Monday, August 10, 2009

Health Care Rejectionists - It's Always Been About Race

Found this at DailyKos

Health Care Rejectionists - It's Always Been About Race
Sun Aug 09, 2009 at 08:15:33 PM PDT

Academic Gerard Boychuk illuminates why the United States has followed such a different course of public policy on health care from Canada's: (PDF)

The politics of race were a central fixture of the period in which American public health insurance policy initially emerged and help to explain both the lack of national public health insurance as well as the specific structure and characteristics of the programs that did develop...

The politics of race had not been a significant barrier to the inception of public health insurance prior to the end of World War II. Had a national program of health insurance been implemented before this point, it almost certainly would have adopted the racialized cast of the existing social programs comprising the American welfare state. To this point, southern Democrats in Congress maintained an effective veto over new programs and, as a result, retained powerful mechanisms to ensure that new programs would not challenge the existing racial status quo...

They could do this by directly excluding African Americans in the South (e.g., by making farm workers and domestic servants, a big part of the African-American population of the South, ineligible) or by leaving administration to states or localities, and letting them either deny benefits or pay lower benefits than to whites.

Health insurance should have been included in the New Deal, because left as it was until later, it became entangled in the post-war politics of civil rights.
In the immediate postwar period, the ability of the South to enforce an effective policy of segregation on the federal government was challenged as was the racial status quo in the South. The federal government abandoned its official policy of racial segregation beginning with the integration of the American Armed forces by executive order in July 1948. As the federal government became more clearly committed to desegregation after World War II, federal intervention in virtually any policy area could be construed as a potential future challenge to the racial status quo. Due to the highly segregated nature of health services provision in the United States, especially--but not exclusively--in the South, it was virtually inevitable that the politics of public health insurance would become inextricably entwined with the emerging political battles over civil rights. This certainly proved to be the case with President Harry S. Truman's attempts--the first by an American president--to enact national public health insurance in the period from 1948-50. Truman's linking of civil rights and health insurance in his 1947 State of the Nation address and his appointment of a high profile integrationist to lead his administration's health care reform exacerbated southern fears that a national program would challenge the racial segregation of health services in the South...

By the 1960s, circumstances relating to both civil rights and public health insurance had changed dramatically. Segregation in health care services had come on the defensive even in the absence of federal programs. Segregation in education had been found unconstitutional in 1954, and there was every reason to believe that similar court challenges would emerge in the area of health services. The passage of the Civil Rights Act, 1964 made such challenges even more likely. Moreover, the provision of the existing federal program for cost-sharing hospital construction enacted in 1946, which explicitly allowed segregation, was struck down in 1962 by the Supreme Court...

Read the rest of this interesting diary over at the link above.

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