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Vernellia R. Randall
Vernellia R. Randall, Does Clinton's Health Care Reform Proposal Ensure [E]qual[ity of Health Care for Ethnic Americans and the Poor?, 60 Brooklyn Law Review 167-237 (1994) (287 Footnotes Omitted)
On September 22, 1993, President Clinton appeared before the American people to discuss his plans to reform the health care system. On November 20, 1993, the Health Security Act (the Act or HSA) was introduced into Congress. The Act responded to concerns about the uninsured and underinsured, about uncompensated care and about cost containment. An implicit assumption has been that economic access is the most significant barrier to health care; and, in fact, it may be. However, there are many other barriers to access.
If equitable access means, or is defined as, the actual receipt of the quality and quantity of services needed, then access in America has been inequitable. Many individuals receive different health care (both quantity and quality) based on characteristics other than medical need. The care received by the wealthy is different than the care received by the poor; the care received by European Americans is different than the care received by ethnic Americans; and the care received by men is different than the care received by women.
Has the HSA designed a system that removes or minimizes inequities? Or will it provide the wealthy with one level of care and the poor with another? Does the HSA fashion a system that distributes health care resources so that ethnic Americans receive the same quantity and quality of care as European Americans? Will the system envisioned result in improved health status for ethnic Americans?
It is important that ethnic Americans do not accept an inadequate solution as a compromise. Once a significant reform package passes Congress and becomes law, the issue of major health care reform probably will not be addressed again for quite some time. Furthermore, as ethnic Americans begin to point out problems with the reformed system, European Americans, particularly those with upper-middle income, are likely to feel resentful toward ethnic Americans. European Americans, having expended a significant amount of energy, time and political capital on reforming the health care system, are likely to consider ethnic American concerns as undocumented complaints.
Consequently, despite the rhetoric of economics, ethnic Americans must ultimately evaluate health care reform on the potential to improve health status. Improving health status depends on improving access to both equal and quality health care. Ultimately, then, health care reform must be evaluated on how effectively it removes (or at least, significantly reduces) barriers to [e]qual[ity] health care.
Using the Health Security Act as a bases for analysis, this article analyzes the potential for health care reform, in its current from, to improve access to health care for ethnic Americans. Unfortunately, the article concludes that health care reform will fail ethnic Americans and the poor because it maintains a structurally and ideologically flawed system; it perpetuates a fragmented system with inadequate infrastructure; it maintains a culturally incompetent system based on illness care; it rations health care through a tiered system based on private interests; and it inadequately protects against health care discrimination.