Sick and tired of racism?

Two studies, both concerning Asian Americans, found evidence of a causal connection between discrimination and depreciated health. The first study examined experiences with discrimination amongst Korean immigrants to the United States and measured those findings against the mental health quality of the subjects. "Researchers found that both overt and subtle discrimination seemed to influence participants' mental health. Overt discrimination was associated with the erosion of positive mood, while subtle racism was associated with symptoms of depression, possibly because more subtle forms of discrimination create 'ambiguities in terms of social identity.'" A second study looked at the impact of discrimination on chronic illness. They observed associations between discrimination and various respiratory, cardiovascular and pain-causing conditions, concluding:"that the everyday perceived discrimination minorities experience could cause stress that can lead to chronic illnesses."

Studies like these have a lot of interesting implications. They illustrate the extent to which cumulative disadvantages still track to characteristics like race not simply because of class conditions, as some materially inclined post-racists may conjuncture. but as a tangible result of discrimination that is currently happening. They also raise a tough moral dilemma for proponents of a health system like the one in the status quo (though I will admit now they do not go far enough to establish the moral necessity of a completely socialized health system).

If we take up the meritocratic position held by many (though certainly not all) opponents of socialized medicine which states that people's capacity to afford health care should, and more or less does, track to decisions about work, education and life-path that people have freely made themselves the status quo would be easier to accept. As one anonymous interlocutor put it in an online forum, claims that the 40 million or so uninsured Americans represent a failure of distributive justice suffer from "a lack of true knowledge as to why those "40 million" are uninsured (here's a hint - a significant number choose to be that way for a variety of reasons beyond "I can't afford insurance") and we start getting down to the real issues at hand." Following this argument to it's conclusion, the quality and cost of a person's health care, and indeed whether a person has any at all, is just if it indexes to that persons choice. So if I choose to remain unemployed or to become obese then I deserve whatever hardships come my way in the market-based health system. Bracketing the (numerous) complications that employment, obesity and the like raise in terms of cumulative disadvantage, we will take that idealized, rationalist approach and put to it the question of race.

A Korean American who either (1) suffered from a mental health disorder as a result of discrimination or (2) suffered from a chronic illness as a result of stress caused by discrimination would face considerable difficulty in paying for health care. At best, our hypothetical Korean would pay much higher premiums and/or deductible and face still higher expenses in treatment. At worst, she or he might be totally unable to find a provider, as many people with chronic and mental illnesses are.

Now, in this person's case there is absolutely no sense in which she or he could be said to have "earned" discrimination, even indirectly by putting oneself in a risky position. Yet she or he may well be priced out of insurance simply as a result of a prejudiced society. Why should our Korean have to face inordinately high costs of health care - or worse, go without any - simply because living as a Korean in a racist white society is difficult?

The moral dilemma illustrated by these studies, put simply, is that there are systematic inequalities in the allocation of health burdens in our society, which impose costs on the people burdened with them that are, as Rawls would have said, arbitrary from a moral point of view. Yet we ask that those people face the costs with whatever resources they can cobble together (forgetting for now that their capacity to do so will be inhibited by their health conditions ). Why shouldn't all members of a society marked by inequality that is arbitrary (morally) and systematic (distributively) have some obligation to contribute to offset those disadvantages?