How the HHS Director Erred by Weighing in on the SCOTUS Decision

Anyone seeking to understand why public health authorities have lost the trust of half the country can look no further than yesterday's press release from the head of HHS.

News of the Supreme Court’s decision on affirmative action in college admissions naturally drew responses from politicians across the country. New York Governor Kathy Hochul said the ruling was “an affront to democracy and equity.” California’s Gavin Newsom called the justices “right-wing activists.” Conversely, Republicans praised the decision. Questioning the legitimacy of the court by Democrats is particularly regrettable, though it’s likely Republicans would do the same if a liberal court had ruled against a policy they favored. All this is to say that everyone played their predetermined roles, as expected.

But one official statement caught me by surprise—and it’s deeply problematic.

Xavier Becerra, the Secretary of Health and Human Services, sent out an admonishing press release immediately following the decision. Becerra said “people of color have been excluded from attending medical school and joining medical organizations for generations,” and that “there is still a significant deficit in the number of Black and Latino doctors and medical students.” He went on to say that we need more healthcare workers who look like and share the experience of the people they serve. And that the “ruling will make it even more difficult for the nation’s colleges and universities to help create future health experts that reflect the diversity of our great nation.”

Even if one agrees with Becerra’s aims, this statement serves no purpose toward HHS’s mission, which is “to enhance the health and well-being of all Americans.” The Supreme Court already made its ruling. Becerra’s complaining about it won’t change it or enhance the well-being of Americans. Instead, all his statement will do is further alienate the significant portion of Americans who already distrust our nation’s health agencies, in part for being politicized.

It is wholly inappropriate—and in this instance polarizing—for the director of an executive branch agency to condemn a ruling from the judiciary.

It should be public health officials’ goal to win over those citizens who are confused by, ignorant of, or don’t agree with their guidance. The CDC, which was seen as overtly political during the pandemic, utterly failed in this regard. Becerra’s statement both exemplifies and exacerbates this existing problem.

HHS is an absolutely massive executive branch agency that oversees numerous health-related agencies, including FDA, CDC, NIH (themselves massive agencies), and manages Medicare and Medicaid. HHS has a proposed 2024 budget of $1.7 trillion (yes, that is a “t”). Even if you are a Democrat you should be unhappy with the man in charge of this colossus taking such a baldly political stance.

Moreover, his view is not even aligned with most Democrats, let alone most Americans. Sixty percent of Democrats, and 74 percent of Americans over all, are against affirmative action in college admissions.

From a YouGov poll of a representative sample of 2,029 American adults. (Bar graphs from NYT.) A different wording of the question yielded similar results.

And there are also some inconvenient data that undercut Becerra’s claims about the ruling adversely affecting future underrepresentation. While whites are slightly overrepresented among current practicing physicians (by about 5 percent), according to the Association of American Medical Colleges, in 2021 51.5 percent of medical school matriculants were white, yet white people compose 58.9 percent of the total population.

The underrepresentation of whites in medical school—the people who will compose the future workforce of doctors—has been a downward trend over at least the last eight years. Continuing to systematically program medical school admissions to admit even fewer white applicants would, for many Americans, ultimately lead to fewer doctors “who look like and share the experience of the people they serve.”

In other words, if affirmative action’s goal is for equitable representation, in short order it would need to be halted—or at least rejiggered—in medical school admissions.

All this, of course, is setting aside whether precise demographic representation is a goal that even should be aimed for. The AAMC has interesting data on the race and sex of various specialities. Pediatrics is starkly overrepresented by females, who compose 65 percent of that specialty. Whites are vastly underrepresented in geriatrics, at just 44.1 percent of practitioners. By the logic of affirmative action, residency match algorithms should be manipulated to allow more males and fewer females to become pediatricians, and fewer Asians and more whites to become geriatricians—plans that don’t seem to be high on the priority list. (Asians are overrepresented in every single one of the 49 specialities listed by the AAMC, and they are increasingly overrepresented in medical schools.)

Americans need to feel that governmental agencies, perhaps especially those that oversee their health and well-being, are non political. Reasonable people can disagree about affirmative action. One need not take a stance on that policy in order to understand that Becerra’s statement furthers the public’s distrust in our health authorities as objective actors, is out of step with most Americans’ views on the topic, and is not even aligned with his professed objectives toward equity and representation.