Deluxe Jim Crow: Civil Rights and American Health Policy, 1935-1954

10. Racial Disparities and the Truman Health Plan

|| 250 || chapter 10 Racial Disparities and the Truman Health Plan When Harry S. Truman assumed the presidency in April 1945, Thomas Parran had been surgeon general for nearly a decade. Parran was the federalofficialwhomostadvancedthecauseofdeluxeJimCrowhealthpolicyas an integral part of the New Deal and helped to define its emphasis on southern uplift, equitable access to health care, and targeting the needs of the medically underserved. As the senior U.S. representative during two years of planning meetings and president of the International Health Conference that established the World Health Organization (who), Parran applied and expanded these principles in formulating who’s goals: “To provide in each country, and throughout the world, an equal opportunity for health for everyone—without regard to race, color, economic condition, religious or political belief.” The six health issues that who prioritized were identical to those that Parran had pursued in the South: malaria, maternal and child health, tuberculosis, venereal disease, nutrition, and environmental sanitation. In his last months as surgeon general, Parran wrote in the American Journal of Public Health that America’s tremendous technological power in medical science, together with its “well known humanitarian zeal,” required that “adequate medical care for all must be the cornerstone of any program designed to meet the health needs of the nation, and this means that medical care must be based on need for services rather than on ability to pay. One of the first problems we must solve, therefore, is that of finding a more efficient method of financing medical care.”1 racial disparities and truman plan || 251 || Oscar Ewing, the “Man Doctors Hate” Parran remained as surgeon general for the first three years of Truman’s administration , but his days were numbered after Oscar R. Ewing took over the Federal Security Agency in August 1947. Ewing, a Harvard Law graduate from Indiana, was an international corporate lawyer earning one hundred thousand dollars a year who had risen in New York political circles to become vice chair of the DemocraticNationalCommitteein1940.Thoughtheirgoalsfornationalhealth policy were nearly identical, Ewing and Parran clashed almost immediately. Parran refused Ewing’s request to award a National Institutes of Health grant to Walter Kempner, an academic medical researcher who had treated Ewing’s wife at Duke University. Parran deeply resented a nonprofessional’s attempt to influence a grant-making decision by the U.S. Public Health Service (phs), but Ewing increased the pressure further by refusing to approve Parran’s appointments to advisory boards for phs agencies. Parran refused to back down and resigned from the phs in February 1948 to become the founding dean of the University of Pittsburgh School of Public Health. Yet another veteran New Dealer left the Truman administration, and the phs shifted its emphasis away fromthecommunicablediseasesofpoverty,particularlysyphilis,thathadriveted the agency’s attention on the South under Parran.2 Ewing characterized his choice for Parran’s replacement, Leonard Scheele, as “just as cooperative as anyone could be,” which spoke volumes about Ewing’s and Parran’s similar but incompatible temperaments as strong-willed, at times unyielding leaders who were reluctant to share their authority. Scheele’s apolitical style contrasted dramatically with Parran’s activism, and Scheele withheld his support from the final attempt to pass the Wagner-Murray-Dingell national health insurance bill in 1948, focusing instead on the less controversial goal of beefing up National Institutes of Health funding for chronic disease research. He refused Ewing’s invitation to join in a televised debate against the American MedicalAssociation(ama),preferringtoremainprofessionallynonpartisanand warning phs officers to follow suit.3 Despite their differences, Parran and Ewing were avowed supporters of national health insurance who melded wartime patriotism with their goals for domestic health policy in an attempt to forge what they hoped would be a new stainless-steel liberalism. Ewing wielded more influence than anyone in postwar Washington except perhaps Truman. The Federal Security Agency || 252 || chapter ten featured eleven bureaus, thirty-six thousand employees, and a $2 billion annual budget. Ewing told Parade magazine in May 1948, “The same zeal and unity of purpose with which Americans contributed to winning the war should be directed toward fighting disease and preventable death and improving the nation ’s health.”4 Like Paul V. McNutt’s stint as chair of the Wartime Manpower Commission and Claude Pepper’s congressional leadership in passing the Lend-Lease Act and chairing the Wartime Health and Education Committee, Ewing’s war-era credentials bolstered his credibility and political...