In April 2005, a group of scholars at the George Washington University School of Public Health and Health Services published a policy brief on “National Security and U.S. Child Health Policy: The Origins and Continuing Role of Medicaid and EPSDT.” (.pdf) The Department of Health Policy chair, Dr. Sara Rosenbaum, and her colleagues studied how Medicaid and its comprehensive benefit package for children, the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program, were seen from the beginning as a key way to help ensure that we would have enough healthy young Americans prepared to serve and defend the country. As Congress and the nation focus more on health care reform now, it’s well worth reexamining the history of how this vital connection was made between child health and national security.
As Dr. Rosenbaum and her colleagues looked at the roots of this link, they focused on an important 1964 government report titled, One Third of a Nation: A Report on Young Men Found Unqualified for Military Service. This study was commissioned as a response to the 50 percent rejection rate among young men drafted into the military in 1962, a rate so high it raised red flags about the nation’s ability to develop a well-prepared military. The rate among men who had stepped forward as volunteers was slightly better, but overall, approximately one-third of prospective recruits were being turned away in the early 1960s. In September 1963, President Kennedy asked the Secretaries of Defense, Labor, and Health, Education, and Welfare to lead a Task Force on Manpower Conservation to study why this was so and determine what could be done to fix it.
What they learned was that far too many prospective recruits just weren’t healthy enough for service. The Task Force’s final report, Dr. Rosenbaum and her colleagues found, “concluded that the military draft failure rate provided powerful evidence of ‘the unfinished business of the Nation.'” They note, “Among [the report’s] most significant findings: the majority of young men rejected for compulsory military service in the early 1960s failed as a result of physical and mental health conditions, many of which could have been diagnosed and successfully treated in childhood and adolescence. These young adults typically came from impoverished families and had experienced unrelenting deprivation in health care, education, and employment. The report’s findings provided compelling evidence for an underlying tenet of President Johnson’s conclusion that improving the health and well being of the nation’s poor required strategies aimed at ameliorating the effects of social, economic, and health disparities.”
President Johnson said after the report was released in January 1964 that “The findings of this Task Force are dramatic evidence that poverty is still with us, still exacting its price in spoiled lives and failed expectations. For entirely too many Americans the promise of American life is not being kept.” Ultimately the Task Force, and the politicians who shaped its initial findings into policy, concluded that one answer was for the government to take a more active role in safeguarding the health of the nation’s children, especially the poorest children who needed the most help. They realized that fighting the inequalities that existed and keeping all children as healthy as possible was necessary for them to grow up to be productive citizens—including members of the military.
Forty years later, evidence still overwhelmingly shows that early intervention and prevention make a critical difference in children’s health. Meanwhile, our national security needs—as well as our nation’s overall needs for healthy, educated citizens prepared to compete in a globalized economy—are more serious than ever. Dr. Rosenbaum and her colleagues say in their conclusion, “The importance of a continuing commitment to broad child health policy endures, even as the health system itself is transformed. National security depends on the growth and development of children; in view of the demographics of those who serve, this dependence is particularly striking in the case of the low-income children who are at greatest risk for poor health outcomes.”
Health disparities still exist for poor children and children of color. But Congress has the opportunity and responsibility this year to make certain that the promise of American life is being kept for all children by committing to real child health system reform. They can include amendments by Representative Bobby Scott that provide comprehensive child-appropriate EPSDT benefits for all children and they can enact amendments offered by Representative Bobby Rush to simplify the health bureaucracy and to make sure that millions of children are better off, and not worse off, than they are today. We must ensure that health coverage in any final health care reform bill will guarantee all children the comprehensive health and mental health care they need and be affordable and simple to get and keep. Our children’s and our nation’s security still depend on making sure that our children really get the health care they need now.