PH 320 Exam #2

JFK

Proposed the Civil Rights Act (CRA) but was assassinated before it was passed

LBJ

Southern Democrat from Texas, was racist in earlier years, but finished out JFK’s legacy by passing CRA

Robert Byrd

Democrat from West Virginia who spoke for 14 hours straight to filibuster the CRA

Everett Dirksen

Republican from Illinois who supported CRA, vote was key in passing CRA

Truman

called for National Health Insurance Fund in 1945

Johnson

signed Medicare Law in 1965 when less than 50% of elderly were insured

Nixon

expanded Medicare to cover persons with disabilities and end-stage renal disease in 1972

Wilbur Cohen

“good wilbur” northern democrat, father of medicare, strong supporter of national health coverage, used incrementalist strategy

Wilbur Mills

“bad wilbur” southern democrat, chairman of ways and means committee, didn’t support medicare due to budget, used fiscal conservatism to back his stance

Northern Democrats

in support of national health coverage, liberal, pro-civil rights

Southern Democrats

not in support of national health coverage or CRA, conservative and segregationist, want states to have control over programs

American Medical Association

opposed national health coverage

Daniel Hale Williams

first African American fellow in ACS

Louis T. Wright

second African American fellow

The Civil Rights Act (1964)

ended discrimination in public places, banned employment discrimination, established the EEOC, no federal funds for discriminatory practice, helped desegregate schools

Voting Rights Act (1965) and Fair Housing Act (1968)

what expanded the Civil Rights Act of 1964

Medicare (1965)

federal health insurance program in the united states for people 65 and older, and younger people with certain disabilities

Medicare Part A

the mandatory hospital insurance

Medicare Part B

the voluntary physician’s insurance

Medicaid

the federal-state program for low-income individuals, individual entitlement program, entirely optional to states, provides medical assistance to select populations,

Implications of CRA

the south became heavily influenced by republicans after the passing of this

Social Security Amendments of 1965

Medicare and Medicaid Act

Blue Cross

the first prepaid hospital insurance plan, given to teachers in Texas in 1929

Stabilization Act

led to creation of insurance as a benefit

Great Society Programming

LBJ programs launched in the mid-1960s that sought to improve poverty, racial injustice, aid to education/arts, urban/rural development, healthcare

Aid to Dependent Children (1920)

Title IV of Social Security Act of 1935, gave federal grants to help states maintain mothers’ pension programs, gave money for children of unemployed child+parent

Medical Assistance for the Aged Program (1960)

kerr-mills program would become the basis for medicaid program, was a federal-state partnership to help elderly poor people that did not qualify for regular state welfare programs

American Care Act

has become more positive as public becomes more familiar

American Health Care Act

tried to replace Affordable Care Act

Beveridge

government run, financed by tax dollars, overtime saves money

Beveridge positives

everyone insured, everyone has a gp

Beveridge negatives

some deficiencies in specialty care, slow response to new technologies

Bismarck

paid by employers and employees, government regulates

Bismarck positives

everyone insured preventative services

Bismarck negatives

possibly none?

National Health Insurance

government runs single payer health insurance

National Health Insurance Positives

everyone insured, preventative services

National Health Insurance Negatives

long wait times for services

Out-of-Pocket

pay for service

Out-of-Pocket positives

pay for what you need

Out-of-Pocket negatives

the poor receive little to no care

combination health insurance

many features of the other systems

Combination positives

theoretically can incorporate the advantages of all the systems

combination negatives

complex, poor safety net, many uninsured

Universal Healthcare positives

lowers healthcare costs for an economy, hospitals and doctors have to provide same quality of care at a lower cost, elimination of need for private insurance/eliminates administrative costs

Universal Healthcare negatives

forces healthy people to pay for others’ healthcare, without financial incentive, people may not be as careful with their health, long wait times for elective procedures

Single Payer Model

paid by taxes, services owned and employed by government, everyone has same access to care

Social health insurance model

everyone must buy insurance through work, government run fund, government pays private doctors and hospitals, subsidized low income enrollees

National health insurance

one insurance company financed by mandatory purchase by all citizens, services provided by private docs

Equal Employment Opportunity Commission

 ensures all have an equal and fair opportunity for employment and advancement

End-Stage renal Disease

was given access to life-sustaining care like dialysis under medicare with nixon

Structural Barriers to Equal Healthcare

private hospital closures in segregated areas + moved to white areas, remaining facilities understaffed and underfunded

Stakeholders in Medicare/Medicaid

health insurers, drug companies, physicians/hospitals, the people

Politics of the 1960s

women’s rights, feminism, increasing US involvement in vietnam, civil rights movement, states rights and democratic party vs. federal power

Who was medicaid designed for?

single mothers, dependent children, disabled, poor, employed (under 65 and not getting medicare) (employed by small business, self-employed, agricultural workers, and domestic workers)

three layered cake

 three part system of medicare/medicaid, this is the work of wilbur mills

Public Assistance Categories (1930s)

who medicaid was eligible for, aid to families with dependent children, blind, permanently and totally disabled, low income was not enough to qualify. state control has allowed structural racism to continue

Healthcare system goals

to provide preventative and treatment health services, to be fiscally responsible, to provide care for all

Unfortunate US healthcare facts

more expensive than any other healthcare system, ranked between cuba and costa rica, the only high income country without universal healthcare

Benefits of ACA

more significant decrease in uninsured for near poor and black, more significant decrease in uninsured for hispanic + non-black

After medicaid expansion

mortality dropped significantly for middle-aged adults after expansion

Progressive critiques of ACA

doesn’t go far enough, increases the role of private health insurance companies

Conservative critiques of ACA

opposed to heavy government involvement, medicaid expansion, individual mandate and constitutionality, partisanship and distaste for obamacare

employer mandate of ACA

Applicable large employers with 50+ full-time employees to offer health insurance that is affordable and provides minimum value

three main barriers to racial progress

awareness, political will, empathy

impacts of FHA red-lining in the 1930s

mortgage/financing discrimination, digital divide, food deserts/nutritional insecurity, population density, poorer public school system, reduced employment prospects, health care access barriers

Health equity

assurance of the conditions of optimal health for all people, valuing all individuals and populations equally, recognizing historic injustices, providing resources according to need

Congruence in physician-patient relationship

improves health outcomes, improves medication adherence and compliance with care plans

precision education

a system that uses data and technology to transform lifelong learning by improving personalization, efficiency, and agency at the individual, program, organization or health system level

AMA of Today

formally acknowledges harm, established task force, is moving from acknowledgement to reparative action

the lost generation

a 100 year deficit of depletion of black physicians from the workforce

theory of change

(relating to AMA) the strategy is built on key actions to advance health equity