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7. Where Is Health? The Place of the Clinic in Social Change
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Carrying signs that read “People’shealth,notMD’swealth”and “AMA, 1st in war, 18th in infant mortality,” radical doctors joined membersofwelfarerights,peace,feminist,andgayliberationgroupstotake over the 1970 annual meeting of the American Medical Association held that year in Chicago. This was one of the People’s Health Care Convention ’s planned events, which included workshops and forums on women’s health, racism in medicine, ending the profit-orientation of medicine, and ending medicine’s collaboration with the war machine. They intended to present a collective “indictment” at the opening ceremonies that included demands drafted by the National Welfare Rights Organization. Among these were that the AMA end its opposition to national health insurance and resolve that a series of medical practices were unethical. The discriminatorypracticestheyidentifiedincludedrefusingservicetopeoplebecause • CHAPTER 7 • Where Is Health? The Place of the Clinic in Social Change Does the physician attend the sick patient—or the sick society? Is his primary contract with the patient—or with the social order? Must he cop out either on social change or on the individual human being? —Dr. H. Jack Geiger, Social Policy We share the conviction of many in our country, often expressed these past few months, that a nation with the technological ability and governmental resources to create a satisfactory environment for an Apollo space capsule on a trip to the moon must find a way to provide healthful living conditions for the people in Houston, Tulare County, Great Falls, Chicago, Washington, Atlanta, and everywhere else in the country. —Dr. Lester Breslow and Dr. Paul Cornely, Health Crisis in America • 181 • of their eligibility or participation in Medicaid; different waiting rooms and patient care facilities for “private” versus “ward” patients; differential diagnostic procedures; and denial of service because of racial, ethnic, and religious, or national origin.1 This, of course, was not the first time that such demands had been made so publicly. At the AMA’s 1968 convention in San Francisco, local participantsinthePoorPeople ’sCampaign,membersoftheMedicalCommittee for Human Rights, and Kathleen Cleaver, representing the Black Panthers, picketed the meeting.2 The passage of Medicare and Medicaid did not change many AMA members’ opposition to government funding of health care. Indeed, AMA president Milford Rouse used his inaugural address at the 1967 convention to urge the profession to reject the notion that health care is “a right rather than a privilege.”3 Members of MCHR, the National Medical Association, and the progressive Physicians Forum issued a statement deploring “the A.M.A. plans to continue its feudal opposition to what has clearly been mandated by the American public—Federal support for medical research, medical education, hospitals, medical insurance for the elderly, programs for the medically indigent, and planning for community health care.”4 By 1970 NWRO had joined with MCHR, People’s Health Coalition, and the Student American Medical Association, to challenge the AMA and American Hospital Association’s ongoing discrimination and to make these institutions accountable for the tax dollars and tax breaks they received. Great Society antipoverty funding and improved sanitation and housing contributed to a 14 percent decline in death rates in the United States between 1968 and 1975.5 As discussed in chapters 1 and 2, the desegregation of medical facilities, passage of Medicare and Medicaid, and rise of neighborhood health centers opened mainstream medicine to tens of millions of people. According to medical historians Michael Byrd and Linda Clayton, the Black and white infant mortality rate declined by more than 50 percent between 1960 and 1980, and maternal deaths during childbirth declined by 66 percent between 1965 and 1974.6 Despite substantial improvements , the Black infant mortality rate remained nearly twice that of white people. Nearly 45 percent of all Black deaths in 1970 were premature deaths, lives cut short by the cumulative bodily toll of racism; in 1984 this figure stood at 42.5 percent.7 At the moment when health was becoming recognized as a human right, observers from across the class and political spectrum agreed that the U.S. 182 WHERE IS HEALTH? [3.87.209.162] Project MUSE (2024-03-28 13:40 GMT) health care system was in crisis. The crisis was one of soaring costs, as we willsee,butthemedicalprofessionitselfwasalsoincrisis.Thisisclearfrom debatesbetweengroupslikeMCHR—towhomDr.Kingin1966observed, “Of all the forms of inequality, injustice in health care is the most shocking and inhumane”—and the AMA. Dissent could also be heard from doctors who regarded creating a just health system part of their commitment to social change. The left was concerned about the “failure...