1. Comments on Katherine Swartz War on Poverty: Care of the Elderly (Some Examples) David Mechanic, Ph.D. Institute for Health, Health Care Policy and Aging Research Rutgers, The State University of New Jersey Ann Arbor, Michigan June 12-13, 2012

2. War on Poverty and Health Care Title VI 1964 Civil Right Act Institutional Population Effects Effects Outcomes Poverty Programs Medicare Civil Rights— Increased Access Improved Desegregation to Hospital and Outcomes and Access Physician Services Reduction in Race Disparities Medicaid Growth in Institutional Capacity – nursing homes; general hospital beds CHCs Increased Costs SSDI – SSI Hospital and Physician Payment for Formerly Free Care

3. Total Mortality, United States, 1900-1990 From House and Williams, 2000 0 2000 4000 6000 8000 10000 12000 14000 1900191019201930194019501960197019801990 Age: 75-8465-7455-64 Deaths per 100,000 Population

4. Probability of Survival after the age of 80 among U.S. Whites and Japanese, Swedish, French, and English and Welsh Persons Born from 1885 to 1889* * As of 1990 Source: K.G. Manton and J.W. Vaupel, New England Journal of Medicine 1995, 333: 1232-1235

5. U.S. Women Fall Behind in Life Expectancy (at age 50) 1980-2005 Source: International Differences in Mortality at Older Ages, National Research Council, 2010

6. Resident Patients in State and County Mental Hospitals: Total Population as a Percentage of 1955 Base Medicaid and SSI/SSDI Introduction of Antipsychotics

7. Nursing Home Residents Before and After Medicaid/Medicare By Age and Race Rate per 1,000 White non-White 1963 65-74 years 8.1 5.9 75-84 years 41.713.8 85+ 157.7 41.8 1969 65-74 years 11.7 9.6 75-84 years 54.1 22.9 85+ 221.952.4 2004 White Black Other 65-74 years 8.5 20.2 6.2 75-84 years 35.2 55.5 17.8 85+ 139.4 160.7 65.3 Sources: Adapted from IOM, Health Care in a Context of Civil Rights, April 1981; Table 15: NCHS, Nursing Home Survey, 2004 (2009)

8. Black-White Infant Mortality U.S., 1950-1995 Absolute Absolute Reduction Reduction White in Rate+ Black in Rate+ 1950 26.8 --- 43.9 --- 1955 23.6 3.2 43.1.8 1960 22.9.7 44.3 (+1.2) 1965 21.5 1.4 41.7 2.6 1970 17.8 3.7 32.6 9.1 1975 14.2 3.6 26.2 6.4 1983 9.3 4.9 19.2 7.0 1985 8.9.4 18.6.6 1990 7.3 1.6 16.9 1.7 1995 6.3 1.0 14.6 2.3 Total Absolute Reduction in Rate, 1950-1995 20.5 29.3 + Per 1,000 Live Births Adapted from Health, United States