing organization and financing of medical services. It then offers proposals for institutional, legal, and cultural change that take pragmatic account of cost concerns (and the American health system's growing reliance on markets) while rejecting, as incident, the racial bias so evident in American medical practice. Finally, the article suggests some broader conclusions that we might draw about the psychology and social expression of bias, from the persistence of racial disparities in health care provision despite society's rejection of racism's overt forms.

Accepted Paper Series