Health Care and Race: The Enduring American Dilemma

Samuel Livingston, PhD

The racial dynamic in the health care debate is often understated. The race – health care connection goes beyond the Tuskegee Study and includes race as a subtext for the denial of universal health care in 20th century American history. According to the Kaiser Family Foundation, in 2008, of the 47 million Americans who go without health care insurance:

  • two-thirds of the are made up of the working poor (too rich for Medicaid and too poor to pay the highway robbery insurance rates.
  • Only 13 percent of white Americans are uninsured,
  • 17 percent of Asians/Pacific Islanders are uninsured
  • 22 percent of blacks are uninsured
  • 36 percent of Hispanics are uninsured
  • 33 percent of Native Americans are uninsured.[1]

Historically, mortality, quality of health care and rates of maintaining health insurance have been functions of social assimilation, race and class.[2] Considering the effect of the lack of health care, we should be shocked into action: A recent study states that annually, forty-five thousand (45,000) Americans regardless of race will die prematurely due to a lack of health care.[3]

On Wednesday, September 9, 2009, President Obama delivered his address on the 2009 healthcare reform initiative. Deflecting right-wing propaganda, a disrespectful outburst from a South Carolinian congressman and the fallout of the “town hall movement,” which has confused many and given off more heat than light on the issue, President Obama outlined the broad parameters of an acceptable healthcare bill. Although conservative commentators such as David Brooks have downplayed race as a factor in the debate over the Affordable Health Care Act and right wing rabble-rousers have distorted the issue arguing that health care is a form of reparations, communities of conscience and memory must consider the historical link between race and health care. The role of race in the American social contract undergirded Joe Wilson’s verbal incontinence and his ideological forbearers’ deprecation of Black vitality as indicated below.

Glaring episodes mark the history of race and health care and the trajectory of African American historical consciousness. As early as 1883, the leading pan-Africanist of his day, Bishop Henry McNeal Turner, addressed the question of African life-chances and demography in America writing,

I know (the African) is increasing South much more rapidly than the whites,

and the ration of increase, should it go on as it did from 1870 to 1880, will

put the Southern States in the hands of the negro in 1900… I can see that

the Southern whites are apprehensive of such a contingency, and to avert it

they are moving heaven and earth to procure white immigration, but with all

they can get and all they can kill and starve to death in the penitentiaries, the

fecundity of the negro is gaining on them rapidly…[4]

Opportunistic southern white leaders took up the cudgel of racism to suppress the “fecundity of the negro” and the upward climb of Black people at the turn of the 20th century. Twenty-five years later, former governor and U.S. Senator Benjamin “Pitchfork” Tillman framed health care and racial demography within a political context. Speaking before South Carolina’s legislators on January 24, 1908, he called on the State government to increase the number of European immigrants and simultaneously decrease its Black numerical dominance. Tillman laid his cards on the table:

when I look around and see how many negroes also are not guilty of race

suicide, I must confess the cold-blooded fact that the negroes are ahead of

us, and unless disease–syphilis, tuberculosis, alcoholism, or something else–

shall come along and desolate these people; unless we do get reinforcements,

the struggle for mastery as between a majority of negroes and a minority

of whites is bound to come.[5]

Denial of health care was a minor one of many efforts to enforce racist, gender-biased and culturally chauvinistic social control measures during the first quarter of the 20th century.

Progressive era politicians made an attempt to provide universal health care.[6] However, a coalition including the American Federation of Labor, doctors, insurance companies and business interests won the day and the American Association of Labor Legislation bill was defeated in congress. President Teddy Roosevelt’s personal convictions may have been born, in part, by seeing his son Archie suffer the ravages of diphtheria in 1907. Regardless, his support of the AALL bill in 1912 failed miserably. Other setbacks during President Franklin Delano Roosevelt’s New Deal and the Great Society Reforms of Lyndon B. Johnson mark the graveyard of failed health care reform. The creation of Social Security, Medicare and Medicaid have not provided for the spiraling costs of health care relative to other household expenses. The cost dynamic has been studied beginning in 1926 when the Committee on the Cost of Medical Care first met. Yet today, health care is pushing toward accounting for one-fifth of all of the wealth that the American economy produces annually.

In the end, it’s all about values. Whose lives are valued and what portion of a society’s collective wealth is it willing to sacrifice so that a neighbor who has less can actually afford quality health care? I was impressed in the 1980s when Surgeon General C. Everett Koop compared the two major industrialized nations without universal health care insurance for its citizens – the two USAs: the United States of America and the Union of South Africa. In the Reagan era, Koop dared to suggest that race and the cost of care were directly linked in the domestic policies of these two nations. In 2001, Koop gave props to a democratic South Africa, which had then “affirmed the right to health care of all of its citizens, (leaving) the United States stand(ing) alone as the industrialized nation that has not yet recognized this right for its people,”[7] Not much has changed despite the election of President Barack H. Obama.

Like many others, I have seen family members ravaged by illness and receive good quality health care. As someone who has kept the vigil beside a hospital bed, the last thing one wants is for an ailing person to be concerned with is the question of cost. America has much to be proud of, however, of her failings, this one ranks up there among the worst. Dr. King saw health care as a central facet of his notion of “Equality Now.”[8] His words convey the matter most clearly, “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”[9] The ultimate measure of a nation is its attempt to reinforce the life-chances of all.

We can all make a difference. Contact (email, write and call) your senator and representatives by visiting the United States Congressional website [] and make your position known.

[1] Michael Millenson, “Want Universal Health Care? The Operative Word is ‘Care.’” Washington Post, Opinions Section, Sun., June 28, 2008. [ 2008/06/06/ AR2008060603498.html ]

[2] The research on this glaring fact is overwhelming. See for example, Stephen J. Kunitz and Irena Pesis-Katz, “Mortality of White Americans, African Americans, and Canadians: The Causes and Consequences for Health of Welfare State Institutions and Policies,” The Milbank Quarterly, Vol. 83, No. 1 (2005), pp. 5-40 and; William W. Dressler, “Health in the African American Community: Accounting for Health Inequalities,” Medical Anthropology Quarterly, Vol. 7, No. 4, Racism, Gender, Class, and Health (Dec., 1993), pp. 325-345. More recently Nicholas Bakalar reported in the New York Times[(Health Section, October 20, 2008,] that race and health insurance were independent variables effecting the survival of trauma.

[3] Press Release: “Lack of Health care now More Lethal” Physicians for a National Health Program. [] posted September 17, 2009.

[4] Edwin S. Redkey (ed.), Respect Black: The Writings and Speeches of Henry McNeal Turner, (New York: Arno Press, 1971), 55-57.

[5] Benjamin R. Tillman, The Negro Problem an Immigration: An Address Delivered by Invitation Before the South Carolina House of Representatives, January 24, 1908. Columbia: Gonzales and Bryan, State Printers, 1908, p.13.

[8] Martin L. King, Jr., “Equality Now: The President Has Power,” originally in The Nation, Feb 4, 1961, 91-95, reprinted in James M. Washington (ed.) A Testament of Hope: The Essential Writings and Speeches of Martin Luther King, Jr.New York: HarperSanFrancisco, 1986, 152-159.

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