For the past several years I have run this post and just as it was those years, it is this year a very important message.
We, as a nation, have made progress and I believe Dr. King would be proud. But our work is far from complete – particularly where health care is concerned. Another doctor, Dr. John M. Eisenberg, a physician of tremendous stature whose life was also tragically cut short (not by an assassin’s bullet but by brain cancer) was equally passionate about the dignity of life and justice for all Americans. Dr. Eisenberg, who among other things, served as the Director of the Agency for Health Care Policy and Research (as AHRQ was known back in the day), cared deeply about access to and the integrity of health care for all Americans – regardless of skin color.
Twelve years ago, on January 14, 2000, Dr. Eisenberg gave what is, in my opinion, a brilliant speech to the employees of the Department of Health and Human Services. As with the past two years I want to share his words with all of you today — as a reminder of how far we’ve come, and how far we still have to go.
When I was invited to welcome you to the Department of Health and Human Service’s 26th observance of Martin Luther King Jr.’s birthday, my first thought was about how honored I was to be asked. My second thought was about what Martin Luther King’s birth could mean to a rebirth of health care in this country. Few have had as much impact upon American consciousness.
But what did Martin Luther King think about health care?
My colleagues and I searched through his writings and his speeches, and realized that he didn’t give speeches about health care. Martin Luther King Jr. was confronting the basic nature of American society. He had mountains to move – and mountaintops to climb – for this country so that today we can address the issues of high quality health care for all Americans.
If Dr. King were alive today he’d be 71 years old. He’d be eligible for Medicare. Like many 71-year-olds, he might be dealing with a chronic medical condition – maybe arthritis, or hypertension, or diabetes. What would he think of the health care system we have today? What would he think of the medical care he might receive? And what advice would he be giving the Department of Health and Human Services?
No, Dr. King didn’t give many speeches about health care. But like the rest of society, health care had to change too.
When I was a teenager in Memphis, before the Medicare program was passed, the Baptist Hospital was the biggest in town, and the proudest of the care it gave. But if you were African American in Memphis and you went to the Baptist Hospital, you’d go in through a back entrance. And you’d go to a segregated ward, where you would be in a big room with about 15 or 20 other people. And your doctor, if he was black, wold not have privileges on staff. And the same would have been true for Dr. King in Montgomery or in Atlanta.
Dr. Vanessa Gamble, who is the new director of minority affairs at the Association of American Medical Colleges here in Washington, has documented the incredibly important role that Medicare and Medicaid played in helping to desegregate hospitals. Medicare was a lever that lifted equity and equality in hospitals. In 1965, our Department issued regulations mandating that hospitals had to be in compliance with the Civil Rights Act–which had been passed just the year before – in order to be eligible for Federal assistance or to participate in any federally assisted program. The passage of Medicare and Medicaid legislation that year made every hospital a potential recipient of federal funds, and therefore obligated every hospital to comply with civil rights legislation if they wanted to get paid.
The law changed, but practice was slower.
When I was a medical student in St. Louis, at Barnes Hospital around 1970, researchers asked why the hospital still seemed to be segregated. Why? Because clerks in the admissions office – both black and white – were so accustomed to the old ways that they continued to admit the races to their old units. The law had changed, but racial stereotypes had remained. Racist practices were illegal, but racism was institutionalized, and the seeds of racism grew into practices that amounted to discrimination.
I ask you, is it any different today, 31 years after Dr. King was shot in my hometown, and we grieved over the loss of a great American? Is it different 31 years after I was ashamed of the symbol that my hometown had become, when all that Dr. King wanted was to put into practice the placards that the Memphis sanitation workers wore, that read, “I am a man”?
Today, research shows that African Americans are one-third less likely to have coronary bypass surgery than whites with the same conditions. Why? And today, African Americans with HIV are less likely to receive antiviral treatment. Why do these disparities occur?
The easy answer is that it is because African Americans are more often uninsured. And that is true. But even with the same insurance, African Americans don’t have the same access to primary care doctors, specialists and hospitals. And most distressing, even with the same insurance and being cared for at the same hospitals, African Americans get different care. In one study I did, if you were a black woman you were much less likely to get referred for cardiac catheterization.
The reason – I fear – is that, despite Dr. King’s advances, and despite civil rights laws, and despite Medicare, racism is a part of the institution of American life, and the seeds of racism still grow into discriminatory practices.
So, now 31 years after Dr. King’s death and 35 years after Medicare broke down segregated wards in the nation’s hospitals, the question for us is: What can we do today in our Department to eliminate these disparities, whether they grow out of the lack of insurance, lack of access, or lack of quality care for those who get access?
No matter where we work in this Department –
- At the Health Care Financing Administration
- At the Health Resources and Services Administration, where programs are supported to help access
- At the Food and Drug Administration, where safe drugs are assured
- At the National Institutes of Health, where research can identify the causes of disease
- At the Agency for Healthcare Research and Quality, where we find out why the quality of care isn’t what it can be, and where our name itself speaks of an arc, of closing gaps.
In every operating and staff division, We can use the levers that we are so lucky to have, and so privileged to use, to eliminate the barriers to high quality health care.
Because we shall overcome.
We shall overcome the disparities in health care, whether they are due to economic barriers, or institutionalized racism, or even unconscious discrimination. We – as public servants – can build on Dr. King’s contribution to the moral health of our country to make our own contributions to the physical and mental health of all of its people.
Let’s make that commitment today.
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