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Health Care Reform and History

Class 4: Civil Rights, Senior Citizens, and Medicare


By the 1960s, politicians had given up on the idea of universal health insurance for all. Instead, they compromised on a system that would cover only those groups not reachable by the private health system: the elderly and the very poor. Thanks to initial support from President John F. Kennedy, pressure from senior citizens and civil rights organizations, and finally the strong-arm tactics of President Lyndon B. Johnson, Congress passed Medicare and Medicaid in 1965. Medicare not only brought health security to senior citizens, but also represented a turning point in civil rights history as the new federal funding forced hospitals to comply with racial desegregation.

Class Resources
Primary Sources
  • Kennedy, John F. “Address at a New York Rally in Support of the President’s Program of Medical Care for the Aged,” May 20, 1962. The American Presidency Project. Available online at
  • Reid , Leahmon L. “Doctors, Dentists Drive Against Hospital Bias,” Jet Magazine Vol. XXX, No. 19 (August 1966): 46–49.
Secondary Sources
  • Zelizer, Julian E., “The Contentious Origins of Medicare and Medicaid” in Medicare and Medicaid at 50: America’s Entitlement Programs in the Age of Affordable Care. Edited by Alan B. Cohen, et al. Oxford: Oxford University Press, 2015, pp. 3–18.
  • Quadagno, Jill. “Promoting Civil Rights through the Welfare State: How Medicare Integrated Southern Hospitals.” Social Problems Vol. 47, No. 1 (Feb., 2000): 68–89.
Discussion Questions:
  1. Why do Medicare and Medicaid cover only the aged and the poor? What political factors went into the creation of these programs?
  2. How important were social movements, including organizations of senior citizens and the Civil Rights Movement, to the passage of Medicare and Medicaid? To what extent do presidents and politicians work with/rely on/turn to social movements for support?
  3. How did Medicare contribute to the racial desegregation of hospitals?
  4. According to the article “Doctors, Dentists Drive Against Health Care Bias,” why and how did some racial discrimination continue after the passage of the Civil Rights Act and Medicare? What types of discrimination? To what extent does racial segregation and inequality continue to be a problem in U.S. health care?
  5. How does Medicare differ from Medicaid? What do the differences between the two programs indicate about Congress’s approach to senior citizens and the poor?
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