Promoting civil rights through the welfare state: How medicare integrated southern hospitals
Abstract
Although the Civil Rights Act of 1964 outlawed segregation and banned racial discrimination in employment and education, compliance was uneven across institutional spheres. Racial integration proceeded more rapidly and smoothly in the health care system than in other institutions because the new Medicare program, the largest expansion of the welfare state since the New Deal, provided the leverage to force health care providers to comply with the law. In this paper, I extend the axiom that the welfare state is a mechanism of social stratification to theorize processes of racial stratification. Drawing upon power resource and feminist theories of the welfare state, I argue that the welfare state can promote racial equality if 1) political resources are available to challenge racially-discriminatory practices; 2) institutions that reproduce systems of oppression are incorporated into the public sphere; 3) the rules and conditions for the distribution of benefits support the objective of racial equality; and 4) the benefits are provided on a continuous and universal basis.
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The Social Security Act (1935) excluded agricultural workers and domestic servants, which at the time constituted three fifths of the Black labor force.
“The Social Security Act (1935) excluded agricultural workers and domestic servants, which, at the time constituted three fifths of the Black labor force Quadagno (2000).”
From Civil rights as determinants of public health and racial and ethnic health equity: Health care, education, employment, and housing in the United States (2018) · cites this paper as Quadagno (2000)
The Hill-Burton Act allowed jurisdictions to construct hospitals restricted to Whites as long as comparable facilities for Blacks could be demonstrated.
“It allowed jurisdictions to construct hospitals restricted to Whites as long as comparable facilities for Blacks could be demonstrated Quadagno (2000).”
From Civil rights as determinants of public health and racial and ethnic health equity: Health care, education, employment, and housing in the United States (2018) · cites this paper as Quadagno (2000)
In Alabama, Hill-Burton funds supported the construction of hospitals in 67 counties, only two of which had non-segregated services.
“In Alabama, Hill-Burton funds supported the construction of hospitals in 67 counties, only two of which had non-segregated services Quadagno (2000).”
From Civil rights as determinants of public health and racial and ethnic health equity: Health care, education, employment, and housing in the United States (2018) · cites this paper as Quadagno (2000)
Pressure from the welfare state through Medicare and enforcement of its anti-discrimination provisions brought hospitals into compliance with CRA desegregation principles.
“Quadagno argues that it was pressure from the welfare state through Medicare and enforcement of its anti-discrimination provisions that brought hospitals into compliance with CRA desegregation principles Quadagno (2000).”
From Civil rights as determinants of public health and racial and ethnic health equity: Health care, education, employment, and housing in the United States (2018) · cites this paper as Quadagno (2000)
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- Authors
- Quadagno, J.
- Affiliations
- Florida State University (US)
- Corresponding author
- Quadagno, Jill
- Venue
- Social Problems
- Publisher
- JSTOR
- Published
- 2000-02
- Volume
- 47
- Issue
- 1
- Pages
- 68-89
- ISSN
- 0037-7791 (ISSN-L)
- 1533-8533
- OpenAlex
- W1973662778
- Cited by
- 46
- References
- 35
- Citations by year
- 2025: 9 · 2024: 1 · 2023: 1 · 2020: 3 · 2019: 1 · 2018: 1 · 2017: 2 · 2016: 4 · 2015: 1 · 2014: 1 · 2013: 2
- FWCI
- 9.78
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Social Problems (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Sociology and Political Science › Race, History, and American Society
- Social Sciences › Political Science and International Relations › Social Policy and Reform Studies
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Keywords
- Medicare, racial integration, Civil Rights Act of 1964, racism in healthcare, welfare state, racial stratification, racial equality, power resource theory, public sphere
- MeSH terms
- Black or African American, Civil Rights, Economics, Hospital, Medicare, Hospitals, Humans, Legislation, Hospital, Race Relations, United States, History, 20th Century
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