In
1969, when I left my job in Washington, D.C. and entered graduate
school, at Johns Hopkins, one of the first courses I encountered was a seminar on
electoral politics taught by Professor Milton Cummings, a student of V.O. Key,
the great scholar of electoral politics in the South.
We read Kevin Phillip's The Emerging Republican Majority and other works signaling a shift in the ground under the Great Society and the move of the Republican Party, the party of Abraham Lincoln, into the South.
Still living in Washington and attending school in Baltimore, I watched as Richard Nixon gradually abandoned the Great Society and began courting a South resentful of voting rights legislation and a war we were losing.
Our eyes were on the war in Vietnam: when would it end? Protests filled the streets of Washington beneath the windows of the Methodist Building apartment where Carole and I lived, right next to the Supreme Court. We were watching the future being shaped before our eyes.
Here we are four decades later and the question is: Will Obama introduce a new era in health policy? Will we have a new democracy at last?
Modern
public health in the U.S. with its national institutions for protecting
the health and safety of the public and the environment was born during
that upsurge of national, progressive democracy we call the Great Society. This was
democracy as verb— democracy as a doctrine of social criticism.
Yet for much of the past four decades we in public health have also lived with an older democratic tradition, the use of sectional politics with its divides of race, religion, and markets as the primary strategy for limiting democratic activism.
I call this the return of the body politics snatchers, or the 'war of the divides.' This is democracy as a noun, allowing society to be governed largely by markets and traditional values, defending the status quo, a politics rooted in the tradition of the "solid" South defending slavery, then segregation.
The struggle between our two democratic traditions goes on today and you who enter the field afresh had best learn the two grammars of our divided American democracy.
1. The other Great Society
Most people when they think about the Great Society think about civil rights sit-ins, about marchers protesting the Vietnam War, flower power, Hair and Haight-Ashbury, Kent State, Roe v. Wade, urban riots—and, yes, the songs—one big political uproar, the high tide of liberalism and then the tide went out.
Carole
and I met in this Washington in 1967 and six months later we were
married. She worked on Capitol Hill, a top aide to a liberal
Republican, Silvio Conte, (Rep., MA). I represented a small life sciences division of a big
aerospace division. Many of my clients were the new health agencies and
Great Society programs.
Still, I don't think either
of us grasped the particulars and the magnitude of the shift that was
occurring, and how and why the backlash was to arise. Yet, after taking
a job at the School of Public Health in Chapel Hill, Carole worked for
Representative Nick Galifinakis (Dem., NC) in his race against a radio
announcer in Raleigh, Jesse Helms, and we watched as Helms won, we knew
something was up...We didn't know what to say to the many idealistic students coming back after an assignment in the Peace Corps.
Today, after a career in public health, when I think about the Great Society, I think about political success, about what Hugh Heclo terms a new “sixties civics,” about making highways and automobiles safer, about launching the long slide for smoking, about making workplaces safer and not a death sentence, about cleaning up the environment.
This “sixties civics” created a new strategy for national democracy and for public health—uncovering and addressing the society’s problems in health and safety, using democratic criticism, conflict, and societal change to make us healthier. This is democracy as verb.
After WWII epidemiology shifted its gaze from epidemics to the social arrangements causing chronic disease and injury.
Epidemiology turned the focus away from what workers, drivers, or consumers do wrong to bodies exposed to ‘designed-in’ dangers brought by the corporation, to what cars, cigarettes, alcohol, pollution, and shop floors do to our bodies together. The Great Society federalized, "collectivized" risk.
We put the body into the national body politic and marketplace.
By re-framing and re-describing health and safety around the threats to our bodies together epidemiology revealed common dangers for us—the dark side of the national marketplace—in smoking, highway safety, alcohol, pollution, etc.---paving the way for federal safeguards for health.
Epidemiology,
from the Greek word demos for village was now the science of what
happens to people’s bodies in our nation, not just societal criticism
but national criticism, democracy’s national news.
Our democracy
and public health thus won a new national mission—curbing the
corporation’s sorry health and safety record on the nation’s highways,
in workplaces, and in the environment. Conflict with the corporation
sets off alarms.
As Schattschneider said, in his classic The Semi-Sovereign People, “When a fight starts, watch the crowd.”
The key question for the public and the national media became— “What did the corporation know and when did it know it?” The crowd represents the public, groups, and the media.
The media was at the center, spreading conflict:, making news—the Surgeon General’s 1962 Report on Smoking and Health, Ralph Nader’s Unsafe at Any Speed, televised hearings with the president of GM apologizing to Nader and to the nation.
To sum up—the Great Society taught us that democracy is not just a noun—it is also a verb—a national noun and verb for changing how we live together to be healthier together.
And yet the new administration hardly mentions the Great Society, and this for a reason.
2. The wars of the divides: sectional politics rises again
In 1980, we both worked in Washington, DC again, myself for the National Institute on Alcoholism and Alcohol Abuse and Carole as a lobbyist for US Rail. We watched President Carter's defeat by Ronald Reagan and the new conservatives who came to town turned my agency upside down.
A distinguished political scientist Bernard Crick, in his In Defense of Politics, said that all democracies face the challenge of divided society: Order, liberties, social justice. The strategy of democratic politics is to preserve the benefits of minimum order, to guarantee specific liberties, and to provide social justice, assuring all a measure of society’s prosperity and protection that they may have a stake in its future.
This was the Great Society’s big idea.
Following the path of other Western democracies, Nixon started down the path of the Great Society but eventually sectional politics returned, with its old grammar that change belong outside democratic control, with the market and traditional values.
It is this backlash of conservative democracy that made the Democrats fearful of the Great Society and it is the principal reason that Obama doesn’t mention LBJ or his achievement.
As I began teaching in Chapel Hill, Jesse
Helms beat Nick Galifinakis for the Senate seat and the party of
Lincoln began to move its headquarters to Dixie.
The GOP goal was to
convince the American people that we are a deeply divided nation, two
nations facing each other across a gulf, divided by values and culture---to
divide the very body politic the Great Society was trying to forge.
We are a divided nation politically—politics is about division. But we are closely divided, not deeply divided, in public opinion. A closely divided opinion resembles a normal distribution, with the great majority of opinion under the middle of the curve.
In a deeply divided nation opinion is a bi-modal distribution, essentially two separate curves.
Over the years our politics increasingly became “off center” in Washington, with the Republican party more and more conservative than its supporters during presidential elections.
What was happening was the return of a very old vision of democracy, a war of the divides or Sectional Democracy, where one party uses the South as an electoral base and mobilizes voters outside that region as a reaction against the idea of a national, progressive democracy and a national democratic community.
The new (old) conservative democracy made the market and traditional values the cornerstone of its vision. It was called market populism or conservative populism because it argued that the market, not government, was the little people’s best friend, not the elites that ruled that other party.
Another term for this version of sectional politics was political fundamentalism.
And the further paradox: the new conservative populism that talked endlessly of smaller government, of cutting taxes, and of letting the free market reign in America, in reality they rigged the markets and kept big government and made it bigger—way bigger in order to privatize government and award the resulting contracts to their political supporters. And they made military spending and war a centerpiece of everything else.
3. Toward a more perfect union; social policy for health
In 1988 we left North Carolina to work in the New York State Department of Health. Everyone thought Mario Cuomo was going to run in 1992. I was charged with working on a new universal health care plan for New York that would become a model for the national campaign. New York was a state that understood the need for progressive democracy, and I believed their governor could lead the way.
In his classic 1960 treatise, Obligation and the Body Politic, Joseph Tussman said:
Familiar as it is, there is something fundamentally misleading with the slogan that the aim of government is the welfare of the individual....It is hard to quarrel with the demand that the body politic provide or safeguard the conditions necessary for the fullest development of each of its citizens...But I do not think we can escape the distinction between the demands or interests of a particular individual and the demands of that system of interests of which each individual is only a part. Government, that is to say, serves the welfare of the community.
In 1968, in his presidential address to the American Public Health Association, Milton Terris argued for a “social policy for health,” a prophetic call that went largely unheeded. I predict the new administration will give great emphasis to social policy but this will only succeed with a return to the strategy of national democracy as verb, using criticism, mobilization, and new institutions to energize and forge a new community and new civics for health.
A strategy of social policy for health forging a stronger sense of a national community, a body politic, is the greatest fear of sectional politics.
Sectional politics cannot survive when a stronger civics, a stronger membership in a national community takes hold.
That all American might be treated as more equal in some conditions more important than others, from equal citizenship, equal access to health care, equal rights to voting, equal rights to earn a living wage, and the like has always been what sectional politics has stridently opposed, from the civil war era and Reconstruction, to the Progressive era, to the New Deal, to the G.I. Bill to Medicare and the public health agencies created during the Great Society.
While the Democrats have led the way in the twentieth century, they have always had in their ranks Southern and Midwestern Democrats of sufficient strength that made an alliance with conservative among Republicans to water down and weaken the New Deal.
And the blow-back against the Great Society was led by Republicans who arose in the South and Democrats who went over to the Republican Party.
More equality and more social justice for all to forge a more perfect union is always opposed by that other past of sectional politics, historically centered in the South, that rests on the assumption that millions among the people are not deserving of such equal treatment.
I can think of no more important strategy for weakening, perhaps fatally, sectional politics than passage of a strong national health care plan.
That plan must gather payment into a single pair of hands, must control wasteful medical spending, and must make health insurance uniform and community-rated, as well as offering a public plan as a yardstick to keep private insurance efficient.
We would ‘justify’ health care reform because everything is now connected to everything else: health care reform is to provide health care for all, to control spending, to save the loss of whole industries, and to avoid wasting dollars on marginal medicine.
We would stress preventive care to save the cost of curative medicine. But we would clearly also justify national health care reform as a way to unify the country more with the bonds of equal protection against the threat of illness, injury and premature death without accessible and equal assurance of health care for each and all.
With time I could illustrate how
the same need for social policy will guide our broader attempts to
eliminate poverty. We will need also to help create new sources among
our national media, to return television, newspapers, magazines and the
like to the task of “fact-checking” our democracy instead of amusing
ourselves to death.
Only with the right plan (meaning “stable” plan) can we strengthen the infrastructure of a national citizenship and of ourselves as members of a national community in ways that overcomes the divisive tactics of conservative democracy.
Inconclusion: a democracy of days?
Once in the 1970s when I was in England on a World Health Organization traveling fellowship to study public health policy, my host for a morning was a former top aide to a recent Prime Minister.
When he looked at my introductory material, he said, “I see you are a professor. What do you profess?” I said, “public health.” He frowned for a moment in puzzlement and then said, “Oh, drains!” Drains is the word the English use for sewers.
We moved to a small town in Arizona in 1996 and I retired and then ran for major to work on a huge (for that town) public health project: overhauling a collapsing waste water system---drains. They put the shovels in on the last day of my second term in office.
We returned to North Carolina in 2005 for three more years and then---finally---we returned to Bisbee, Arizona and I stopped chasing the body politic and turned to the rest of life itself.
We cannot survive as a great democracy, as a great republic, is our daily diet is the war of the divides or even a new social policy for health and much else. Our democracy must somehow be seen as strengthening our daily life. Our republic must become a republic of days.
This is from the lovely short poem, "Days," by the British poet, Philip Larkin.
What are days for?
Days are where we live.
They come, they wake us
Time and time over.
They are to be happy in:
Where can we live but days?...
I wonder if those in DC and the new Obama administration stop to think that what most of us want is our days back, the days where we live, the days where we are not beset with concerns about war, about a planet that is being destroyed, about how to secure good health care for every American, about an economy that seems beyond anyone's ken, about an end to attacks on unions and working people who simply want a job that pays enough for day-to-day living, and above all, about a politics that so easily descends into a frenzy of racial hysteria?
Most of us want our politics to clear a space for life itself, for our days to be happy in.
I
have thought of most of my adult life as divided into two major periods: many years
chasing the body politic at the national level, where my focus was on
major systems of policy: system world. And then we moved to a small
town in Arizona and went local.
I saw myself as now turning toward life itself, daily life. Perhaps I was still longing for a past in my native Texas, a longing for a home where daily life is celebrated, a past that for me never truly was as we moved from place to place, looking for work.
But it is all life itself. A life seeking a different democracy is a life seeking a different life together and that is, after all, the other side of life itself.
Life itself is life together, whether as a great nation or as a small town in Arizona. But only if we see our democracy as a democracy of days, a democracy that strives for daily life for all, days that are peaceful and happy.
In the end, we only have days, day by day, and if we can't have a politics that helps safeguard our days for the business of life itself, then what are our politics for?
Can we imagine a nation that slowly turns away from the drama of endless threats, away from an empire of 800-plus military installations scattered everywhere in the globe?
Can we imagine a nation that doesn't have troops in Germany or England or Italy or Japan or Korea or Spain?
Can we still have hope for the U.S. as a republic focusing on the enriching the dailiness of life itself for all its citizens, a democracy of days?
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