Freedom From the Market by Mike Konczal

Author:Mike Konczal [Konczal, Mike]
Language: eng
Format: epub
Published: 2020-02-15T00:00:00+00:00

On the day before Medicare went into effect, in every hospital in the South, over every drinking foundation, over every bathroom, over every cafeteria, there were signs reading “White” and “Colored” for separate but presumably equal facilities. On the day that Medicare went into effect in the South, all those signs and separate facilities began to come down. This I think was a singular achievement of Medicare. In one day Medicare and Medicaid broke the back of segregated health services.35

The effects were immediate and dramatic. Segregated health care was horrific for the black people who had to suffer under it. Infant mortality rates serve as a simple, but devastating, illustration. Up until that point, 40 black infants would die for every 1,000 born, rates that resemble countries like India or Iraq now. In 1965, black newborns were four times more likely to die of pneumonia and gastroenteritis than white newborns. These were two common causes of death among newborns that had become significantly easier to treat with medical advancements in administering antibiotics and fluids to babies. Those advancements lowered the rate of death for white babies, but you would never know these methods were even invented if you looked at the death rate for black babies. These life-saving improvements, and the expansion of Hill-Burton hospitals to carry them out, simply passed black families by. The desegregation of hospitals collapsed these rates, with the overall rate of black infant deaths falling by nearly half within a decade. The infant mortality rate in Mississippi fell by 25 percent in just the first year. This period of medical desegregation was the only convergence in black-white infant mortality rates since World War II.36

Universal public programs can create levels of access that the private sphere and marketplace will never match. Public programs can overcome and break persistent and widespread discrimination, especially against the most disadvantaged. Public programs can ensure that citizens have access to the fundamental supports they need to live free lives. Health and access to medical services are an obvious part of this support. Sickness can be a form of confinement, preventing us from living free lives. The market alone can’t provide health care to everyone because it will quickly exclude those that need it the most. By ensuring health care is broadly available, independent of race, income, or preexisting conditions, the government can help ensure our freedom.

In the 1960s, the government used federal funding as a mechanism to break Jim Crow. President Obama used the same kind of funding mechanism to push an expansion of Medicaid with the Affordable Care Act. Under the passed law, states that wouldn’t expand Medicaid to working-class people would jeopardize all their Medicaid funding. Losing this funding is something states wouldn’t risk, and it was assumed all states would follow with expansion. When the Affordable Care Act came before the Supreme Court, it was this Medicaid funding requirement that Chief Justice John Roberts successfully stripped out of the law as a price to pay for it to survive.

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