Racial Inequities in Mortality and Access to Health Care: The Untold Peril of Rationing Health Care in the United States

On February 25, 2007, a 12-year-old African American boy named Deamonte Driver died of a toothache because he did not receive a routine $80 tooth extraction that may have saved him, which was covered by his insurer: Medicaid. Unable to afford $80 or find a dentist that took Medicaid, Deamonte wound up in the emergency room, underwent two brain surgeries, and was in the hospital for six weeks of treatment, which cost approximately $250,000. In the end, Deamonte still died from a brain infection caused by the spread of the bacteria from the abscess in his mouth. While Deamonte did not die as a result of disparate treatment based on his race, his death occurred because of the disparate impact of income inequality on minorities. Specifically, minorities are disproportionately poor and lack health insurance or rely on government health insurance, such as Medicaid. *78 As a result, they are disproportionately denied access to health care because either they cannot afford to pay or physicians will not accept patients covered under government health insurance. Wholly avoidable, Deamonte\u27s death is a glaring example of the perils of the United States\u27 policy of rationing access to health care based on ability to pay and how this policy exacerbates racial inequities in health care. However, most United States citizens, including members of the United States Congress, deny that rationing occurs in the United States. For instance. during the recent battle over health care reform Republicans asserted that health care reform would lead to rationing of care, while Democrats vigorously denied that the United States rations or that health care reform would result in rationing. This rhetoric fails to acknowledge the reality of some 46 million Americans who lack access to health care: rationing of health care already exists in the United States. In fact, access to health care in the United States has been rationed for decades based on a person\u27s ability to pay. This system of rationing, which serves as a means to allocate scarce resources, has lead to an untold number *79 of deaths. Scholars have written about the rationing phenomena and proposed cost-benefit solutions. However, the disproportionate effect that current and proposed rationing methods have on minorities has been ignored. My article begins to fill this void by not only demonstrating how the current rationing policy disproportionately affects minorities and exacerbates racial inequities in health care, but also by illustrating why current costbenefit proposals will not benefit minorities. Specifically, section I briefly reviews rationing policies in the United States and general problems with the policies. Section II examines empirical data illustrating how rationing health care based on ability to pay has a disparate impact on African Americans. Section III discusses whether current rationing policy based on the ability to pay is race neutral, or merely an example of structural racial bias. In section IV, I critique the proposed cost-benefit solution to improving rationing methods and suggest that rationing care without addressing structural bias will only exacerbate racial inequities in health care