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THREAD—"By the 1950s, black doctors and nurses were pushing for a federal health care system for all citizens."
"That fight put the National Medical Association (the leading black medical society) into direct conflict with the A.M.A., which was opposed to any nationalized health plan."
"In 1945, when President Truman called on Congress to expand the nation’s hospital system as part of a larger health care plan, Southern Democrats obtained key concessions that shaped the American medical landscape for decades to come.
"The Hill-Burton Act provided federal grants for hospital construction to communities in need, giving funding priority to rural areas (many of them in the South). But it also ensured that states controlled the disbursement of funds and could segregate resulting facilities.
"Professional societies like the American Medical Association barred black doctors; medical schools excluded black students, and most hospitals and health clinics segregated black patients. nytimes.com/interactive/20…
"Federal health care policy was designed, both implicitly and explicitly, to exclude black Americans. As a result, they faced an array of inequities—including statistically shorter, sicker lives than their white counterparts.
"What’s more, access to good medical care was predicated on a system of employer-based insurance that was inherently difficult for black Americans to get.
"'They were denied most of the jobs that offered coverage, says David Barton Smith, an emeritus historian of health care policy at Temple University. 'And even when some got health insurance, as the Pullman porters did, they couldn’t make use of white facilities.'
"In the shadows of this exclusion, black communities created their own health systems.
"Lay black women began a national community health care movement that included fund-raising for black health facilities; campaigns to educate black communities about nutrition, sanitation and disease prevention;
"... and programs like National Negro Health Week that drew national attention to racial health disparities. Black doctors and nurses—most of them trained at one of two black medical colleges, Meharry and Howard—established their own professional organizations...
"... and began a concerted war against medical apartheid. By the 1950s, they were pushing for a federal health care system for all citizens.
"That fight put the National Medical Association (the leading black medical society) into direct conflict with the A.M.A., which was opposed to any nationalized health plan.
"In the late 1930s and the 1940s, the group helped defeat two such proposals with a vitriolic campaign that informs present-day debates: They called the idea socialist and un-American and warned of government intervention in the doctor-patient relationship.
"The group used the same arguments in the mid-’60s, when proponents of national health insurance introduced Medicare. This time, the N.M.A. developed a countermessage: Health care was a basic human right.
"Medicare and Medicaid were part of a broader plan that finally brought the legal segregation of hospitals to an end:
"The 1964 Civil Rights Act outlawed segregation for any entity receiving federal funds, and the new health care programs soon placed every hospital in the country in that category.
"But they still excluded millions of Americans. Those who did not fit into specific age, employment or income groups had little to no access to health care.
"In 2010, the Affordable Care Act brought health insurance to nearly 20 million previously uninsured adults. The biggest beneficiaries of this boon were people of color, many of whom obtained coverage through the law’s Medicaid expansion.
"That coverage contributed to a measurable decrease in some racial health disparities, but the success was neither as enduring nor as widespread as it might have been. Several states, most of them in the former Confederacy, refused to participate in Medicaid expansion.
"And several are still trying to make access to the program contingent on onerous new work requirements. The results of both policies have been unequivocal. States that expanded Medicaid saw a drop in disease-related deaths, according to the National Bureau of Economic Research.
"But in Arkansas, the first state to implement work requirements, nearly 20,000 people were forced off the insurance plan.
"One hundred and fifty years after the freed people of the South first petitioned the government for basic medical care, the United States remains the only high-income country in the world where such care is not guaranteed to every citizen. marketwatch.com/story/ingraine…
"In the United States, racial health disparities have proved as foundational as democracy itself. 'There has never been any period in American history where the health of blacks was equal to that of whites,' sats Evelynn Hammonds, a historian of science at Harvard University.
"'Disparity is built into the system.' Medicare, Medicaid and the Affordable Care Act have helped shrink those disparities. But no federal health policy yet has eradicated them." epi.org/publication/ib…
