Are black Americans entitled to equal health care? a new research paradigm

This paper analyzes the health, economic and legal implications of most major health systems' reform initiatives in the 20th century and, briefly, the 19th century. The paper suggests that models of analysis grounded in science deter the development of claims for racial equality in health care. Because race is a legal construct, the paper suggests that the 14th Amendment's Equal Protection Clause is an analytical framework that better accommodates the complexity of the health system, is at the heart of our national laws and ethos, and has political rhetorical power to further the political and policy debate. Major components of the health care system, including professional training, hospital construction, and health care financing, are analyzed for racially discriminatory purpose or impact and the extent of government participation. The paper gives particular attention to: the Flexner Report and the limited number of black physicians; the Hill-Burton program and the disproportionate assistance it gave to white controlled hospitals; and, efforts to expand health insurance coverage that also disproportionately favored the needs of the white community. Given the compounding effects of numerous policy decisions made over many years, there should not be any great wonder that such gross disparities in morbidity and mortality exist between black and white Americans. Further research and analysis of the policy decisions that have constructed the current health care system as well as framing those analyses as claims for racial fairness will better develop the policy debate than more narrowly focused analytical models from biomedical science or epidemiology. The law produced slavery and segregation, which usually determined where you lived, where you went, what work you could do, and what you learned. That legally constructed system significantly determined what you earned and what health you had. The biomedical models of analysis of our health system are too narrowly focused and temporally limited to identify the broad systemic barriers to equal health and health care. An analytical framework from law more easily accommodates the complex dynamics of our health care system. The equal protection clause of the 14th amendment has been used to analyze complex social and economic models, such as housing and education and has moved those systems to greater racial equality. The equal protection clause is at the heart of our national laws and ethos and, as a claim for fair treatment from government, has considerable rhetorical power. Menefee presents an analysis of major health policies dealing with training of physicians, construction of hospitals, and financing of personal health care. He suggests it demonstrates a health system rooted in racial discrimination and perpetuating racial discrimination in education, employment and housing. The history of successes using this analytical framework in other areas of social policy validates its consideration by health policy analysts for further research.