Activism for Health Equity: Lessons from History

1. Activism for Health Equity: History’s LessonsPNHP Annual Meeting , Atlanta Nov. 4, 1017David Barton Smith“The past is not dead, it’s not even past.” Faulkner • U.S. health system’s “formative years“ bookended by the Plessy and the Brown Decisions (e.g. 1896-1954). • The way we think about, finance and organize health care continues to be shaped by that dysfunctional experience. • Yet physician activists have produced profound changes.

2. MCCR “Picket” AMA ConventionJune 1963

3. March on Washington August 28, 1963

4. Mounting Pressure from Civil Rights Activists Brown v. Simkins v. Title VI. Medicare Board of Ed Moses Cone Civil Rights Act 1954 1963 1964 1965 ???

5. The Universal Conclusion of the “Experts”: Hospitals Won’t Need to Worry of about Title VI in Medicare’s Implementation • AMA: hadopposed Medicare and threatened a boycott. • Hospitals: Well insulated, connected, powerful institutions that had already effectively resisted Title VI compliance in the use of Hill-Burton hospital construction funds. • Title VI: a hopelessly flawed provision of the Civil Rights Act of 1964. • Politicians and bureaucrats: No interest in forcing the issue. Never came up in the legislative debate over Medicare. • Mission Impossible: The office established to assure compliance in more than 6,000 hospitals had a staff of 5 and a 4 month deadline.

6. MLK at Chicago Annual Meeting of MCHR March 25, 1966: “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”

7. Regulatory Capture by the Activists • Authors the enforcement guidelines and procedures. • Recruits & Trains 1,000 inspectors as temporary transfers from DHEW’s Public Health Service and the Social Security Administration. • Energizes an invisible army of local civil rights activists and hospital workers. • Forces the highest risk federal domestic policy initiative in our history.

8. June 1966 Crisis: Most Hospitals in South Still Non-compliant Staff work round the clock. LBJ, fully engaged, turns up the heat. “War Room” at Social Security. VA, military hospitals, National Guard helicopters on standby.

9. Victory Elimination of all the symbols of a racially and economically divided hospital system. Access to care on the basis of need not race or economic resources and reduced health “disparities.” Success made threat of the use of the federal purse credible and produced dramatic transformations in other sectors (e.g. Title IX). But …… “the past was not dead.”

10. Keys to the Victory • The gift of the civil rights movement- We are all in it together (No free market freedom of choice!)- Medicare. • Regulatory precision, consistency and a pre-existing appeals process. • The “Golden Rule.”

11. We have the Power to Heal T Power to Heal Documentary Produced by Barbara Berney, Directed by Charles Burnett Supported by NEH, Arthur Vining Davis and WETA PBS Airing: February 2018?? Preview: https://vimeo.com/226755305 Password: PTHselects720