"THE MEDICAL world just reflects the real world." That's how one African American patient summed up the reality of the health care system--a reality reflected in the findings of a report released last month that found that minorities in the U.S. consistently receive lower quality health care than whites.

The Institute of Medicine study concludes that minority patients are more likely to have a poor health status and higher rates of chronic diseases than whites--and that minorities have lower rates of insurance coverage and less access to health care services.

In part, this is because poverty--which affects minorities disproportionately--goes hand in hand with increased rates of illness. And living with a for-profit health care system means that poor people get a lower standard of care--when they're able to qualify for health insurance at all, that is.

As one man told researchers, "Often times, the system gets the concept of Black people off the 6 o'clock news, and they treat us all the same way--here's a guy coming in here with no insurance. He's 'low breed.'"

Another African American patient described his doctor's attitude when he was diagnosed with diabetes. "I need to write this prescription for these pills, but you'll never take them, and you'll come back and tell me you're still eating pig's feet and everything," the doctor said.

Not surprisingly, minorities are less likely to receive more sophisticated--and more expensive--treatments such as bypass surgery, kidney transplants or certain expensive drug therapies for the treatment of HIV and AIDS.

"The real challenge lies not in debating whether disparities exist, because the evidence is overwhelming, but in developing and implementing strategies to reduce and eliminate them," said Dr. Alan Nelson, chair of the committee that wrote the report.

Among the "strategies" called for in the report are increased physician awareness of racism, more interpreters, more minority physicians and more money for the Office of Civil Rights to enforce antidiscrimination laws.

But the one strategy that would help the most isn't even mentioned--a national health care system that could provide coverage for everyone in the U.S. regardless of race or income level.

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