The emergency room is where the United States’ social problems come home to roost

Stat, Uché BlackstockJan. 30, 2024

From “Legacy” by Uché Blackstock, M.D., published by Viking, an imprint of Penguin Publishing Group, a division of Penguin Random House, LLC. Copyright © 2024 by Uché Blackstock, M.D.

In the U.S., access to health care has long depended on insurance and a person’s ability to pay, with patients of color making up a disproportionate number of the under- or uninsured, as I have seen firsthand.

This trend dates back to the mid-20th century, a period when medical technology improved substantially, and visits to hospitals increased. Although insurance policies at the time covered hospital visits, they didn’t tend to cover outpatient office visits, and so people without insurance found that they could access no-cost care through hospital emergency rooms instead.

As a result, the history of emergency medicine is bound up in the experiences of Black and Latinx communities’ exclusion from the health care setting. Prior to the 1960s, the vast majority of hospitals in the United States were segregated by race, or they had separate wings or staff for patients strictly stratified according to skin color. Many Black communities in the South simply had no access to hospitals at all. After the passage of the Civil Rights Act in 1964, Title VI of the act mandated that any hospital that practiced racial discrimination would have federal funding withheld from it.

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