Medicare And The Desegregation Of American Hospitals
As anyone who has followed the Obamacare roller coaster over the past 4 years knows, passing legislation is only the first step in reforming a healthcare system. Since Obamacare came into law, we have been consumed by battles over how to implement it, and by struggles over how to make it work effectively. But such implementation struggles are not new to Obamacare. We sometimes fail to remember that previous healthcare laws rolled out with a fair amount of controversy of their own.
For example, when Medicare was passed into law in 1965, the program was far from a done deal, especially in the South where Medicare threatened to end hospital segregation.
Federal programs had long been a challenge for those in the South who favored segregation. When Social Security was passed into law, southern Democrats managed to keep most black people out of Social Security by excluding farm and domestic workers from receiving such benefits. But Social Security eventually expanded to include these people, which did not please many southern conservatives. That’s why when Medicare was passed into law, they were determined to prevent it – another damn federal program – from interfering with the southern way of life. At the time, you see, many southern hospitals were segregated. If these hospitals wanted to receive Medicare funds, however, they would need to desegregate.
Lyndon Johnson was determined to use Medicare to force these hospitals to change, so he sent 1,000 inspectors south to determine whether hospitals were in compliance with federal law. They found half of the hospitals to be delinquent. Southern hospitals, it seemed, hoped that the federal government would simply give up, when they realized the size of the challenge they faced. But Johnson refused to back down. He held strong. As explained in The Heart of Power, federal regulators told one Confederate hospital in Louisiana:
“That they must not only take the ‘white’ and ‘colored’ signs off the doors but that they must also label them ‘entrance’ and ‘exit’ and fix the door handles accordingly. They were also told not just to take the ‘colored’ and ‘white’ signs out of the waiting rooms but to label one the ‘main waiting room’ and to cordon off the other, and put…in a sign saying ‘overflow waiting room’ – to be used only when the main waiting room is full.”
Anyone who has read Robert Caro’s glorious biography of Johnson knows that LBJ was power-hungry, willing literally to lie, cheat and steal his way to political victory. But this complex man was also deeply committed to racial justice. And when he had federal leverage to end the abhorrent practice of hospital segregation, he did.