Medicare, Medicaid and Jim Crow Health Care

by Jack R. Johnson 08.2021

Graphic by Doug Dobey

In what may be a career defining faux pas, Elise Stefanik, who recently replaced Liz Cheney as chair of the House Republican Conference, let loose with this odd twitter comment not long ago:

"Today’s Anniversary of Medicare & Medicaid reminds us to reflect on the critical role these programs have played to protect the health care of millions of families. To safeguard our future, we must reject Socialist health care schemes."

Odd, of course, because many well-known Republicans have argued vociferously that Medicare and Medicaid are exactly that: socialist health care schemes. 

In fact, in 1961 as Kennedy was trying to get a Medicare bill passed, Ronald Reagan produced a LP whose title left little doubt where he stood: Ronald Reagan Speaks Out Against Socialized Medicine. In an eleven minute long rant, the father of the modern conservative movement railed against big government and argued that "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." But Reagan warned that if his listeners do not stop the proposed medical program, "behind it will come other government programs that will invade every area of freedom as we have known it in this country until one day […] we will wake to find that we have socialism. […] We 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."

Of course, we do have Medicare and Medicaid and Reagan’s dire predictions notwithstanding, American men and women are still apparently free. 

Reagan didn’t act alone. He was likely hired by the American Medical Association which was spending an inordinate amount of time and energy demonizing the proposed legislation. This demonization didn’t start with the Kennedy administration, and it wouldn’t end there, either.  But the largest barrier to nationalized health care, or even a modest goal like Medicare and Medicaid for the elderly and poverty stricken wasn’t just the AMA. It was also the racist institutions of the South and the powerful hold Southern politicians still had on the Democratic Party.

A case in point was President Harry Truman’s valiant effort to pass a national health care plan prior to Kennedy’s attempt. After FDR’s death, Truman tried to expand the New Deal legacy by advocating for a national health care program, but he soon discovered why FDR had been so hesitant in pursuing that course. According to The New Yorker, “The AMA conducted the most expensive lobbying effort to that date in opposition to Truman’s health-care plan, which it branded as ‘un-American’ and ‘socialized medicine.’” Charging that the Truman Administration consisted of “followers of the Moscow party line,” the AMA worked closely with the conservative coalition in Congress to kill the measure in committee.

None of this was true, of course. Truman was hardly following a “Moscow party line,” but there was one other factor mitigating against a national health care program that conservatives left largely unspoken: race. Like other forms of segregation, health-care segregation was originally a function of Jim Crow laws. In the 1940s, most Southern hospitals, clinics, and doctor’s offices were totally segregated by race, and many more maintained separate wings or staff that could never intermingle under threat of law. 

After the 1948 surprise election upset (the one where Truman cheerfully touts the “Dewey Defeats Truman” Tribune headline), Truman thought his prospects for a national health program were largely revived.  Not only had he won the election with a mandate from the people for a national health program, setting the AMA back on its heels, but Congress had also swung back to a Democratic majority in both chambers.  The problem wasn’t just the AMA, however.

Southern Democrats, so called ‘Dixiecrats’ in key leadership positions blocked Truman’s initiatives, fearing federal involvement in health care might lead to integration of hospital care and the medical field in general. Truman’s proposed bill, The National Health Insurance and Public Health Act, received 15 days of public hearings by the Senate in 1949, but the bill failed to gain support from Southern Democrats necessary for passage. By 1950, the proposal was dead.

Truman later called the failure to pass a national health insurance program one of the most bitter and troubling disappointments in his presidency.

“I put it to you,” he said, “is it un-American to visit the sick, aid the afflicted or comfort the dying? I thought that was simple Christianity.”

It would be another decade before President Johnson managed to push through the expansion to Social Security that we have come to know as Medicare and Medicaid. It would come a year after the momentous Civil Rights Act of 1964, and exactly one week before the passage of the Voting Rights Act of 1965. President Truman was at his side. 

However, the Dixiecrats were correct in their surmise that Federal legislation for health care, even narrowly targeted programs like Medicare and Medicaid, would affect the South’s ability to continue segregation.  Since Medicare’s universal coverage of elderly people brought federal funds to about every hospital in America, it also bound them by Title VI’s nondiscrimination clauses, which essentially ended segregation in those hospitals—some of the last public arenas in which Jim Crow legally held sway. 

So perhaps someone needs to tell Elise Stefanik that we’ve already embraced at least in part “socialist health care” schemes. And in doing so, we also helped to banish Jim Crow laws in the health care field hopefully for all time; an anniversary well worth celebrating.