‘1619,’ Episode 4: How the Bad Blood Started

Sep 14, 2019

Today on “The Daily,” we present Episode 4 of “1619,” a New York Times audio series hosted by Nikole Hannah-Jones. You can find more information about it at nytimes.com/1619podcast.

Black Americans were denied access to doctors and hospitals for decades. From the shadows of this exclusion, they pushed to create the nation’s first federal health care programs. Guests: Jeneen Interlandi, a member of The New York Times’s editorial board and a writer for The Times Magazine, and Yaa Gyasi, the author of “Homegoing.”

Background reading:

• “One hundred and fifty years after the freed people of the South first petitioned the government for basic medical care, the United States remains the only high-income country in the world where such care is not guaranteed to every citizen,” Jeneen Interlandi writes.
• The Times Magazine asked 16 writers to bring pivotal moments in African-American history to life. Read Yaa Gyasi’s story “Bad Blood” here.
• The “1619” audio series is part of The 1619 Project, a major initiative from The Times observing the 400th anniversary of the beginning of American slavery. Read more from the project here.

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my Uncle Eddie was my favorite uncle he was my dad's younger brother not that much older than me and he was a complete jokester and cut up he was the one who was always playing some practical joke on you or who in some way Joyce felt was taking things too far because he just thought everything was funny so for instance if you fell asleep in his house he might light a match and stick it between your toes and let it burn down to wake you because he thought it was funny

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he called me bird which was my nickname and we like to listen to music together we like to watch TV together he was never mad I never remember him ever disciplining me for anything and in fact when my father and I would fight when I was a teenager I was sometimes pack my bag and go stay with him for a couple of days and he would never kind of sell me out

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when I got into college at the University of Notre Dame I think the only person prouder than my mom and dad was my Uncle Ed and when I graduated my uncle picked out this all red outfit from head to toe he had on a red hat and a red shirt and red pants and these red Gators and he was determined that he was going to show everyone how proud he was of me

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out dressing everyone at the graduation and he certainly did

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so we just were always very close whenever I would come home we would get breakfast together at morgues and just talk about life and all he would tell me all the time was how proud he was of me

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besides being a lot of fun my Uncle Ed was also one of the hardest working men that I knew he worked a lot of jobs doing things like working in animal processing plants and the last job that he had was Roofing and he did roofing for a lot of years often coming home at the end of the day kind of grimy and sometimes with his joints in his hand so swollen that he couldn't even make a fist he relished working hard he was proud that he could provide for

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family even without an education and then about 2009 he started to feel a pretty severe pain in his back and that pain began to spread from his back down into his legs and he started to have trouble moving and there was some mornings where he would have to kind of crawl out of bed but around that time my uncle also got laid off from the job where he was doing Roofing

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and with that layoff he lost his health insurance so like many people he had first avoided going to the doctor all together because he didn't have insurance but then when it got kind of unbearable he went to the free clinic because my uncle did not have health insurance they would not give him the test that he probably needed to find out what was going on with his back they wouldn't give him an x-ray they wouldn't give him a CAT scan or a pet scan and instead they just tried to diagnose based on what he was telling them and they

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I told him that he probably just needed an alignment in his spine that that's what was bothering his back so they sent him to a chiropractor

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my uncle would end up going back about five or six times as his back was getting progressively worse and and the final time that he went to the chiropractor as the doctor was working on his back they both heard a big pop

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that pop concerned everyone and so the chiropractor told him as my uncle kind of gets up off the bed and is barely able to stand up that he better go to the emergency room right away

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when you got to the emergency room that doctor recognize right away the something serious was going on and actually gave my uncle the X-ray and the CAT scan that he probably had needed months before and what that doctor saw scared him

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he saw these spots on the scans that he had taken all over my uncle's back and along his spine and it's at that point where we find out that my uncle has cancer and that he'd likely had cancer for many many months if not longer and we learned that the cancer is stage 4 and it has metastasized throughout its entire body and because of that the cancer is terminal

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and it is because of that diagnosis that my uncle was finally able to get access to the insurance that he had needed so badly all those months before

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and that's because with this diagnosis of terminal and treatable cancer Mike was able to qualify for federal disability and federal disability means because your physical health is so poor and you were unable to work the government will help you and pay for your insurance and your medical treatment so it took literally my uncle getting a death sentence before he was able to get health insurance that Healthcare gets him out of those freak

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X and into an actual Cancer Clinic in Illinois and it's there that the doctors give us the news that had they been able to see him months before he could have had a Fighting Chance

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but it was too late

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and so in those next four months we just saw my uncle's Health deteriorate more rapidly than any of us could have imagined and his body with her to almost nothing and in the end the pain of the cancer was so bad that he didn't even want to fight anymore

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so the age of 50 just two weeks after my daughter was born my uncle passed away

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I remember in those last days when he was in hospice and I just had my baby I called him to give him the news

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he was really weak he could barely talk

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but he said I'm so happy that I'm going to get to see my baby bird

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and so when my daughter was just two weeks old I had to wrap her up and put her on an airplane as we flew back to Waterloo to bury my uncle

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from The New York Times magazine I'm Nicole Hannah Jones this is 1619

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okay Janine enter Landy where do you want to start I think we should start in the fall of 1866 with a woman named Rebecca Lee Crumpler

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Rebecca Lee Crumpler is a young black woman who was born free and raised in Pennsylvania by her aunt her aunt was a Medicine Woman she used to go from home to home tending to the sick and Rebecca liked to tag along and to help her she liked it so much that she went on to become a nurse and she was so good at being a nurse that she makes the really unusual decision to go on and become a doctor so she eventually goes to the New England female Medical College which is a college that was specifically built to train women in medicine

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and that's really extraordinary because around the time she graduates there's about 54,000 doctors in the country and only 300 of them are women and only one of those women is black and that woman is Rebecca Lee Crumpler

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and so about a year after she finishes Medical School the Civil War comes to an end and she makes another unusual decision which is to completely uproot her life and to head down to the South you remember when the Civil War was being fought well I came in much by but I remember this much because four million people have just been released from slavery into Freedom not a little more would need but what he had been off to war and come back you know it almost didn't tell you know it was you

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he didn't tell you we didn't kill the Crumpler knows that it's going to be a huge challenge to help these people assimilate into society and to address their many basic needs including Health Care mama what you want a going is well all of you niggas is all free now Yankees all going home I spent a lot of time reading the slave narratives and we're not really taught that emancipation came and someone would walk on the plantation and say you are free

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but nothing came with that these were people who just literally were told you're free to go but giving no resources to go with even just with basic shelter we didn't have no property we didn't have no huh they didn't have places to go about 19 years old maybe more stay right there we didn't want to go we have no well nothing we didn't have nothing like you can just turned out so they were forced to take up residence in abandoned prisons former

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Terry Barracks empty churches refugee camps I know I remember one night I was out I have two free and I didn't have nowhere to go I do not know where sleep I didn't know what to do the crammed together in very close living quarters they don't have the tools necessary to maintain good hygiene and get along the best you court and as a result of all of this they're getting sick

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but they can't tap into any healthcare system because at that time there really isn't any organized Health Care system to speak of most Medical Care is provided at home by family members or by doctors who would actually visit the house and the only hospitals that exist are much more like institutions for the very poor or for people who get sick and don't have any family members to take care of them and those facilities were private and they were run by charitable groups and when the newly emancipated turn to those facilities for help they

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they were turned away they were told no

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and they start dying and really high numbers so much so that in some towns and cities their bodies are littering the streets

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this is a massive Public Health crisis and so to deal with this crisis the federal government creates what ends up being the nation's first federal health care program it's called the Freedmen's Bureau medical Division and this is what Rebecca Crumpler is heading south to do she's going to Virginia to treat the newly emancipated through this new medical program and what does she see when she gets there so when she gets to the South and she starts working she sees that this new program is a

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complete mess the hospital she is gone to just like all of the other hospitals in this program are completely under resource they don't have enough beds or sheets or Linens they don't have enough medicine they don't have enough quarantine facilities and they're in the middle of a smallpox outbreak and there's this horrible shortage of doctors there's only about a hundred and twenty doctors employed by the entire program so you're saying that the federal government at that time was only supplying 100 doctors to serve the entire emancipated population of four

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a million people yeah so this is one of the crazy things about the Freedmen's Bureau medical division which is it was founded in utter ambivalence officials wanted their communities clean enough to prevent diseases that might eventually spread into white communities but they don't want to provide any free assistance because they're worried that it's going to create dependency among the Black American community and so what they do is they open these hospitals and they staff them with a few doctors but then they closed them down at the first sign of progress

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grass and they refused to send resources that their own doctors including Crumpler requesting you know they're saying can we have additional staff to address the smallpox outbreak no can we have more blankets and more bedding no can we have an extra facility for quarantine so that the diseases don't spread know and so unsurprisingly black people continue to die at very very high rates in that hospital in Virginia where Rebecca Crumpler is gone what specifically is standing in the way of hospitals like that getting more support

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Port well one of the things was as you have all of these people dying from preventable things the theory emerges and the theory goes that this High death rate is actually just nature taking its course so black people aren't dying for want of basic necessities they're actually dying because they're biologically inferior to whites and ill-suited for freedom

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the argument became that African-American specifically were literally going extinct and that to provide any type of funding or resources to fight that would be wasteful and foolish because you're just trying to prevent the inevitable and this Theory actually gains pretty wide traction there's a congressman from Ohio who uses it to argue against the Freedmen's hospitals in the US House of Representatives he takes to the house floor and he says quote note

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charitable wax scheme can wash out the color of the Negro can change his inferior nature or save him from his inevitable fate so what you're saying is that this theory of Extinction was so mainstream that you could actually hear it being argued on the floor of the house yes that's correct and so because that theory became so mainstream and so kind of generally accepted the lack of funding in the lack of resources persist in the Friedman hospitals continue

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struggle and the ambivalence is so profound that a Friedman's hospital in North Carolina when doctors detect smallpox in a couple of their patients Bureau officials are terrified of the disease spreading into the community but they also don't want to invest the resources to treat it and to prevent that spread so they put out an order to burn their own Hospital down so this is the first example of government funded Healthcare and it is an example of something that was set up to fail

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exactly right and you know as the hospital Burns to the ground there's this feeling that black people have that they're on their own

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that the government created the system to help them but they didn't really want to help them and so that they were going to have to take care of themselves and Rebecca Lee Crumpler understands this and she decides to write a book it's called The Book of Medical discourses in two parts and it's not addressed to her colleagues in the white medical community or to segregationist in Congress

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it's addressed to the black community specifically to black mothers and black nurses and what she tells them in this book is how to take care of yourselves how to prevent diseases like cholera how to treat basic ailments like hemorrhoids and bronchitis and what's so profound about this book is that she's telling black Americans you're not inferior you're not going extinct you can take care of yourself and this is kind of the first example of something that Echoes down through

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Ages which is black medical professionals taking matters into their own hands

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and in the coming decades they open medical schools they build hospitals and they organize themselves to push back against this system that's trying to shut them out completely

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mr. president so fast forward mr. speaker to January of 1947 members of the Congress of the United States President Truman State of the Union Address I come before you today to report on the State of the Union it's actually the first state of the union that's televised and he opens with this joke about how both chambers of Congress have been taken over by Republicans but since I was here last

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one side of the room is much more full than the other side of the room and as the New York Times reports you can clearly see his smile when he makes this joke

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the little more than halfway through his speech of all our national resources none is a more Basic Value than the health of our people he turns to Health Care over a year ago I presented to the Congress my views on a national health program to provide adequate Medical Care to all who need it what he wants is a government-run health insurance program that everybody pays into ahead of time and that people can draw from when they need it not a charity but on the basis of payments made

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by the beneficiaries of the program but he's essentially talking about is Universal Health Care

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so by the time Truman's giving this address the nation's Health Care system has grown up a bit from the day's right after the Civil War but not by much all of the hospitals that were created through the Freedmen's Bureau have been closed down except for one that's in Washington DC and other hospitals have been built but there's not nearly enough of them especially in the South and to make matters worse the hospitals that do exist are all segregated

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in fact a separate but equal Clause had actually been written into the law

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and what that meant was black patients had to either go to their own black facilities which were few and far between and a lot of places or they were relegated to the basement words of white hospitals in those words were small and they did not provide as good care as you got in the white facilities and there were also lots of rules about who white nurses could serve in these hospitals because I know I've read Jim Crow laws it said white nurses couldn't serve black patients particularly black men and this is also true for doctors right

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for nurses specifically because there was a lot of concerns about keeping white women away from black men so you maybe had a couple white doctors that would check on black patients but again even the white doctors that would attend the black patients would do that after they took care of all of their white patients so it was second class in every conceivable way but it's not just black Americans who are not getting enough care its many poor white Americans as well so at that time most Americans were not insured and the insurance that did exist was employer-based which means you had to get a

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a certain type of job where the employer actually offered this benefit and then you can have it the problem for black people and for poor white people is that they didn't have those kinds of jobs that offered health insurance so they had to pay out of pocket basically the whole system is not working and Truman sees this as one of the most pressing problems the country is facing and so he decides that national health insurance is the fix

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I've repeated asked the Congress to pass a health program and this government-sponsored health insurance initially has really widespread support the nation suffers from lack of medical care that situation can be remedied but then days after Truman wins the election the American Medical Association which is the largest and arguably the most powerful Professional Organization for doctors in the country

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launches this massive campaign to take it down

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and what you have to understand about the AMA is that it's an almost exclusively white organization at that time virtually all of its local chapters exclude black doctors completely and just a few years earlier the organization had refused to protest the separate but equal Clause that legalized Hospital segregation plus this is a time when health care costs are rising and private insurance is really taking off and what the AMA understands is that a national health insurance program is probably going to hurt

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profits and so they've actually been fighting against this idea for years and now with Truman's national health insurance program they take that fight to a whole new level they've hired a PR firm it's actually the first political consulting firm in the country and together they devised this plan to completely torpedo Universal Health Care and what does that fight look like what it looks like is all out War it's radio ads its newspaper ads its magazine ads they're delivering

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lets's and mailers to people's homes in the end they send some hundred million pieces of literature all across the country and what's on that literature and what's In Those ads is a campaign slogan it says keep politics out of medicine they call Truman's plan socialized medicine they labeled Truman as a communist and you have to remember this is during a time when communism was a real scare and they terrify people with this idea that if Truman gets his way government officials are then going to be able to

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intervene in private medical decisions and when they do they're going to destroy the sacred doctor-patient relationship and that campaign Works popular support for the bill suddenly plummets it fails to get through Congress and the Healthcare System the nation is left with at the end of this fight is still too expensive for most Americans to afford and as segregated as it has ever been

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To Kill a Mockingbird is the most successful American play in Broadway history says 60 Minutes Rolling Stone gives it five stars calling it a landmark production of an American classic To Kill a Mockingbird is All Rise one of the greatest plays in history Raves NPR the New York Post says it will change how you see the world this is what great theaters for all rise for Harper Lee's To Kill a Mockingbird a new play by Aaron Sorkin this is a phenomenon says New York Magazine on Broadway at the Shubert Theater get tickets at tell a charge.com

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Janine when did all of this start to change so it really starts to change with a man named Montague Cobb

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Montague Cobb is this fascinating character he's a beloved doctor and medical professor at one of the only black medical colleges in the country at that time Howard University over 41 years he teaches thousands of medical students about anatomy and he's kind of famous for playing classical music on his violin and reciting poetry for his students while they're dissecting cadavers

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he's already established himself on the national stage during the fight between Truman and the American Medical Association Cobb was one of the only doctors to defend Germans plan and defy the AMA

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three Commissioners said that he had no objection to having cut it in turns at gallons is soon as he could build separate facilities for them well that was a bad thing to say at that time and since you know there's not a lot of recordings of Cobb out there but there is a documentary from the 1980s called step-by-step where Cobb himself talks about this time steps were also being taken by dr. Cobb to end segregation in the medical profession I think first point of overt

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Tak was on the theme of old clothes to sand the Negroes Hospital dilemma cop use the analogy of Rights giving hand-me-down clothes to blacks to illustrate how they also gave blacks hand-me-down hospitals this one isn't new but it's better than anything he has or could get

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he's also been outspoken about Hospital segregation for years because he recognized how deadly it could be

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there's all these horror stories they're true stories of black Americans who are mistreated or denied Care at White hospitals and died as a result

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there's this one example from 1931 where a light-skinned black man gets into a car accident and he's taken to a white hospital it's Grady Memorial Hospital this is an Atlanta and doctors there they mistake him for a white patient so they start treating him and it's only when his family comes to the hospital that they realize he's actually black so what do they do they pull them off the examining table and they sent him to the Blackboard across the street where he later dies

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so these kinds of stories were common knowledge and Manju Cobb really wanted to change that so he launches a national conference on Hospital desegregation and he pulls people in from all over the country to come and talk about this issue every year and he really implores his white colleagues to take the matter seriously and to think about it but he didn't get very far even with all of those efforts not much changed and he realized eventually that left to their own devices white hospitals are going to stay White

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then in 1963 he takes the reins of the nation's leading black medical organization because remember the AMA has this history of excluding black doctors so what black doctors have had to do is create their own professional societies and the leading one is called the national Medical Association or the nma and it's at this moment when Cobb is in this leadership position that the fight for universal health insurance that started decades back and the fight for a desegregated health

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Care system that started at the end of the Civil War finally merge into one fight and that fight is about Medicare

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ladies and gentlemen the president of the United States my fellow Americans we have had many a hard-fought presidential campaigns so what was the role of Medicare in all of this well the proposal for Medicare is actually born From the Ashes of Truman's failed national health insurance program I am Tim to preserve and strengthen our social security system after that plan dies in Congress people who want something like it conclude that they need to think smaller and more incrementally

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I intend to make it stronger by keeping benefits up with so beginning under President Kennedy and continuing under President Johnson their efforts Target what is perhaps the most uncontroversial group anyone can think of I do not believe that older Americans should be forced to live out their lives in poverty old people are tiny savings destroyed by illness dependent upon their relatives

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feeling unwanted by their country the choice is yours once again this bill would put the government smack into your hospital defining Services setting standards that the AMA comes out in full force against the idea whether they need it or not whether they want it or not they'd be in they use all the same tactics and all the same arguments that they used last time around the American taxpayer certainly has a right to question the free

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I'd those who do not need these benefits would be taking at the expense of his children to convince the American public that this is a terrible idea and that it's going to destroy Healthcare as they know it to the millions of Americans who may have a doubt I implore you ask your doctor

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ask your doctor thank you but this time under Montague Cubs leadership the nation's black doctors come out in full force to support Medicare

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I decided that all this was bad and picked up a baseball bat began to swing it about get a little room they lead protests they Lobby Congress and they launched their own public relations campaign explaining to the nation that in fact this won't destroy medicine this will make medicine more equitable

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and their message is what it's been for a long time Healthcare is a human right and that any program that expands Access to Health Care is the duty of a free and Democratic Society

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meanwhile the fight for civil rights is escalating all across the country outside of the medical world the Civil Rights Act is a challenge to all of us and of course that effort culminates in the Civil Rights Act of 1964 which says that discriminating on the basis of race is unconstitutional vestiges of Injustice and we're specifically it says that the government can pull federal dollars from any facility or entity that does not comply

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like a lot and that includes hospitals not approach the observance and enforcement of this law and a vengeful spirit

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its purpose is not to punish the vast majority of hospitals do nothing they don't just suddenly desegregate and it's unclear when or even if they're going to face any consequences at all for that and this is where Medicare comes in because Medicare is like a new pile of federal money that's dangled in front of hospitals across the country but in order to get that money hospitals have to comply with federal law like the Civil Rights Act

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they would have to actually desegregate so as Congress begins to debate the bill Montague Cobb knows that this is the moment to both create a national health insurance program and desegregate the nation's hospitals and when he's called upon to testify he says that after two decades of arguing and equivocating it is past time for the nation's leaders to take quote definitive action to expand Access to Health Care

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and at the end of his testimony he recites this him by Charles Matheson and it goes oh love that will not let me go I hide my helpless self in thee I give thee back the life I owe that in thine ocean depths it's flow May richer Fuller be

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and then he tells Congress

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like this love the benefits of Medicare cannot be taken away and he asks them can we deny this small Assurance to those on Whose shoulders we stand

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so I'm willing to struggle along and let us learn step-by-step but because man is such a slow learner let us recognize our mistakes

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and

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remedy them

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without having to repeat the historical process again and again and again

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and so Medicare passes and what happens is within four months of implementation nearly three thousand hospitals desegregate

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but of course the health disparities between black Americans and white Americans persist to this day black women are three times more likely to die of causes related to pregnancy than white women black people with HIV tend to get worse care than white people with disease one study found that black patients with diabetes did worse than white patients even when they had the same doctor

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black Americans die at higher rates for many cancers that would have been treatable had they been caught earlier

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my name is Yo Jesse and I'm going to read a short piece I wrote called Bad Blood upon closer inspection the leaf her two-year-old was attempting to put in his mouth in the middle of the playground on that lovely fall day was in fact a used tampon she snatched it from him and Purell both of their hands before rushing them back to their apartment on Dean

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she put him in the bath and scrubbed and by the time her husband found them they were both crying we have to leave New York she said after he'd put the baby to bed let's move back home there are tampons and Alabama he said and then what's the worst that could happen

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it was the question they had played out since graduate school when her hypochondria had been all-consuming back then leaning into her fears describing them had given her some comfort but then they had Booker and suddenly the worst looked so much worse he could get an STD and then we'd be the black parents at the hospital with a baby with an STD and the pediatrician call social services and they would take him away and we'd end up in jail

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okay he said slowly that would be bad but it's statistically very very unlikely would it make you feel better if we called the doctor she shook her head her husband only used the word statistically when he wanted to avoid using the words you're crazy she knew that the doctor would just tell her to trust him but she also knew that when the worst happens in this country it often happens

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ins to them

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she comes by her hypochondria and I at your phobia honestly she's growing up in Alabama people still talked about their grandfathers fathers and brothers who had died of bad blood that was the catch-all term for syphilis anemia and just about anything that ailed you the 600 black men who were enrolled in the Tuskegee study were told they get free medical care

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instead from 1932 to 1972 researchers with the United States Public Health Service watched as the men developed lesions on their mouths and genitals watched as their lymph node swelled as their hair fell out

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watched as the disease moved into its final stages leaving the men blind and demented

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leaving them to die

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all this when they knew a simple penicillin shot would cure them all this because they wanted to see what would happen

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for years afterward her grandmother refused to go to the hospital even at 89 perpetually hunched over in the throes of an endless cough she'd repeat anything but the doctor Bad Blood begets Bad Blood she's more trusting than her grandmother but she still has her moments like many women she was nervous about giving birth all the more so because she was doing it in New York City were black women are 12 times more likely to die in childbirth than white women

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and in that very statistic the indelible impression of Tuskegee the lingering niggling feeling that they are never fully safe in a country where doctors and researchers had no qualms about watching hundreds of black men die slowly brutally simply because they could

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when she held Booker in her arms for the first time and saw her grandmother's nose on his perfect face love and Fear Rose up in her

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what's the Worst That Could Happen her husband asks and she can't speak it the worst

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instead she tries to turn off the little voice in her head

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the one that wants to know how exactly do you cure Bad Blood

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To Kill a Mockingbird has not played to a single empty seat report 60 minutes it's the most successful American play in Broadway history Rolling Stone gives it five stars calling it unmissable and Unforgettable all rise for the miracle that is Mockingbird on Broadway it's a New York Times critic Spic Jesse Green calls it a Mockingbird for our moments beautiful elegiac satisfying even exhilarating Harper Lee's To Kill a Mockingbird a new play by Aaron Sorkin a New York Times critic Spic tickets at tell a charge.com