REFLECTING on the REAGAN REVOLUTION

Presentation by: Jennifer Frazer

Presentation by: Steven Berizzi
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Presentation by: Steven Berizzi
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Presentation by: Steven Berizzi
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PRESIDENT REAGAN and the AIDS EPIDEMIC, 1981-1989

By Steven S. Berizzi, Professor, History & Political Science

Prologue: American Government and Public Health

    What happens when two fundamental principles of American government collide?  To understand how President Ronald Reagan and his administration responded to the AIDSepidemic in the 1980s, we must begin with that question.  On one hand, in his first inaugural address, Reagan declared: “In this present crisis, government is not the solution to our problem; government is the problem.”  He was referring specifically to a serious recession that began in the late 1970s, but this phrase was taken by many to signify Reagan’s commitment to reducing the size of the national government and its involvement in the lives of Americans.  In his own words, Reagan was expressing an idea as old as the American Republic, built on ideas originatedthat originated with revolutionary pamphleteer Thomas Paine and President Thomas Jefferson.  On the other hand, although the American tradition of limited government is an old notion, by definition, it has limits. The Preamble to the Constitution calls for American government to “promote the general welfare”, and that occasionally requires expansive action.  

    Limits on government are especially challenging in the area of public health.  How much should the government do to prevent widespread threats to safety and to protect Americans lives?  The Framers almost certainly did not imagine circumstances in which the federal government would have to respond to a nation-wide public health emergency.  When one occurred, the responsibility to combat it was expected to be left to the states and their local political subdivisions.  How do we know?  Article I, Section 8, grants Congress vast powers but is silent about public health.  And the Tenth Amendment, ratified only three years after the Constitution, succinctly states: “The powers not delegated to the United States by the Constitution, nor prohibited by it to the states, are reserved to the states respectively, or to the people.”  As a result, in 1793, when an epidemic of yellow fever ravaged Philadelphia, then the national capital, state and city government were responsible for combatting the menace.  

    In 1953, 160 years later, the first year of Dwight Eisenhower’s presidency, Congress authorized creation of the cabinet-level Department of Health, Education, and Welfare.  In 1979, Congress separated the Department of Education from the current Department of Health and Human Services [“HHS’], which came into existence in 1980.  Conservative Republican Reagan, formerly governor of California, was elected president later that year and took office in January 1981.  

Principal Source

    Before proceeding, I must emphasize that most of the events related and summarized here were chronicled in painstaking detail by San Francisco journalist Randy Shilts in And the Band Played On: Politics, People and the AIDS Epidemic, which was originally published in 1987.  With the perspective provided by nearly 35 years, the Shilts book contains some inaccuracies of fact and debatable interpretations.  To borrow a phrase from something I read a few months ago in a theater review, journalism “is an art of the present, which makes it prone to error”. However, no one did more to report about the early years of the AIDS epidemic than Shilts, who died from AIDS in 1994.  Despite occasional flaws, this book is fascinating and indispensable!

The Reagan Presidency and the AIDS Epidemic

    A few months after President Reagan took office, the federal Centers for Disease Control[“CDC”], an agency within HHS, began receiving reports from Los Angeles and New York City of clusters of medical cases involving rare forms of pneumonia and skin cancer among otherwise healthy young men, most of whom were discovered to be gay.  Treating physicians and local researchers soon realized that the varied symptoms of the disease – which as yet had no name – were caused by a breakdown in the victims’ immune systems.  It was not until the late spring of 1982 that officials at CDC coined the phrase Acquired Immune Deficiency Syndrome, almost always shortened to AIDS.

By then, as the epidemic spread, activists, especially in San Francisco and New York City, demanded action by the federal government.  In May 1983, Edward Brandt, M.D.,Assistant Secretary for Health at Health and Human Services, 1981-1984, declared, AIDS was “the No. 1 priority’” of the United States Public Health Service.  That declaration was auspicious but also suspicious because it left many questions unanswered.  Beginning in January, 1983, Democrats had controlled the House of Representatives, but, at that time, not all Democrats supported large-scale funding for AIDS research, and the Republican-controlled Senate was unsympathetic, either on fiscal or cultural grounds or both.  Throughout the 1980s, there was a series of battles in Congress during the political struggle against AIDS.

    The focus, speed, and effectiveness of the Reagan administration’s response to the AIDSepidemic, which took over 80,000 American lives during the Reagan presidency between 1981 and 1989, has long been contested.  Reagan’s defenders assert the federal government did as much as it could and did more as the dimensions of the crisis became known.  To Reagan’s critics, including Shilts, the administration was slow to perceive the threat and then unwilling to commit sufficient resources needed to combat the epidemic.  Shilts asserted that some Reaganappointees and like-minded people in Congress dismissed AIDS as a disease largely confined to gay communities in New York and California.  In that narrative, Reagan was too easily influenced by his political allies in the Christian Right, who abhorred homosexuality, viewed the AIDS epidemic as a moral issue, not a public health crisis, and opposed vigorous federal efforts, even after thousands had died.  In reply, Reaganites assert that the president was preoccupied with more pressing matters, including reviving the economy, the growing threat of the Soviet Union, and risks to United States interests in Latin America and the Middle East.  Between 1981 and 1989, fraught years of controversy about funding for AIDS research and treatment, it is possible that even the Secretaries of Health and Human Services simply did not understand the dimensions of the growing crisis.  It is equally possible, however, that they sought to prove their loyalty to Reagan’s fiscal austerity agenda in domestic policy by not asking for more resources.  

    The AIDS epidemic had received some coverage in the mainstream media before 1985, the first year of Reagan’s second term, but AIDS became an international story when film star Rock Hudson died from the disease in October of that year.  President Reagan had been acquainted with Hudson in Hollywood, and Reagan’s wife, Nancy, was reported to be a friend.  Hudson’s death was big news for a few days, but, a couple of months earlier, what became known as the Iran-Contra scandal had broken, and that became the nation’s obsession for the next two years.  It is possible that some media decision-makers preferred coverage of troubling events in Washington and elsewhere to reporting about the so-called “gay plague”.  

    It appears that anti-gay Reagan staffer Patrick Buchanan and Senator Jesse Helms had the president’s ear.  However, any assessment of the Reagan administration’s response to the AIDS epidemic must go beyond political hacks and homophobes.  Most of the public was largely indifferent to a disease thought to victimize gay men, a significant turning point was national reporting about Ryan White, an Indiana teenager who contracted AIDS from a blood transfusion.  In 1985, at about the time of Rock Hudson’s final illness, Ryan was prohibited from attending his local high school.  He eventually graduated from another school, but his illness advanced, and he died from AIDS in 1990 at age 19.  In powerful visual ways, Ryan White and Rock Hudson personified AIDS in the middle 1980s.

Concluding Thoughts

    Close to 40 years after Ronald Reagan entered the White House, his legacy still provokes debate.  To McGill University presidential historian Gil Troy, Reagan was “the greatest president since Franklin Roosevelt.”  To others, he was clueless at best and an evildoer at worst.  For purposes of this presentation, we must conclude by asking: During eight years in office, most ofwhich coincided with the early years of the AIDS epidemic, could Reagan have done more to address the crisis?  As I suggested above, the answer is complicated.  Reagan might simply have been preoccupied with other urgent issues, leaving the federal government’s response to AIDS to his three Secretaries of Health and Human Services, only one of whom was a physician.  Or Reagan’s administration might have consciously ignored AIDS because its earliest victims were members of a socially and politically disfavored group.  Or, especially, during the last two years of his presidency, Reagan might have had his own health problems that made him incapable of understanding the full extent of the threat of AIDS to public health and safety.  While trying to be charitable, Reagan’s apparent indifference to AIDS appears to me to be the logical outcome of the cultural conservatism of his background and base of political support. his policy preferences, and his vision that was summarized in one short phrase: – “morning in America”, used during his 1984 re-election campaign.  These are conclusions of hindsight, but that is what historians make

    In an essay I graded in the spring term, a student wrote, “history never changes.”  That is nonsense!  Because the study of the past changes constantly, it is better to conclude with these profound words of wisdom from the great Dutch scholar Pieter Geyl: History is an “argument without end.”

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