Just a reminder that we’ll be discussing this book in a few hours (9AM PT/Noon ET). The link for paid subscribers to jump into our Zoom room is here.
This past July, Medicare turned 61. Most Americans just think of it as the program that gave seniors inexpensive healthcare for the rest of their lives, but — unknown to most Americans — it was also the most successful racial integration program in the history of the United States. Sadly, the way that happened has been almost entirely scrubbed from our national memory.
As recently as 1964, Black Americans were routinely turned away from the majority of America’s hospitals. Even women in labor, even people bleeding from a car wreck, Black people were turned away, and on those rare occasions when they were admitted to a hospital they were segregated to wait in basement wards, sometimes for days, until all the white patients upstairs had been seen. The Louisiana Red Cross labeled its blood supply “White” and “Colored.”
Even though the Civil Rights Title VI outlawed this, the hospital industry ignored it. The American Hospital Association’s own magazine ran an article explaining that keeping the races apart “must be [a hospital’s] primary consideration.”
Enter a brilliant move by Lyndon Johnson and a handful of men at HEW and Social Security: they wrote the Medicare Act in a way that prevented even one dollar of Medicare funds to go to any hospital that wasn’t in compliance with the Civil Rights Act.
Then they tipped off Dr. Martin Luther King Jr., the NAACP Legal Defense Fund, and the (Black) National Medical Association, who recruited hundreds of Black volunteers to fan out across the country and try to get into hospitals. When doctors and hospitals figured out what was happening, some of these people had crosses burned in their front yards or the lug nuts removed from their cars’ wheels.
But Johnson held firm and refused to pay them anything at all if there was any proof whatsoever they were still engaging in racial discrimination. And within an astounding 4 months, roughly 6,500 hospitals bent their knees and medicine went from being America’s most segregated institutions to its most integrated.
The chapter starts with what came before. There’s the American Medical Association hiring a B-movie actor named Ronald Reagan to record an LP warning that Medicare was the first step to socialism, a record my dad played for our whole family. There’s LBJ explaining the AMA to George Meany with a story about chickens (you’ll see why I couldn’t paraphrase it). And there’s the day the AMA’s leadership walked into the Cabinet Room to fight Medicare and walked out having endorsed it on camera. It’s truly a hero’s journey story and deserves to be more well-known.
LBJ takes it to Reagan and the doctors
America took a somewhat different path.
On June 13, 1961 President John F. Kennedy gave a speech proposing what we today call Medicare. ““I do not know any problem or remedy more obvious which now faces the Congress of the United States,” Kennedy said, speaking of elderly Americans on fixed incomes without health insurance.
“Now, the program we suggested,” Kennedy said, “will provide that [the working person] will set aside during his working years an average of $13 a year, not a burden for anyone employed, $13 a year. And that man and woman will know when they are over 65 that they will never be a burden upon their children and never be a charity case upon the national government…”
It was a sweeping and classic Kennedy proposal, on the order of sending a man to the moon, that, four years later, President Johnson would remind Americans of as he used Kennedy’s memory to shame legislators into voting for Medicare.
“There isn’t a country in Western Europe that didn’t do what we are doing 50 years ago or 40 years ago,” Kennedy said. “We are not suggesting something radical and new or violent. We are not suggesting that the government come between the doctor and his patient. We are suggesting what every other major, developed, intelligent country did for its people a generation ago.”
He closed the speech with the simple challenge: “I think it is time the United States caught up.”112 In response, the all-white American Medical Association hired B-movie actor Ronald Reagan to record a chilling warning, one that successfully defeated Kennedy’s initiative. Reagan cast the debate not as one about healthcare but as a battle between democracy and socialism, then the feared province of the Union of Soviet Socialist Republics, the USSR.
“[T]his threat is with us,” Reagan warned in a grave voice, “and, at the moment, is more imminent” than any time in the past.
Embracing his version of Frederick Hoffman’s 1920s warnings about the dangers of the “Prussian way” of single-payer medicine, Reagan said, “One of the traditional methods of imposing statism or socialism on a people has been by way of medicine. It’s very easy to disguise a medical program as a humanitarian project. Most people are a little reluctant to oppose anything that suggests medical care for people who possibly can’t afford it.”