David Barton Smith offers a complete chronicle of racial segregation and discrimination in health care in the United States using vivid firsthand accounts as well as a formal review of the current evidence of inequity in patterns of use and outcomes. Smith details the efforts through the courtsand federal regulation to address these disparities, discusses their persistence in more subtle forms, and offers possible strategies for ending them.Health Care Divided: Race and Healing a Nation tells the story from 1920 to the present by distilling a narrative from archival records and interviews with key participants. The book traces the decisive role race has played in shaping the development of American medicine and our system of medical care and goes on to explore the effect of this legacy on the organization of long-term care for the elderly and prenatal care for infants.Identified here are lessons largely overlooked by health services leaders, researchers, and policy analysts and examines how this divided health system persists, both exacerbating and distorting racial disparities. Smith asserts that in spite of federal efforts to end segregation, health care remains, at best, more than half the distance between a fully separate and an integrated system.This book will appeal to the general reader though will be of particular interest to those in or preparing for health related professions and to those interested in African American and recent American history, political science and organization behavior, public policy and race relations, and trends in health care in the absence of a national reform initiative."Health Care Divided is a fascinating and often distressing history of our racially divided health care system." -- Ruth Roemer, J.D., UCLA School of Public Health, and Past President, American Public Health Association The research for this book was supported by a Robert Wood Johnson Health Policy Investigator Award.

“Do we want to perpetuate a Jim Crow health system?” A brilliant, idealistic physician named Jean Cowsert asked that question in Alabama in 1966. Her answer was no—and soon after, she died under suspicious circumstances. Unearthing the truth of Cowsert’s life and death is a central concern of David Barton Smith’s Malicious Intent. Unearthing the grim history of our health care system is another.

Race-related disparities in American death rates, exacerbated once again by the COVID-19 pandemic, have persisted since the birth of the modern US medical system a century ago. A unique but perpetually unequal history has prevented the United States from providing the kind of health care assurances that are taken for granted in other industrialized nations. The underlying story is one of political, medical, and bureaucratic machinations, all motivated by a deliberate Jim Crow systemic design. In Malicious Intent, David Barton Smith traces the Jean Cowsert story and the cold case of her death as a through line to explain the construction and fulfillment of an unequal health care system that would rather sacrifice many than provide for Black Americans.

Cowsert’s suspicious death came at a key moment in the struggle for universal health care in the wealthiest country on earth. Malicious Intent is a history of those failed efforts and a story of selective amnesia about one doctor’s death and the movement she fought for.

In less than four months, beginning with a staff of five, an obscure office buried deep within the federal bureaucracy transformed the nation's hospitals from our most racially and economically segregated institutions into our most integrated. These powerful private institutions, which had for a half century selectively served people on the basis of race and wealth, began equally caring for all on the basis of need.

The book draws the reader into the struggles of the unsung heroes of the transformation, black medical leaders whose stubborn courage helped shape the larger civil rights movement. They demanded an end to federal subsidization of discrimination in the form of Medicare payments to hospitals that embraced the "separate but equal" creed that shaped American life during the Jim Crow era. Faced with this pressure, the Kennedy and Johnson Administrations tried to play a cautious chess game, but that game led to perhaps the biggest gamble in the history of domestic policy. Leaders secretly recruited volunteer federal employees to serve as inspectors, and an invisible army of hospital workers and civil rights activists to work as agents, making it impossible for hospitals to get Medicare dollars with mere paper compliance. These triumphs did not come without casualties, yet the story offers lessons and hope for realizing this transformational dream.

This book is the recipient of the Norman L. and Roselea J. Goldberg Prize from Vanderbilt University Press for the best book in the area of medicine.

TThe recent growth of "assisted living" facilities and programs has shaken the foundations of the system of long-term care for the elderly in the United States. Fueled by consumer frustrations with the available options, notably nursing homes, the assisted living model emerged during the 1990s to promise shelter, health care, control of one's own life, less government involvement, and a "real home." But how well have the advocates and developers of assisted living delivered on such promises? And what are the model's implications for public policy and the future of caregiving?

In Reinventing Care, David Barton Smith offers brilliant insights into those questions by examining the realities of assisted living in New York City. Encompassing the largest, most concentrated population of elderly in the United States, New York spends more per person caring for its seniors than any other urban center. Yet, while the size of the city's care system boggles the mind, it nevertheless contains the same elements that exist in other metropolitan areas and thus provides valuable lessons for the nation as a whole.

Smith's study draws on twenty-five years of research, including hundreds of interviews and visits to representative facilities. He provides a succinct overview of how care is presently organized for New York's aging population and traces the history of the system up to the present. Among the key issues he addresses are the role of market forces and government regulation, the impact of class differences on access to quality care, and the ways in which perceptions of community affect the creation and management of assisted living programs. At the heart of the book are ten fascinating case studies, half of them focused on private-pay facilities and the other half on public-pay institutions.

While finding that the actualities of assisted living rarely match the rhetoric of its proponents, Smith sees much to admire in its goals. He suggests tactics and strategies--such as promoting family- and community-based models of assisted living and adopting a standard of licensure for certain facilities--that could point the way to a better future.