PART THREE

The Modern Fight for a Human Right to Healthcare

Is Healthcare a Right or a Privilege?

Although there are a variety of ways and means by which Americans can acquire healthcare or health insurance, the bottom line of it all is quite binary: access to quality healthcare is either a right or a privilege.

The answer to this debate informs the entire spectrum of policy solutions and systems to fund and deliver healthcare.

It’s the largest question of all: does human nature or high-functioning political culture require that healthcare be a birthright of citizenship or even of humanity, or do we need to hold out healthcare and other essential services as if they were a carrot before a horse to get people to pull the cart of an economically and politically functional society?

And does treating healthcare as a thing to be earned rather than a birthright actually help a society or country in any way? Does it increase worker productivity? Does it lead to a healthier population? Does it incentivize people in any positive way whatsoever?

Conservatives say that people should have full access to quality healthcare only if they earn it. They have a variety of rationalizations, justifications, and historical examples to support their hypothesis. Most of these go something like this:

These objections, at their core, argue that we’re each responsible for ourselves, but none of us are really responsible for anybody or everybody else. Just slightly changing the question, though, immediately shows the logical and moral fallacy of these statements.

Instead of asking, “Should your tax money go to provide society (including yourself) with healthcare, or should you alone be responsible for taking care of sickness?” try asking, “Should your tax money go to provide society (including yourself) with a fire department, or should you be responsible for putting it out if your house catches on fire?”

While the first organized municipal fire department was described in a 1690 book by Jan van der Heyden, it was largely for wealthy people and mostly privately funded.¹ By the 1830s, insurance companies had started funding fire departments, but they only showed up when the home of a policyholder was on fire.

The problem they encountered was that fires have an obnoxious tendency to move from one wooden building to the next—much like infectious diseases in people.

Various American communities experimented with paid, private fire departments, but the optics of driving a fire truck past a house that hadn’t paid into the department and letting it burn down were bad—and, again, fires often don’t just stay where they started. (There are still some private fire departments in the United States, although the biggest are in large high-end gated or private residential communities and supplement local fire departments.)

All but the most hard-core libertarian ideologues would agree that publicly funded fire departments that take care of everything and anything that may catch on fire are a good idea.

Thus, the follow-up question is always, “Isn’t your body more important than your house? Why should we all contribute to protect your house when it catches on fire, but not contribute to protect your body when it (metaphorically) does?”

In this section, we will see the history of the fight for healthcare as a right and how it has been undermined simultaneously by well-funded libertarian and “free market” think tanks, along with America’s history of white supremacy. America’s current healthcare system is simultaneously a product of white supremacy and systemic racism and an instrument for upholding those same institutions.

Why Social Security Doesn’t Already Include a Right to Healthcare

President Franklin Roosevelt made Frances Perkins our first female labor secretary, letting her confront an issue she well knew and giving her an opportunity to push for a national healthcare system.

As a working woman, she was often ignored or treated with massive disrespect and even outright scorn. Her husband and daughter both suffered from serious bipolar disorder, and wags in the press accused her of having an affair with Eleanor Roosevelt—“How else,” they would ask, “could a woman possibly end up in the Cabinet of the most powerful man in the world?”

Her first contact with real poverty was as a new college student, and she wrote of that experience, “From the time I was in college I was horrified at the work that many women and children had to do in factories. There were absolutely no effective laws that regulated the number of hours they were permitted to work. There were no provisions which guarded their health nor adequately looked after their compensation in case of injury. Those things seemed very wrong. I was young and was inspired with the idea of reforming, or at least doing what I could, to help change those abuses.”²

In 1905, when she was working with the poor as a student in Chicago, she wrote, “I had to do something about unnecessary hazards to life, unnecessary poverty. It was sort of up to me.”³

She became a crusader for workers’ rights and safety after America watched dozens of young women and girls throw themselves to their deaths in New York City when the Triangle Shirtwaist Factory caught fire with the workers locked inside.

As her biography on the Frances Perkins Center’s website says,

While Perkins deserves much credit for the authorship and passage of many of the New Deal programs, she was empowered by the loud demands of people and the growing strength of worker unions at the time.

One part that she fought hard for, but never lived to see put into law in the United States, was universal health insurance coverage. Social Security was always intended to be a cradle-to-grave program of coverage, and in Perkins’s mind that included health insurance coverage for everyone through the government.

Roosevelt and Perkins were slandered as communists and socialists for their economic proposals, but like Bismarck before them, the Roosevelt administration persuaded lawmakers to implement new social programs as a matter of national security.

The Depression had already forced Congress’s hand to pass a series of socially and economically progressive emergency relief measures. In January 1935, FDR introduced the administration’s plan for economic security to Congress, much of it aimed to make many of the temporary emergency measures permanent.

On February 25, 1935, Perkins spoke at length about the program in a national radio address, first explaining, “The process of recovery is not a simple one. We cannot be satisfied merely with makeshift arrangements which will tide us over the present emergencies. We must devise plans that will not merely alleviate the ills of today, but will prevent, as far as it is humanly possible to do so, their recurrence in the future. The task of recovery is inseparable from the fundamental task of social reconstruction.”⁵

She went on to lay out exactly how their plan addressed the nation’s economic security: “Our program deals with safeguards against unemployment, with old-age security, with maternal aid and aid to crippled and dependent children and public health services.”

But she recognized that public health services didn’t include public health insurance, which she hoped to see presented as a concrete plan in some near future: “Another major subject—health insurance—is dealt with briefly in the report of the Committee on Economic Security, but without any definite recommendations. Fortunate in having secured the cooperation of the medical and other professions directly concerned, the committee is working on a plan for health insurance which will be reported later in the year. Our present program calls for the extension of existing public health services to meet conditions accentuated by the depression. Similarly, the provisions for maternal aid and aid to dependent and crippled children are not new departures, but rather the extension and amplification of safeguards which for a number of years have been a recognized part of public responsibility.”⁶

As the Frances Perkins Center notes, the American Medical Association mobilized such intense opposition to her plan for universal health insurance that it threatened to scuttle the entire Social Security Act from becoming law.⁷

Author Adam Cohen clarified to Amy Goodman in 2009, “She really was the conscience of the New Deal in many ways . . . she chaired the Social Security committee. And she wanted it to go further . . . to include national health insurance, but the AMA (American Medical Association), even back then, was very strong and opposed it. And she and a couple other progressives on the committee said, you know, ‘We better just settle for what we can get.’ They didn’t want to lose the whole Social Security program.”⁸

Perkins herself wrote in an introduction to Edwin E. Witte’s book Development of the Social Security Act that national health insurance “would have killed the whole Social Security Act if it had been pressed at that time.”⁹

By August 14, 1935, despite a report having been commissioned, nothing was moving forward with the plan for national health insurance. Historian Jaap Kooijman wrote in Presidential Studies Quarterly that Assistant Secretary of Labor Arthur Altmeyer asked Roosevelt’s press secretary Stephen Early what he should do with the health insurance report. According to Kooijman, Altmeyer “believed that the report described a ‘practical program’ that could challenge the opposition.” Early responded that it was an “old report—and the president hopes no publicity will be given it. Just forget about it.”

The report was forwarded to the Social Security Board for further study, but shortly thereafter Roosevelt signaled that he had no intention of promoting the plan further.

Kooijman describes the dedication of a partially federally funded medical center in Jersey City, New Jersey. When Roosevelt spoke, he declared that “we must do more, much more to help the small-income families in time of sickness,” but then he conceded to the gathered medical professionals that “the overwhelming majority of the doctors of the Nation want medicine kept out of politics. On occasions in the past attempts have been made to put medicine into politics. Such attempts have always failed and always will fail.”¹⁰

Frances Perkins lived long enough to see two more major attempts to create a universal health insurance system, first as part of FDR’s “Second Bill of Rights,” and then when President Harry Truman similarly failed. She died on May 14, 1965, just two and a half months before Medicare was signed into law on July 30, 1965.

But if FDR was right and doctors wanted “medicine kept out of politics,” how did other developed English-speaking countries like Canada and those in the United Kingdom get their universal healthcare programs?

Healthcare to Defeat Fascism

As far as the press knew, President Franklin D. Roosevelt, along with a small entourage, had taken the presidential yacht, the Sequoia, on a 10-day fly-fishing trip off the coast of northern New England in early August 1941. In reality, he’d left the yacht on August 5 to board the USS Augusta, just off the coast of Newfoundland, Canada.¹¹ It was a Northampton-class heavy cruiser that later would be the flagship for the D-Day landings.

The United States had not yet entered the war—that would happen when the Japanese attacked Pearl Harbor on December 7—but there were urgent questions to be answered for the future, particularly if fascism was defeated.

The Augusta met the HMS Prince of Wales, a British battleship that would later be sunk by a Japanese torpedo off the coast of Singapore, but that day it was secretly carrying British prime minister Winston Churchill.

Sunday morning, August 10, the two leaders met on the fantail of the Prince of Wales and sat through a church service with the ship’s crew; Churchill himself had selected the hymns, working from the obscure up to a finale with “Onward Christian Soldiers.”

Churchill later said that he’d chosen that particular hymn to highlight the service because “I felt that this was no vain presumption, but that we had the right to feel that we are serving a cause for the sake of which a trumpet has sounded from on high.”

After the service, he concluded that the choice was both wise and important.

“When I looked upon that densely packed congregation of fighting men of the same language, of the same faith, of the same fundamental laws, of the same ideals,” Churchill said, “it swept across me that here was the only hope, but also the sure hope, of saving the world from measureless degradation.”¹²

Nobody knows for sure what was discussed during Roosevelt and Churchill’s several days of meetings. American fascists like Charles Lindbergh, who were agitating against America coming to Europe’s defense against Hitler, would have met public news of the meeting with outrage; they and their Republican allies in Congress were constantly accusing FDR of a secret plan to enter the war.

Republican opposition to challenging Hitler was so strong, in fact, that America’s then-top-selling novelist, Rex Stout (creator of the Nero Wolfe detective series, which sold over 70 million copies), published a book made up entirely of floor speeches from American fascist sympathizers such as Representative Hamilton Fish, Republican of New York, who declared at an America First rally, “Colonel Lindbergh was right when he said in one of his recent speeches, ‘Let us stop this hysterical chatter about calamity and invasion.’”¹³

Fish said, on the floor of Congress on June 22, 1940, “Let us have an end to the secret diplomacy and the secret commitments of President Roosevelt . . . Roosevelt alarmed the nation. . . . We have more to fear from the warmakers from within than from our enemies without.”¹⁴

Stout’s book The Illustrious Dunderheads, today a classic and a collector’s item, illustrates what a struggle FDR faced against America’s right wing.

The Atlantic Charter was a short document sent by telegraph from FDR’s warship to Washington, DC, on August 14, 1941. Its purpose was to define what the developed world would need to do after the war was over to prevent the rise of another fascistic regime among other democratic nations.¹⁵

It said explicitly that neither the United States nor Great Britain was trying to seize any country’s territory, that Nazi-occupied countries should have “self-government restored to [them],” and that “all nations” should work toward “securing, for all, improved labor standards, economic advancement and social security.”¹⁶

When the nearly 200 legislators that Stout quotes later learned what FDR and Churchill had been planning, all hell broke loose.

Roosevelt briefed Congress on August 21 and responded to the GOP outrage that he’d dared meet with Churchill in secret and negotiate a document that “promoted socialism” by metaphorically tweaking their noses.

“There isn’t any copy of The Atlantic Charter, so far as I know,” he said. “I haven’t got one. The British haven’t got one. The nearest thing you will get is [from] the radio operator on Augusta and Prince of Wales. That’s the nearest thing you will come to it. . . . There was no formal document.”¹⁷

Nonetheless, The Atlantic Charter set off a firestorm that eventually led to Britain—and almost every other country in Europe—developing a universal national healthcare program. Its core premise was that fascist governments, being focused on the rights and income of corporations and the very wealthy (the most common definition of fascism then was “a merger of state and business interests, combined with belligerent nationalism”), produced increasing levels of misery among their people as wages slipped and workers’ rights were suppressed.

That misery, while causing many to openly ask for strongman rule, could effectively be answered by a government that actually met the needs of its people. Social welfare programs, including a national healthcare program, in other words, were the best way to prevent the rise of fascism in a democratic republic.

In the United States, New York Post columnist Samuel Grafton published an article stating that “[t]he English press began to debate the need for an ‘economic bill of rights,’ to defeat Hitlerism in the world forever by establishing minimum standards of housing, food, education and medical care, along with free speech, free press and free worship.”

FDR’s main speechwriter, Sam Rosenman, wrote that a copy of Grafton’s article was in the file that Roosevelt had compiled in preparation for his later “Four Freedoms” speech, which explicitly called for healthcare in the United States to be legally a universal American right rather than a mere privilege.¹⁸

The Atlantic Charter also led to a September 1942 publication by the US National Resources Planning Board titled After the War—Toward Security: Freedom From Want. The pamphlet noted that “without social and economic security there can be no true guarantee of freedom” because having a strong social safety net including provisions for the nation’s health was, “indeed, a fundamental part of national defense.”¹⁹

Across the Atlantic, just after America joined Britain to fight fascist Germany, Robert M. Barrington-Ward, editor of the London Times, wrote Churchill in April 1942 that it was time for Britain to take up “the essential purpose of the Charter.”

“They are aims which will more and more obliterate the distinctions once possible between domestic and foreign policy,” Barrington-Ward wrote, echoing the idea that the best way to fight fascism was to remove the worker insecurity that often brought it to power (as had happened in Germany in the wreckage after World War I). “The realization of the Charter,” he added, “can and must begin at home.”²⁰

And the “aims” that so animated Barrington-Ward? “The fundamental demand of the peace-makers,” he wrote, “from uncounted millions of mankind, will be for welfare and security.”

Two months later, in November 1942, Sir William Beveridge presented a report to the British Parliament summarizing how that nation might most effectively “banish poverty and want” from its shores and prevent forever a fascist rise in the UK.

The Beveridge Report: The British Plan for Defense and Welfare

The Beveridge Report, while not well known in the United States, is as familiar to every British schoolchild as Lincoln’s Gettysburg Address is to Americans. Beveridge saw himself as a revolutionary in the mold of FDR—taking bold steps to solve big problems, paramount among them the widespread lack of access to healthcare.

“A revolutionary moment in the world’s history is a time for revolutions, not for patching,” he wrote about his report.²¹

At the time, the UK’s health and insurance system resembled today’s in the United States. There was means-tested help for poor people, along with competing insurance companies and competing hospital systems, while doctors and pharmaceutical companies pretty much charged whatever they could get away with.

Beveridge pointed out that Britain’s social welfare system, including supports for healthcare, was a “complex of disconnected administrative organs, proceeding on different principles, doing invaluable service but at a cost in money and trouble and anomalous treatment of identical problems for which there is no justification.”²²

Beveridge wrote that there were then “five giants on the road” blocking progress toward a more just society, including “Want, Disease, Ignorance, Squalor, and Idleness.”²³

When the report was submitted to Parliament, a huge debate broke out, with conservatives like Brendan Bracken suggesting that it should be suppressed and never officially published.

Sir Kingsley Wood, the chancellor of the exchequer, complained that following Beveridge’s recommendations would hit Britain—even after the war—with “an impracticable financial commitment.”

Nonetheless, with Churchill’s emphatic support, the cabinet voted on November 26 to publish the Report on December 2, 1942.

Beveridge’s report hit Britain like a thunderclap. As recounted in Welfare States and Societies in the Making, “The MOI Home Intelligence reported that the plan had been ‘welcomed with almost universal approval by people of all shades of opinion and by all sections of the community,’ and that it was seen as the first step towards postwar reconstruction and as ‘the first real attempt to put into practice the talk about the new world.’ . . . A British Institute of Public Opinion Report based on a sample taken in the fortnight after publication of the White Paper found that 95 per cent of the public had heard about it; that there was ‘great interest in it,’ most markedly ‘among poorer people.’ The greatest criticism, the BIPO found, was that the proposed old-age pensions were not high enough. ‘There was overwhelming agreement that the plan should be put into effect.’”²⁴ Amazingly, Churchill’s own conservative Tories were among the most anxious to fascism-proof Britain with a strong social welfare system, including a national health service. “The Tory Reform Committee, consisting of 45 Conservative MPs, demanded the founding of a Ministry of Social Security immediately.”²⁵

The next spring, the war was still going on, worse than ever in some respects. Nonetheless, Churchill and Parliament continued hard at work on implementing Beveridge’s vision for a national healthcare system. He gave a speech broadcast live by the BBC on March 21, 1943, which he titled “After the War,” promising that once the war was over, there would be “a four-year plan” that would put into place a national “compulsory” (everybody in) health insurance program for the country.

“I have been prominently connected with all these schemes of national compulsory organized thrift from the time when I brought my friend Sir William Beveridge into the public service thirty-five years ago,” Churchill said, then mentioning Lloyd George’s social security program for widows, orphans, and people over 65, which had been put into place 18 years earlier with Churchill’s help.

“The time is now ripe for another great advance,” he summarized, “and any one can see what large savings there will be in administration once the whole process of insurance becomes unified, compulsory and national. Here is a real opportunity for what I once called ‘bringing the magic of averages to the rescue of the millions,’ therefore, you must rank me and my colleagues as strong partisans of national compulsory insurance for all classes, for all purposes, from the cradle to the grave.”²⁶

Churchill won World War II but lost the British election of 1945, so it was Prime Minister Clement Attlee, with the help of his health minister, Aneurin Bevan, who put the National Health Service into place.

According to Historic UK, “This project was said to be based on three ideas which Bevan expressed in the launch on 5th July 1948. These essential values were, firstly, that the services helped everyone; secondly, healthcare was free and finally, that care would be provided based on need rather than ability to pay.”²⁷

Churchill had promised that “every preparation . . . will be made with the utmost energy . . . so that when the moment comes everything will be ready.”²⁸ He hadn’t failed.

In 1948, President Harry Truman tried unsuccessfully to pass the national single-payer healthcare system that FDR had proposed four years earlier, but Truman was defeated in the effort by Republicans in Congress.

These failed attempts in the United States did not stop Canadians from picking up the idea.

How Canada Won a Right to Healthcare

It’s nearly impossible to disentangle universal healthcare from basic human rights; healthcare is the ultimate right-to-life issue. But it can also be expedient for conservative politicians who would otherwise not be inclined to “give” citizens free healthcare.

The arch-conservative Otto von Bismarck brought universal healthcare to Germany, and the hard-core conservative Winston Churchill first proposed the British National Health Service in his March 21, 1943, speech (saying it must cover all Britons “from cradle to grave”).²⁹ Closer to home, the Canadian national Medicare system was taken national with legislation supported by Canada’s conservative prime minister, John Diefenbaker.³⁰

But in every case, and consistently around the world, it was a progressive, grassroots sentiment that brought universal healthcare to the fore.

Tommy Douglas was, in many ways, the Bernie Sanders of Canada (albeit in the 1940s and 1950s), from his childhood experiences that turned him into a progressive activist to his untiring decades of work to make healthcare a right, rather than a privilege.

Healthcare—or the lack of it—informed Douglas’s own journey.

In 1910, when he was six years old, he injured his leg, and because his family lacked access to a doctor or hospital, it healed badly. The wound continued to hurt and fester until, four years later, the infection worked its way deep into his leg bone.

In desperation, his parents took him to a doctor, who said that surgery to open the leg and clean out the wound would be too expensive and complex for the family to afford; he’d have to amputate the leg. By happenstance, another surgeon at the hospital “took an interest” in the case and offered to do the surgery for free if his medical students could watch, a deal the Douglas family made, saving the leg.³¹

“Had I been a rich man’s son,” Douglas wrote, “the services of the finest surgeons would have been available. As an iron molder’s boy, I almost had my leg amputated before chance intervened and a specialist cured me without thought of a fee.”³²

In 1919, Douglas was a teenager living with his parents in Winnipeg. A huge workers’ protest for better wages and safer working conditions had formed on a major street a block or so away, and Douglas climbed to his rooftop to check it out.

As he watched, a large contingent of police arrived, pulled out their weapons, and shot 20 of the peaceful protesters, killing two and severely injuring most of the rest. The young Douglas was horrified; watching those men writhe in pain and die was, for him, a life-changing experience.

A decade later, he was working as the pastor of the Calvary Baptist Church in Weyburn, Saskatchewan, still horrified by working people’s lack of access to healthcare.

“I buried two young men in their 30s with young families who died because there was no doctor readily available and they hadn’t the money to get proper care,” he wrote at the time.³³

And then another labor strike came to his door, this time miners in his little town protesting dangerous working conditions, brutal bosses, and lousy pay. Douglas organized his church to collect blankets and food for the striking workers, who were essentially camping in the streets and public places as they conducted their protest.

After a few days of this, as Douglas was passing out food, the police again showed up, firing into the crowd and killing three of the miners on the spot.

The experience led Douglas, in 1934, to join the Cooperative Commonwealth Federation (CCF), a political party advocating democratic socialism for Canada. The next year, he ran for parliament on their ticket and won a seat in Canada’s federal House of Commons.

After nine years of working without success at the federal level to bring about healthcare for all Canadians, Douglas gave up and returned to Saskatchewan, running for premier (what we’d call governor) and winning the seat at the age of 39.

In 1947, he succeeded in passing numerous progressive reforms, including forcing the University of Saskatchewan to open a school of medicine to ensure that the state would have a good supply of doctors and other medical professionals.

Only Saskatchewan’s larger cities had electricity when Douglas was elected; within a few years he’d extended it to every rural area in the province. He passed a law requiring two weeks of paid vacation for workers and a bill of rights ending legal racial discrimination. He put into place a state-run low-cost auto insurance program and a law guaranteeing the “right of assembly” so that police could never again legally attack or kill strikers.

The formerly backwater province, as a result of Douglas’s reforms (raising taxes on the very wealthy, seizing private electric and water utilities and turning their profits over to the state, and taking over the lumber industry), had one of the strongest economies in the entire nation.

In 1958, John Diefenbaker became prime minister of Canada as he formed the first conservative government to run that nation since Prime Minister R. B. Bennett had given up on politics and fled to England in 1935.

The next year, in Saskatchewan, Douglas proposed a provincewide program he called Medicare, charging $5 a month and providing full medical, hospital, and dental coverage for all Saskatchewan residents of all ages.

In the lead-up to the vote, the Canadian Medical Association (CMA) and the American Medical Association (AMA) worked together with insurance companies and Saskatchewan’s conservative elite to fight Douglas’s proposal tooth and nail.

They raised a war chest unseen in previous Canadian politics, flooding the airwaves and newspapers with warnings of “Socialism!” and delivering detailed indictments of “government-controlled medicine” to every home. Province-wide, local chambers of commerce and boards of trade held public rallies charging Douglas and advocates of Medicare with communist leanings, saying they’d destroy the very fabric of the nation.³⁴

One anti-Medicare propaganda piece said that Douglas’s proposal would drive so many physicians out of Saskatchewan that “[t]hey’ll have to fill up the profession with the garbage of Europe; some of the European doctors who come out here are so bad we wonder if they ever practiced medicine.”³⁵

Nonetheless, Douglas prevailed and Saskatchewan got Medicare. And the people loved it.

Medicare and Douglas’s popularity in Saskatchewan inspired Diefenbaker to work with him to bring Saskatchewan’s Medicare program to the entire country, with the first successful federal legislation to accomplish this introduced in 1961, splitting the costs roughly 50/50 between federal and provincial governments.

Again, the CMA, AMA, chambers of commerce, and other business organizations launched a campaign, this time nationwide, of vilification similar to the earlier one in Saskatchewan, highlighted by a 23-day nationwide doctors’ strike in 1962 in protest of “socialized medicine,” along with “racial slurs, red-baiting, acts of violence and threats of blood in the streets.”³⁶

The Keep Our Doctors committee—a 1960s astroturf version of the Koch brothers’ 2009 Tea Party—joined in, with the Billy Graham of Canada, a right-wing priest named Athol Murray, telling a nationwide radio audience, “This thing may break into violence and bloodshed any day now, and God help us if it doesn’t!”

Nonetheless, Canadians could see with their own eyes how well it worked in Douglas’s Saskatchewan: a national Medicare system was fully implemented when the last province ratified it in 1966, making Douglas a national hero and helping Diefenbaker maintain his hold on federal politics until he died in office in 1979.

It hadn’t been easy for Douglas. The Royal Canadian Mounted Police (their federal police force, like the United States’ FBI) harassed and spied on him for decades, compiling an official file with more than 1,100 pages.

He was burned in effigy numerous times, threatened with death, and accused by the American Medical Association and their Canadian brethren of communist leanings, alternately depicted in conservative media as a “Nazi, Stalinist or both.”³⁷

Despite it all, today every Canadian has comprehensive health insurance provided by that nation’s Medicare program, and Tommy Douglas, “the father of Canadian Medicare,” has repeatedly been selected as the most popular Canadian in Canadian history.

LBJ Takes It to Reagan and the Doctors

America followed 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 a simple challenge: “I think it is time the United States caught up.”³⁸

In response, the all-white American Medical Association hired B-movie actor Ronald Reagan to record a chilling warning, one that 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 at 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.”

Dismissing the idea that elderly people in America were experiencing a healthcare crisis, he said Kennedy’s program “is presented in the idea of a great emergency that millions of our senior citizens are unable to provide needed medical care. . . . Now the advocates of this bill, when you try to oppose it, challenge you on an emotional basis. They say, ‘What would you do, throw these poor old people out to die without medical attention?’ That’s ridiculous; and, of course, no one’s advocated it.”

But Reagan was, indeed, advocating that seniors continue to die from lack of access to healthcare. And all in the name of fighting those evil socialists and communists.

The 33⅓ rpm long-form recording was distributed by the AMA to doctors and conservatives all across the country; my dad, a mere foot soldier in the GOP, had a copy of it that he played for our entire family.

At its end, Reagan called on us all to send letters to our members of Congress to “demand the continuation of our traditional free enterprise system.”

“If you don’t,” he warned, “this program, I promise you, will pass just as surely as the sun will come up tomorrow; and behind it will come other federal programs that will invade every area of freedom as we have known it in this country. Until, one day, as [former Socialist Party candidate for president] Norman Thomas said, we will awake to find that we have socialism.”

I can still remember my dad quoting Reagan’s last line: “If you don’t do this and I don’t do it, one of these days you and I are going to spend our sunset years telling our children, and our children’s children, what it once was like in America when men were free.”³⁹

It wasn’t until 2008 that the AMA formally apologized to Black doctors for almost two centuries of white-supremacy-fueled opposition to integrating the nation’s medical system, and even then the president of the AMA at the time wasn’t willing to do the job; it fell to Ronald M. Davis, the association’s “immediate past president.”⁴⁰

While America’s white doctors were worried about Medicare, they were even more hysterical about having to work with Black doctors and treat Black patients, which universal coverage like Medicare would require. Reagan’s recording helped the all-white AMA fight back Kennedy’s “socialism,” but only for a few years.

The month before Medicare passed Congress, the 10,000-plus physicians of the Ohio Medical Association voted for a boycott if it became law. Shortly thereafter, a group of AMA doctors set out for Washington, DC, to fight the bill.

AFL-CIO president George Meany, a big supporter of Medicare, was worried. He went to the White House to share his concerns about the incoming doctors with President Johnson.

Robert Dallek, in his 1998 biography of LBJ, Flawed Giant: Lyndon Johnson and His Times, recounts the conversation.

Nonetheless, the AMA’s opposition to Medicare was problematic for Johnson. He didn’t have the easy target of hospitals he could strong-arm with a single organization representing over 100,000 doctors, the way he’d manipulated the leadership of the AMA.

Medicare Part A paid for hospital expenses, and Medicare Part B reimbursed doctors for their services; both required compliance with Title VI of the Civil Rights Act.

But integrating doctors’ offices wasn’t as easy as integrating hospitals, because their billing and practices were scattered all over, and the AMA continued (while giving lip service to integration) to countenance segregation.

In 1965, an integrated crowd of 200 protesters picketed the American Medical Association’s annual convention, calling for integration of that organization. The next year, 400 people showed up to demonstrate.⁴²

When the contingent of AMA doctors that George Meany had worried about showed up at the White House with just two days to go before President Johnson would have to either sign or veto Medicare, LBJ performed one of the political magic tricks that had made him famous.

The LBJ Presidential Library quotes Joseph Califano, who later wrote up the story in The Triumph and Tragedy of Lyndon Johnson: The White House Years.

Medicare: America’s Most Successful Racial Integration Program

The fact that in the entire history of the United States, Medicare was this country’s most successful racial integration program is astonishing and virtually unknown to most citizens. The history is amazing.

It’s a coincidence that Frederick Hoffman’s book Race Traits and Tendencies of the American Negro and the Supreme Court’s Plessy v. Ferguson decision were both issued in 1896, but a coincidence fraught with significance.

That is also the year that Temple University professor David Barton Smith identified as the beginning of the modern US healthcare system, a process he chronicled in considerable detail in his brilliant book The Power to Heal: Civil Rights, Medicare, and the Struggle to Transform America’s Health Care System.

The “germ theory of disease” work of Louis Pasteur, Joseph Lister, and Robert Koch in the 1860s and 1870s was only beginning to gain wide acceptance in medical practice in America in the 1890s. Antibiotics wouldn’t become available in a meaningful way until the 1930s, so the need for a “clean” environment for surgery and other medical procedures drove the development of hospitals all across the country.⁴⁴

The 1896 Plessy decision gave those hospitals all the power of law they needed to strictly enforce racial segregation, resulting in generations of African American citizens dying at home for lack of medical treatment or having to settle for levels of care reminiscent of the days of slavery.

As of 1964, things hadn’t changed that much. Black people were routinely denied entrance to most hospitals, even when in labor or suffering from severe trauma, and when they were admitted, it was often into cramped basement quarters where they’d have to wait for hours—sometimes days—until doctors had attended to all the white patients upstairs.

When the Supreme Court ordered desegregation of America’s schools in the 1954 Brown v. Board of Education decision, they required it be done with “all deliberate speed.” “Deliberate,” it turned out, was a word open to interpretation, and America’s schools are still highly segregated, with today’s private school sector almost entirely segregated.

Thus, when the Civil Rights Act made its way through Congress and was signed into law by President Johnson in 1964, everybody figured it would be a replay of Brown: full of sound and fury but, in reality, signifying nothing.

However, the following year a small group of men in the federal government—including LBJ; Social Security commissioner Robert Ball; John Gardner, secretary of Health, Education, and Welfare; Wilbur Cohen, undersecretary of Health, Education, and Welfare; and Surgeon General William Stewart—entered into a conspiracy of sorts with a disparate group of civil rights activists, including the Southern Christian Leadership Conference (SCLC), the Student Nonviolent Coordinating Committee (SNCC), the National Urban League, and the NAACP (among others), to undertake the largest, most consequential, and fastest integration of healthcare in all of American history.

The tool they used was the Medicare law that was passed in 1965, along with the fact, downplayed to a whisper by LBJ and his allies, that it required compliance with the Civil Rights Act of 1964.

Medicare “Inspectors” Defeat Goldwater’s Racists

Title VI of the Civil Rights Act required that any business receiving federal assistance of any sort must be integrated, but hospitals basically laughed at that provision, just as most schools had done a decade earlier.

The November 1964 issue of Hospitals, the publication of the American Hospital Association, carried an article by the administrator of Methodist Hospital, in Gary, Indiana, unearthed and quoted by David Barton Smith in The Power to Heal.⁴⁵

Noting that “the historical right of medicine [is] to make the patient’s wellbeing its most important concern,” the article says that when “patients have predetermined convictions on racial matters, efforts to force changes in them at the time of illness can be detrimental to their medical care.”

Couching the entire argument in the frame of white patients’ potential to freak out if they’re in a hospital room, ward, or floor with Black patients, the article asserts that maintaining segregation “must be [a hospital’s] primary consideration.” Therefore, of course, “[d]ifficulties will arise in the implementation of the Civil Rights Act.”

Just as they had with implementation of Brown v. Board of Education.

But the election of 1964, in the wake of JFK’s assassination, not only swept LBJ into a full term but also produced a 248–187 Democratic majority in the House and an overwhelming 64–35 Democratic majority in the Senate.

Thus, Medicare passed Congress just a week before the Voting Rights Act did and was signed into law by LBJ on July 30, 1965.⁴⁶ Monies appropriated by the Act would be available a mere 11 months later, on July 1, 1966.

But only for fully integrated hospitals.

By the spring of 1966, the co-conspirators were assembled and in action.

On March 4, 1966, Surgeon General Stewart sent a letter to every hospital in the nation stating, “Title VI of the Civil Rights Act of 1964 prohibits discrimination on the basis of race, color or national origin in Federally-assisted programs,” adding that “to be eligible” for federal funds, hospitals “must be in compliance with Title VI.”⁴⁷

Enclosed with the letter was a form for hospital administrators to fill out and sign, certifying that their hospital no longer practiced racial discrimination. One can imagine them smiling and casually jotting down their signatures, certain that this would go no further than Brown had.

“Three weeks later on March 25, 1966,” Smith wrote, Martin Luther King Jr. gave a “recruitment pitch for volunteers to join the upcoming battle” before the second annual convention of the Medical Committee for Human Rights. The result was the coalition of civil rights organizations mentioned earlier, drawing together a huge, national pool of volunteers to “inspect” hospitals, both overtly and covertly.

The effort, Smith documented, was mainly led by the NAACP Legal Defense Fund, the National Medical Association (the organization for Black physicians, as the AMA was still fully whites only), and the Medical Committee for Human Rights.⁴⁸

Medicare Ends Segregation in America’s Hospitals

Throughout those months after Martin Luther King’s March 1966 call for “hospital inspectors” to crisscross the country, the coalition of civil rights groups fanned out, and where they were identified by local hospitals and the local police were notified, things often got ugly.

One inspector had the lug nuts from the front right wheel of her car removed; a snowstorm slowed her car enough that when the wheel fell off, she wasn’t seriously injured. Others were arrested on bogus, made-up charges.

An inspector in Mississippi said that his “name was in the telephone directory so it wasn’t hard for any of [them] to find out where I lived. . . . I had a five-foot cross burned in my front yard.”⁴⁹

Inspectors discovered hospitals all over the country that required their Black employees to hop into empty beds in all-white wards when they knew the inspection was coming. Other hospitals that had all-Black wards would rapidly shuffle Black and white patients, mixing them together, on the day of the visit.

The inspectors would report this back to the Department of Health, Education, and Welfare (HEW), which was charged with implementation of Medicare, and the hospitals quickly learned that such tricks didn’t work. The inspectors and HEW were not going to let hospitals move with “all deliberate speed” the way the Eisenhower administration had let schools do.

Even institutions peripheral to hospitals like blood banks discovered that the Johnson administration had no intention whatsoever of backing down.

When it was discovered that the Louisiana Red Cross was still labeling their blood supply as “White” and “Colored,” a telegram went to the director of the Louisiana Hospital Association saying that all the hospitals in Louisiana would be denied Medicare money if they failed to correct the situation. As Smith wrote, “The Louisiana blood supply was integrated overnight.”

In 1964, Republican senator Barry Goldwater of Arizona had spoken in opposition to the Civil Rights Act, saying, “To give genuine effect to the prohibitions of this bill will require the creation of a Federal police force of mammoth proportions.”⁵⁰

Goldwater—and his conservative colleagues (including several Southern Democrats who later defected to the GOP over their defense of segregation)—also worried that the Act would, as Goldwater said, “result in the development of an ‘informer’ psychology in great areas of our national life—neighbors spying on neighbors, workers spying on workers, businessmen spying on businessmen.”

Envisioning a white backlash and blood in the streets, Goldwater had warned in his speech on the Senate floor, “These, the federal police force and an ‘informer’ psychology, are the hallmarks of the police state and landmarks in the destruction of a free society.”

But there was big money at stake. In some hospitals, as much as two-thirds of their total billings were for people over 65, and old folks were often indigent. Across the board, America’s hospitals were looking at Medicare funds making up as much as half of their total budgets by the end of the 1960s, rescuing an industry that was then deep in trouble.

Medicare payments would begin flowing on July 1, 1966, and the day before, LBJ recorded a televised address to the nation.

“Medicare begins tomorrow . . .,” he said. “Since I signed the historic Medicare act last summer, we have made more extensive preparation to launch this program than for any other peaceful undertaking in our Nation’s history. . . . This program . . . is a test for all Americans—a test of our willingness to work together. In the past, we have always passed that test. I have no doubt about the future. I believe that July 1, 1966, marks a new day of freedom for our people.”⁵¹

The following day, around 6,500 hospitals and 1,200 home health agencies, now almost fully integrated (there were a few stragglers), became eligible for payments that would rescue their industries.

As Smith wrote, “In four months they transformed the nation’s hospitals from our most racially and economically segregated institutions to our most integrated. In four years they changed patterns of use of health services that had persisted for half a century. . . . A profound transformation, now taken for granted, happened almost overnight.”⁵²

Thus, it wasn’t a “mammoth federal police force” or informers (other than the hospital inspectors) who nonviolently integrated the overwhelming majority of the nation’s hospitals in less than a single year: it was Medicare.

Which may help explain why white conservatives are so opposed to Medicare for All to this day.

Ted Kennedy’s Fight for Expansion

In the 1970s, the entire liberal wing of the Democratic Party was all in on reprising the single-payer universal healthcare program that Harry Truman had tried to get through Congress in the 1940s. Even the nation’s biggest unions agreed.

The Campaign for National Health Insurance (CNHI) collected multiple millions of members; it was funded, in large part, by the AFL-CIO and run, day to day, by the Teamsters. In 1975, Democratic senator Ted Kennedy of Massachusetts was their champion, and he was trying to negotiate some sort of national healthcare plan with President Gerald Ford.

Ford, after all, had called for a national healthcare insurance system in his first address to the nation after Nixon’s resignation and his own elevation to the presidency. But when it came time to present a program, Ford defaulted to the GOP’s theory that only private industry and the profit motive could do good things.

When, in 1975, the CNHI condemned Ford’s idea, which involved having the federal government backstop and subsidize for-profit health insurance companies and add a catastrophic care provision to Medicare, Kennedy pulled out of the negotiations. (It’s widely believed that Kennedy had similarly rejected Jimmy Carter’s proposal for a national healthcare system during the 1980 Democratic primary election, but that’s not the case.)

Kennedy said, “We are the only industrialized nation in the world outside [apartheid] South Africa that does not have universal, comprehensive healthcare insurance. And here, as well as in South Africa, black people are sick twice as often; they receive less care; they die younger; and sooner.”⁵³

It wasn’t the first time a Democratic president or serious contender for the presidency would call for a national healthcare system.

Twenty years earlier, in 1945, President Harry Truman had similarly proposed a single-payer healthcare system:

The American Medical Association came out with a blistering attack, calling Truman’s program “socialized medicine.” It was enough to galvanize the Republicans and scare the Democrats.

Millions more Americans would die of lack of healthcare access, and tens of millions would be bankrupted or have their lives and families shattered by medical debt, before the issue was again taken seriously on the national stage in the 2020 Democratic primary election.