Thread by @Docs_4_Bernie

THREAD.

As #BlackHistoryMonth ends and the #SouthCarolinaPrimary begins, let's revisit the story of Medicare & how it tangibly advanced racial equity in the 1960s.

The story shows the power of movement-aligned politics to effect social & system change.

Before Medicare, hospitals were deeply segregated due to Jim Crow. Many outright refused care to Black people. If care was provided, it was heavily segregated with separate entrances, waiting rooms, wards, even separate china & silverware. Separate, and certainly not equal.

Care was triaged by skin tone, not severity of condition. If you were Black with a serious illness, you would be lucky to find a hospital or clinic that allowed you to wait until all the White patients had been seen before you would receive medical attention.

Surely there must have been exceptions. For example, what if you suffered a devastating, flip-over car accident? Truly an emergency that warrants exception, right?

Wrong. No exceptions, as we know from the deaths of Juliette Derricotte, the Dean of Women at Fisk University, and her student Nina Mae Johnson, who were denied care by the nearest hospital, which only accepted White patients.

No exceptions. As we know from Dr. Brenda Armstrong. As a child, her pregnant mother struggled to deliver a baby too large for her pelvis. Her father, a physician himself, recognized her need for a C-section, but was refused care at the nearest, but white-only, hospital.

Dr. Armstrong's brother was ultimately born, but suffered a brain injury and paralysis, complications that could have been prevented with medical care.

This is the way healthcare "worked" for Black Americans... until Medicare.

whyy.org/segments/medic…

On July 30, 1965, Medicare was signed into law to provide health insurance to the elderly. The key to Medicare's success was the civil rights focus of its implementation by the Social Security Administration and the Public Health Service.

A year before Medicare was passed, Title VI of the Civil Rights Act had passed to prohibit discrimination of race, color, & national origin. Ten years prior Brown v Board ruled school segregation unconstitutional. Yet little had been done in 10 years' time to desegregate schools.

At the time Medicare was signed to law, the people with decision-making power on how to implement it happened to also be dedicated civil rights activists.

Learning from the slow implementation of the Brown v Board desegregation decision, they tied Medicare implementation to Title VI, which meant hospitals would be required to prohibit discrimination and effectively desegregate care in order to receive Medicare federal funding.

This lead to rapid desegregation of hospitals across the country, increased racial diversity of medical providers, and major improvements in the health & financial security of older Black Americans. The figure below shows death rates for ages 65+.

asaging.org/blog/medicare-…

Of course, Medicare was not a panacea for racism and its manifestation as racial inequity in health. Life expectancy is still lower for Black people, Black women are 4 times more likely to die during pregnancy, Black infants are twice as likely to die, compared to white people.

We still have hospitals segregated in their effects, especially because hospitals serve neighborhoods and are thereby directly affected by rampant residential segregation via redlining and gentrification.

thelancet.com/journals/lanpl…

Still it's undeniable that implementing Medicare helped narrow the chasm of racial inequities experienced in health, systems, & society.

What were the ingredients of Medicare's success?

- universal policy
- deliberate racial justice focus
- movement aligned
- political courage

#Bernie2020 is grounded upon such moral moments in US history. @BernieSanders recognizes the need for organizing power among the people & empowers us to fully exercise our democratic rights for the benefit of the people, most especially the exploited & segregated among us.

Medicare may have left Black people behind if not for the Civil rights activism of those in positions of decisional power at the time. #Bernie from the start intentionally puts Black & marginalized people in positions of decisional power to shape policies that touch our own lives

For more on how #MedicareForAll can advance racial equity, follow the work of #Bernie2020 Surrogate @DrSriram's campaign: @allmeansall #AllMeansAll

Hear direct accounts of the history of hospital segregation and Medicare from those alive during the struggle: blbfilmproductions.com/interviews.html

khn.org/news/1965-the-…

If you're a doctor or health worker who supports both #SandersForPresident & #MedicareForAll, sign up to join us!

docs4bernie.org/join-us/