Health Care Policy 1960’S & 1970’S

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Graduate social work students analyze the history of health care reform in the 1960s and 1970s.

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  • General Themes: Strong support and push for a National Health Insurance plan (NHI) in the 60’s, but dwindled in the mid-70’s; NHI was no longer a priority at the end of the decade Introduction of health care regulations in the 70’s Shift toward “cost containment” health care Paternalistic decision of who’s worthy and unworthy of health care Culturally-insensitive decisions in health care More awareness of health from modern technology Emphasis on physician/nurse education, improvement of health facilities Women’s reproductive health advocacy
  • Kerr-Mills Act: Federal grants given to states to fund health care for elderly poor (only 28 states participated) No government cost control; federal government continued to keep its distance from an this assumed state-responsibility (The Henry J. Kaiser Family Foundation, 2009).
  • Under 65 with certain disabilities, People with ESRD, Railroad Retirement Board Poor = Aid to indigent aged, AFDC
  • "It is estimated that as many as one in three low-income women who would have an abortion if the procedure were covered by Medicaid are instead compelled to carry the pregnancy“---even still, reproductive justice falls in the hands of individuals and private donors because the government won’t fund it.
  • Health Care Policy 1960’S & 1970’S

    1. 1. Health Care Policy 1960’s & 1970’s Ana Balzar Jenna Brown Lindsay Dickes Becca Ellison Diane Morris Jessica Ruhter
    2. 2. Relevant Health Care Policy & Events in the 1960’s & 1970’s <ul><li>1960 </li></ul><ul><ul><li>“ A Great Society” </li></ul></ul><ul><ul><li>Kerr-Mills Act </li></ul></ul><ul><ul><li>FDA approved birth control pill </li></ul></ul><ul><li>1962 </li></ul><ul><ul><li>Health Services for Agricultural Migratory Workers Act </li></ul></ul><ul><li>1963 </li></ul><ul><ul><li>Maternal and Child Health and Mental Retardation Planning Amendments </li></ul></ul><ul><li>1964 </li></ul><ul><ul><li>First Surgeon General’s Report on Smoking and Health is released </li></ul></ul><ul><li>1965 </li></ul><ul><ul><li>Medicare and Medicaid signed into Social Security </li></ul></ul><ul><li>1970 </li></ul><ul><ul><li>Kennedy’s “Health Security Act” </li></ul></ul><ul><li>1972 </li></ul><ul><ul><li>Birth control pill approved for all women </li></ul></ul><ul><li>1973 </li></ul><ul><ul><li>Health Care Regulations begin </li></ul></ul><ul><ul><li>The Health Maintenance Organization Act (HMO) </li></ul></ul><ul><ul><li>Roe v. Wade </li></ul></ul><ul><li>1974 </li></ul><ul><ul><li>Support from both parties for NHI </li></ul></ul><ul><ul><li>Nixon’s Comprehensive Health Insurance Plan (CHIP) </li></ul></ul><ul><ul><li>Kennedy-Mills Comprehensive National Health Insurance Act </li></ul></ul><ul><ul><li>Numerous other NHI proposals </li></ul></ul><ul><li>1976 </li></ul><ul><ul><li>NHI no longer a government priority </li></ul></ul><ul><li>1977 </li></ul><ul><ul><li>The Health Care Financing Administration </li></ul></ul><ul><ul><li>The Health Maintenance Organization Amendments </li></ul></ul><ul><ul><li>The Indian Health Care Improvement Act </li></ul></ul><ul><ul><li>The Rural Health Care Services Amendments </li></ul></ul>
    3. 3. The Birth of Medicare & Medicaid : A conservative compromise or a liberal stepping stone?? <ul><li>Expansion of Kerr-Mills Act </li></ul><ul><li>Title 18 and 19 of Social Security Amendments of 1965 </li></ul><ul><li>Signed by Johnson on July 30, 1965 </li></ul><ul><li>Alternative to national health insurance (NHI) </li></ul><ul><li>Had been debated for over 20 years </li></ul><ul><li>Seen as threat to Social Security </li></ul><ul><li>Cost not central to decision </li></ul><ul><li>Lacked support from both parties </li></ul><ul><ul><li>Conservatives compromised for a program they saw fit for the state/local government </li></ul></ul><ul><ul><li>Liberals compromised for a program that would hopefully lead to national health care </li></ul></ul><ul><li>Key Players throughout the years: </li></ul><ul><ul><li>Mills </li></ul></ul><ul><ul><li>King-Anderson </li></ul></ul><ul><ul><li>Kennedy (John, Ted) </li></ul></ul><ul><ul><li>Johnson (“Dream of a Great Society”) </li></ul></ul><ul><ul><li>Nixon </li></ul></ul><ul><ul><li>American Medical Association (AMA) </li></ul></ul>Johnson signs the Social Security Amendments of 1965 with Truman at his side. Image courtesy of http://media3.washingtonpost.com
    4. 4. Medicaid vs. Medicare <ul><li>“ Recipients” </li></ul><ul><li>Received little attention and support </li></ul><ul><li>Poor, blind, disabled </li></ul><ul><ul><li>“ Poor” = Receiving aid from public assistance </li></ul></ul><ul><li>Federally-initiated, state-operated </li></ul><ul><li>Funded by regular tax dollars </li></ul><ul><li>Welfare-linked public assistance program </li></ul><ul><li>Means-tested (worthy vs. unworthy) and strict eligibility </li></ul><ul><li>Run through welfare offices </li></ul><ul><li>Paternalistic, culturally-insensitive </li></ul><ul><li>“ Beneficiaries” </li></ul><ul><li>More widely supported by public and aging politicians </li></ul><ul><li>Nearly anyone over 65 years old qualifies </li></ul><ul><li>Federal program </li></ul><ul><li>Funded by Social Security (through special trust fund) </li></ul><ul><li>Social Insurance program </li></ul><ul><li>Automatic eligibility after 65 </li></ul><ul><li>Run through Social Security offices </li></ul><ul><li>Beneficiaries can also qualify for Medicaid </li></ul>
    5. 5. 1964 Report of Smoking & Health <ul><li>In 1964 46% of all Americans smoked </li></ul><ul><li>Smoking was accepted in offices, airplanes and elevators; cartoon TV programs were sponsored by cigarette brands. </li></ul><ul><li>The 1964 report on smoking and health had an impact on public attitudes and policy. </li></ul><ul><li>A Gallup Survey conducted in 1958 found that only 44 percent of Americans believed smoking caused cancer, while 78 percent believed so by 1968 (The Reports of the Surgeon General, 2009). </li></ul><ul><li>In 1965, Congress required all cigarette packages distributed in the United States to carry a health warning, and since 1970 this warning is made in the name of the Surgeon General. </li></ul><ul><li>In 1969, cigarette advertising on television and radio was banned, effective September 1970. </li></ul>
    6. 6. Abortion <ul><li>Up until the 1960’s, proponents of abortion reform were challenging long-standing state laws that dated back to the 19 th century. </li></ul><ul><li>1966-70, 13 states reformed their statutes to permit therapeutic abortion for various medical indications. </li></ul><ul><li>1973, Roe V Wade and Doe v Bolton </li></ul><ul><li>In 1973 abortion number was 616,000 and almost doubled to 1.2 million by 1979. </li></ul><ul><li>Abortion quickly became an issue of Federalism as well as a factor in the ongoing constitutional conflict between church and state. </li></ul><ul><li>1977, states began winning back some control over abortion. </li></ul><ul><ul><li>Beal v. Doe, Maher v Roe, Poelker v Doe </li></ul></ul><ul><li>Courts failed to resolve dilemma of abortion. Part of the answer for erratic patterns of the court since 1973 is personnel changes. </li></ul><ul><li>Justice Douglas, advocate of individual privacy, resigned in1975 due to ill health. </li></ul><ul><li>Justices Burger and Powell two weaker supporters of Wade changed positions in cases after 1973. </li></ul><ul><li>Presidents Kennedy, Johnson, Nixon, Ford, and Carter did not use their political influence to address this issue in a constructive manner. </li></ul><ul><li>Congresses principle response to abortion was to treat it as ‘separation of powers’ and dealt with it within the context of its own control over public funding. </li></ul><ul><ul><li>Hyde Amendment </li></ul></ul><ul><ul><li>Family Planning Act </li></ul></ul>
    7. 7. Legalization of the Birth Control Pill and Women’s Emancipation <ul><li>Concept of birth control relies on a morality separating sex from reproduction (a re-orientation of sexual values) </li></ul><ul><li>1870s marks the beginning of campaigns for voluntary motherhood. </li></ul><ul><li>Voluntary motherhood is a feminist socialist movement supported by local health professionals, clergy members, and feminist activists who share birth control methods at grassroots levels prior to legalization. </li></ul><ul><li>Early meaning of pill was different for people of different races: in the early 1960s, government invested in family planning for black people and first clinics were in black neighborhoods. </li></ul><ul><li>Value of black children to white people drops after slavery and suddenly efforts are to minimize black population. </li></ul><ul><li>Birth control may be the material basis for women’s emancipation. Constitutes the “elimination of women’s only significant biological disadvantage” (Gordon, 1976). </li></ul><ul><li>1959: President Eisenhower states in press conference that birth control is government’s responsibility or business. </li></ul><ul><li>May 1960: the FDA approves the first birth control pill. </li></ul><ul><li>June 1965: Griswald vs. Connecticut legalizes the pill for married women. </li></ul><ul><li>December 1967: NAACP charges Planned Parenthood with using the pill as an “instrument of racial genocide” in public statement. </li></ul><ul><li>March 1972: Eisenstadt vs. Baird legalizes the pill for unmarried women. </li></ul><ul><li>1973: number of American women on the pill reaches 10 million. </li></ul><ul><li>1974: Government supports birth control clinics in 2,379 of nation’s 3,099 counties </li></ul><ul><li>1982: Women of reproductive age who are employed reaches 60% </li></ul>
    8. 8. The Indian Health Care Improvement Act of 1976 <ul><li>Enacted as part of a series of self-determination legislation in the 1970’s as a means for “the Indian individual, the Indian family, and the Indian community be motivated to participate in solving their own problems” (Danziger, 1984, p.71). </li></ul><ul><li>Triggered by investigations by several national task forces, commissions, and congressional committees that uncovered many problems in the reservation living conditions, and discovered low levels of education, health, and income (The Kennedy Report) (Danziger). </li></ul><ul><li>Goal of the act was to provide more access to health care resources, provide more services to the Indian population and adequate and fully staffed facilities (by 1982 Native orgs operated 4 hospitals and 272 clinics) (Danziger). </li></ul><ul><li>Many Indian leaders complained that the IHS and BIA treated Indians in a condescending manner and interpreted the self-determination acts to benefit them more than the population the acts intended to serve. There was also heavy criticism of Congress: the commitment they had made was not matched with adequate funding for the programs; many thought the programs has been designed to fail (Danziger). </li></ul><ul><li>The IHS also provided family planning services to American Indians because of their high birth rate, but it was later revealed that they had sterilized 25 to 50 percent of Native American women between 1970 and 1976 without their consent, which has had long lasting effects on Indian communities (Lawrence). </li></ul>
    9. 9. Health Services for Agricultural Migratory Workers Act of 1962 <ul><li>Two presidential committees were commissioned to investigate the situation of domestic and foreign migrant labor in the U.S., and found that migrants had poor economic, education and health conditions (NCFH). </li></ul><ul><li>Public awareness increased in the 1960’s with the documentary “Harvest of Shame”, which depicted their working and living conditions and their exploitation. The farm labor movement of the 1960’s (Chavez) waged successful strikes against growers in California, thus calling national attention to the movement (NCFH). </li></ul><ul><li>As a result, President Kennedy signed a the bill into law, designed to monitor the health status of migrant workers, provide funds and information, and in 1966 hospitalization was added to the services provided by migrant clinics (NCFH). </li></ul><ul><li>In the 1970’s, the bill was reauthorized again, and the National Advisory Council on Migrant Health was created to advise and make recommendations on behalf of migrant workers. This council still exists today (NCFH). </li></ul><ul><li>Problems: many health centers are located far away from migrant camps, there isn’t sufficient transportation available and health teams need permission from the grower to enter the camps. The funding is also inadequate, however by 1976 health centers had provided services to 415,000 seasonal and migrant workers (Cohn & Raphael, 1977). </li></ul>
    10. 10. Health Maintenance Organization (HMOs): A Health Insurance Band-Aid <ul><li>What is an HMO?? </li></ul><ul><ul><li>“ It’s just a starter, but I think it’s the first significant delivery system change that we have seen that is innovative,” Rep. Paul G. Rogers (D-Florida) (p. 15, Hicks, 1973). </li></ul></ul><ul><ul><li>Strategy to improve health care access while reducing costs to individual consumers </li></ul></ul><ul><ul><li>Limited access to certain forms of care </li></ul></ul><ul><ul><li>Focused on prevention, rather than treatment </li></ul></ul><ul><ul><ul><li>More out-patient focused </li></ul></ul></ul><ul><ul><li>Supplemental to insurance, not an alternative to health insurance </li></ul></ul><ul><ul><li>No support for Medicaid recipients </li></ul></ul><ul><li>Was this health policy reform?? Or a way to patch up existing health care?? </li></ul>
    11. 11. But… is it all for show?? <ul><li>Strong support and push for a National Health Insurance plan (NHI) in the 60’s, but dwindled in the mid-70’s </li></ul><ul><li>NHI was no longer a priority at the end of the decade </li></ul><ul><li>Introduction of health care regulations in the 70’s </li></ul><ul><li>Shift toward “cost containment” health care near end of decade </li></ul><ul><li>Paternalistic decision of who’s worthy and unworthy of health care </li></ul><ul><li>Culturally-insensitive decisions in health care </li></ul><ul><li>Emphasis on physician/nurse education, improvement of health facilities </li></ul><ul><li>Women’s reproductive health advocacy </li></ul><ul><li>Through the 60’s and 70’s, the government felt increasing pressure from the people to initiate health care reform, but the majority of the programs were under funded and not cost-effective! </li></ul><ul><li>… Alas, there is still no health reform and we are still working towards National Health Insurance! </li></ul>

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