Can you imagine what life would be like today for old and/or impoverished Black folks, if they did not have both Medicare and Medicaid? Think about it. 

Over the past twenty-seven years, Black communities have been devastated by the triple public health assaults of AIDS, drugs, and violence, all orchestrated within the context of a deliberate racist political reaction to the second reconstruction that was ushered in by the historic Brown vs. Board of Education decision of 1954.  

Beginning in 1980, these profound pandemics arose out of massive Black population displacement, incarceration, absence of healthcare access, and despair from conditions that Black people did not create and do not control. The Democratic and Republican parties moved precipitously to the right under specious slogans of white nationalism such as New Democrat and Contract with America respectively. Among their brain-child, right-wing national programs, were fake wars on crime and drugs and “ending welfare as we know it”. 

Accordingly, powerful, rich corporate elites and their political puppets intentionally created these draconian right-wing policies and their foreseeable outcomes in order to re-gain some semblance of meaningful control of the Black community and their freedom movement that had been lost by them due to the historic success of the civil rights movement of the 1960’s. The white nationalists were triumphant. The impact of their policies has been genocidal. 

Had not Medicare and Medicaid existed during this twenty-seven year period of stealthy white supremacist resurgence in the promulgation of national public policy, whole demographic categories of Black people in America, principally those living in urban centers and rural communities would have been obliterated at levels far greater than what has already taken place. The “official” pronouncement to explain our disappearance would simply be that “we brought it upon ourselves”. The white nationalists say that now. 

Medicare and Medicaid, federal programs created in 1965, are anti-poverty measures that had contributed to the significant drop in the rate of poverty of African Americans between 1967 and 1972. From 1967 to 1979, the poverty rate of African Americans dropped from 39.3% to 31.0%. However, between 1980 and 1992, the African American poverty rate remained at 30% or higher. The poverty rate in 1988 was slightly higher than it was in 1968. 

But in 1982, the 400 richest families in the United States owned $92 billion. Thirteen years later in 1995, the 400 richest owned $480 billion. During the same period, stock prices went up 400 percent.  

In contrast, during this same time, 40 million people in the United States were without health insurance. Infants died of sickness and malnutrition at a rate higher than that of any other industrialized country. In 1988, 40,000 babies died before their first birthdays. For people of color, the statistics were worse: Infants died at twice the rate of white children, and the life expectancy of a Black man in Harlem, according to a United Nations report, was less than that of Cambodians or the Sudanese. These dire conditions persisted as hospital closings in already medically underserved communities of color accelerated, throughout the nation.  

Not surprisingly, the corporate public policy elites and their political mouthpieces were even at that time ignoring the will of the American people who, in 1989 and by a 61% majority, wanted an expanded and improved Medicare for All, single-payer healthcare system, to end the dire healthcare crisis in the United States. But where did Medicare and Medicaid come from in the first place? 

Medicare and Medicaid are federal programs that were born directly from the revolutionary civil rights movement of the 1950’s and 1960’s. Black people said, “We will not be moved” and acted accordingly. At the same time, the United States was waging a racist, imperialist, and illegal war against the people of Viet Nam. Hence, the powerful elites in the United States were faced with losing the store: 

In other words, the potentially more powerful domestic revolt was threatening the capacity of the United States to prosecute an aggressive war against a social and economic justice movement abroad, while waging a domestic war against its own citizens’ social and economic justice movement at home. Hence, the United States was in an untenable political position. 

Given that the economy was expanding in the 1960’s, the corporate elites decided to blink in the face of domestic political pressure and to support Medicare and Medicaid, which became two among the social and economic justice by-products of the political contradictions of that day. Indeed, Medicare and Medicaid were the most far reaching anti-poverty measures since the advent of Social Security. 

Keep in mind that Medicare is primarily a single-payer social insurance program, administered by the federal government, as an earned right to entitled persons. Medicare covers almost all people over sixty-five (all who receive any kind of Social Security) and people with certain disabilities. Medicaid is a single-payer public assistance program for the poor.  

But even at its inception, Medicare and Medicaid were being strangled by institutional racism and class privilege: Medicaid still does not cover the impoverished who do not meet the government’s definition of poverty. Many physicians still refuse to accept Medicaid patients. These patients are disproportionately Black. Elder Black people who are disproportionately of a lower income status are increasingly very hard pressed to pay for the regressive co-pay structure of Medicare and the unregulated prescription drug costs that are currently skyrocketing and are not covered by Medicare. Lastly, Medicare either does not provide or severely limits coverage for long-term care, mental health care, and dental care.  

So, despite the monumental improvement in healthcare access represented by Medicare and Medicaid, institutional racism and capitulation to a market-driven healthcare system still perpetuates healthcare apartheid in the operation of these two historic anti-poverty/ pro-healthcare programs. 

Since 2000, all citizens of the United States have been getting poorer. The national rates of severe poverty have climbed sharply during this period. The populations experiencing severe poverty at increasing rates are children, African Americans and Latinos. Further, the economy no longer has the growth rates prevalent in the 1960’s or 1990’s. The country is now mired in another racist, illegal, aggressive war against an innocent and defenseless people; it is the longest war in US history and one that is placing an unprecedented strain on the already over-strained and failed US healthcare system. 

Presently, Black people may not endure the continuing and deepening wave of destruction that is now upon us. This is a matter of survival. The wave of destruction has three ominous features: 

1. increasing severe poverty among African Americans 

2. the inability of African Americans to emerge from the reactionary public policy structural assaults of the 1980’s and 1990’s 

3. the deepening healthcare crises in the US where now nearly 50 million Americans are uninsured and medical costs have nearly tripled. 

But there is a solution to the severe healthcare crisis in the United States.  

We must secure now an expanded and improved Medicare for All, single-payer healthcare system in the United States. Such a system fixes all of the deficiencies in the operation of the present Medicare and Medicaid national programs: all people will be covered from the womb to the tomb with excellent comprehensive coverage. No person will be excluded for any reason, including citizenship status, income, or employment status. In addition, an improved Medicare for All, single-payer national healthcare system will contain provisions for preventive health coverage, comprehensive coverage for mental healthcare, dental care, long-term care for chronic illnesses. Lastly, prescription drugs will be free and affordable for everyone, without exception or gaps in coverage. 

An expanded and improved Medicare for All, national single-payer healthcare system will respond to the clarion calls of freedom of Black people who dismantled Jim Crow. Under this new system, no longer will Black people be denied healthcare and Black people will have a significantly improved opportunity to work ourselves out of poverty. 

You can help: 

Contact House Speaker Nancy Pelosi (D-Ca) and Charles Rangel (D-NY), chair of the House Ways and Means Committee to hold congressional hearings immediately on the severe healthcare crisis in the United States, where Cong. John Conyers’ (D-Mich.) Bill HR 676 has a comprehensive public review. 

Also contact, the federal elected official in the congressional district where you live and urge him or her to support HR 676.  

Organize a meeting in your community on the healthcare crisis.  

Contact Healthcare-Now at www.healthcare-now.org and at 800-453-1305 for suggestions on how to organize such a meeting and how to build this historic human rights movement generally.  It is not difficult. We have materials that can assist you. We want to hear from you. 

The national movement for an expanded and improved Medicare for All, national single-payer healthcare system is growing across the country, exponentially. A fatal error would be to celebrate too soon. We have an excellent 18-month window of opportunity to make healthcare a human right, in this country. The majority of the American people have supported this campaign for decades. We have also entered a presidential election cycle. What has been missing is a powerful people’s human rights movement, comparable to the civil rights movement of the 1960’s, to force the elites to move out of the way. We need you to actively participate in this freedom work and to give it an even deeper mass base. 

This historic dynamic has begun. 

In New York City on March 29, 2007, several thousand people demonstrated for an expanded and improved Medicare for All, single-payer healthcare system. Scores of people were arrested for righteous civil disobedience actions. The demonstration was organized by ACT UP, and co sponsored by over twenty community-based organizations including, Healthcare-NOW! and Physicians for a National Health Plan. 

These are the strategies that dismantled Jim Crow and gave us Medicare and Medicaid. We must now up the ante and institute these same proven “in your face” strategies to ensure that every resident in this country is guaranteed quality health care through an expanded and improved Medicare for All, national single-payer healthcare system. Contact us. We must not be moved. 

Mr. Sankofa is a human rights public policy specialist and community organizer. He is a national organizer for Healthcare-Now. He is also the strategic planning consultant for the National Coalition of Blacks for Reparations in America, Legal Defense, Research, and Education Fund. As a former trial attorney, specializing in complex institutional reform litigation, Mr. Sankofa, directed the AIDS Project of the National Prison Project of the ACLU Foundation. He is a graduate of Bowdoin College in Brunswick Maine and the Antioch School of Law. Raised in Washington, DC, Mr. Sankofa now lives in Brooklyn, New York. Click here to contact Ajamu K. Sankofa, Esq. and Healthcare-NOW. 

Click here to read any of the articles in this special BC series on Single-Payer Healthcare.