COMMENTARY

Medicare Turns 50: Here Is My Favorite Story

Disclosures

October 07, 2015

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I'm Dr George Lundberg, and this is At Large at Medscape.

By this time in 2015, you have been exposed to innumerable articles with endless slants noting the 50th anniversary of Medicare legislation. Here is my favorite Medicare story. And I would like to hear yours.

I have to tell you that I am a great fan of Medicare. Why is that?

In 1951 and 1952, I worked summer vacations as an orderly in the City Hospital of Mobile, Alabama, managed by the Sisters of Charity of the Roman Catholic church. Hospital orderlies were traditionally Negroes, which was the correct term back then. But the nuns took white male students in summer, especially if one of them was in premedicine, like me. The other two I worked with were in Catholic seminary, one of which was in the Vatican. Oscar, Oliver, and I took turns on all shifts in legally segregated white and black male wards.

In 1953, just before medical school, I worked as a clinical chemistry lab technician at the federally funded new Hill-Burton Druid City Hospital. We ran a blood bank with black and white segregated blood. From 1953 to 1957, I was in medical school in Birmingham with clinical training at the legally segregated Jefferson-Hillman Hospital.

In 1955, Rosa Parks began the bus boycott down the road in Montgomery. I soon joined the US Army and left the South for more than 10 years.

In 1958, Martin Luther King, Jr, famously used the quote, "...the arc of the moral universe is long, but it bends towards justice"[1] in an article and later in speeches.

In January 1963, governor George Wallace, in his inaugural address, said, "...segregation today, segregation tomorrow, segregation forever."[2] In June that year, he stood in the schoolhouse door to attempt to prevent integration at the University of Alabama, where I had attended.

In 1964, the Civil Rights Act was passed. In 1965, both the Voting Rights Act and Medicare/Medicaid legislation were passed, all with a Democratic congress and a white male Southerner schoolteacher from South Texas as President. And everything changed.

I left the army in 1967 as a lieutenant colonel and went job hunting. In Birmingham, I found an entirely different medical world—integrated student body and workforce, hospital rooms, even the blood bank. Wow! I saw integration work in the military and then suddenly in American medicine. And it still works in the military and in American medicine.

I credit Medicare law, financial incentives, and the professionalism and basic goodness of healthcare workers, and I am proud. Despite this, racial disparities in healthcare delivery and outcomes do still exist.

The remainder of our society is still in big trouble. Public schools are more segregated than ever—especially in places outside the South, such as New York City and Chicago, but also in cities in the South, such as Charlotte. Housing patterns are increasingly segregated, especially in such cities as Cleveland, Milwaukee, Detroit, and Louisville.

Intercollegiate athletics, once a leader in integration, are moving back to segregation, this time by sport. Basketball; track; and, increasingly, football are black sports. Baseball, softball, swimming, motor car and horse racing, hockey, and golf are white sports.

Racism in America is not dead. It is very much alive in beliefs, practices, and actions in all American states, some more than others. The fiery and nasty George Wallace may smile from his grave noting that "segregation tomorrow" is still a reality. The later repentant George Wallace understands and may be sad. As for Martin Luther King, Jr, much more "curve bending" is needed.

My father suffered from hypertension and had heart attacks before Medicare. Self-employed and uninsured, he was cared for by a kindly general practitioner in a small-town hospital and died at home in his early 60s. My mother suffered her strokes after Medicare and was cared for largely by specialists in urban hospitals and died in her late 70s.

Anybody who thinks American medicine was better before Medicare really does have a hole in his or her head. Despite its many faults that beg to be fixed, Medicare is a huge success story, and "separate but equal" is never equal. That's my opinion.

I'm Dr George Lundberg, At Large at Medscape.

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