I. INTRODUCTION

Health care reform is a major initiative in the United States today. The concern regarding health care is widely discussed and recorded in literature that includes books, articles, and editorials. Most of the discussion focuses on reforming health care to control cost or to provide better access. Very little of that discussion observes the needs of persons of color, in general, and African-Americans, in particular.

The need to focus specific attention on African-American health care and health care reform is overwhelming. Not only are African-Americans sicker than European-Americans, they are dying at a significantly higher rate. These are undisputed facts. This disparity in health care has the effect of precluding African-Americans from gaining full access to the economic system. Decent health is a precursor to getting the other attributes, such as money, education, contacts, know-how, necessary to exploit the American system to full advantage. When people are sick and poor, they are just as enslaved as if the law made them so.

Factors affecting health include socioeconomic status, biology, and environment. Yet, in a racist society such as ours, the effect of race is all-encompassing. Race not only affects socioeconomic status, biology, and physical environment; it also affects the way health care institutions function to provide services. Independent of economics, race affects access to care. Independent of economics, race affects the type and quality of health care treatment received. Consequently, to improve the health of African-Americans, it is not sufficient merely to remove economic barriers to access. To improve the health of African-Americans, health care institutions must be more than affordable. They must be just. If we want justice in health care for African-Americans, then every effort must be made to design a system that provides needed health care by assuring complete access and by eliminating institutional racism. Consequently, a just health care system will focus on eliminating the disparity in health care between African-Americans and European-Americans. Several policy approaches can be taken to deal with this issue: 1) expanding insurance coverage, 2) targeting special health services to African-Americans, and/or 3) using Title VI of the Civil Rights Act of 1964 to eliminate racist practices in health care delivery and health care education.

This paper evaluates these policy options and the feasibility of reforming an unjust health care system to meet the needs of African-Americans. Part I explores the disparity between the health status of African-Americans and European-Americans. Part II discusses the health care system and the manifestations of institutional racism. Part III analyzes selected policy options for making the health care system more just.