by Joshua Zeitz
Local civil rights officials, who operated under the auspices of the Coordinating Council of Community Organizations, encouraged the White House to view Chicago’s willful maintenance of a dual school system, and its misappropriation of Title I funds, as a threat to the Johnson administration’s broader educational agenda. “The Elementary and Secondary Education Act is a program too crucial to national survival to be weakened through disbursement of its funds in a manner contrary to the requirement of the Act,” they implored Cater, “and for educational programs which are inadequate to achieve its goals.”
In the early fall of 1965, Keppel’s office instructed Willis to respond to allegations that he had earmarked Chicago’s Title I funds for white children who were not poor. His team afforded Chicago officials no more leeway than they extended to southern officials. For every school in the city, the Johnson administration demanded student enrollment figures by race; average class sizes, daily attendance, and student-teacher ratios; open or over capacity; information on available courses and curricula; an accurate count of classrooms, gymnasiums, libraries, and lounges; dropout statistics; and faculty backgrounds. When the superintendent gave him the cold shoulder, Keppel informed Willis on September 30 that his office would defer the delivery of federal funds—$32 million in total—pending a resolution of the complaint. He struck the same collaborative, encouraging tone that HEW assumed with southern governors and school districts—Keppel informed the Illinois state superintendent of schools that he would send teams to Springfield and Chicago to help local officials meet federal guidelines—and forewarned Doug Cater of his action. The next day, Cater informed the president that he might receive blowback over HEW’s action in Chicago. An initial investigation found that “a couple of vocational schools might be in violation,” but Keppel “believed the whole matter can be worked out swiftly.”
Keppel was acutely aware, as he told an interviewer several years after the fact, that “northern school districts were practicing discrimination by subvisible means. . . . [I]t’s a national problem, but it’s a lot harder to catch the boys up north, because down south they said, ‘Sure, we’ve got black schools and white schools. What are you fellows talking about? We treat them all equally.’” The challenge in the North was “not only more subtle” but “much more of a public policy problem to handle—much more!” Two days after Cater informed him of the Chicago affair, LBJ flew to Manhattan, where he was scheduled to sign a sweeping immigration reform law. Daley was in town and secured a private audience with the president, during which he unleashed his rage at Keppel and other bureaucrats in HEW. LBJ promptly instructed Wilbur Cohen to travel to Chicago posthaste and “fix the problem.” The assistant secretary complied, squeezing a few minor concessions from Daley’s office but effectively walking back the administration’s position. In early 1966, Johnson appointed Keppel to the post of assistant secretary of HEW and tapped Harold Howe, a career educator, to replace him as education commissioner. On paper, it was a promotion; in reality, Keppel would later observe, “I was fired. . . . I was the chief SOB with the Southerners. And then you get to be a chief SOB with the Northern Democrats in one city! Come on—you’re useless! Get out!”
Howe would take a more diplomatic tact with Daley, but by December 1966, just months into his tenure, his office informed the mayor and his superintendent that the city’s schools were out of compliance and at risk of losing their funds. For Johnson, as for any Democratic president, Richard Daley represented a unique case. Joseph Califano instructed Howe to work directly with the mayor; HEW should not publicize its findings, he ordered, but should make strong recommendations to the Board of Education (ending apprenticeship programs with unions until black students were admitted in proportionate numbers; engaging pupil placement specialists to reduce segregation in neighborhood schools) that would bring them back into compliance with Title VI. By then, white voters in Chicago—as in many northern cities—were in full backlash mode against the Johnson administration and liberal judges who appeared to threaten the integrity of their neighborhoods and local institutions. That trend would eventually speed the dissolution of LBJ’s sweeping 1964 electoral mandate and pave the way for conservatives to chip away at the Democratic coalition of black and white working-class voters—a coalition dating back to Franklin Roosevelt’s tenure.
David Seeley, the official responsible for civil rights compliance within the Office of Education, would later deny that “the reversal of the withholding action” in Chicago was as much “an example of unwarranted political interference by Mayor Daley” as “an example of the danger of taking strong governmental action in a politically sensitive area like civil rights.” It was unclear to administration officials in 1965 that the law empowered them to withhold funds where it was not manifestly evident that the state or city maintained dual school systems. “As head of the Office of Education civil rights enforcement program during this period,” he maintained, “I can attest to many situations in which President Johnson was under considerably stronger and more persistent political pressures to undercut our enforcement efforts and in which he displayed admirable backbone in resisting them.”
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Schools might have been the most controversial, but they were not the only institutions that the Johnson administration desegregated during the Great Society’s general rollout. In March 1966—less than four months before Medicare was due to launch—the Public Health Service, a division of HEW, sent a questionnaire to over ten thousand participating hospitals, nursing homes, and qualified health-care facilities, inquiring whether they were in compliance with the new civil rights law. Traditionally, many hospitals and doctors’ offices across the South either pointedly refused to care for black patients or consigned them to segregated and often inferior wings within the same building. In many cases, they even designated separate emergency rooms and nurseries for each race. Just as Title VI of the Civil Rights Act made federal education funds unavailable to segregated schools, it required that health providers participating in Medicare integrate their facilities and file the very same 441-B forms certifying compliance that schools submitted to become eligible for compensatory education dollars. In effect, even as it set about constructing the single largest health program in the nation’s history, the Johnson administration also faced the challenge of integrating hospitals and nursing homes throughout one-third of the nation. This task was not merely an administrative nuisance: it was a threat to the entire system. Southern health-care providers could very well have opted out of the new program, effectively killing Medicare in one-third of the states.
HEW dispatched more than a thousand inspectors to visit hospitals directly and ensure they were complying with Title VI. Close to seven thousand facilities swiftly acquiesced; another fifty-five hundred fell into line after inspection. Unsurprisingly, most of the noncompliant facilities were in four Deep South states: Mississippi, Louisiana, Alabama, and South Carolina. As with schools, HEW kept Califano and Cater informed of the most granular details on a weekly and sometimes daily basis. Having learned the hard way a year earlier that it was essential to issue clear and concise guidelines, the department produced a fifteen-minute film in coordination with the American Hospital Association that outlined the metrics that institutions were required to meet and enlisted charitable organizations like the National Social Welfare Assembly to encourage obedience to the law among grassroots members and activists.
The guidelines were sweeping. All people were to be admitted for inpatient and outpatient services without regard to color, race, or national origin. Where there was a “significant variation between the racial composition of patients and the population served,” the hospital had an affirmative obligation to justify that variance to federal officials. Each facility’s “rooms, wards, floors, sections, and buildings” must be integrated; officials were not to ask patients whether they wished to share quarters with someone of a particular race. “Employees, medic
al staff and volunteers of the hospital are to be assigned to patient service” on a color-blind basis. Training programs were to be fully integrated. The guidelines required that hospital employees apply “courtesy titles” like “Dr.,” “Mrs.,” and “Mr.” without regard to race and that formerly segregated institutions conduct proactive outreach to nonwhite physicians, nurses, and civil rights organizations—and take out advertisements in local media outlets—announcing the change in policy. The Johnson administration was not merely forcing hospitals to extend access to black citizens. It was enforcing a mandatory shift in how medical professionals treated African Americans as patients, colleagues, and human beings and placing new quantitative and qualitative obligations on local institutions.
In the same way that the Office of Education enjoyed discretion over the disbursement of ESEA funds, the Public Health Service—under the direction of Surgeon General William Stewart—was responsible for certifying hospitals compliant with Title VI. In a hopeful dispatch to hospital administrators just prior to Medicare’s rollout, the surgeon general affirmed that the “transition has not been as difficult as some feared. To the contrary, it has contributed to better patient care and in addition has proven to be both administratively and economically advantageous.” But the administration would remain vigilant. “Your participation in the Hospital Insurance for the Aged program,” Stewart warned, “even if you are otherwise certified as eligible,” was wholly dependent on compliance with Title VI. The administration dispatched Stewart to negotiate personally with municipal and hospital officials in a number of cities, including Memphis, New Orleans, and Shreveport, hosted twenty state hospital associations for an instructional conference in Washington, D.C., and conscripted major employers and labor unions to exert economic and peer pressure on recalcitrant institutions.
In May 1966, HEW’s secretary, John Gardner, informed the president that roughly 15 percent of all hospital beds in the nation were still in nonconforming institutions and that most nonconforming institutions were heavily concentrated in several Deep South states. On the eve of the program’s launch in July, only 34 percent of hospital beds in Mississippi were in compliance with Title VI. There were holdouts—even at the end of LBJ’s term as president in 1968, an official at HEW conceded that a “handful of hospitals, largely in the Delta area of Mississippi and Alabama,” remained out of step with the law (and therefore ineligible to accept Medicare dollars). But for the most part, the administration’s commitment to enforcing the civil rights law, and its willingness to withhold federal dollars from hospitals that could scarcely afford to lose them, compelled sweeping changes. Arthur Hess, a career administrator at HEW, recalled a memorable visit to a southern hospital. When he and other federal officials informed hospital officials that their facility was still noncompliant, and that it would not be permitted to participate in Medicare, administrators and board members began “ranting and raving” in a noisy display of resistance. Yet as Hess and his colleagues left the meeting, one board member quietly sidled up to them and said, “Keep the heat on.” Local hospital boards needed to use federal compulsion to cover themselves with their own elected officials and community members. In effect, the Johnson administration was engaged in an elaborate pantomime. The pressure worked. By the end of the decade, the number of black and Latino hospital patients grew by 30 percent, while the portion of hospitals that employed minority doctors or dentists rose by 61 percent.
Unlike hospitals, nursing homes would not be eligible to participate in Medicare until January 1, 1967, but the administration began its education and enforcement activities the summer before. Of fifteen thousand extended-care facilities in the United States, HEW estimated that only six thousand would elect to participate in Medicare and only three thousand would earn certification. Nevertheless, it was imperative that the department issue firm guidance across the board. Unlike hospitals, whose patient populations were by definition transitory, nursing homes were residential in character and would prove a more bitter battleground, north and south. Furthermore, Peter Libassi, the general counsel of HEW, informed Cater and Califano that while “most of the hospital discrimination was in the South, discrimination in [nursing homes] is more widespread. Many institutions in the North have been admitting patients of only one race until this time.” Just as the Office of Education had carried its Title VI compliance efforts into Chicago and other northern cities, HEW applied the law with equal force and consistency both above and below the Mason-Dixon Line. Libassi was confident that the rollout would progress smoothly, as indeed it did the following year. The department had increased its dedicated compliance staff and had “learned a great deal during these last five months and expect to put our experience to good work.”
Wilbur Cohen scarcely exaggerated the point when he observed that on “the day before Medicare went into effect, in every hospital in the South, over every drinking fountain, 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.” In reality, most hospitals removed those signs two years earlier, after passage of the Civil Rights Act. But the scale of change was breathtaking. No president before or after LBJ attempted to introduce a major, new government entitlement while at the same time using that very benefit to break down long-established patterns of de facto and de jure discrimination. On the contrary, while a handful of New Deal initiatives either expressly or incidentally undermined Jim Crow, for the most part Franklin Roosevelt—Johnson’s hero—struck a devil’s bargain that left many African Americans outside his administration’s protective embrace. The context in which LBJ operated was starkly different, but a lesser president might have temporized in the interest of ensuring an orderly rollout of Medicare and ESEA. Johnson knowingly assumed great risk.
Weeks before Medicare’s launch, a correspondent warned the president that southern hospitals were just as much hot spots as schools. The administration was demanding an overnight end to practices that had been in place for as long as most people could remember. “And they won’t [comply] Lyndon. You know that. Do you want to be responsible for closing St. Francis Hospital in Biloxi, Mississippi? That’s what will happen if you put this thing into effect. . . . Doctors won’t treat the coloreds, and the nurses won’t treat them.”
“It was a great gamble,” remembered Harry McPherson. “Whatever he decided, thousands of people, either the elderly or the blacks, might have been deprived of hospitalization.” Johnson wagered a big bet—and he won.
CHAPTER 9
The Fabulous Eighty-Ninth
Two weeks after LBJ outlined his vision of the Great Society in 1964, Dick Goodwin and Bill Moyers traveled on presidential instructions to Cambridge, Massachusetts, where they met with thirty professors from the Boston area. Over a long lunch at the home of John Kenneth Galbraith, the young White House aides solicited the formal participation of America’s public intellectuals in task forces that would help design the themes and substance of Johnson’s domestic agenda. The outcome of the meeting was fourteen committees that met and corresponded over the coming months to propose policy and legislation concerning transportation, natural resources, urban life, the environment, agriculture, civil rights, health and welfare, and infrastructure. Though John Kennedy enjoyed a reputation as the thinking man’s liberal, it was LBJ—not his predecessor—who fully leveraged the talent and imagination of the country’s academics. The original task forces that Goodwin and Moyers assembled included top administrative and faculty talent from the University of California, the Carnegie Corporation, the Brookings Institution, Harvard, MIT, and Princeton. Unlike ceremonial committees before and after, the LBJ task forces exerted tangible influence on policy making. Their members interacted freely with designated White House liaisons—including Cater (transportation), Lee White (natural resources, civil rights), Goodwin (e
ducation, natural beauty, metropolitan and urban problems), and Heller (intergovernmental fiscal cooperation)—and the output of their labors enjoyed wide circulation and consideration within the West Wing.
Shortly after the election, on November 10, Moyers, Goodwin, Cater, and Myer Feldman, a holdover from Kennedy’s staff, reviewed the task force reports and flagged the most promising and feasible of proposals for the president’s consideration. “If we had adopted all of their ideas,” an aide observed, “we would have had to come up with a budget of [tens of millions of dollars].” Moyers and his colleagues presented an abridged twelve-hundred-page version of the task force recommendations to Johnson at the LBJ Ranch over the Thanksgiving and Christmas holidays. Some of the ideas rehashed legislation that JFK had already submitted to Congress—Medicare, aid to education, immigration reform—but that had languished in committee. Others were entirely new, including enhancements to public culture and pathbreaking environmental initiatives, preschool initiatives, work-study programs, library services, instruction in the arts and sciences, federal aid to college and graduate students, preservation of scenic areas adjacent to federal highways, formalized revenue-sharing arrangements with states, health care for poor children, and a broader safety net for workers who were not covered by Social Security.