Jan 20, 2019
Despite vehement opposition from the American Medical Association, Medicare and Medicaid were passed into law in 1965. Importantly, the federal government required participating hospitals to comply with the non-discrimination rules of the Civil Rights Act of 1964. Hospitals and doctors who wanted payments from Medicare and Medicaid were mandated to provide all medical services to minority patients and to hire medical personnel regardless of race. Nonetheless, before Medicare was officially launched in July 1966, there were still many hospitals and clinics that continued to discriminate against patients and families on the basis of race.
"Of all the forms of inequality, injustice in health is the most shocking and the most inhuman because it often results in physical death. I see no alternative to direct action and creative nonviolence to raise the conscience of the nation."
In March 1966, Dr. Martin Luther King, Jr. and his allies at the Medical Committee for Human Rights called for non-violent direct action, lawsuits, and complaints to the federal government against such hospitals. Dr. King and the MCHR identified the then-segregated American Medical Association as complicit with the discrimination and racism practiced by hospitals across the country. They accused the AMA of a "conspiracy of inaction" in civil rights. Dr. King then elaborated, "We are concerned about the constant use of federal funds to support this most notorious expression of segregation. Of all the forms of inequality, injustice in health is the most shocking and the most inhuman because it often results in physical death. I see no alternative to direct action and creative nonviolence to raise the conscience of the nation."
Thanks to the persistent efforts of civil rights activists, including many minority medical professionals denied membership by the AMA and state medical societies, Medicare and Medicaid delivered better health care to millions of minority patients. Sadly, because of conservative backlash against civil rights and the social safety net, additional progress in health justice would be very slow for the rest of the 20th century. Disparities in minority health persisted or worsened.
Since it was passed in 2010, the Affordable Care Act has made an enormous positive impact on the lives of millions of Americans. For minority communities, the ACA has provided the greatest extension of health justice since the passage of Medicare and Medicaid. Among non-elderly blacks, the uninsured rate decreased from 17 percent to 12 percent. For non-elderly Latinx, the uninsured rate decreased from 26 percent to 17 percent and for Asians, from 15 percent to 8 percent. The expansion of Medicaid has proven to be the most important factor in reducing these coverage disparities, covering a quarter of black and Latinx adults and over half of black and Latinx children.
Yet there continue to be shocking injustices for Americans trying to access their basic human right to health care. In 2012, the Supreme Court ruled the ACA's Medicaid expansion is not mandatory for states. Since then, many governors and state legislatures continue to deny health care to millions. Many states make eligibility and enrollment in Medicaid onerous for patients and families struggling with low incomes and poor health. Republicans in Congress have repeatedly attacked the ACA. The Trump administration continues to undermine Medicaid and the health insurance exchanges. All of these policy decisions have racist impacts and contribute to inequities in health: Over half (59 percent) of America's uninsured are people of color.
To guarantee health care as a basic human right and bend our moral arc toward justice, we must pass Medicare For All.
Now is the time to once again raise the conscience of our nation, especially as our minority communities become the majority of the population. We can not continue to leave health care as a privilege that depends on where you live, what you earn, or what you look like. To guarantee health care as a basic human right and bend our moral arc toward justice, we must pass Medicare For All.
Skeptics and critics of Medicare For All say the policy is "unrealistic" for America's health care "system." Whenever I hear those critiques from conservatives, moderates, AMA leaders, and so-called progressive allies, I think of how Dr. King responded to his contemporaries who criticized the "unrealistic" demands of civil rights activists.
To paraphrase his Letter from a Birmingham Jail, it should be unrealistic for black mothers to die at three times the rate of white mothers. It should be unrealistic for black babies to be twice as likely to die as white babies. It should be unrealistic for Latinx children to be twice as likely as white children to lack coverage for health care. It should be unrealistic for insurance company executives and Big Pharma corporation CEOs to take home billions of dollars while 40 percent of Americans do not have $400 available for an emergency. Millions of Americans are rejecting these unjust realities across American health care and support Medicare For All.
But won't Medicare For All be disruptive for American health care? I certainly hope so.
But won't Medicare For All be disruptive for American health care? I certainly hope so. For years I have listened to academics, technocrats, hospital executives, and other health policy "experts" exaggerate the value of tinkering at the edges of our broken health care system and patiently waiting for half-measures to bear fruit. I have attended too many conferences, webinars, and lectures that repeatedly describe how change can only happen slowly.
To my colleagues in academic medicine, public health, and policy, I have to ask: Are we serious about dismantling the "obnoxious negative peace" of America's current health care system, where profiteering is comfortable and patients suffer needlessly? If we, as health care providers, health justice advocates, and everyday Americans are truly dedicated to making health care a basic human right in reality and not just rhetoric, then we are obliged to remodel our comfort zones -- and to do so with urgency.
Making health care a basic human right through Medicare For All is a civil rights journey. Throughout these endeavors, we will be tested in many ways because "all" has always been the heaviest word in American history. We struggle to extend liberty and justice to all of us, whether that be in voting, criminal justice, fair pay, clean air and water, immigration, and so on. Health care justice for all will be similarly difficult -- but not impossible -- if we are serious about the urgency of now.
Medicare For All requires us to follow the lead of the real Dr. King who disrupted negative peace and comfort zones, who urged those who yearn for justice "to use time creatively, in the knowledge that the time is always ripe to do right. Now is the time to make real the promise of democracy and transform our pending national elegy into a creative psalm of brotherhood. Now is the time to lift our national policy from the quicksand of racial injustice to the solid rock of human dignity." Now is the time for Medicare For All and for health care to be a basic human right regardless of where you live, what you earn, or what you look like.
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