The Power to Heal

David Barton Smith

Description

In less than four months, beginning with a staff of five, an obscure office buried deep within the federal bureaucracy transformed the nation's hospitals from our most racially and economically segregated institutions into our most integrated. These powerful private institutions, which had for a half century selectively served people on the basis of race and wealth, began equally caring for all on the basis of need.

The book draws the reader into the struggles of the unsung heroes of the transformation, black medical leaders whose stubborn courage helped shape the larger civil rights movement. They demanded an end to federal subsidization of discrimination in the form of Medicare payments to hospitals that embraced the "separate but equal" creed that shaped American life during the Jim Crow era. Faced with this pressure, the Kennedy and Johnson Administrations tried to play a cautious chess game, but that game led to perhaps the biggest gamble in the history of domestic policy. Leaders secretly recruited volunteer federal employees to serve as inspectors, and an invisible army of hospital workers and civil rights activists to work as agents, making it impossible for hospitals to get Medicare dollars with mere paper compliance. These triumphs did not come without casualties, yet the story offers lessons and hope for realizing this transformational dream.

Sujets

• Health Policy
• Civil Rights
• Medical
• Médecine
• History of the United States
• Civil and political rights
• Politics
• Health
• History

Informations

• Publié par: Vanderbilt University Press
• Date de parution: 01 juillet 2016
• Nombre de lectures: 0
• EAN13: 9780826521088
• Langue: English

Extrait

The Power to Heal
THE POWER TO HEAL
Civil Rights, Medicare, and the Struggle to Transform America’s Health Care System
DAVID BARTON SMITH
Vanderbilt University Press
Nashville
© 2016 by Vanderbilt University Press
Nashville, Tennessee 37235
All rights reserved
First printing 2016
This book is printed on acid-free paper.
Manufactured in the United States of America
This book is a recipient of the Norman L. and Roselea J. Goldberg Prize for the best project in the area of medicine.
Library of Congress Cataloging-in-Publication Data on file
LC control number 2015042860
LC classification number LCC RA412.4
Dewey class number 368.4/200973—dc23
ISBN 978-0-8265-2106-4 (hardcover)
ISBN 978-0-8265-2107-1 (paperback)
ISBN 978-0-8265-2108-8 (ebook)
To those who awoke to a common dream and all who now struggle to realize it .
Contents
Preface
1. Formative Years
2. Backbone
3. Better Part of Valor
4. “Children’s Crusade”
5. Casualties
6. Seen the Glory
Notes
Bibliography
Index
Preface
Medicare is a vibrant half century old. None now attacking the Affordable Care Act’s more conservative approach to expanding access to health insurance dare voice similar objections to this far more ambitious and popular one. It’s an anachronism. How did it happen?
Much of the story has disappeared. Medicare’s birth emerged from the last turbulent stages of the civil rights era. Indeed, as the story in this book documents, it was the concealed gift of that struggle and one of its most significant accomplishments. The civil rights movement reached its full power as a transformational force with Medicare’s passage and implementation. The most common responses to racial and economic disparities in opportunities in our nation’s history have been: “it’s just the way things are” or “it just takes time.” However, for the civil rights activists involved in the implementation of the Medicare program in 1966, the response was, “Now!” 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. The fundamental moral imperative—that those needing medical care should receive it—began for the first time to reflect actual use of services. A profound transformation, now taken for granted, happened almost overnight.
That victory and the ideas and heroes that made it possible deserve celebration. Their neglected gift offers hope. In no other area of American society, still traumatized by a brutal racial history, has the dream of a racial and economic justice come as close to being realized.
The story of that transformation has been lost. At the time, federal officials, politicians, and hospitals kept quiet, fearing a backlash. Most, later embarrassed about this past, had no interest in preserving the story. It just didn’t fit any of the more self-serving narratives about race, health care, politics, the role of government and the private sector in the United States. Its lost heroes play no role in any of those more accepted narratives. At its heart was an odd, implausible collection of people thrown together for a few months that changed health care in the United States. Few believed what they actually accomplished was possible. I’ve distilled the essential pieces of the story into the six chapters of this book. In essence, we possess a too long neglected gift that offers the power to heal, and, perhaps more than ever before, we need to use it.
Pulling this story together has taken, on and off, fifty years and the help of hundreds. I am indebted to all who provided inspiration, encouragement, and clues. The participation of my two siblings, Woollcott and Barbara, and my mother, Nancy, as civil rights activists during the period described in this book first made me aware of how much of the important parts of the story had been lost. 1 I entered the health services research doctoral program at the University of Michigan in medical care organization in the fall of 1965, during the same time that Medicare was being implemented. 2 My dissertation involved fieldwork in an early HMO set up by the United Auto Workers in Detroit during the riots of 1967. 3
It was, however, more than twenty years later that my health services research interests overlapped with that earlier personal history. I was asked to look at numbers related to disparities in black access to nursing homes in Pennsylvania in 1989 by Ann Torregrossa, Mike Campbell, and Philip Tannenbaum of the Pennsylvania Health Law Project. The conclusions triggered a class action lawsuit against the Pennsylvania secretary of welfare by the Pennsylvanian Health Law Project and led later to a similar lawsuit against the secretary of health and human services (HHS) instigated by Gordon Bonnyman of the Tennessee Justice Center and others connected to the Poverty and Race Research Action Council (PRRAC). 4 Neither was successful in gaining legal remedies, but I learned much about how the “system” worked that I could not have learned in any other way. It stimulated the submission of an application for a Robert Wood Johnson Foundation Health Policy Research Investigator Award. That award in 1994 led to a book, Health Care Divided (Smith 1999). 5 It was a story, as I discovered from many of the remarkable people I interviewed, most now deceased, that needed to be told more fully than was possible at the time.
Many others have since helped immeasurably in doing this. Karen Thomas’s book Deluxe Jim Crow helped flesh out the painful ambiguity of choices during the Jim Crow era’s influx of federal funding for hospital construction initiated with the Hill-Burton Act of 1946 (Thomas 2011). John Dittmer helped describe the peculiarly central role played by a small group of activists that formed the Medical Committee for Human Rights in The Good Doctors (Dittmer 2009). Beatrix Hoffman’s Health Care for Some placed it the larger history of rationing of care in the United States (Hoffman 2012). T. R. Reid in The Healing of America did a marvelous job of providing a readable way of placing the American health care system’s peculiarities in an international context (Reid 2010). One would have to include more hopeful books on race, such as Isabel Wilkerson’s The Warmth of Other Suns , about the impact of the Great Migration, and more pessimistic ones, such as Michelle Alexander’s The New Jim Crow , about the growth in incarceration (Wilkerson 2010; Alexander 2012). There have also been many moving recent biographies and histories of the broader civil rights struggle. All these accounts helped inspire me to take a shot at telling the still-untold parts of the story.
The immediate stimulation to undertake such a writing project came from the interest of Barbara Berney in converting the story into a documentary film. 6 We have shared resources, and some of the documentation and interviews she and her team have tracked down have found their way into these pages. More recent papers, enriched from the insights and interaction with many colleagues, have also helped in fleshing out the story presented here. 7
I am also indebted to those who helped in transforming crude early drafts into a more polished final product. Among these, Joan Apt, my wife and much-loved all-purpose personal critic, and Bob Uris, longtime friend, writing critic, and aging squash partner, read all parts of the manuscript and helped in many ways in making it clearer and more readable. Michael Ames, director of Vanderbilt University Press, provided much encouragement and gentle guidance. Joell Smith-Borne, managing editor, and Kathleen Kageff, who did the wonderfully clear, careful copyediting of the manuscript, helped immeasurably in transforming it into its final form as a book.
Finally, I am indebted to the inspiration of all those who played a part in providing the gift that this book is about and those who now use that gift to realize the promise it still offers for transforming America’s health system.
The Power to Heal
1
Formative Years
The patterns of medical practice and its financing in the United States developed between 1894 and 1954. Scientific advances, interest group clashes over power, and underlying social attitudes about race and class shaped its development. Just as early childhood experiences shape a person, so these early years shaped most of what continues to be distinctive about the American health care system.
During this period other industrialized nations, faced with the same rapid improvements in medicine, explored ways to best distribute its benefits. The historical narrative of these other nations said, in essence, “for all our differences we have a common identity, and, just as in any functional family, we look after each other.” The universal health insurance systems created in every other wealthy industrialized country became a way of expressing that common bond, the fundamental moral conclusion that no one should be denied needed medical care (see Reid 2010: 237–39).
That never happened in the United States (Hoffman 2012). Indeed, in terms of a national health care system, the United States produced the lone, stunted outlier. Its health care costs tower over other industrialized nations—more than twice the median per capita cost and twice the percentage of its gross domestic product are allocated to health care. Yet it has fewer physicians and hospital beds per capita, and its citizens receive fewer services (Squires 2011). The United States does poorly in comparison to other nations on most measures of health. For example, it ranks twenty-seventh out of thirty-