"Do we want to perpetuate a Jim Crow health system?" A brilliant, idealistic physician named Jean Cowsert asked that question in Alabama in 1966. Her answer was no-and soon after, she died under suspicious circumstances. Unearthing the truth of Cowsert's life and death is a central concern of David Barton Smith's Malicious Intent. Unearthing the grim history of our health care system is another.

Race-related disparities in American death rates, exacerbated once again by the COVID-19 pandemic, have persisted since the birth of the modern US medical system a century ago. A unique but perpetually unequal history has prevented the United States from providing the kind of health care assurances that are taken for granted in other industrialized nations. The underlying story is one of political, medical, and bureaucratic machinations, all motivated by a deliberate Jim Crow systemic design. In Malicious Intent, David Barton Smith traces the Jean Cowsert story and the cold case of her death as a through line to explain the construction and fulfillment of an unequal health care system that would rather sacrifice many than provide for Black Americans.

Cowsert's suspicious death came at a key moment in the struggle for universal health care in the wealthiest country on earth. Malicious Intent is a history of those failed efforts and a story of selective amnesia about one doctor's death and the movement she fought for.