Bob Rosenblatt, Special Correspondent
Throughout 2015, the Academy is working with partners to create a platform for dialogue around the history and future of these two vital programs, including this weekly Covered blog series. Covered is written by Bob Rosenblatt, a Senior Fellow at the National Academy of Social Insurance and editor of the website HelpWithAging. Learn more about the Academy’s celebration of the 50th anniversary of Medicare and Medicaid.
Senate Wrestles with Medicare and Desegregation of Southern Hospitals
by Special Correspondent Bob Rosenblatt
July 3, 1965
Washington, DC – Integrating America’s vast hospital system will be a major part of a Medicare program pending in Congress, but it has gotten virtually no discussion among lawmakers. Passage of the bill, currently awaiting approval from the Senate Finance Committee, is expected to be approved by Congress sometime this summer.
The federal civil rights law passed just last year prohibits discrimination in hospitals. Nevertheless, Negro patients and white patients often are in separate wards in southern hospitals and Negro doctors rarely have operating privileges in white hospitals. Only 6 percent of southern hospitals are integrated, according to a 1959 study. The other 94 percent, do not admit Negro patients, or admit them only to segregated wards.
The federal law known as the Hill-Burton Act has financed the construction and expansion of thousands of hospitals since 1946 and allowed segregation in admitting and housing patients, and in the selection and hiring of medical interns, residents and other staff members. The law said hospitals could not discriminate, but permitted them to have “separate but equal” facilities. This has resulted in strict segregation with white and Negro patients often housed in completely separate wings of a hospital. In Atlanta, for example, at Grady Memorial Hospital, white patients were in two wings A and B facing one direction and Negro patients were in two different wings facing the opposite direction. Many Atlanta residents referred to the hospital as "the Gradys." Title VI of the Civil Rights Act overturned the Hill-Burton policies, forbidding such discrimination.
The recent question of whether the Johnson Administration intends to apply the new civil rights law to the nation’s 7,000 hospitals seems to be answered in the affirmative by an April 13th memo from Health, Education and Welfare (HEW) Secretary Anthony Celebrezze to Sen. Harry Byrd (D-VA), chairman of the Senate Finance Committee. There has, however, been no detailed discussion within the executive branch of how the federal government will integrate hospitals in communities with a long history of segregation.
The Medicare law should contain specific provisions forbidding discrimination, Dr. W. Montague Cobb, president of the National Medical Association. (NMA), told the Senate Finance Committee on May 4. “The principle is now firmly established in law that health care supported in whole or in part by public funds must be administered without discrimination as to race, creed, color, or national origin. We strongly urge that due antidiscrimination provisions be clearly written into H.R. 6675 so that possible litigation may be avoided.” NMA represents Negro physicians across the country.
Rather than ask for specifics in the legislation, the Administration says it will rely on the HEW memo as sufficient authority to deal with segregated hospitals.
The NMA is a strong advocate of the new Medicare benefit, and is the only doctors’ group favoring it.
“We have not come hastily to this position,” Dr. Cobb told the Finance Committee. “Our 5,000-member organization, formed in Atlanta in 1895 because of exclusionary practices against Negro physicians, has gained in its 70 years a pervasive and national knowledge of the health needs and problems of those in poor economic circumstances,” he said.
The NMA’s position contrasts with the position of the American Medical Assn (AMA), which is a vociferous and determined opponent of any efforts to expand the federal government’s role in the health care system.
The NMA endorsed a national health care proposal as far back as 1946, and in 1962 backed it as part of the Social Security system, Dr. Cobb said. The current bill would help the elderly manage their health care costs “on the most rational and equitable basis possible,” he said. “The nationwide and uniform coverage afforded would protect against the exhaustion of meager life savings, liens on previously mortgaged real estates and the indignities of means tests.”
The Medicare proposal would provide a universal system of hospital coverage for all Americans over the age of 1965 financed through the Social Security system. It was approved by the House, and is expected to win easy passage through the Senate.
The version passed by the House would provide 60-days of hospital care during a spell of illness, with a $40 deductible paid by the patient, 100-days in a nursing home after a hospital stay and 100-days of home care visits.
The Senate Finance Committee is now considering the bill and has increased the benefits. The committee has boosted hospital care coverage to 90-days, with the patient paying $10 per day for each of the extra 30-days. Nursing home care would be increased to 180 days, with the patient paying $5 per day for the extra 80-days. Home care visits would get another 75-days, without any added charge for the patients.
Dr. Cobb dismissed the assertion by the AMA and other opponents of the bill that Medicare represents socialized medicine. The Social Security system would pay hospitals, not physicians, and doctors would be paid by private insurance companies operating the voluntary Part B of Medicare, he noted. “The assertion that this is socialized medicine is, therefore, pure nonsense,” he said.
The Medicare bill, backed by the Johnson Administration and big majorities in both chambers of Congress, seems headed for easy passage. But what remains uncertain is how hard the Administration will be willing to press Southern hospitals as it seeks to implement, given the deeply rooted pattern of segregation in those facilities.
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