April 3, 2014 5:56 pm

Why Obamacare is a civil rights issue

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There is a racial subtext to the American healthcare debate, writes Gary Silverman

One of the pleasures of watching old movies again is that sometimes you see something new. Such was the case recently when I caught the classic Giant for the umpteenth time. It provided some unexpected perspective on one of the biggest issues of our time: “Obamacare”.

Based on an Edna Ferber novel, the 1956 film tells the story of a posh young woman from Maryland horse country (Elizabeth Taylor) who marries a Texas rancher (Rock Hudson) and meets trials and tribulations as they raise a family in his rough-and-tumble home state.

I return to the movie regularly because I love the parts with James Dean. In his last role before he cracked up his car in California, Dean plays a ranch hand in Hudson’s employ who strikes it rich as an oil man, but never gets over Taylor (there are few sweeter moments in cinema than when Dean makes tea for the two of them – and neither takes it with sugar).

But the scene that stood out for me this time was the one in which Dean drives Taylor through the village where her family’s Mexican-American workers live. She finds a sick baby, and is told by his ailing mother that the doctor “is too far to come”. Taylor is moved by what she sees, and asks a white physician to visit the village – only to be schooled in the ways of traditional Texas healthcare by her husband.

“He can’t do that. He can’t go there. He’s our doctor,” Hudson tells Taylor, making it clear that he is defining “our” in racial terms. “He don’t tend [to] those people. They have a way of doing things by themselves.”

I realise that Giant is only a movie – and a Hollywood one at that. (La Liz overcomes Rock’s objections in this case and sets off with the doctor on a Mexican-American house call, paving the way for so much consciousness-raising in the film that her husband later protests: “I’m not the Red Cross. I’m a cow man.”)

But the fact of the matter is that the cinematic squabble between Taylor and Hudson reflects American reality – then and now. There is a racial subtext to our healthcare debate. Non-Hispanic white people, as we call them, make up a majority of the US population but a minority of the uninsured. Most Americans without health insurance are Hispanic, black or otherwise non-white in the US sense of the term.

The last time that the US Census Bureau counted the number of Americans without medical insurance it put the total at almost 48m, 55 per cent of them non-white. Among white Americans, 11 per cent lacked coverage. For blacks the figure was 19 per cent. Among Hispanics it was 29 per cent.

Most Americans without health insurance are Hispanic, black or otherwise non-white in the US sense of the term

In Texas, which is now the most populous US state after California, the uninsured still look a lot like the folks who tugged at Taylor’s heartstrings in Giant. A staggering 39 per cent of the state’s Hispanic population lacks health insurance, compared with 22 per cent for African-Americans and 17 per cent for whites, according to the most recent data tracked by the Henry J Kaiser Family Foundation.

In this context, there is an implicit civil rights dimension to President Barack Obama’s Affordable Care Act. It’s not easy to talk about this in the US, because it’s not easy to explain – to others or ourselves – why the health insurance coverage figures are so skewed by race in the first place.

But it’s a reason to root for Obamacare, for all its flaws. The plan was never perfect. It isn’t the single-payer system that many on the left really wanted. Nor is it the kind of thing that is going to turn on the Republican party and its mostly white supporters, either.

FT Video Archive

So, you want to sign up for Obamacare?

December 2013: Officials say the site can now handle 50,000 concurrent users – so now all of Grand Forks, North Dakota or La Crosse, Wisconsin can walk through the door – all at once.

Obamacare isn’t even close to covering all the uninsured. It was big news this week when the White House said it had reached its target of signing up 7m people for private health insurance exchanges. Millions more are benefiting from provisions in the law expanding Medicaid coverage for the poor and enabling children to stay on their parents’ insurance until age 26. But universal coverage remains only a dream.

What I like about Obamacare is that it shows some respect for “those people” – as Hudson called them in Giant – who are good enough to work the fields and mow the lawns, and build the roads and sew the clothes, and diaper the babies and wash the dishes, but somehow aren’t good enough to see a doctor from time to time to make sure there is nothing wrong inside.

When I was a boy, I used to go to family gatherings and there were a good number of “those people” in the room. They’re all gone now, but I try not to forget about them.

gary.silverman@ft.com

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Letter in response to this column:

Making universal coverage a reality / From Mr David Moore

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