This is the second entry in a two-part op-ed series on institutional racism in American medicine.
A little over a year before the coronavirus pandemic reached our shores, the racism problem in U.S. health care was making big headlines.
But it wasn't doctors or nurses being accused of bias. Rather, a study published in Science concluded that a predictive health care algorithm had, itself, discriminated against Black patients.
The story originated with Optum, a subsidiary of insurance giant UnitedHealth Group, which had designed an application to identify high-risk patients with untreated chronic diseases. The company's ultimate goal was to help re-distribute medical resources to those who'd benefit most from added care. And to figure out who was most in need, Optum's algorithm assessed the cost of each patient's past treatments.
Unaccounted for in the algorithm's design was this essential fact: The average Black patient receives $1,800 less per year in total medical care than a white person with the same set of health problems. And, sure enough, when the researchers went back and re-ranked patients by their illnesses (rather than the cost of their care), the percentage of Black patients who should have been enrolled in specialized care programs jumped from 18 percent to 47 percent.
Journalists and commentators pinned the blame for racial bias on Optum's algorithm. In reality, technology wasn't the problem. At issue were the doctors who failed to provide sufficient medical care to the Black patients in the first place. Meaning, the data was faulty because humans failed to provide equitable care.
Artificial intelligence and algorithmic approaches can only be as accurate, reliable and helpful as the data they're given. If the human inputs are unreliable, the data will be, as well.
Let's use the identification of breast cancer as an example. As much as one-third of the time, two radiologists looking at the same mammogram will disagree on the diagnosis. Therefore, if AI software were programmed to act like humans, the technology would be wrong one-third of the time.
Instead, AI can store and compare tens of thousands of mammogram images — comparing examples of women with cancer and without — to detect hundreds of subtle differences that humans often overlook. It can remember all those tiny differences when reviewing new mammograms, which is why AI is already estimated to be 10 percent more accurate than the average radiologist.
What AI can't recognize is whether it's being fed biased or incorrect information. Adjusting for bias in research and data aggregation requires that humans acknowledge their faulty assumptions and decisions, and then modify the inputs accordingly.
Correcting these types of errors should be standard practice by now. After all, any research project that seeks funding and publication is required to include an analysis of potential bias, based on the study's participants. As an example, investigators who want to compare people's health in two cities would be required to modify the study's design if they failed to account for major differences in age, education or other factors that might inappropriately tilt the results.
Given how often data is flawed, the possibility of racial bias should be explicitly factored into every AI project. With universities and funding agencies increasingly focused on racial issues in medicine, this expectation has the potential to become routine in the future. Once it is, AI will force researchers to confront bias in health care. As a result, the conclusions and recommendations they provide will be more accurate and equitable.
Thirteen months into the pandemic, Covid-19 continues to kill Black individuals at a rate three times higher than white people. For years, health plans and hospital leaders have talked about the need to address health disparities like these. And yet, despite good intentions, the solutions they put forth always look a lot like the failed efforts of the past.
Addressing systemic racism in medicine requires that we analyze far more data (all at once) than we do today. AI is the perfect application for this task. What we need is a national commitment to use these types of technologies to answer medicine's most urgent questions.
There is no antidote to the problem of racism in medicine. But combining AI with a national commitment to root out bias in health care would be a good start, putting our medical system on a path toward antiracism.
U.S. Secretary of State Marco Rubio delivers a keynote speech at the 62nd Munich Security Conference on Saturday, Feb. 14, 2026, in Munich, Germany.
Marco Rubio is the only adult left in the room
Finally free from the demands of being chief archivist of the United States, secretary of state, national security adviser and unofficial viceroy of Venezuela, Marco Rubio made his way to the Munich Security Conference last weekend to deliver a major address.
I shouldn’t make fun. Rubio, unlike so many major figures in this administration, is a bona fide serious person. Indeed, that’s why President Trump keeps piling responsibilities on him. Rubio knows what he’s talking about and cares about policy. He is hardly a free agent; Trump is still president after all. But in an administration full of people willing to act like social media trolls, Rubio stands out for being serious. And I welcome that.
But just because Rubio made a serious argument, that doesn’t mean it was wholly persuasive. Part of his goal was to repair some of the damage done by his boss, who not long ago threatened to blow up the North Atlantic alliance by snatching Greenland away from Denmark. Rubio’s conciliatory language was welcome, but it hardly set things right.
Whether it was his intent or not, Rubio had more success in offering a contrast with Vice President JD Vance, who used the Munich conference last year as a platform to insult allies and provide fan service to his followers on X. Rubio’s speech was the one Vance should have given, if the goal was to offer a serious argument about Trump’s “vision” for the Western alliance. I put “vision” in scare quotes because it’s unclear to me that Trump actually has one, but the broader MAGA crowd is desperate to construct a coherent theory of their case.
So what’s that case? That Western Civilization is a real thing, America is not only part of it but also its leader, and it will do the hard things required to fix it.
In Rubio’s story, America and Europe embraced policies in the 1990s that amounted to the “managed decline” of the West. European governments were free riders on America’s military might and allowed their defense capabilities to atrophy as they funded bloated welfare states and inefficient regulatory regimes. Free trade, mass migration and an infatuation with “the rules-based global order” eroded national sovereignty, undermined the “cohesion of our societies” and fueled the “de-industrialization” of our economies. The remedy for these things? Reversing course on those policies and embracing the hard reality that strength and power drive events on the global stage.
“The fundamental question we must answer at the outset is what exactly are we defending,” Rubio said, “because armies do not fight for abstractions. Armies fight for a people; armies fight for a nation. Armies fight for a way of life.”
I agree with some of this — to a point. And, honestly, given how refreshing it is to hear a grown-up argument from this administration, it feels churlish to quibble.
But, for starters, the simple fact is that Western Civilization is an abstraction, and so are nations and peoples. And that’s fine. Abstractions — like love, patriotism, moral principles, justice — are really important. Our “way of life” is largely defined and understood through abstractions: freedom, the American dream, democracy, etc. What is the “Great” in Make America Great Again, if not an abstraction?
This is important because the administration’s defenders ridicule or dismiss any principled objection critics raise as fastidious gitchy-goo eggheadery. Trump tramples the rule of law, pardons cronies, tries to steal an election and violates free market principles willy-nilly. And if you complain, it’s because you’re a goody-goody fool.
As White House Deputy Chief of Staff Stephen Miller said not long ago, “we live in a world … that is governed by strength, that is governed by force, that is governed by power. These are the iron laws of the world that have existed since the beginning of time.” Rubio said it better, but it’s the same idea.
There are other problems with Rubio’s story. At the start of the 1990s, the EU’s economy was 9% bigger than ours. In 2025 we were nearly twice as rich as Europe. If Europe was “ripping us off,” they have a funny way of showing it. America hasn’t “deindustrialized.” The manufacturing sector has grown during all of this decline, though not as much as the service sector, where we are a behemoth. We have shed manufacturing jobs, but that has more to do with automation than immigration. Moreover, the trends Rubio describes are not unique to America. Manufacturing tends to shrink as countries get richer.
That’s an important point because Rubio, like his boss, blames all of our economic problems on bad politicians and pretends that good politicians can fix them through sheer force of will.
I think Rubio is wrong, but I salute him for making his case seriously.
Jonah Goldberg is editor-in-chief of The Dispatch and the host of The Remnant podcast. His Twitter handle is @JonahDispatch.