CONCLUSION
The current health care system is flawed in a number of ways. There are significant economic barriers, including no insurance, no money, co-payments and deductibles. People do not have universal portable health care coverage. Moreover, even the massive financing reforms of the Health Security Act that are aimed at increasing coverage do not automatically translate into broadened access and improved services. After some years, when government and private institutions encounter budgetary stringency, it is likely that they will economize by decertifying persons and placing limits on benefits.
Furthermore, the reformed system lacks adequate infrastructure to provide culturally competent care. Instead, it perpetuates a middle-class European American focus for the delivery of health care. Where services do exist, there is significant fragmentation with ill-defined or inadequately defined community health or public health programs. Furthermore, the Act permits different population groups to receive different health care treatment. This is due in part to the institutional racism in the system but also to the insufficient or nonexistent health research data that is race or culture-specific (including quality assurance or utilization review data). Given the focus of cost containment on middle-class health care needs, there exists the potential for significant health care discrimination. The existing anti-discrimination laws will not effectively combat this discrimination. For these reasons, the Health Care Security Act is only a partial answer and, in many ways, an inadequate answer to the need for health care reform.
. The term (e)qual(ity) menas equal and quality. It was coined by Professor Ann. C. McGinley of Brooklyn Law School.
. Assistant Professor, University of Dayton; J.D., Northwestern School of Law, Lewis and Clark College; M.S.N., University of Washington; B.S.N., University of Texas.
I wish to acknowledge the Edward V. Sparer Public Interest Fellowship Program Brooklyn Law School, for supporting the research for this article. I thank Professors Richard Saphire, Jeffrey Morris, Anna Williams Shavers and Douglas Wells for their useful review and comments, and the participants of the Fifth Annual Meeting of The Midwestern People of Color Legal Scholarship Conference for not only their review and comments, but also their support and mentoring. I also want to thank Drs. W. Michael Byrd and Linda Clayton for their pioneering research on racism in the health care system and health reform. Finally, I want to thank my sons, Tshaka and Issa for their support and good humor.
. The Health Security Act was introduced into the House as H.R. 3600, 103d Cong., 1st Sess. (1993), and into the Senate as S. 1757, 103d Cong., 1st Sess. (1993) (hereinafter the HSA).
