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Sickness & struggle, part 4

Radical movements create context for 1960s health care reform

Published Sep 3, 2009 10:42 PM

The 1960s was a decade of worker mobilization, youth and student radicalization, and revolutionary struggle inside the United States and around the world. The 1959 Cuban revolution, on the eve of the new decade, was a sign of the struggles to come.

That revolution, incidentally, was accompanied by great advances in health care. The Cuban medical system has since developed into one of socialist medicine’s greatest achievements.

The Great Proletarian Cultural Revolution was launched in China in 1966 with the support of Mao Zedong. The Cultural Revolution was the largest movement of revolutionary youth and students in world history. Its recognition of the need for continual revolution in all spheres of society—political, cultural and economic—sent chills down the spine of the ruling class, from Japan to Western Europe and the United States.

This is the same decade that the U.S. saw the development of the Civil Rights Movement, the Black Liberation Struggle, and the student-based anti-war movement to stop the U.S. war in Vietnam. These radical movements posed a challenge to national oppression, war and capitalism itself. As such, they forced elected politicians to pay attention to the plight of poor and working people.

Voices such as those of Martin Luther King Jr., Malcolm X and Huey P. Newton captured the imagination of all those struggling under the weight of capitalist injustice, especially the nationally oppressed. In April 1963 King wrote from a rotting jail cell in Birmingham that “freedom is never voluntarily given by the oppressor; it must be demanded by the oppressed.” These leaders, and others like them, organized a movement to demand freedom through the churches, mosques, unions, campuses—anywhere the poor and dispossessed could be reached.

Michael Harrington’s 1962 work, “The Other America: Poverty in the United States,” exposed the extreme poverty of that decade. Harrington estimated that at that time there were some 50 million poor people in this country. Harrington was a self-identified socialist, a former editor of The Catholic Worker and an organizational secretary for the Workers Defense League.

In his chapter entitled “The Invisible Land,” Harrington speaks to what he calls one of the most familiar forms of the vicious circle of poverty: “The poor get sick more than anyone else in the society. That is because they live in slums, jammed together under unhygienic conditions; they have inadequate diets, and cannot get decent medical care. When they become sick, they are sick longer than any other group in the society. Because they are sick more often and longer than anyone else, they lose wages and work, and find it difficult to hold a steady job. And because of this, they cannot pay for good housing, for a nutritious diet, for doctors. At any given point in the circle, particularly when there is a major illness, their prospect is to move to an even lower level and to begin the cycle, round and round, toward even more suffering.”

The political turbulence created by the 1960s-era social movements and the popular response to Harrington’s work have been credited with pressuring President Lyndon Johnson’s administration to create the Great Society programs.

Two key Great Society programs dealt with the struggle for access to health care. The 1965 passage of Medicare and Medicaid represents the biggest health care reform won by the working class in U.S. history. These two popular social programs, insufficient as they are, represent a type of concession that can only be won when a mass movement of workers and oppressed stands up and challenges the system.

Medicare and Medicaid were enacted as Title XVIII and Title XIX of the Social Security Act. Medicare extended basic hospital and physician coverage to elderly individuals aged 65 or older. Medicaid addressed the medical care needs of a fraction of the poor by providing coverage to low-income children and their caretaker relatives.

The Medicare program was opened to the public in 1966. On July 1 of that year the true state of U.S health care was exposed as 19 million individuals enrolled in the program.

Medicaid eligibility has been confined to certain low-income individuals and fami

lies. An applicant’s income is just one factor in determining eligibility. The program was not intended to provide medical assistance for all poor people. Even the very poor are ineligible unless they meet criteria for one of the designated eligibility groups. Both programs were modified in 1972 to expand coverage for the blind and disabled.

Medicare and Medicaid, popular despite their overwhelming inadequacy, did not end the struggle for health care reform. Martin Luther King Jr. saw this clearly, stating in his March 25, 1966, speech before the National Convention of the Medical Committee for Human Rights in Chicago that “of all the forms of inequality, injustice in health care is the most shocking and the most inhumane.”

The struggle for pro-worker health care reform has continued in the spirit of King, just as the cruelty and injustice of inadequate care has continued to the present day.

Next: Cuban socialism builds a model health care system.