Americans well remember how black people had to ride in the back of the bus and drink from separate water fountains before civil rights laws were passed in the mid-1960s. But most don't know that African Americans often could not receive treatment in the same hospitals and physicians' offices as white people, and that black doctors couldn't practice or train at the same institutions as whites.
On Thursday, the 50th anniversary of President Lyndon Johnson's signing of the legislation that established Medicare, National Public Radio's Morning Edition program aired a piece about how Medicare helped desegregate the nation's healthcare system. While the American Medical Association infamously opposed the Medicare legislation, it was strongly supported by the National Medical Association, which represents black doctors.
Johnson invited the NMA to attend the bill's signing, and conspicuously did not invite the AMA.
The Medicare law prohibited Medicare payments from going to institutions that discriminated on the basis of race. Many hospitals changed their admissions and physician-credentialing policies based on that provision.
But that alone wasn't enough, according to David Barton Smith, a health management and policy professor at Drexel University, who is writing a book on Medicare and the civil rights movement. After the bill's signing, hundreds of civil rights volunteers joined efforts with a small team of federal inspectors to monitor hospitals' compliance with the law's non-discrimination provisions.
Smith told NPR that the volunteers made sure “that all of the white and colored signs were removed. But then, they would go back and insist that hospital employees and patients not self-segregate in the waiting rooms. They were pretty fierce about it. And they had an invisible army, in the sense of local civil rights groups that would guide them in their inspections, including a lot of black health workers that helped in providing the eyes and ears for making sure that the hospitals were not just trying to cover everything up.”
Within a few months, Smith said, 2,000 U.S. hospitals were desegregated.
NPR also interviewed Dr. Edith Mitchell, president-elect of the National Medical Association, whose grandmother went to a hospital in a southern state soon after Medicare became law.
“My grandmother was in the first group of individuals to receive a Medicare card,” Mitchell said. “And it was the first time that my grandmother had ever been admitted to a hospital, although she had given birth to five children. She had a chronic condition, and she was in a hospital room with a Caucasian patient, who we knew, who my grandmother knew. And just to be able to lie in the bed in a room where another Caucasian patient was in the room was something that never happened before.”
Mitchell added, “I think that Medicare actually contributed to a new day.”