Consumer Power Report #485
Vijay Chokal-Ingam made headlines earlier in 2015 for claiming race plays a significant role in medical school admissions. Chokal-Ingam, a former medical school student and the brother of actress Mindy Kaling, claims he was rejected from medical schools in part because it’s more difficult to apply as an Asian. What makes Chokal-Ingam’s story so amazing is not that he was rejected, but that he reapplied and was accepted – after claiming to be an African American.
Chokal-Ingam describes his story in detail on a website promoting his forthcoming book, titled Almost Black: The True Story of an Indian American Who Got Into Medical School Pretending to Be An African American: “In my junior year of college, I realized that I didn’t have the grades or test scores to get into medical school, at least not as an Indian-American. Still, I was determined to become a doctor and I knew that admission standards for certain minorities under affirmative action were, let’s say … less stringent?
“So, I shaved my head, trimmed my long Indian eyelashes, and applied to medical school as a black man,” Chokal-Ingam wrote. “My change in appearance was so startling that my own fraternity brothers didn’t recognize me at first. I even joined the Organization of Black Students and started using my embarrassing middle name that I had hidden from all of my friends since I was 9 years old. Vijay the Indian-American frat boy become Jojo the African American Affirmative Action applicant to medical school.”
Chokal-Ingam’s story highlights a largely unknown issue dominating medical schools: the rising importance of race in the medical school admissions process. Medical school applicants know race can be a significant advantage or disadvantage when filling out an application, and the wealth of data available seem to confirm these suspicions.
According to the American Medical Association (AMA), between 2013 and 2015 applicants to medical school who self-identified as “Black or African American” were significantly more likely to be accepted with relatively mediocre grades and MCAT scores compared to “White” or “Asian” applicants.
More than 41 percent of black applicants with an MCAT score between 24 and 26 and a grade point average (GPA) between 3 and 3.19 were accepted into medical school, compared to 7.9 percent of white applicants and 2.9 percent of Asian applicants.
“Hispanic or Latino” applicants with the same academic profile experienced higher acceptance rates as well. More than 29 percent were accepted between 2013 and 2015.
The advantage enjoyed by African American and Hispanic applicants over white and Asian applicants has been justified by many as necessary to ensure underserved minority populations receive needed health care. The theory is that if doctors are predominantly white and Asian, they won’t want to spend time serving impoverished African Americans or Hispanics. In short, only minorities want to help other minorities, so more minority doctors will mean improved medical treatment for minority populations.
Liliana Garces, a professor at Penn State University, says research supports that claim.
“Doctors of color are more likely than their white peers to work within communities of color,” Garces said. “There was a study that was just published that documents the very strong association between racial diversity and students’ self-rated reports of cultural competence, attitudes about access to health care and, for nonwhites only, plans to serve communities that are underserved.”
A closer look at the policies supported by Garces, many in the AMA, and numerous medical colleges across the country reveals multiple problems with these biased admissions standards.
First, the advantages given based on race do not typically take household income into account, so the African American children of very wealthy heart surgeons are inexplicably given an admissions advantage over an Asian student from an impoverished inner-city neighborhood. Rather than assume African American and Hispanic candidates are likely to serve lower-income communities, medical schools should simply identify candidates, regardless of race, who desire to serve impoverished groups.
Second, the race categories are exceptionally broad and put many historically impoverished communities under racial designations many think of as wealthy. For instance, a lower-income Pakistani, Iraqi, or Ukrainian applicant whose family just recently moved to the United States would be classified under the current system as “White” or “Asian.” According to the U.S. Census Bureau, poverty rates for Vietnamese Americans in many cities are much higher than for other racial groups, including many Hispanic populations. In Boston, the poverty rate for Vietnamese families tops 30 percent, and poverty rates for Vietnamese families in Philadelphia and Seattle are above 20 percent.
Third, as Mark J. Perry reports for the American Enterprise Institute, in several states, including California, Florida, New Hampshire, and Texas, it is illegal for state colleges to give an admissions advantage to applicants based on race. Because medical school-specific data are not often available publicly, it’s very hard to tell whether colleges in these states are violating the law, but many experts, including Perry, suggest this is a very real possibility given the national data.
Some may be inclined to think medical school admissions advantages based on race lead to less-qualified doctors or create an environment where many inept applicants sneak into medical school because they happen to have the “correct” skin color. This couldn’t be further from the truth. The reality is that virtually all of those who are accepted into medical school are more than qualified to be medical doctors – but so are thousands of others who do not get accepted into medical school.
For more than 10 years, less than half of all medical school applicants end up matriculating into a medical school each year, even though the quality of the average medical school applicant and the need for doctors have been rising significantly, according to data by the Association of American Medical Colleges.
In a truly free-market system – one where the number of students in medical school is not heavily regulated by AMA or other government-approved associations – the number of doctors will be determined by the demand for doctors, and medical experts will go wherever the patients are. Instead of trying to manipulate the health care market using racial profiling and strict market controls, the health care market should be ruled by the natural forces of the free market – the very same forces that served as the foundation for the world’s most advanced medical system in the first place.
— Justin Haskins (Disclosure: Haskins’ wife is a graduate of Rush Medical College and is currently in the neurosurgical residency program at Duke University.)
IN THIS ISSUE:
Health care fraud topped the list of federal crackdowns this year under the False Claims Act, accounting for more than half of $3.5 billion in settlements and judgments.
The federal government recovered $1.9 billion to settle claims against companies and people charged with providing unnecessary or inadequate care, paying kickbacks to health care providers, or overcharging for goods and services paid for by Medicare, Medicaid and other federal health care programs. The settlements were for the fiscal year that ended Sept. 30.
Hospitals were involved in nearly $330 million of settlements and judgments, led by a massive settlement by 457 hospitals in 43 states related to cardiac devices that were implanted in Medicare patients in violation of Medicare billing rules. That included eight hospitals affiliated with Advocate Health and Hospitals, based in Downers Grove; and Memorial Health System and Memorial Medical Center, of Springfield.
SOURCE: By John Russell, Chicago Tribune
Puerto Rico’s elected officials have a message for their counterparts on the mainland: Fix health-care funding disparities or care for our poor and elderly in your hospitals.
Almost 70 percent of the island’s 3.5 million people get health care through Medicaid, Medicare and Medicare Advantage. Funding formulas for these federal programs shortchange Puerto Rico because it’s not a state, commonwealth officials say.
Puerto Ricans are U.S. citizens “who can hop on a plane and go to Florida, Texas and the Carolinas and get full Medicaid funding and other federal benefits,” said Pedro Pierluisi, Puerto Rico’s non-voting representative in Congress.
As Puerto Rico runs out of a cash to pay its $70 billion debt, commonwealth and U.S. officials are warning that an economic and fiscal crisis could become a humanitarian one. Puerto Rico, where 46 percent of citizens live in poverty, gets a lower percentage of federal funds for Medicaid than 26 other states even though none comes close to its levels of poverty. Making up for inadequate federal funding has contributed to Puerto Rico’s debt crisis, commonwealth officials say.
Puerto Rico racked up more debt than any state except California and New York to balance budgets as the island’s economy has shrunk 15 percent since 2006. Commonwealth obligations have been trading at distressed levels for two years. A tax-exempt general-obligation security with an 8 percent coupon changed hands Dec. 3 at an average yield of 11.2 percent, for an equivalent taxable yield of 18.5 percent for top earners. …
Delays in health-care reimbursements have forced some medical centers to close floors and eliminate specialized services, according to congressional testimony on Oct. 22 by Antonio Weiss.
SOURCE: By Martin Z. Braun, Bloomberg
A Senate subcommittee has asked four drug companies to provide company records, research and marketing cost information to better understand how drugmakers set the prices of products they’ve recently acquired.
The U.S. Senate Special Committee on Aging, which on Wednesday will host its first hearing on the topic, hasn’t yet said which, if any, of the companies complied with the request for records.
The companies were each asked to provide about 20 sets of records, including communication with board members and any correspondence with the U.S. Food and Drug Administration.
The committee has said it also will investigate pharmaceutical company mergers and acquisitions and the FDA’s drug-approval process. The goal is to shed light on what’s become a firestorm in the healthcare industry.
This summer, several companies scooped up the rights to sell drugs and immediately hiked up their prices. Turing Pharmaceuticals in August raised the price of an older drug used to treat a parasitic infection from $13.50 a tablet to $750 a tablet. Other companies did the same with drugs to treat multidrug resistant tuberculosis, kidney disease and cardiac arrest.
Putting an Obamacare repeal on the president’s desk would mark a major psychological – if not an actual – victory for Republicans. But it also could come with electoral repercussions that Democrats believe could boost their efforts to recapture the Senate in 2016.
This week, Senate Majority Mitch McConnell (R-Ky.) is poised to clinch the elusive 51 votes he needs to pass a repeal after devising a bill to appease a small group of conservative Republican senators. But the new version also would gut an expansion of Medicaid that’s put millions of Americans from low-income households on the insurance rolls.
And it just so happens that some of the most vulnerable Republicans up for reelection next year are from states that have expanded Medicaid and extended health care benefits to thousands of their constituents.
Democrats see a campaign ad that writes itself: Sen. X voted just last year to take away health insurance from tens of thousands of constituents.
“In the states that have [expanded Medicaid], to take it away could cause chaos. So to let ideology overcome practicality is not very good for those senators,” said Sen. Chuck Schumer (D-N.Y.). It “could be a good issue for us.”
Still, Republicans are undeterred. Passing the repeal fulfills a years-long promise from GOP leaders. And now the party can make the case to 2016 voters that the final obstacle to killing the health care law is electing a Republican president who would actually sign a repeal into law.
SOURCE: By Burgess Everett, Politico