There is no greater embarrassment to the world's wealthiest nation than the fact that over 44 million of its own citizens are uninsured and, at least, another 60 million are “under-insured.” Therefore, over one-third of Americans are ill prepared for the financial hardships resulting from mounting medical problems. For many, emergency departments—often cramped and understaffed—are the only access to health care. With inordinate waiting periods and some patients only presenting when the disease is intolerable (which is oftentimes a reliable marker for an advanced state of the disease), the current state of health care in the United States is not sustainable or ethical. Equal access to health care is one of the inherent responsibilities of this great nation. This country spends over a trillion dollars per year for health care, which no other nation can even approach. The health care industry is the only trillion-dollar industry in the United States. With $1.7 trillion being spent for health care last year, it is unlikely that more dollars would effectively address the disparity issue. In fact, this is, perhaps, one of the few times when “how” money is used rather than “how much” is at the crux of a better and more equitable system. Based on the premise that universal access to basic medical care is a right, meaningful health care reform—a critical element in combating racial disparity—cannot be based on a person's socioeconomic status. With the first national health care disparities report demonstrating racial disparity in surgical complications, the authors explored possible causes using New York State Hospital data. The purpose of the study was to investigate possible racial disparity (African American versus Caucasian) with regard to surgical complications in the state of New York. Hospital discharge data obtained from 1998–2000 in New York was used in the analysis. The data included information on 145,833 African Americans and 865,293 Caucasian patients. The authors highlight that previous studies have shown that African Americans have had higher complication rates than Caucasians. The present study, unlike the earlier ones, controls for patient comorbidity. It also controls for such hospital characteristics as hospital size, academic affiliation, hospital specialization (using the Herfindahl index) and other hospital demographics. Also, hospital ecological characteristics were controlled for such factors as percent of African American patients discharged in the past year, percent of Medicaid patients discharged, and Metropolitan Statistical Area sizes. The primary statistical method used in the data analysis was the hierarchical logistic regression, which controlled sequentially for patient and hospital characteristics. The first logistic regression model included race and gender and age, with the second adding the presence or absence of comorbidities and length of stay. The third added patient social and economic factors, including insurance, HMO status, and admission type (elective nor not). The fourth and fifth added hospital characteristics from the AHA file and hospital ecological characteristics, respectively. Tables 1 and 21 contain the main results. However, it should be noted that for Table 1, which has African Americans and Caucasians compared on outcome variables, patient demographics, patient morbidity indicators, patient social factors, hospital characteristics, and hospital ecology, there is no mention as to the statistical methodology used to produce the P values. Therefore, no determination can be made regarding the appropriateness of the analysis. Also, due to the extremely large sample sizes, virtually any difference between the 2 study groups (African Americans and Caucasians) will be statistically significant. Whether these differences are important in any practical sense remains to be answered. For example, the authors noted that the unadjusted complication rate for African Americans is 1.8% and 1.4% for Caucasians. This difference is 0.4% or 4 people out of a 1000. Although statistically significant, this difference cannot be considered “large” by any reasonable definition. The major portion of this paper addressed whether this 0.4% difference could be eliminated after controlling for several independent variables. The authors ultimately conclude that the higher rates of surgical complications among African Americans, as compared with Caucasians, are primarily explained by patient comorbidities and secondarily by hospital characteristics. Unfortunately, with comorbidities in African Americans so closely linked with health care disparity, particularly with respect to suboptimal access to medical management, the authors cannot readily uncouple the surgical complications from a more systematic racial and socioeconomic bias.