This article argues that, although Medicare was enacted to make health care services equally accessible to all, differences in use of services still exist by race and socioeconomic group. Indicators, like percentage of patients with localized cancers and use of preventive services across a range of domains, support this general view that less affluent elderly people and older people from minority groups have less access to care.

Since similar disparities exist in services that must be recommended by physicians, the "culture of poverty" argument (that poor and minority patients don’t use services because they choose not to) does not completely explain health services disparities. Characteristics of the health care system are likely to reinforce these patterns, and research is needed to identify these characteristics.