March 30, 2005

Leaving People Behind

Laurie Garrett's book, Betrayal of Trust: The Collapse of Global Public Health talks about the history of 'saving money' at the cost of public health, which inevitably proves costly indeed in terms of epidemic disease and general poor health among the populace. The segment I refer to here talks specifically about the implementation of Social Security.

The first thing to understand, which I did not know, was that Roosevelt's original proposal was a full bore cradle-to-grave healthcare, unemployment, and pension system. The second thing to note is what killed it and led to our current compromises: Racism.

It's long infuriated me when people start talking about sending minority rights, women's issues, gay rights, and other social justice issues overboard. I could say that I found the attitude callous and unethical, that I consider it a betrayal of the values that keep me calling myself a Democrat, and that the urge to hurl invective at the offenders was pretty overwhelming. Now I can call this attitude something else: Tactically stupid and politically irresponsible.

We could have had universal health care in the 1930's if Southern demagogues hadn't filled the heads of susceptible voters with the thoughts that (oh my god!) blacks might get the same benefits. Because no one had been able to tackle racism, a good idea was DOA in spite of large congressional majorities. People rejected something that would have benefitted them immensely because they couldn't stand to share it with people they didn't know better than to hate, and the AMA was cheering all the way.

The world isn't that different now. The Democratic party has a lot of good ideas, but still hasn't crafted a message powerful enough to overcoming the aversion to sharing prosperity with the political punching bag of the year. Greedy corporations and elite economic interests win, working class people lose, and the wrong people get blamed.

Another point this makes is that progressives should dream big. The Republicans have learned this, and they often propose a tax hike about twice as big as they would insist on having, so that even if some of it has to go they can still be happy with the results. Ask for the moon, and even if you don't get it, you could still wind up in orbit.

The excerpt is long, so be sure to read to the end on the flip:

The New Deal's impact on public health was, however, remarkably positive and the benefits often came from surprising sources. The health of American Indians improved as a result of changes in their land rights under the Indian Reorganization Act of 1934. Mortality decreased among farmers and "Okie" farm workers as a result of New Deal agricultural programs. Rural areas saw their food poisoning rates go down as the Tennessee Valley Authority brought electricity to tens of thousands of households, allowing installation of refrigerators. Eight million workers suddenly had money with which to feed their chldren, thanks to employment with the WPA. Hookworm infection rates declined as southern families earned enough to provide their children with shoes.

The 1934 congressional elections swept so many Roosevelt supporters into the House and Senate that Republicans formed an impotent minority. Despite its tremendous popularity, Roosevelt's Brain Trust met its match when the administration moved to create health insurance and Social Security programs. Roosevelt's plan was to set in place a "cradle-to-grave" social insurance program that would cover every American's health, medical, and pension needs and would be financed through a payroll contribution system. FDR envisioned a system that would serve as a safety net for unemployed workers, offer prenatal care to their pregnant wives, and provide a living wage for retirees. As he conceived it, every American, regardless of race or class, would come under the U.S. Social Security umbrella.

That was going too far

Southern political leaders said they would never vote for a law that might carve cents out of the paychecks of white workers to pay unemployment benefits to "Negroes to sit around in idleness on front galleries." The Republican Party said the FDR plan was overtly socialistic and, by said definition, had to be blocked.

And, of course, the American Medical Associtation chimed in again, with its leaders opposing all of the health insurance provisions of FDR's Social Security proposal.

In the face of dogged opposition, the finally adopted Social Security Act of 1935 compromised or defeated all of FDR's original intentions for it and was a deeply flawed piece of legislation. As the AMA had hoped, it had no provisions for health insurance.

Thus, for the second time in U.S. history, the possibility of universal health care based on compulsory insurance was raised -- and defeated. And the primary force responsible for vanquishing it was, in both cases, the AMA.

Paul de Kruif, who was highly critical of the compromises struck in the Social Security Act, eventually concluded that the only hope of salvaging public health in the United States rested with further federalization and creation of a large corps of USPHS officers. He advocated creation of something not terribly unlike the future U.S. Center for Communicable Diseases.

In The Fight for Life de Kruif wrote:

Why cannot our U.S. Public Health Service be entrusted with co-ordinating in the instances of these now-preventable plagues, the people's fight for life? You hear the wail that this will breed a new bureaucracy. Let this then be remembered: we have an army and a navy supported by the government, by all the people -- to defend our nation against threat of human invasion that becomes real not once in a generation. They are bureaucracies, granted.

But is it anywhere advocated that the army and the navy be turned over to private hands and the defense of our country be left to us individuals armed with scythes and shotguns, because the army and navy are bureaucratic? ... Who then objects to the organization of a death-fighting army against the far more dangerous subvisible assassins in ambush for all the people -- always? ...

If you allow our death-fighters [Ed. - Mr. de Kruif refers here to public health workers] -- we can assure you they are competent -- the money to wipe out such and such and such deaths that cost us billions to maintain, within a generation there will no longer be this drain upon the wealth of our nation.

The honorable Mr. de Kruif obviously never reckoned with people who were ridiculous enough to argue that the American public should believe it could defend itself from invasion with shotguns, and furthermore that the military should be outsourced to private companies.

So no wonder we still don't have a health care system envisioned some 80 years ago. That's a whole grandparent ago, for which span of time progressives have seriously underestimated the appeal and bloody-mindedness of bigoted loudmouths working hand-in-glove with the economic elite.

Posted by natasha at March 30, 2005 01:17 AM | US Politics | Technorati links |