The present black health crisis is a continuum. After 346 years of neglect, flawed efforts were made to admit black Americans to the "mainstream" health system. Gains were significant from 1965 to 1975; however, since then black health status has eroded. Since colonial times, the racial dilemma that affected America's liberal democratic system also distorted medical relationships and institutions. There are clear connections between campaigns to defeat bills that would improve the health of blacks and other disadvantaged groups and acquiescence with the present reassignment of them to the underfunded, overcrowded, inferior, public health-care sector. Physician leadership helped to establish the slaveocracy, create the racial inferiority myths, and build the segregated health subsystem for blacks and the poor. Clearly, if the history-based health disparities are to be resolved, black physician leadership will be necessary. Without justice and equity in health care, the dream of Martin Luther King will never become a reality for African Americans.