Medicare has not only remade healthcare finance, but pushed race relations forward

At age 50, Medicare is baked into the American landscape in much the same way as guns and pizza. Take any of those three away, and the entire republic would probably collapse.

But unlike guns and pizza, Medicare has also served as a linchpin of civil rights and equality in the United States. Its creators did so by using the program to place hospital finances into a nearly inescapable bind if they engaged in what had been business as usual in the U.S. for the prior 175 years.

Given the family occupying the White House and what has been a remarkably frank debate about race relations in this country over the past couple of years, it's a little hard to believe that just 50 years ago the U.S. was in a comparative stone age. Yet blacks were still being killed in the South for the crime of trying to vote, and were often barred from any place of business where their presence might offend white patrons.

What made the civil rights movement of the 1960s relatively successful was not just the courage of its leadership, but the fact those leaders focused on something that truly would get the attention of white America: Economic chokepoints. Not riding on the buses at all in Montgomery, Alabama eventually forced the cash-strapped city to allow blacks to ride wherever they wanted on the vehicles. And if you sat at a lunch counter for hours on end waiting for service that never came, it prevented a bunch of other customers from being served and paying for their meals.

Many hospitals in the U.S. were also segregated--or had just a handful of beds for African-American patients. That led to national disgraces such as Charles R. Drew, M.D., who pioneered blood banking and storage, resigning from the American Red Cross because it insisted on segregating blood donations by race.

Lyndon Johnson, who in spite of being remarkably coarse regarding race relations for much of his political career, practically made a 180-degree turn on that issue when he became president. That and his remarkable gifts for lawmaking--and arm-twisting lawmakers--led not only to the creation of Medicare, but the mandate that hospitals could no longer be segregated if they were to participate in the program. Medicare was probably the very first U.S. government program that insisted on colorblindness from the beginning.

In retrospect, hospitals really had no choice but to desegregate. Medical technology had made so much progress in the 50 years before Medicare began that the lifespan in the U.S. had grown by nearly a quarter of a century. It had become obvious that younger patients were less and less likely to be regulars in hospital beds. And to have a steady payment stream to treat the growing base of older patients was a financial godsend.

These days, if a hospital is kicked out of the Medicare program, its management tries to move heaven and earth to get back in its good graces, as closing its doors is usually the only other alternative.

Of course, not everything is equal in terms of healthcare delivery in the U.S. African-Americans and Latinos under the age of 65 are less likely to have insurance and more likely to suffer from chronic illnesses than whites. And even among those in the Medicare population, coordination of care and outcomes tend to be better in more affluent--and whiter--communities than elsewhere.

But Medicare has left its mark on this country in an indelible manner. It has not only remade U.S. healthcare finance, but has played a significant role in pushing race relations forward. - Ron (@FierceHealth)