President Biden is not the first American chief executive to come up against recalcitrant governors and other officials willing to put their political interests ahead of the well-being of citizens. But the enormous resources of the federal government give him tools to overcome those forces.
When Lyndon B. Johnson won the monumental legislative battle to establish Medicare and Medicaid in 1965, tens of millions of Americans became eligible for government-financed medical coverage. But there was a big stumbling block to those programs actually achieving their promise: segregation.
The Civil Rights Act, passed the year before, had prohibited facilities that received federal funding from discriminating by race, creed or national origin. To collect from Medicare, hospitals and clinics had to offer proof that they were integrated, from their patient wards and cafeterias, right down to their blood supplies. Black patients — as well as qualified Black doctors, nurses and medical technicians — could not be denied admittance, or shunted into inferior wings.
The nearly simultaneous enactment of these two historic pieces of legislation was not a historic coincidence. Johnson saw health care and civil rights as inextricably linked. So did some segregationist governors, including Alabama’s George Wallace, who encouraged facilities in their states to resist becoming colorblind when it came to the access and care they offered. With just two months to go before Medicare went into effect, half the hospitals in a dozen Southern states had not met the standards for compliance.
There appeared to be a real possibility this would mean inadequate services for newly enrolled beneficiaries in some parts of the country. As a backup, Johnson ordered his staff to look into making federal facilities operated by the military, the Veterans Administration and the Public Health Service to make care available. But it turned out that was not necessary. The leverage that finally brought hospitals into line was their desire not to miss out on federal money.
“Johnson saw Medicare as more than a passive vehicle of paying hospital bills — he saw it as an instrument of social change,” David Blumenthal and James A. Morone wrote in their 2009 history “The Heart of Power: Health and Politics in the Oval Office.”
The parallels are not precise to what Biden faces more than a half-century later. As covid-19 surges once again, the current president is trying to overcome politically motivated, misinformation-driven resistance to lifesaving vaccines, which is particularly intense among Republicans. Even such common-sense measures as wearing masks have become political signifiers. GOP governors, most notably Florida’s Ron DeSantis and Greg Abbott of Texas, have banned mask mandates in schools and elsewhere.
But Biden needs to show some LBJ-like aggressiveness in using Washington leverage when persuasion and rationality are not enough.
Defense Secretary Lloyd Austin is preparing to require that the 1.3 million U.S. active-duty troops be fully vaccinated against the coronavirus, as they must be against other diseases, but he and Biden should go further and extend that order to National Guard members and reservists, who must be prepared to deploy as first responders. Vaccinating them is not only common sense, but could send a strong message to the communities across the country in which they live.
After DeSantis threatened to withhold the salaries of superintendents and school board members who defy his executive order against classroom mask mandates, The Post’s Annie Linskey reported that the Biden administration is examining whether it can direct unused stimulus funds to help make those local education officials financially whole. Also reportedly under consideration: withholding Medicare or other federal money from institutions such as nursing homes and universities unless they require their employees to be vaccinated.
All of this will be more feasible and politically palatable once the Food and Drug Administration gives final approval for the Pfizer shot, which is expected in the coming weeks. Even then, there would no doubt be backlash. But this is a president who promised a “full-scale wartime effort” to overcome the coronavirus, a shape-shifting and lethal enemy that has found collaborators in the Republican political class.
Science has given us the weapons to better protect the U.S. populace from this threat. The commander in chief has some yet-to-be-used powers and incentives to assure their deployment. It is no time to be squeamish about using them.