Why is my doctor worried about my mortgage payments?
So I found myself wondering as I filled out a questionnaire before a recent primary-care visit.
Along with the usual prompts about my health, I encountered a series of questions related to my financial situation.
The form asked whether in the last 12 months I was unable to pay my mortgage or rent on time, and if I was “worried that my food would run out before I got the money to buy more.”
These questions weren’t an attempt to gauge whether I would pay my medical bill; they were part of a campaign driven by political activists out to justify socialist policies in the name of improving health care.
Federal rules issued by the Centers for Medicare and Medicaid Services actually give doctors a financial incentive to ask these questions.
In other words, medicine is one more institution that has been co-opted to advance a leftist party line.
The questions I was asked reflect the activist obsession with what’s known as the “Social Determinants of Health.”
The way the argument goes, factors like income, education, neighborhood conditions, racism, access to transportation and so on heavily determine a patient’s health.
The World Health Organization and the Centers for Disease Control repeatedly assert that these factors are major drivers of disparities in life expectancy, infant mortality, diabetes rates and cardiovascular disease across racial and socioeconomic groups.
But it’s not true: The framework is based on critical logical and empirical fallacies.
It confuses correlation with causation, while systematically downplaying or ignoring biological, behavioral and genetic variables that often have far more to do with differences in patient health outcomes.
But that’s what you’d expect from a notion that has nothing to do with medicine — and everything to do with politics.
A few examples show the absurdity of the activist enterprise.
Under this leftist framework, people with lower incomes must necessarily have worse health outcomes.
Yet Hispanic Americans have a higher life expectancy than whites despite their lower average incomes, according to federal data.
That’s a fact of life that activists ignore, because it doesn’t support their plan to divvy up money along racial or socioeconomic lines.
Or consider that black Americans have higher rates of hypertension and stroke.
Those who believe that social determinants control for health say discrimination must be the cause — that racism leads to higher poverty rates in black communities, hurting health in turn — yet when researchers investigate hypertension among black adults, they find lifestyle choices like diet are the more reality-based factors.
Activists don’t acknowledge that truth, because it doesn’t justify their demand for redistribution.
The willful ignorance of evidence is part and parcel of the activist worldview.
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Behavioral factors — diet, physical activity, tobacco use, alcohol consumption and so on — consistently explain much of the variance in chronic disease outcomes, dwarfing the effects of income or education.
The Framingham Heart Study and numerous cohort studies repeatedly find that modifiable behaviors dominate risk, even in impoverished populations.
People who choose not to smoke, who eat vegetables, and who exercise regularly have better cardiovascular outcomes than those who do none of those things.
Social conditions can make healthy behavior harder, but they don’t make it impossible — and they certainly don’t deposit plaque into arteries.
And the belief that health is socially determined does real damage.
Insisting that health disparities are largely if not entirely structural removes agency from individuals, while absolving personal responsibility.
This not only misdiagnoses the real causes of health disparities, it also justifies expensive, marginally effective socialist policies.
Case in point: The CDC’s “Health Impact in 5 Years” initiative explicitly lists income supplements and public transportation as health interventions.
Yet evidence from major health providers shows that financial support has no meaningful effect on health outcomes.
That includes universal basic income programs, a major leftist priority — which, evidence shows, have no impact on health.
But this isn’t about medicine.
It’s about redistribution — and even racial reparations — masquerading as health care.
The activist endgame is obvious: Once health outcomes are attributed primarily to income gaps, any disparity justifies — even demands — government intervention.
Taxation, seizure, and compelled transfer of wealth then cease to be economic questions; they become public-health emergencies on par with an epidemic.
But they’re not.
President Donald Trump should repeal the federal rules that encourage this abuse of medicine.
The social-determinants framework supplies the moral and scientific veneer for a permanent machinery of wealth distribution.
Remember that the next time your doctor asks if you can afford your mortgage.
It’s not a matter of medicine, but a matter of leftist politics — and you’re the lab rat.
Dr. Stanley Goldfarb is chairman of Do No Harm.