HealthCommentary

Exploring Human Potential

This Is Not My First Pandemic.

Posted on | January 19, 2022 | 3 Comments

Mike Magee

This is not my first pandemic. When I was a little boy –70 years ago – I was lying on an examination table on a Sunday morning, in my underwear, in my father’s office that was attached to the house.

The door to the room was closed and my brothers and sisters were huddled outside.  I was inside with my father and a neurologist who had extended to him the professional courtesy of coming to our home on a Sunday morning. It was cold in that room, but his hands were warm as he raised my leg in the air and said, “Now, with all your might, I want you to hold you leg up” – and he let go.

I was four years old and I remember that leg falling to the table, as if it were detached, not even mine.  And I can’t remember what he said. But I do know that the way he said it allowed him to not only tell my father and me that I had polio, but also to bring us closer together – as father and son – to manage both our fears which were coming from very different places that day, and to point us both to a more hopeful future.

Some 20 years later, I became a doctor. But in truth, my medical education began that day in his office.  I recovered quickly, was soon back to exploring, wondering, questioning.  And one day, I said to my mother, “Mom, do you think if dad had wanted to, he could have been a bus driver?”

It seemed to me at the time that being a bus driver was the most complex, responsible and interesting of all jobs, certainly beyond the reach of most normal human beings.  That you could master the skills necessary to drive this huge machine; that you could deal with the complexity of communicating with all types of human beings; that you could safely transport them to their destination, and remain calm, collected, and happy most of the time; and that you could do it day in and day out, year in and year out. Well, you can understand why I was so impressed.

This morning, on the eve of my 74th birthday, as our nation struggles with its own pandemic, and societal disruption made worse by a partially compromised health care system unable to manage a massive accumulation of fear and worry, I found myself reflecting again on these two stories.

From the first story – the boy with polio and the two doctors together one Sunday morning – I recall with gratitude the neurologist’s “professional courtesy.” How should we caregivers – doctors, nurses, family members – treat each other? How well do we care for each other and each other’s families these days?  With all we have been through, how do we find our way back to that space, that feeling I felt that Sunday morning, as I watched two caregivers care for each other as they cared for me?

And the 2nd story, the bus driver and my mother’s reaction.  Did she silently voice, “Do you know what your father does, how complicated it is, and the toll on all of us?” Perhaps somehow my own questioning of the connection between caring health professionals and the maintenance of a healthy, civil society was seeded that day, transferred from my mother’s inner sanctum, to my childhood unconscious recesses for later exploration.

Fifty years later, with a team of sociologists in Philadelphia, our studies established that physicians, nurses, and caregivers contribute 3 important functions to stable civic societies that go far beyond the standard nuts & bolts of healthcare.

The first is this – that together as a collective, hundreds of thousands of times each day, health care professionals  process the populace’s fear and worry, which in our absence would accumulate and undermine our society.

Second, as with my father and his small son, in individualizing care, they subtly reinforce essential bonds between the individual, the family, the community and society.

And third, caregivers point the people toward a hopeful future, instilling in them the confidence necessary to invest their money, their time, and their dreams in what could be, rather than what might have been.

My mother knew the truth – the full role and contribution of health care workers and their imperfect systems. She observed it. She supported it. She nurtured it.

We, as Americans struggling to stay afloat in an ever changing and destabilized environment, are still learning the full meaning of what doctors and nurses and their many teammates do.  We are so busy doing that we fail to appreciate what has been done, and what, together we will accomplish in the future.  But my mother knew!

As for driving a bus, the idea still intrigues me. And truth be told, the skills, responsibility, and sense of common stewardship that members of the health care team work to master are quite transferable to many other critical roles in society. Caring for each other, after all, is (or at least should be) our common human goal and purpose.

Doris Kearns Goodwin and Jon Meacham Reflections on Jan. 6th.

Posted on | January 10, 2022 | 4 Comments

Mike Magee

On the one year anniversary of the June 6th Insurrection, historians were well represented by two of their own – Jon Meacham and Doris Kearns Goodwin – who were invited to address members of Congress in a session moderated by Carla D. Hayden, Librarian of Congress. Here is a review for your reflection and consideration.

Ms. Hayden welcomed members to “a solemn occasion, a patriotic occasion, and a prayerful one for our country.” She also quoted words from the show Hamilton, “If we lay a strong enough foundation, we will pass it on to you.” She then turned to the two historians, and asked them, speaking of the Founders, “Were they sure (they had a strong enough foundation back then)? Did they know?”

Over the next hour, Meacham and Goodwin, traded and shared historical narratives, chosen to illustrate both America’s vulnerability and resilience.

Meacham led initially with these remarks, “I think they (the Founders) would be surprised that we have come this far. They were aware of the fallibility of humankind. They were incredibly aware of the fragility of humankind. They had a keen awareness of imperfection and appetite and ambition. They knew that the struggle in everyone’s soul, which would find full expression in a popular government, was (a struggle) between generosity and greed, and between kindness and cruelty….It was about curbing our worst instincts, to give our better angels a chance to take flight.”

In a moment of self-reflection, he said, “If I get things right 51% of the time, that is a good day. Why would a popular government be anything different? A Democracy is the manifestation of all of us. So our habits of heart and mind matter enormously. What you saw a year ago today was the worst instincts of both human nature and American politics – the will to power over the idea of equality and the rule of law taking precedence. And without recognition that the experiment is worth defending…Without the defense…then we slip into a state of chaos.”

Goodwin then affirmed that knowledge and truth are prerequisites for preservation of the American experiment. She said, “I keep thinking as a historian that the interesting thing is we know what the people living at the time did not know. We know the Revolution was won. We know George Washington became the President, not a military (dictator). We know the Civil War ended with the Union restored. We know the Allies won WW II. But the people living (at the beginning of our nation) did not know that. They were living with the same anxiety we are living with today. How will this resolve itself? The hope (is that)…we have come through these times before…We are going to write the chapter of our story just like our ancestors wrote the chapters of their stories and they did pretty well. They failed at times. But as you say, even though there are bad angels, we got extraordinary good angels, even on January 6th.”

Both historians were drawn to comparisons with the 1850’s. Meacham went first. “Mark Twain once said, ‘history may not repeat itself but it does rhyme.’ The issue I think about the 1850’s…is that we did not have a common story. There was not a sense we were all devoted to what became the most important sentence ever originally rendered in English, which is ‘All men are created equal, with inalienable rights, among them, life, liberty, and the pursuit of happiness.’ An amazing sentence that has changed more lives around the world than any other single sentence. It was written, not in a vacuum, but as part of this remarkable experiment that we were part of and are part of. It is a reorientation of reality, when you think about it, from popes and princes and prelates and kings who are given authority over all of us…who were organized (vertically), to reorganize (horizontally)…and the American (vision), for all its faults, was the fullest political manifestation of that shift in reality…There was an idea worth defending. If enough of us do not assent to that idea, then madness comes.”

Goodwin picked up, telling the story of Preston Brooks, a violently racist congressman from South Carolina, who in the 1850’s nearly beat to death with his cane the leading abolitionist in the Senate, Massachusetts Senator Charles Sumner, on the Senate floor. Rather than unify the elected politicians of the day, it further galvanized their disagreement over slavery, creating what were called then “alternate realities.” In Goodwin’s words, “That is when you knew something was happening in the country. There was a sense that there was a partisan crack in the 1850’s…Obviously it ended badly with the Civil War. But out of that, what came, had to be done, which was to undue the original sin of slavery, and those people fought for that. We had a leader in Abraham Lincoln who carried us through that.”

Forty years later, Goodwin recounted, “Teddy Roosevelt warned that the real problem for Democracy, the threat would be if people began regarding each other as the other rather than as common American citizens…He saw what we are feeling today. What did he do about it? He argued there should be a fundamental fairness, ‘a square deal’ for the rich and the poor.” A bit further on, Goodwin picks up the thread, repeating parts of LBJ’s classic March 15, 1965 “We Shall Overcome” address to a joint session of Congress that Goodwin’s future husband, Richard, wrote.

She begins by setting the narrative in Selma, Alabama. “This is how change takes place. When an outside movement to create the social conscience and change public sentiment (takes flight), then the inside channels of power have to mobilize….(LBJ) understood that when John Lewis and his fellow soldiers on that bridge (endured) a brutal attack, that the consciousness of the country had been changed, and it was time to move to that.” Suggesting that this was a ‘lean in’ moment occurring just a week after Bloody Sunday, she repeated the words her late husband had crafted and LBJ had uttered that evening, “This is not a Negro movement, not a White movement, not a Northern movement, not a Southern movement…It is simply wrong to deny your fellow Americans the right to vote…There is a long way to go, but if we work together, we shall overcome.”  Summarizing, Goodwin simple states, “The outside movement met the inside power.”

Before the session ended, Meacham recommended to Congressional leaders in the solemnly silent chamber to “tap the brakes on nostalgia.” Explaining his meaning, he said, “There is a human tendency to want the past to have been simpler…But there was never a once upon a time and there is not going to be a happily ever after. This is an unfolding job….You are here to do this, to govern in an imperfect world. And you know that. This country as we know it right now is about 56 years old…The first actually integrated election occurred in 1968. 52 years ago.”

Asked to sum up, Jon Meacham said, “January 6th is not a wake-up call. That is not the right way to put it. It is, as the President says, an inflection point – either a step on the way to the abyss, or it is a call to arms, figuratively, for citizens to engage and say…the work we are about is more important than the will and whim of a single man or single party or single interest.”

In turn, Doris Kearns Goodwin closed by emphasizing that the work of the June 6th Select Committee of the House was critical. She said, “We have to retell the story of January 6th with all the gaps filled in. I have a fundamental belief that if that story is told in its fullest…we can retell it in a way that really happened and I do believe a line will be drawn. Maybe it is 50/50 now and (with an additional 5% convinced) becomes 55/45.” The goal she says is for transformation of our leaders so that “the ambition for self, (now) becomes something larger”, allowing our representatives to stand up for what is right.

In closing, the words of Winston Churchill were invoked: “The future is unknowable, but the past gives us hope. It is the present we have to get through.”

You may view the full session in its entirety HERE.

One Year After January 6th: A Role For Restorative Justice and Universal Health Care In America.

Posted on | January 6, 2022 | 2 Comments

Mike Magee

“We’re better than this” is the common refrain heard from many political leaders following the deadly assault on our democracy on January 6th. We hear empty appeals for blind appeasement from the likes of Kevin McCarthy in the interest of “bringing our country together.” But for those of us who study medical history, pursuing this course takes our nation in exactly the wrong direction.

Rather, the model we must follow is the model of Germany in 1945, or South Africa in 1995. In both cases, strict legal and public accountability (retributive justice) were married with fundamental expansion of universal social services to rebuild confidence and trust in their government’s ability to assure safety and security, and an equal playing field for all of their citizens (restorative justice).

In sorting through the legacy of Hitler’s regime in Germany, the Allied forces established the International Military Tribunal.  One of the series of trials, opened on November 19, 1945 in the Palace of Justice in Nuremberg, delved into egregious examples of medical criminality, including Nazi experimentation on human subjects. These trials are often cited as an example of “retributive justice.” Of 23 defendants, 7 were hanged, 7 acquitted, and the rest given sentences of from 10 years to life in prison.

These judgments were conducted under the direction of U.S. judges and prosecutors and fully compliant with U.S. standards of criminal procedure. Yet another 25 years would pass before any of the 10 agreed-upon medical ethics research standards were integrated into US trial law.

Legal scholars such as Michelle Miller at Cornell Law School attribute this lapse to the self-regarding biases of leaders within the Medical Industrial Complex. As Jay Katz, a physician and professor of law at Yale wrote in 1992 of the Nuremberg directives, “It was a good code for barbarians, but an unnecessary code for ordinary physician-scientists.” In other words, it was assumed that American medicine’s noble professionalism was adequate to ensure appropriate ethical standards.

Adding to the irony, at the very same moment that the leaders of the Medical Industrial Complex were rejecting President’s Truman’s 1946 call for a national health plan as “socialized medicine,” our military under the Marshall Plan was fast at work creating highly successful national health plans for our two main vanquished archenemies, Germany and Japan. We were willing to allocate precious taxpayer resources to assure this expression of “restorative justice.”

An analysis of the German and Japanese programs made some years later by the Rand Corporation summed up the Marshall Plan’s rationale: “Nation-building efforts cannot be successful unless adequate attention is paid to the health of the population. The health status of those living in the country has a direct impact on the nation’s construction and development, and history teaches us it can be a tool in capturing goodwill of the nation’s residents.”

A similar restorative approach was utilized in South Africa in 1995. Nelson Mandela’s Truth and Reconciliation Commission conducted over 1000 public hearings on their road to a free democracy, offering amnesty to those who publicly admitted past crimes of sectarian violence and asked for forgiveness. Less recognized, Mandela simultaneously instituted fundamental social service reform, including free primary level public health care for all in 1996 serviced in over 350 newly constructed health clinics by 1997.

Now a quarter of a century later, Mandela’s words, delivered that day, continue to resonate on our own shores.

He said: “With our freedom won, we faced the challenge of using our limited resources to provide the majority of our people with adequate housing, education and health services. These things are regarded as basic human needs anywhere in the world and yet most of our people had been denied them…

“Because there were very few hospitals and clinics, only those with money and who were healthy enough could travel the long distances to get proper medical help. This was the situation of millions of South Africans across the country.

“One of the most important steps the government has taken to deal with this crisis in our nation’s health was to introduce free universal primary health care. Since April last year, for the first time in our history, basic health-care has become available to everybody without cost. And to make that health-care easily accessible, to especially the poor, we launched the clinic-building programme so that there would be a clinic within walking distance – five kilometres – of every household.

“Primary Health Care uses measures for both prevention and cure, like immunisation, family planning and health education. But in order for these programmes to work we also need to make sure that communities have adequate shelter, employment, sanitation and clean water supply. Poverty and lack of essential services are the greatest threat to our nation’s health.”

The failures of this nation’s health care system have been well documented, and now include the mismanagement of the Covid-19 pandemic, certain to claim more than a million American lives. As with Germany in 1945, and South Africa in 1995, creation of reliable health access for all would assist our troubled nation in her efforts to address racism, disinformation, and the current erosion of public trust – problems that are egregious and deep-seated.

Criminal investigations of the January 6th insurrectionists are well underway and appropriate expressions of retributive justice. No one is above the law. At the same time, movement toward universal health care in America, as an expression of restorative justice, and a means to begin to address societal financial, educational and health inequities, would be a logical next step if we truly wish to “bring our nation together.”

A 2022 New Year Message – With Help From The Lamont’s.

Posted on | December 31, 2021 | 2 Comments

On December 31, 2021, our family received a Holiday Card from Ned and Annie Lamont and their family. Its message so capsulized our own feelings that I wanted to share the message with you. Here is their wish – and ours as well.

For Sarah Weddington (1945-2021), RIP = Rest In Power.

Posted on | December 30, 2021 | 2 Comments

Mike Magee

“I am sure when my obituary is written, the lead paragraph will be about Roe v. Wade. I thought, over a period of time, that the right of a woman to make a decision about what she would do in a particular pregnancy would be accepted, that by this time, the 30th anniversary of Roe v. Wade, the controversy over abortion would have gradually faded away like the closing scenes of a movie and we could go on to other issues. I was wrong.”  Sarah Weddington, 2003.

_______________________________________________________

Sarah Catherine Ragle Weddington died in her home in Austin, Texas on December 27, 2021. She was 76. She was born in Abilene, Texas on February 5, 1945, the daughter of a Methodist minister father and a college business professor mother.

Bright and inquisitive, she graduated from small Methodist McMurry College magna cum laude at the age of 19, and enrolled at the University of Texas at Austin Law School. She was one of 40 women in a school of 1,600 students. Her course work was briefly interrupted in her final year, at age 22, by an unwanted pregnancy. With her soon to be law student husband, Ron Weddington, she traveled to Mexico for what she later described in a 1992 autobiography as a “safe abortion.” She later remembered her last thoughts as they administered her anesthesia, “I hope I don’t die, and I pray that no one ever finds out about this.”

After passing the Texas bar, she hung out a shingle in Austin, Texas where she supported herself by writing wills, and resolving uncontested divorces. She had no trial experience, but was fascinated by women’s rights issues, and with several other women in the area, advised college women which doctors in the area might be willing to perform abortions, currently illegal in the state unless to save the life of the mother.

At the time, she was asked by one student whether she could be prosecuted for helping a friend receive an abortion. Not knowing the answer, she turned to a more experienced former fellow student and friend, Linda Coffee, who was clerking for a federal district judge in Dallas. At the same time, Coffee was advising a pregnant woman named Norma McCorvey, who had already had two children given up to adoption, and was pursuing an illegal abortion as a solution to a third unwanted pregnancy.

In December 1969, Coffee wrote Weddington, “Would you consider being co-counsel in the event that a suit is actually filed? I have always found that it is a great deal more fun to work with someone on a lawsuit of this nature.” Two months later, the new legal team met in a pizza shop with McCorvey, soon to be retitled Jane Roe, and a challenge to the Texas anti-abortion law, and to Dallas District Attorney, Henry Wade, was born.

In December 1971, when Sarah Weddington, age 26, stood before the Justices of the Supreme Court to argue Roe v. Wade, she had never tried a legal case. The lawyer’s lounge at the Court didn’t even have a women’s rest room. She felt the full weight of responsibility on her young shoulders. She later recalled, “I cared so much about the result. I was the only person that would be allowed to speak to the Court for the plaintiffs, asking them to overturn the restrictive Texas law. So it was fear-invoking, awe-inspiring, and something you just want so much to win you can taste it.” In October 1972, she was back again to field the all male Court’s questions.

One year later, her name would be forever recorded in legal history, and the case itself would be one of the most cited precedents ever to appear in American legal annals. The 7-2 majority decision leaned heavily of the First, Fourth, Ninth and Fourteenth Amendments, and resulted in a cascading reversal of existing state laws outlawing abortion in the years that followed.

Initially widely praised and supported by both medical and religious organizations, within five years, the reversal of Roe v. Wade became the rallying call and fundraising organizing tool of a new evangelical political movement self-titled, the Moral Majority. As it rose, so did the number and seriousness of death threats to the young lawyer.

What became of Sarah Weddington? She was Texan through and through, part of a group of notable women achievers of the time, sometimes referred to as the “Great Austin Matriarchy”which included Barbara Jordan, Sissy Farenthold, Ann Richards, Molly Ivins, and Liz Carpenter. In 1972, while awaiting the epic decision, she ran for a seat in the 150-member Texas House of Representatives and won, serving three successive terms. Her legislative aide at the time was none other than the future Texas Governor, Ann Richards. Three years later, she was labeled “the hardest working member of the house.” Over the years that followed, she served in President Jimmy Carter’s administration on women’s issues, helped advance the movement to approve the Equal Rights Amendment, and ultimately settled in as the first female director of Federal Government Relations for the state of Texas.

Of hiding her own abortion, she later said, “For a lot of years, that was exactly the way I felt. Now there’s a major push to encourage women to tell their stories so people will realize that it is not a shameful thing. One out of every five women will have an abortion.”

Four years ago, she was asked to predict the staying power of the Roe v. Wade decision. She said at the time, “If Gorsuch’s nomination is approved, will abortion be illegal the next day? No. One new judge won’t necessarily make much difference. But two or three might.”

Up to her death, she was known for advocacy. Sherrilyn Ifill, president of the NAACP Legal Defense and Educational Fund, marked her loss with three simple words: “Rest in power.”

Santa’s Message on Health – 2021

Posted on | December 20, 2021 | 4 Comments

Mike Magee

When I first posted “Santa’s Letter” four years ago, these three of our ten grandchildren were believers, Trump was in power, and immigrant children were literally dying in cages on our southern border. The words written then, by our youngest of four children and her husband, were much needed reassurance.

Our challenges in 2021 are different but no less significant and disorienting. The ongoing pandemic, a climate crisis now visible enough to be difficult to deny, and real threats to our form of government coming from within rather than from outside our borders simply head the list.

And yet – there is still a Santa Claus for true believers. And as he says above, believing in magic, family, laughter, yourself – these are not “luxuries,” but rather essentials to a healthy human existence. Read along with me:

“Dear Quinn, Luca and Charlotte,
Thank you for believing in my magic. I hope you will always believe in magic. 
Believe in the magic of family. There are times you will stumble, but your family will always be by your side. 
Believe in the magic of laughter. It will keep you whole. 
Believe in yourselves because I believe in you. 
Take care of each other.
Love always,
Santa”

This coming year will be a critical challenge for all Americans. How will the American family respond? How do we make America healthy again? I cling to Santa’s final words – “Take care of each other.”

Here is what that means to me as a health professional.

If we acknowledge the learnings of all other developed nations, we will embrace:

1. Universality: Health coverage and quality accessible health services are a right of citizenship in the United States.

2. Public Administration: Administration of basic health coverage is organized in the most cost-efficient manner possible with central oversight by the government. Incremental steps allowing the option of public sponsored plans to those already insured should be encouraged.

3. Local Control of Delivery: The actual delivery of services to ensure quality and cost effectiveness is provided by health professionals and hospitals at the local and state levels.

4. Health Planning is a Priority:  Creating healthy populations is a high priority for our national and state leaders. Working to establish health budgets and priorities, leaders must integrate health services with other social services, advance prevention planning and manage vulnerable populations.

5. Transparency: Providers submit bills. Government ensures payment of bills. Patients focus on wellness or recovery. All essential services (those defined under the ACA)  are covered.

Wishing you a happy and healthy New Year!

Eisenhower to Biden on Health Care: “Enlarge the Problem.”

Posted on | December 16, 2021 | 2 Comments

Mike Magee

My good friend, Kim Bellard, in a piece published in Medium titled “The Eisenhower Principle”, shines a light on this genuine American hero’s seminal military, political and management insight – “If a problem cannot be solved, enlarge it.”

In Kim’s astute health care analysis, he notes We’ve learned only half of Eisenhower’s adage: we’ve got the letting the problem get bigger part down, but we’ve forgotten the part about how/when to come up with solutions.”

In the spirit of uncovering solutions, it is worthwhile to retrace Eisenhower’s steps, supported by his own commentary, in the decade that followed WW II.

Section 1: The Chance For Peace.

The  “Chance For Peace” speech was delivered on April 16, 1953, shortly after Stalin’s unexpected death. In the speech, Eisenhower stated:

“Every gun that is made, every warship launched, every rocket fired signifies, in the final sense, a theft from those who hunger and are not fed, those who are cold and are not clothed…This world in arms is not spending money alone. It is spending the sweat of its laborers, the genius of its scientists, the hopes of its children. The cost of one modern heavy bomber is this: a modern brick school in more than 30 cities. It is two electric power plants, each serving a town of 60,000 population. It is two fine, fully equipped hospitals. It is some fifty miles of concrete pavement. We pay for a single fighter with a half-million bushels of wheat. We pay for a single destroyer with new homes that could have housed more than 8,000 people…This is not a way of life at all, in any true sense. Under the cloud of threatening war, it is humanity hanging from a cross of iron.”

For those who actively criticized President Biden’s unilateral disengagement from Afghanistan, consider the anti-war stance of our nation’s most decorated general. As President, in foreign affairs, he demonstrated enormous restraint, even as his supporters questioned his decisions. For example, he did not take any advantage when Stalin died unexpectedly in 1953, and he resisted being drawn into Indochina in 1954 when the French departed, electing to “wage peace” rather than engage in another war. Similarly, in 1956, when Hungry was invaded by the Soviets, he chose (at least publicly) to stand down. In the midst of the Cold War, he envisioned a negotiated truce with the Soviets on nuclear weapons, a long range goal that was eventually scuttled near the end of his second term by the shooting down of an American U-2 spy plane over Soviet territory. He did take definitive action on two occasions, in 1955 and 1956, when he believed American interests were at risk. In the first case, when Communist Chinese appeared ready to attack Taiwan, he seeked and gained Congressional approval to use force “if necessary to assure the security” of Taiwan. The Chinese backed off. A year later, when the United Arab Republic seized the Suez Canal, and Israel invaded Egypt, American allies, Britain and France, were ready to enter the fray, which would likely ignite a broader conflagration. Eisenhower immediately involved the UN and all parties were forced to stand-down. Crisis averted.

Section 2: The Pivot.

While Communism and the Cold War must be managed, Eisenhower had strong ambitions for his domestic agenda which he labeled “the middle way” to domestic prosperity. This included balancing the budget, building up America’s highway infrastructure, and continuing the New Deal commitments – a decision that more than raised the eyebrows of the Republican Old Guard. He extended insurance coverage through Social Security and bumped the minimum wage from .75 cents an hour to 1$ an hour. For passage he relied on Democrats to support key legislation.

Believing “what was good for business was good for the nation”, he stacked his Cabinet with successful millionaire businessmen including Secretary of Defense Charles E. Wilson (General Motors CEO), Secretary of the Treasury George M. Humphrey (M.A. Hanna Steel Company), and Secretary of the Air Force Harold E. Talbott (a director in both TWA and Douglas Aircraft Company). He saw this as simply a common sense, pragmatic approach. Would Americans rather he choose “some failure…or a successful businessman,” he asked.  Clearly the new president intended to be activist in the domestic arena, and signaled this early to the business community with corporate tax cuts. Prosperity and expansion of the middle class were his key objectives.

Seven months before his heart attack, on January 31, 1955, Eisenhower delivered his “Special Message To Congress Recommending A Health Program.” This needs to be appreciated in the context of what had occurred over the past twenty years in the health insurance arena. When FDR declined to use political capital required to pass Social Security legislation to advance health insurance in 1937, opposition was abundant. The American Medical Association was fully engaged and pulled out all the stops. This included an FDR lunch with famous neurosurgeon Harvey Cushing, Roosevelt’s son’s father-in-law, the day before FDR’s announced decision to delay action. Into the resultant void came the non-profit Blue Cross and Blue Shield plans.  For-profit companies watched from afar through the 1930s. Once profitability was clear, they streamed in behind the Blues, so that by the time the country was prepared for post World War II expansion, the private insurance infrastructure was firmly in place.

In the early years of the war, the economy super-heated and caps were placed on employee salaries to prevent inflation. Employers, competing for scarce workers, began to layer on benefits, including health insurance. By 1949, the government ruled that benefits were part of the negotiated wage package, and five years later, the IRS exempted employer-provided health benefits from income tax. Coincident with this, labor and management dueled over the issue. In 1949, the United Auto Workers Toledo local began a drive to create a regional pension plan that would spread risk across many auto industry suppliers. The reasoning was that even if your particular company went bankrupt, your benefits would be safe because they came from a regional pool, not directly from your employer. Business owners and large employers disagreed with the concept. They felt that collectivization threatened the free market and business owners’ autonomy. In the United States a year later, Eisenhower’s future Secretary of Defense, Charlie Wilson, then president of General Motors, began offering GM workers health care benefits and a pension. The offer was more defensive than beneficent. In the single decade between 1940 and 1950, the number of Americans covered by employer-sponsored health care increased from 21 million to 142 million.

The opening paragraph of Eisenhower’s 1955 Special Message on Health Care reads, “ Because the strength of our nation is in its people, their good health is a proper national concern; healthy Americans live more rewarding, more productive and happier lives.”

Section 3: Tipping His Hat To Truman.

By now, President Eisenhower clearly had determined that health care deserved to be at the center of his domestic agenda.  His second paragraph in the 1955 State of The Union address focused on chronic disease. “Deaths from infectious diseases have diminished. During the past year, important progress has been made in dealing with such diseases as rheumatic fever, high blood pressure, poliomyelitis and tuberculosis. Intensified research has produced more knowledge than ever before about the scourges of heart disease and cancer.”

Two paragraphs later, he highlighted President Truman’s accomplishments noting the 1947 Hospital Survey and Construction Act (known also as the Hill-Burton Act) as a critical achievement that had greatly expanded America’s caring capacity. It provided federal funding in support of communities advancing local hospital construction to expand access throughout the country to 4.5 hospital beds per 1000 citizens. In return for the grants, hospitals had to commit to non discriminatory behavior based on race, creed, color or national origin; agree to provide a “reasonable volume” of free care to needy residents (though “reasonable volume” was not defined for another twenty years); and the community had to demonstrate the long term economic viability of the hospital construction that was to be funded.

Eisenhower then acknowledged the 83rd Congress’s expansion of this law saying, “The 1954 amendments to the Hospital Survey and Construction Act opened another new chapter in the national drive for better health. Under these amendments, further provision was made to help build health care facilities for the chronically ill; to aid in the construction of nursing and convalescent homes; to provide for more diagnostic and treatment centers for patients who do not need hospital care; and to help make centers available for the rehabilitation of the disabled.”

And yet,  Eisenhower said clearly in 1955, we can do more. In his words, “These achievements represent a major gain for the immediate and future welfare of countless Americans – in the health of both mind and body. Recent advances do not, however, represent our full capacity to wage war on illness and disability throughout the land. As a nation, we are doing less than now lies within our power to reduce the impact of disease. Many of our fellow Americans cannot afford to pay the costs of medical care when it is needed, and they are not protected by adequate health insurance. Too frequently the local hospitals, clinics, or nursing homes required for the prevention, diagnosis and treatment of disease either do not exist or are badly out of date. Finally, there are critical shortages of the trained personnel required to study, prevent, treat and control disease.”

Section 4: The Solutions.

Eisenhower then laid out a long list of recommendations that read remarkably progressive for it’s day. It includes:

Lower the Cost of Care: Expanding the numbers covered by health insurance and the scope of benefits with a special focus on protection against catastrophic costs, coverage for the disabled and those in rural areas, and coverage for low income Americans.

Health Facility Construction: Improved access to funding mechanisms with federally backed support for privately funded construction loans to health care facilities.

Health Manpower: Grants to support expanded training of nurses and public health specialists including those focused on mental health.

Expansion of Public Health Programming: Expanded grants for the Public Health service, the Children’s Bureau of the Social Security Administration, and the Food and Drug Administration.

Environmental Health: Expanded research on air pollution control, and water purity.

Mental Health: Increased funding for training of mental health professionals, expansion and improvement of mental health facilities, and strategies to manage mental health in the community rather than in large institutional settings.

International Health: Stronger support of the World Health Organization (WHO). His positioning for support was new for the day. As he said, “For half of mankind, disease and disability are a normal condition of life. This incalculable burden not only causes poverty and distress, and impedes economic development, but provides a fertile field for the spread of communism.”

These were not simply words for Eisenhower, they were backed up by organizational action that he had taken in 1953.

On April 11, 1953, the president provided his signature of approval and HEW was created. Within its’ umbrella were sheltered Social Security providing 70 million Americans with $4 billion annually on the back of proceeds from a $19 billion dollar trust fund; the Public Health Service and its’ new National Institute of Health (NIH) and National Cancer Institute (NCI); the Office of Education overseeing national education policy; the Food and Drug Administration; The Office of Vocational Rehabilitation; the Children’s Bureau; the American Printing House for the Blind; the Columbia Institute for the Deaf; and St. Elizabeth’s Hospital for the Mentally Ill.

In a bipartisan slight of hand, Eisenhower appointed Democratic Texan, Oveta Culp Hobby, as HEW’s first Secretary. She had been a strong Eisenhower supporter in 1952. He backed her up by appointing Nelson Rockefeller the under-secretary. Rockefeller accepted the role against the advice of his handlers who felt it was beneath him to be the number two. But as he stated, “I’m responsible for creating this baby. I have a responsibility for seeing to it that it succeeds.”

Section 5: In Summary – Eisenhower Gets The Final Word.

In his contemporary review, Kim Bellard reflects, Yet still the outlines of a solution continue to elude us. It seems there is no health problem so big that we can’t turn it into a political issue, not even a pandemic.”

But in shining a light on this remarkable American, Bellard reminds us that Biden is on the right path in promoting peace time oriented spending priorities, confronting the enemies of truth, and believing that the health of Americans is the critical determinant in the economic and political future of our American democracy.

Eisenhower had no second thoughts about the wisdom of such investment. As health care expenditures hit $4.1 trillion this week, controlling 1/5 of our GDP, Eisenhower would likely advise President Biden to “lean in” to the problem, expose the liars and haters, and do the right thing.

Our former President gets the final word:  “I believe that the social gains achieved by the people of the United States, whether they were enacted by a Republican or a Democratic administration, are not only here to stay but are to be improved and expanded…Anyone who says it is my purpose to cut down Social Security, unemployment insurance, to leave the ill and aged destitute, is lying. Should any political party attempt to abolish social security, unemployment insurance, and eliminate labor laws and farm programs, you would not hear of that party again in our political history.”

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