by Joshua Zeitz
In the 1960s, there was also no ecosystem of business lobbies and conservative think tanks to engage in a guerrilla war against Medicare. Though the American Medical Association had long resisted the law, and while hospitals and individual physicians were under no obligation to participate in the program and see Medicare patients, most health-care providers largely acquiesced after its passage, joining with hospital organizations, insurance carriers, and religious and lay groups to help implement the program. Reflecting on the achievement many years after the fact—but well before enactment of the ACA—a Johnson administration official noted that “in Medicare we never had a class action suit in the first or second year. . . . There were no strong advocacy groups following our every move . . . and there was little litigation, except on the basis of individual claims, that went past the appeals process. By the time Medicare was implemented, major interest groups were involved—the AFL-CIO and senior citizens’ organizations for example—but worked with us for change rather than filing suits.” Obama’s ACA met with organized resistance at every turn; by contrast, Medicare’s early foe—the American Medical Association—soon accepted the program as established law and learned to live with it; indeed, many doctors soon discovered that it was a golden goose.
Finally, Medicare had a far narrower mandate than certain later initiatives. The program came under early and heavy criticism for its out-of-control costs, and indeed between 1966 and 1971 annual Medicare spending jumped from $3.5 billion to $7.9 billion, well in excess of what the Johnson administration initially projected. Detractors then and later would fault Medicare, with its fee-for-service model, for fueling runaway medical inflation across the board. Some of that criticism was fair, though hospital costs had already been sharply on the rise before Medicare, jumping 149 percent between 1950 and 1963, compared with a hike of just 27 percent in the consumer price index. In effect, medical inflation began outstripping general inflation well before Medicare. More fundamentally, Medicare was never intended to overhaul the health-care economy. The program used existing insurance carriers as administrative agents—that usually meant large, established companies that could demonstrate “unquestionable capability to administer effectively and efficiently . . . for a beneficiary group of significant size” and the ability to effect “prompt and proper payment under the concept of ‘reasonable charges’”—and deliberately took a light hand in enforcing delivery and price controls. As an administration official later noted, Medicare “accepted the going system for the delivery of care and the program structure was modeled on previous private insurance arrangements. Reimbursement of institutions followed the principle of cost reimbursement that had been worked out with the American Hospital Association and the majority of Blue Cross plans. Physician reimbursement followed the direction of private commercial insurance, making payments based, by and large, on what physicians charged their other patients.” The program was constructed solely to extend medical care to seniors, and because so many seniors availed themselves of its blanket coverage, costs soared. It simply “wasn’t possible in 1965 to put cost controls in. It would never have passed Congress,” Wilbur Cohen affirmed. “Even if we could have, no one knew how to do it in 1965.” By contrast, Obama’s ACA was designed to extend coverage and control costs and in this regard has a much more ambitious mission. In short, Americans expected more of the ACA—and in some case feared the ACA more—because the program was sold as a transformative measure.
In 1961, Ronald Reagan ominously warned that passage of Medicare would constitute “a short step to all the rest of socialism.” In fact, LBJ relied on private insurance carriers, to the chagrin of liberals who might have preferred to bypass the entrenched medical establishment. The irony was not lost on the authors of a contemporary study who noted that “Medicare . . . began with an apparent paradox. Private enterprise had failed, markedly, to provide adequate health insurance for the elderly: hence the passage of Medicare. Yet private insurance was chosen to administer the new governmental system.” Doctors, whose lobby had steadfastly resisted the program, learned to love it: their incomes rose approximately 11 percent each year over the first seven years of implementation. For most seniors, it soon became impossible to fathom a world without Medicare. As Johnson predicted, it became a third rail in American politics that only the most outspoken entitlement hawks dared attack. Its enduring success owed in no small measure to its smooth launch.
CHAPTER 8
Get ’Em! Get the Last Ones!
When Lyndon Johnson decreed in New Orleans that the Civil Rights Act of 1964 would be the guiding law of the land—“I signed it, and I am going to enforce it,” he pledged in his most famous campaign speech—skeptics could be forgiven their incredulity. Throughout his tenure as Senate majority leader, LBJ earned a well-deserved reputation for prevarication and avoidance on the subject of civil rights. During his service in the House of Representatives, from 1937 to 1948, he voted reliably with the southern bloc against federal antilynching laws, equal employment measures, and the elimination of the poll tax. In the Senate, he devoted his maiden speech to a full-throated defense of the South’s political traditions. In 1957, he maneuvered the first meaningful civil rights legislation through Congress in almost a century but only after he stripped it of its enforcement mechanisms. Though in his first months as president he lent considerable muscle to the fight for a new, more comprehensive civil rights law, by no means was it clear that he would compel compliance. Many liberals regarded him at best as a new convert to the cause and at worst as an opportunist who had no intention of enforcing its more controversial provisions. But Johnson proved good to his word, if not better, and his administration began with that most taboo of public spaces: schools.
It had been over ten years since Chief Justice Earl Warren—his eyes fixed downward on a prepared text, his full shock of white hair set sharply against the top of his long black judicial robes—stunned the world on May 17, 1954, when he announced in stark, unyielding terms that “in the field of public education, the doctrine of ‘separate but equal’ has no place.” The ruling was stunning and led many observers to declare premature victory. The reaction to the Court’s unanimous decision in the case of Brown v. Board of Education—arguably, the first major legal blow leveled against Jim Crow—elicited cries of anguish and outrage from the Deep South, shocked disbelief from the nation’s most experienced political observers, and a surge of optimism from African American communities throughout the country. The Chicago Defender, a venerable black newspaper, optimistically predicted that Brown meant the “beginning of the end of the dual society in American life and the system . . . of segregation which supports it,” while the author Ralph Ellison hoped that “another battle of the Civil War has been won. The rest is up to us and I’m very glad. . . . What a wonderful world of possibilities are unfolded for the children.” “We assumed that Brown was self-executing,” recalled Julius Chambers, then a teenager in North Carolina who would one day become director-counsel of the NAACP Legal Defense Fund, the organization that argued the case before the Supreme Court. “The law had been announced, and people would have to obey it. Wasn’t that how things worked in America, even in white America?” he later reflected.
That was of course not how things worked. After the Court ruled in a subsequent decision in 1955 (dubbed Brown II) that local authorities should proceed with “all deliberate speed” in desegregating their facilities, most southern school districts evaded the letter and intent of the decree by using a variety of methods to avoid full compliance with the Court’s decision, including “pupil placement” plans, which assigned students to schools by means of racially biased testing criteria, and open enrollment plans, which placed the onus on individual black students to apply for transfers into white schools. Lower federal courts gave the South wiggle room by distinguishing between desegregation, which mandated an end to formal rules separating white and black students, and integration, which involved the deliberate
achievement of racial balance. In 1960, less than 1 percent of black students in the South attended majority-white schools; in 1964, still less than 5 percent. In Alabama, Mississippi, and Louisiana, less than 1 percent of all black children attended school with even one white student—a testament to the Deep South’s dogged maintenance of dual education systems.
Southern resistance to integrated schools cannot be measured in numbers alone. It was a story that played out in hundreds of school districts among thousands of actors—many of them children—every day.
It was the story of Dorothy Counts, a fifteen-year-old who in 1957 enrolled as the first and only black student at Harding High School in Charlotte, North Carolina—an ostensibly moderate, “New South” city with a thriving business community that endeavored to distinguish itself from retrograde “Deep South” hamlets in Alabama and Mississippi. Though municipal officials intended her enrollment to meet a token measure of compliance with Brown (she was one of just four black students assigned to all-white schools and the only black pupil at Harding), Counts met with a firewall of violent resistance. On her first day of class, white residents—many of them adults several multiples of her age—greeted her with jeers, shoves, and a barrage of sticks and small rocks. They spat on her and vomited ugly racial epithets. Dorothy stayed home from school for two days and then steeled herself for a return. Her classmates shoved and elbowed her in the halls, vandalized her locker, and pelted erasers at her head. The mob shattered a window in her father’s car as he attempted to drive her home. The Counts family had had enough. They moved north to Philadelphia, where she attended a nonsegregated high school.
It was also the story of Ruby Bridges, who in 1960 became the first black student to attend William Frantz Elementary School in New Orleans, after the federal district judge J. Skelly Wright, a native Louisianan, ordered the city to comply with Brown. Dressed immaculately in a starched white blouse, dark skirt, and polished Mary Janes, Ruby—a six-year-old girl in pigtails—walked quietly and with cool resolution as four U.S. marshals escorted her through an angry mob of 150 white protesters, most of them housewives, who pelted her with rotten eggs and vegetables and chanted the vicious doggerel “Two, four, six, eight. We don’t want to integrate. Eight, six, four, two. We don’t want a chiggeroo.” One of the federal lawmen who protected her that day remarked that “she showed a lot of courage. She never cried. She didn’t whimper. She just marched along like a little soldier, and we’re all very very proud of her.” White parents withdrew their children from the school and placed them in “private” academies supported by public funds. Throughout the fall, Ruby maintained her public composure, but she was rattled when one of the white women who heckled her each morning outside the school door threatened to poison her food. At the end of the semester, her teachers found Ruby’s locker crammed with uneaten sandwiches that her mother had prepared for her lunch.
Shortly after John Kennedy’s assassination, Burke Marshall, the head of the Justice Department’s Civil Rights Division, observed that the South’s decade-long campaign of “massive resistance” to the Supreme Court was “testing . . . the durability of the federal structure.” State and local governments patently refused to desegregate their school systems, requiring the Justice Department to file individual suits that wound their way slowly through the federal court system. “It is as if no taxpayer sent in a return until he personally was sued by the Federal government,” Marshall lamented. “The crisis is more deplorable, of course, because it is not private persons . . . who are failing to comply with laws, but the states themselves.” It was precisely this moral and legal crisis that LBJ was determined to surmount.
Lyndon Johnson had an “abnormal, superstitious respect for education,” George Reedy confided to an interviewer. He also believed with every fiber of his being that access to education should be color-blind. At age twenty-one, he taught elementary school in Cotulla, a small town on the South Texas plains, where all of his students were Mexican Americans. He was appalled by their dire poverty. Most of his students went hungry in the afternoons because their parents lacked the wherewithal to pack them off for the day with lunches. Over the single academic year he spent as a teacher, he championed his students, pushing them to learn and dream big. “Those little brown bodies had so little and needed so much,” he painfully recalled. “I could never forget seeing the disappointment in their eyes and seeing the quizzical expression on their faces—all the time they seemed to be asking me, ‘Why don’t people like me? Why do they hate me because I am brown?’” As president, he now wielded power to right a wrong that had haunted him for decades, and he would make good use of it.
Title VI of the 1964 Civil Rights Act empowered the executive branch to cut off school funding for districts that still practiced de jure segregation. The 1965 Elementary and Secondary Education Act, which increased federal funding for public schools from just $2.7 billion in 1964 to $14.7 billion in 1971, rendered that enforcement authority more important. Federal funding now amounted to upwards of 30 percent of some southern districts’ prospective budgets. If local officials insisted on maintaining dual school systems, not only might they face Justice Department suits and, potentially, court orders; the administration could also summarily withhold a large portion of their eligible federal education funding.
In theory, Title VI relieved the courts of the responsibility for enforcement. As one administration official observed, it offered a “golden opportunity for taking the intolerable pressure of the school cases off the federal judges by introducing a powerful new force for school integration.” In reality, the aggressive means by which the Johnson administration administered Title VI spurred federal judges to involve themselves more, not less, in local school desegregation battles. Wielding two sticks—Title VI enforcement, which enabled the administration to cut off federal funds, and Justice Department lawsuits, which could result in judicial orders that federal law enforcement authorities would be compelled to enforce—the administration quickly showed its determination to bring the era of “all deliberate speed” to a close.
The Office of Education began driving southern districts to comply with Title VI even before the president signed ESEA into law and in many cases—such as Georgia, where Governor Carl Sanders, a relative moderate, sharply rejected the administration’s scrutiny of districts that he deemed desegregated—bumped up against local resistance. Not just Douglass Cater and Joe Califano, but even Vice President Hubert Humphrey, who for a time acted as the administration’s senior policy coordinator on civil rights, carefully oversaw negotiations between HEW and the Justice Department, on the one hand, and southern governors, on the other. Despite complaints by southern governors and members of Congress, Johnson gave his aides free rein in demanding that thousands of school districts submit clear desegregation plans to the commissioner of education, who alone would certify their compliance with the law. No White House had ever involved its staff in so granular, expansive, and consistent a review of civil rights compliance.
Within two weeks of ESEA’s enactment on April 11, Doug Cater informed Johnson that HEW and the Department of Justice had decided to issue firm guidelines to districts that maintained dual school systems—which was to say, most localities in the former Confederate states, as well as many towns in the border states. “The problem was simply this,” Cater informed LBJ. “Approximately 500 districts have submitted plans, most of them considered by the Commissioner of Education to be unacceptable. . . . It would be impossible to negotiate with each administration on an ad hoc basis. In fact, there has been evidence in negotiations attempted thus far that many districts are holding back on making commitments until they determine whether the Office of Education means business.” The administration’s parameters applied to all school districts that were not under court desegregation orders (such judicial decrees superseded HEW’s authority) and required that they integrate at least four grades by the start of the 1965–1966 school year and all
grades by the fall of 1967. Districts were permitted to use two mechanisms: geographic rezoning or “freedom-of-choice plans” that permitted parents to select the school they preferred for their children. Cater acknowledged that civil rights activists would look with disfavor upon the allowance of choice plans, which resembled the very mechanisms that white officials had used for over a decade to circumvent Brown. But the guidelines emphasized that “performance not paperwork is the ultimate measure of a plan’s adequacy.” Cater regarded the means by which districts desegregated as less important than the end. If the administration enforced its own requirements, choice plans could in fact operate as a powerful desegregation tool.
Much of the onus fell on Francis Keppel, who served by his own admission as the administration’s “chief SOB with the Southerners.” With only five months until the start of the new school year, his office was responsible for coaxing, cajoling, and haggling with over 5,000 individual districts throughout the South. “I had a whole crew of fellows trying to talk these Southern school districts into changing,” he remembered. “They’d put up a plan—we wouldn’t like it, and we’d [send] it back. I used to have to go over with Joe Califano about every three days, just as if you were reporting on your hunting trip, saying, ‘We’ve now got 3,200 of them,’ and, ‘We’ve now got 3,800 of them.’ We finally got down to a hundred of them or something.” During his regular meetings at the White House—sometimes held in the Fish Room, sometimes in Califano’s basement-level office suite—the president would routinely “wander in and out saying, ‘Get ’em! Get ’em! Get the last ones!’ We were going absolutely nuts. But it was a kind of political game. He wanted them all in the bag, you know, by September.”