I suspect that access is a more complex notion than we give it credit for. There are very intricate reasons why some Americans are denied access - some of which were predictably engineered in the 1940s by established custodians of American social and urban planning. Now we have some races who live in complete isolation, living only among themselves in over 500 of the total 3200 plus counties in the country. I examined access as a function of opportunity and utilization and found that geography DOES matter. We  reported this in two articles this month in The Journal of the American College of Surgeons and Archives of Surgery.

Racial clustering and access to colorectal surgeons, gastroenterologists, and radiation oncologists by African Americans and Asian Americans in the United States: a county-level data analysis. Hayanga AJ, Waljee AK, Kaiser HE, Chang DC, Morris AM. Arch Surg. 2009 Jun;144(6):532-5

Residential segregation and access to surgical care by minority populations in US counties.  Hayanga AJ, Kaiser HE, Sinha R, Berenholtz SM, Makary M, Chang D. J Am Coll Surg. 2009 Jun;208(6):1017-22

If you are distrustful of the health system and you have no exposure to the system except through distant strangers, you will be less likely to wish to use those services until too late. This has important preventive health implications. These populations do not get screened, get diagnosed late and die earlier.  This has received a certain amount of attention.

http://www.thedoctorschannel.com/video/2071.html

http://www.healthfinder.gov/news/newsstory.aspx?docid=628090
http://www.redorbit.com/news/health/1704005/research_finds_segregation_reduces_access_to_surgical_care

http://cancer.med.upenn.edu/resources/article.cfm?c=3&s=8&ss=23&Year=2009&Month=06&id=16305

http://www.eurekalert.org/pub_releases/2009-06/jaaj-ucw061109.php

http://www.physorg.com/news164302548.html

http://esciencenews.com/articles/2009/06/11/study.finds.segregation.decreases.access.surgical.care.minorities

http://www.sciencecentric.com/news/article.php?q=09061606-us-counties-with-more-african-american-patients-may-have-fewer-colorectal-cancer-specialists

http://www.modernmedicine.com/modernmedicine/Modern+Medicine+Now/Racial-Clustering-Linked-With-Access-to-Colon-Canc/ArticleNewsFeed/Article/detail/604058?contextCategoryId=46736

America has significant health challenges but without addressing the effect of racial clustering and geography, there is little to believe that health disparities in access in  the US will be resolved before 2010 like the federal government promised many years ago.