Racism Is A Big Factor In Why The U.S. Doesn't Have A Better (And Cheaper) Healthcare System

The following is part of an excellent and thought-provoking post by Thom Hartmann at The Hartmann Report: 

America has 51 billionaires who made their money from our profit-driven healthcare system, the only one in the developed world. It’s not only obscene that they’re taking so much money from so many of us who have so little; it’s also killing all of us. 

We’re among the worst — and most expensive — healthcare systems in the developed world, with Thailand and Ecuador even beating us out. 

And the reason it stays that way, according to a shocking new study, is because about half of all white people would rather inflict pain on all of us (including themselves) than allow for a system which may also benefit Black people. 

If that sounds irrational, it is. But it’s also completely consistent with a history that includes white communities closing their own schools and swimming pools back in the 1960s when LBJ forced them to allow Black children in.

Sixty-six years ago, on a campaign swing through Tennessee, Lyndon Johnson turned to his press secretary Bill Moyers in a hotel room and explained, with the bluntness of a man who’d grown up watching it work in Texas, why America couldn’t have nice things. 

“If you can convince the lowest white man he’s better than the best colored man,” LBJ said, “he won’t notice your picking his pocket. Hell, give him somebody to look down on, and he’ll empty his pockets for you.” 

Moyers wrote about it years later in The Washington Post, and the line has been quoted ever since because it explained, in one sentence, the entire arc of “conservative” behavior from Reconstruction to Nixon to Reagan to Trump.

Last week, a pair of political scientists at the University of Delaware put empirical meat on the bones of what Johnson learned the hard way. Sumeyye Mine Iltekin Gocer and Joanne M. Miller, writing in the peer-reviewed journal Research and Politics, surveyed more than 700 white Americans and split them into two groups.

One group was asked whether white Americans were winning or losing politically. The other was asked whether white Americans were winning or losing compared to racial minorities. Both were then asked how they felt about economic redistribution programs like food stamps and Medicaid, the things that put food on tables and keep people from dying of treatable diseases.

The first group’s answers tracked roughly with their income and ideology. The second group, the ones prompted to think about race before answering, turned against redistribution across the board, even programs that would obviously benefit them, even when they themselves were poor.

 

The mere act of comparing themselves to Black and brown Americans made them willing to sacrifice their own healthcare, their own paycheck, their own kid’s future, as long as people of color were sacrificed too.

That’s the trap. That’s how a country with the largest economy in human history ends up as the only developed nation on Earth without universal healthcare, the only rich country where 600,000 people a year still go bankrupt because somebody in the family got sick, and where, alone among our peer nations, we’ve built an entire group of healthcare billionaires on the simple business model of denying claims and pocketing the difference.

There are now fifty-one of them. Fifty-one Americans whose ten-figure fortunes exist because we refused, decade after decade, to do what every other developed country figured out by the 1970s.

Becker’s Hospital Review crunched the latest Forbes list and counted them up: hospital chain heirs like Thomas Frist Jr. at $41.1 billion, medical-device dynasties like the Cooks and the Strykers, pharma fortunes, insurance fortunes, and a long tail of executives who got fabulously wealthy off the misery of people trying to pay for chemo. 

Some who became morbidly rich off healthcare even went into politics like Senator Rick Scott, whose company committed the largest Medicare fraud in American history when he was CEO. Others simply pour millions into buying Republican politicians and judges to maintain the profitable status quo.

These billionaires exist nowhere else in the developed world for a simple reason: no other developed country has set up its healthcare system so that human sickness is a profit center.

From Nixon‘s Southern Strategy to Bush’s Willie Horton ads to Trump’s racist birtherism, scaring White people about Black people has been the go-to position of the GOP since the 1960s. And stopping “socialism” that may benefit Black or Hispanic people is at its core. 

Canada doesn’t have hospital billionaires. France doesn’t have insurance billionaires. We do, and we have fifty-one of them, and the reason we do is the reason LBJ named in that hotel room.

The people who’d benefit most from a national healthcare system are the people who keep voting against it. Look at the map. Of the ten states that still refuse to expand Medicaid under the Affordable Care Act, seven are former Confederate states with large Black populations.

 

Alabama, Florida, Georgia, Mississippi, South Carolina, Tennessee, and Texas have together left billions of federal dollars sitting on the table, billions that would have built rural clinics, kept hospitals open, paid for prenatal care, and saved roughly 1.5 million of their own citizens from going uninsured. 

Their Republican legislators won’t take the money, their Republican governors campaign against the money, and their Republican voters keep electing the people who refuse the money, all because that money would also benefit the Black and Hispanic people who live in those states.

And the bodies pile up. Tennessee has the highest maternal mortality rate in the United States, 42.1 deaths per 100,000 live births averaged across 2019 to 2023, with Louisiana and Mississippi right behind. 

The Commonwealth Fund found this past summer that Alabama, Arkansas, Georgia, Louisiana, Mississippi, North Carolina, and Tennessee all have maternal death rates more than double those of California, Colorado, Massachusetts, and Minnesota.

Mississippi just declared a public health emergency over infant mortality because the state’s babies are dying at the rate of 9.7 per 1,000 live births, nearly double the national average, and for Black babies in Mississippi the rate is 15.2, which would be a national emergency in any country that wasn’t busy looking the other way.

Life expectancy tells the same story in the same racist handwriting. Mississippi sits dead last in the country at around 71 years, followed by West Virginia, Alabama, Louisiana, and Kentucky. . . .

LBJ laid out the con in a Tennessee hotel room in 1960. The Delaware researchers just confirmed it in 2026. 

The only question left is whether we’ll act on what we now know, or whether somebody like me in the next generation will be writing the same article about the seventy-fifth healthcare billionaire and asking the same exhausted question about why we still can’t have what every other developed country built two generations ago.