The Soul of America – Jon Meachem (2018)

Introduction: To Hope Rather than to Fear

“Americans today have little trust in government; household income lags behind our usual middle-class expectations … the alienated are mobilized afresh by changing demography, by broadening conceptions of identity, and by an economy that prizes Information Age brains over manufacturing brawn.”

Gunnar Myrdal described the American Creed as “devotion to the principles of liberty, of self-government and of equal opportunity”. “The war between the ideal and the real, between what’s right and what’s convenient, between the larger good and personal interest is the contest that unfolds in the soul of every American”. “We cannot guarantee equal outcomes, but we must do all we can to ensure equal opportunity. Hence a love of fair play, of generosity of spirit, of reaping the rewards of hard work and faith in the future”. “The United States has long been shaped by the promise … of forward motion, of rising greatness, and of the expansion of knowledge, of wealth, of happiness”.

“Our greatest leaders have pointed toward the future – not at this group or sect.” “The president of the United States has not only administrative and legal but moral and cultural power”.

Fear: feeds anxiety and produces anger, about limits, points at others, assigning blame, pushes away, divides. Hope: breeds optimism, about growth, points ahead, working for a common good, pulls others closer, unifies.

One: The Confidence of the Whole People

America began with dreams of God and Gold. In 1630, John Winthrop said “For we must consider that we shall be as a City upon a hill”. Meachem argues that we must understand the dynamic between the presidency and the people at large, between a powerful chief and a free, disputatious populace. The presidency was defined in the shadow of the ineffective Articles of Confederation and the hatred of monarchy. Walter Bagehot in 1867 contrasted the dignified and the efficient parts of British parliamentary system. We have no king, so the US president must fill the dignified, symbolic, honorary, universal, ideal, inspiring, cohering role. “Our past presidents have unified and inspired with conscious dignity and conscientious efficiency”.

LBJ: “the moral force of the Presidency is often stronger than the political force”. Jefferson sought “to unite himself with the confidence of the whole people”. “Jackson believed in the nation with his whole heart. To him, the nation was a sacred thing”. Jackson: “The president is the direct representative of the American people”. Lincoln moved from a compromising, tentative early tone to exerting moral leadership for the country in the Gettysburg address, defining America ever after in terms of democracy and equality, followed by appeals to the “better angels of our nature” and binding the wounds of war.

Teddy Roosevelt coined the term “bully pulpit” to describe the president’s unique opportunity for moral leadership. Woodrow Wilson wrote of the president: “His position takes the imagination of the country. He is the representative of no constituency, but of the whole people”. Character and temperament clearly matter in such a president. FDR perfected the “fireside chat”. Meacham notes “A leader’s balancing act, then, was the education and shaping of public opinion without becoming overly familiar or exhausting”.

The character of the country is as important as the character of the president. It’s inclinations, aspirations, customs, thought and the balance between the familiar and the new. The Declaration of Independence introduced “the pursuit of happiness” to the world stage, not as individual self-interest but the joint pursuit of private and public good, the good of the whole.

Even by 1750, commentators noted the strong American belief in progress. Reason, religion and capitalism all contributed to forming this hopeful view. Actual progress “does not usually begin at the top and among the few, but from the bottom and among the many”. Referring to civil rights and Womens’ rights, Meacham says, “It took presidential action to make things official … but without the voices from afar, there would have been no chorus of liberty”.

Two: The Long Shadow of Appomattox

Robert E Lee’s surrender to Ulysses S Grant was a solemn, respectful, muted, balanced, even hopeful event, but it did not mark the end of America’s struggle with equality between the races. Grant fought against the Klan, but Andrew Johnson tried to prevent progress and Rutherford B. Hayes ended Reconstruction in 1877, allowing the Confederate States to return to “home rule”.

The decades before the Civil War had been intensely fought off the battlefield. The war killed one-fourth of the Rebel soldiers. The war resolved the question of union (sort of) and emancipation (sort of), but the path forward was uncertain and debated at the national and state levels. Northerners and Southerners debated the cause of the war (states rights or slavery) and the cause of the Union’s military victory (industrial and military capacity, leadership, tactics, bravery or God). Even the great American hero, Abraham Lincoln, held mixed, moderate, evolving, tactical and ideal values and positions about slavery and the equality of the races. He didn’t have a clear plan because he was not sure about actual equality, he recognized that a majority of citizens did not believe in true equality or intermixing, and he understood that social institutions don’t change quickly or easily.

Virginian Edward Pollard published the “Lost Cause” in 1866, outlining a defensive and proud Southern position that did not embrace defeat, but triggered a new war for the preservation of Southern culture. “The war has left the South with its own memories, its own heroes, its own tears, its own dead”. The war “did not decide negro equality; it did not decide negro suffrage; it did not decide states’ rights … the Southern people will still cling to, still claim, and still assert them in their rights and views”. This was couched as a holy war against the oppressors.

The Ku Klux Klan was formed in 1866. It terrorized blacks and “others”. It worked to undermine Reconstruction. It supported the political actions required to completely disenfranchise blacks from voting and to segregate all services and social relations.

The “voice of the people” initially drove the federal government to pass the historic constitutional amendments, the Civil Rights Act of 1866 and the Reconstruction legislation of 1867 despite President Johnson’s opposition. He was impeached but escaped removal by one vote.

President Grant leaned into further steps towards racial equality but found that northern support for significant change was weak and that Southern opposition to any legislation, or compromise discussions, was consistent and universal. He was able to pass the Enforcement Act of 1870 that gave the federal government powers to pursue the Klan. The Klan’s public face disappeared, and its private actions faltered for some time, but violence and the threat of violence were used to complement the Jim Crow laws and establish a one party, dictatorial state throughout the “solid South” for decades into the future.

Three: With Soul of Flame and Temper of Steel

Womens’ suffrage, immigration and labor protections joined civil rights as major issues by the turn of the 19th century, epitomized in modern, progressive, reformist politicians such as Teddy Roosevelt.

Israel Zangwill’s play “The Melting Pot” celebrated the positive interactions of various races, religions and ethnic groups in teeming New York City. Teddy Roosevelt approved of the message as he interpreted it. America welcomes foreign groups if they embrace their Americanness and downplay their roots. Roosevelt employed logic and morality to conclude that it is “a base outrage to oppose a man because of his religion or his birthplace”. On the other hand, Roosevelt held no such accommodating views regarding native Americans. Like his contemporaries, he was influenced by Herbert Spencer’s social Darwinism, scientific eugenics and apologetics for Britain’s imperial rule (White Man’s Burden). He believed that the progress of the Anglo-Saxon nations in the last 100-300 years reflected some form of superior readiness for the modern world.

Teddy Roosevelt was born in New York City in 1858 to a prominent family and benefited from their wealth, perspective and social standing. Teddy decided at an early age to be a “muscular”, driven individual, embracing the outdoors, adventure and change, especially when driven by himself. His “Citizen in a Republic” or “Man in the Arena” speech summarizes his view of a fully engaged life well lived. Roosevelt said, “Like all Americans, I like big things; big prairies, big forests and mountains, big wheat fields, railroads and herds of cattle, too, big factories, steamboats and everything else”.

Roosevelt’s progressive politics were influenced by Jacob Riis’ 1890 illustrated book “How the Other Half Lives”, which showed real urban living and working conditions. They were also influenced by Jane Addams’ Hull House initiatives to support the acclimation of immigrants to the United States.

Roosevelt crusaded against machine politics, monopolies, poor working conditions, and for conservation, railroad regulation, food safety, Womens’ suffrage and political reform.

Roosevelt invited Book T. Washington to dinner at the White House, a small step forward, which was criticized by many and elevated by many Southern journalists and politicians as an unremovable stain.

In each Roosevelt situation, we see a heroic man of privilege making decisions and taking actions to move his country forward. In hindsight, he was shaped by the views of his society, for good and for bad. He believed in progress, rationality, betterment and action. He was a Republican, a representative of the powerful Northeastern region, interests and his social class. He was idealistic, confident in the ability of individuals and governments to make things better. “We have room for but one flag, the American flag, for but one language, the English language, for but one soul loyalty, and that is loyalty to the American people”.

Four: A New and Good Thing in the World

The teens and twenties provided the 19th amendment for Women’s suffrage, but also a rebirth of the Ku Klux Klan opposed to blacks, Catholics, Jews and foreigners. Meachem reviews Wilson, Harding and Coolidge on these issues and finds just lukewarm support for “equal rights” a century ago.

In 1918 Wilson reversed his long-standing opposition to Women’s suffrage as it had become politically more favorable in the 70 years since the movement’s founding in Seneca, New York. The leaders had adopted a strategy of civil disobedience: lectures, protests, marches, lobbying, arrests for trespassing, and starvation pledges.

Wilson maintained his Virginian view of the Civil War, Reconstruction and negro rights. He met with black leaders at the White House but did not listen or engage, emotionally walking them out the door. Wilson denounced lynching and purged two racist senators from the Democratic party in 1918. Seeking support for his progressive economic policies in a 50th anniversary Gettysburg speech, he spoke of “the people themselves, the great and the small, without class or difference of kind or race or origin”, but also indicated that the combatants were morally equal.

A North Carolinian, Thomas Dixon, published a series of three novels between 1902 and 1907 reviving support for the “Lost Cause” version of the Civil War. One of the novels was filmed by D. W. Griffith in 1914 as “The Birth of the Nation”. It celebrated white supremacy and attacked African Americans. Wilson showed the film at the White House but later distanced himself from any formal support. In 1915 the new Klan was re-founded near Atlanta based upon “unease about crime, worry about anarchists, fear of immigrants flooding in from Europe desolated by war, and … anxiety about Communism”. The Klan promised racial solidarity and cultural certitude as the transition from an agricultural to an industrial and urban world accelerated. Klan Imperial wizard Evans claimed, “we demand a return of power into the hands of the everyday, not highly cultured, not overly intellectualized, but entirely unspoiled and not de-Americanized average citizens of the old stock”.

The first world war led to the Espionage Act of 1917 and the Sedition Act of 1918, restricting free speech. Dissident groups, including labor unions and socialists, were pursued, charged and imprisoned. Eugene Debs was imprisoned for his opposition to the war. The Postal Service was used to restrict the dissemination of publications. Anarchist bombs exploded in 1919, leading to greater federal investigation of “threatening” sectors. Socially, politically and journalistically Americans were pressured to become more patriotic and completely support American institutions.

The pendulum started to swing back after 1920 when the New York legislature tried to unseat 5 duly elected Socialist party members. Leading voices remembered the core principles of democracy, confident that the system could survive a small amount of dissent.

The Klan reached a peak of influence in 1925, with 2 million members and strong political representation and influence at the state and national levels. A Democratic Party plank criticizing “secret organizations” like the Klan failed to be adopted in 1924. The Klan’s 1925 march on Washington attracted 30,000 participants. The Klan’s extreme positions were later rejected in many states and by national politicians and the Supreme Court and its influence once again faded by the end of the 1920’s. Harding was a leader in opposing the extra-legal actions of the Klan. Coolidge also took steps in the mid-1920’s to oppose the Klan. Yet, the National Origins Act of 1924 greatly restricted immigration.

The teens and twenties witnessed some progress for women, threats to free speech or nonconformity, and an expanded opposition to “others” by race, ethnicity or religion. Economic progress in the twenties softened the edges of opposition to “others”. The US, like most other nations, became more nationalistic or patriotic in the shadow of the Great War. The general positive attitude towards scientific, business and government progress continued, leading most politicians to reject extremist, irrational positions even if they were not quite ready to fully embrace the implications of “equality” expressed by Lincoln 50 years earlier.

Five: The Crisis of the Old Order

The Great Depression threatened the US as it threatened Europe. 20% unemployment. In 1932, FDR saw army chief of staff, Douglas MacArthur as a threat to democracy, leaning towards a military government. Louisiana governor and senator Huey Long posed a leftist populist threat. Father Charles Coughlin’s radio broadcasts stirred populist, nativist and anti-Jewish sentiments. Charles Lindbergh inspired the isolationists who wanted to leave Europe to its intramural squabbles. Novelists such as Nathanael West and Sinclair Lewis highlighted the attractions of fascism and populism to a suffering public. A group of Wall Street investors conspired to overthrow FDR in a military coup in 1933.

Business and political leaders understood the nation’s challenges. They were unsure about FDR’s policies, political judgements, character and ability. Columnist Walter Lippman wrote, “Franklin D. Roosevelt is no crusader. He is no tribune of the people. He is no enemy of entrenched privilege. He is a pleasant man who, without any important qualifications for office, would very much like to be president”.

Roosevelt exceeded expectations. His themes of “the salience of hope, the dangers of fear, and the need for open American hearts” were effective. He prioritized the most important topics and mostly won his battles. He used his communications skills to speak with the nation, each small town, neighborhood and person. He believed in idealism and pragmatism. He promoted plans but adapted and adjusted quickly. He moved quickly but didn’t preach revolution. He overreached and then reset. He courageously faced situations as they were, not how he wished them to be. He delayed decisions when he could. He played off advisors against each other. He used his wife for political advantage. He was self-aware, knowing that he was leading in an extraordinary time, that his decisions effected civilization and that he was surely making some mistakes. Yet, he maintained a sense of hope and a spirit of optimism.

Despite the country’s strong isolationist leanings, FDR prepared the nation for war. He found ways to support the UK, such as the lend-lease program. He fought against the isolationist views of many important political and banking leaders.

FDR took small steps to reduce racial discrimination. With A. Philip Randolph’s Pullman Car Union threatening a march on Washington, he opened up employment in the defense industries to African Americans. Eleanor Roosevelt promoted racial progress, including resigning from the DAR when it prohibited Marian Anderson from performing at their Constitution Hall. Anderson garnered national publicity with her concert on the steps of the Lincoln Memorial. FDR signed the executive order that moved 120,000 Japanese Americans from their West Coast homes to internment camps further inland away from the potential war zone.

FDR took some early steps to promote greater emigration of Jews from Europe to the US and elsewhere. However, by 1940 he had concluded that preparing for war and winning the war was the best way to save the most Jews from Naziism.

As Allied troops were landing in northern France in 1944, FDR was at his idealistic best, praying for the world, “Almighty God: Our sons, pride of our Nation, this day have set upon a mighty endeavor, a struggle to preserve our Republic, our religion, and our civilization, and to set free a suffering humanity. … Help us to conquer the apostles of greed and racial arrogancies. Lead us to the saving of our country, and with our sister Nations into a world unity that will spell a sure peace — a peace invulnerable to the schemings of unworthy men”.

Six: Have You No Sense of Decency?

The post-war world in the US offered a contrast between widespread prosperity plus political moderation and the emergence of a new strain of anti-establishment conservatism fueled by the power of the mass news media.

Harry Truman won a surprise presidential victory in 1948 on the coattails of FDR’s New Deal and war victory. Eisenhower cruised to victory in 1952 and 1956, nominally as a Republican, but truly as a moderate centrist eager to preserve the peace and gains of the last decades. The growing prosperity, baby boom and suburbanization prompted recognition of the wonders of a growing middle class.

Economists, journalists and politicians had all worried that the end of the war would lead to a recession or depression due to lack of aggregate demand, hiccups from war production transitions and Europe’s slow recovery. Instead, pent-up demand and increased American production capacity led to a boom period. The business cycle had not been tamed, but it was less threatening. Business and labor fought over contracts but settled their differences as the US increased its production for the world. Per capita income, birth rates, employment rates, college education, home ownership, women’s opportunities, farm incomes and life expectancy all grew rapidly.

Meachem notes that the “middle class” became a more recognized term and a larger group as many earned greater incomes, formed businesses and joined professions. There was a pride in the “bourgeois” class as the US competed with the USSR for world leadership. He also highlights the role that government has played in spurring economic success (despite the popular emphasis on individual effort), noting the earlier railroad, infrastructure, homestead and land-grant college investments; regulatory and labor changes of the progressive era; the various New Deal safety net programs and the continued post-war investments in highways, GI’s, aerospace, R&D, defense, etc.

With the economy humming and fascism defeated, politicians turned to the Cold War, excess government, socialism, welfare and liberty to win attention, votes and power. Eisenhower easily won elections, but his moderate positions did not help the Republican Party to distinguish itself from the Democrats or to greatly increase its state or national powers.

Robert Welch, a Massachusetts business owner, founded the John Birch Society in 1954 focused on a conspiracy among American elites, including Ike, to cooperate with the communists. Welch and his followers saw the world in “black and white” terms, contrasting secular communism with a Christian-style western civilization. The nuclear weapons race and threats of the Cold War provided an existential survival context for this world view. The “loss of China” to communism raised the specter of a global communist state. The US did have several high profile and damaging espionage cases. There were communist “fellow travelers” in the media, entertainment, university and international affairs worlds.

Wisconsin Senator Joseph R. McCarthy exploited these worries. Beginning in 1950 he promoted this “conflict of civilizations” view, pushed the limits in alleging conspiracies and traitorous acts and managed to attract and keep attention from the growing mass print, radio and TV media. Although the State Department had implemented a loyalty program and cleared out “marginal” staffers, McCarthy was able to use his alleged “list of 205 members of the Communist Party” for several years to build political power.

Most politicians ignored him. Eisenhower chose to not respond to his claims, even though they were addressed at him, George Marshal and John Foster Dulles in his cabinet. Eventually, in Spring, 1954, an Edward Morrow investigative report, Eisenhower speech and US Army counsel Joseph Welch’s congressional committee testimony undercut McCarthy. Morrow: “We must not confuse dissent with disloyalty”. Ike: “We are worried about Communist penetration of our country … the need that we look at them clearly, face to face, without fear, like honest, straightforward Americans, so that we do not develop the jitters or any kind of panic, that we do not fall prey to hysterical thinking.” Welch: “Until this moment, Senator, I think I never really gauged your cruelty or your restlessness. You have done enough. Have you no sense of decency, sir, at long last? Have you no sense of decency?”

Meachem contrasts the 1955 conservative revival of William F. Buckley with that of the John Birch Society and Joe McCarthy. He considers Buckley’s philosophy and media-based opposition to be more legitimate. Opposing the flow of power to the state following 20 years of New Deal and liberal orthodoxy is described as a valid perspective. On the other hand, Meachem shares Richard Hofstadter’s description of “pseudo-conservatism” as “incoherent about politics”, “largely appealing to the less educated members of the middle classes”, “feels that his liberties have been arbitrarily and outrageously invaded”, reflecting “status aspirations and frustrations”. Political philosophy and material interests are subordinated to personal views, feelings, loyalties, interests, status and projections in this form of political attraction.

Seven: What the Hell is the Presidency For?

The Civil Rights Act of 1964 and the Voting Rights Act of 1965 are widely seen as the most important steps in securing individual rights in the last century. Their passage relied upon prior political steps, Supreme Court decisions, JFK’s legacy, the civil rights movement, Martin Luther King’s actions and ideas, American ideals and the unique qualities of Lyndon Baines Johnson.

In 1948 Hubert Humphrey and other progressives urged Americans to “get out of the shadow of states’ rights and walk forthrightly into the bright sunshine of human rights.” Strom Thurmond walked out of the Democratic convention to form the Dixiecrat Party, winning 4 states. Truman took steps to integrate the US military in 1948. The Civil Rights Commission and the Civil Rights section of the Department of Justice were created in 1957. The Civil Rights Act of 1960 strengthened the federal government’s ability to enforce voting rights and enforce judicial decisions. The Warren Court’s 1954-55 decisions rejected the “separate but equal” principle for public education.

President John F. Kennedy observed the civil rights movement. He protected the federal government’s rights. He enforced court rulings. He nationalized state troops. His Department of Justice monitored Civil Rights. Kennedy spoke with civil rights leaders. In June 1963 he addressed the nation and introduced legislation that became the Civil Rights and Voting Rights Acts.

The South fought against desegregation. In 1960, the South was 21% non-white while the rest of the country was 7% non-white. Georgia (29%), Alabama (30%), Louisiana (32%), South Carolina (35%) and Mississippi (42%) had the largest minority populations. Southern congressmen and Senators held the “swing vote” in the Democratic Party and used their seniority to block legislation. A leading public intellectual, Robert Penn Warren, wrote in 1956 about two curses on the nation. Southerners used the “Lost Cause” version of the Civil War as a “Great Alibi” to excuse any behavior. Northerners rejoiced in the “Treasury of Virtue” from their war victory, secure in their moral superiority for all time. Lynching and threats from the Klan were real. Blacks could not register or vote. Violence was a constant presence, especially in response to the civil rights actions.

George Wallace became governor of Alabama in January 1963 declaring “segregation now … segregation tomorrow … segregation forever” from the state capitol steps. Wallace was a gifted politician and populist. He lost the governor’s race in 1958 to a more racist Democratic candidate and vowed “never again”. He said “I’m gonna make race the basis of politics in this state … and I’m gonna make it the basis of politics in this country”. He blocked desegregation of the University of Alabama. Meachem emphasizes his personal style. “A visceral connection to crowds”. “Simply more alive than all the others”. “He made those people feel something real for once in their lives”. “He provoked devotion and rage”. Kennedy was able to desegregate the university. Meachem comments, “He [Wallace] savored the hour, however hopeless it was. The very hopelessness of it all was in fact part of the defiance, for Southerners loved tragic stands against the inevitable”. LBJ was able to pass civil rights legislation over Wallace’s opposition. Wallace won 5 states in the 1968 presidential election, providing Nixon with a victory over Humphrey.

The civil rights movement worked relentlessly from 1955 to 1965 to prepare the American public for this change. Non-violent, civil disobedience. Persistence. Strategic confrontations. Leveraging the media. Visual images. Dignity and discipline. Daily life. Buses, education, church, lunch counters, voting, jobs, soldiers, workers. Integrated partners. Patience. Courage. Numbers. Messaging. Patriotism. Rights. Citizens. Justice. Tired. The Founders. Persistence.

Martin Luther King supercharged this with his rhetoric. “Stand up for righteousness. Stand up for justice. Stand up for truth”. “I have a dream”. “Judged not by the color of their skin but by the content of their character”. “Work and fight until justice runs down like water and righteousness as a mighty stream”. “I have a dream that one day every valley shall be exalted, every hill and every mountain shall be made low”.

LBJ had a large view of himself, history and the presidency. Note the chapter title. “Now I represent the whole country and I can do what the country thinks is right”. “The president is the cannon”. “I want you guys to get off your asses and do everything possible to get everything passed as soon as possible”. “The job of the President is to set priorities for the nation, and he must set them according to his own judgment and his own conscience”.

Lady Bird Johnson said, “Lyndon acts as if there is never going to be a tomorrow.” “Lyndon is a good man to have in a crisis”. Despite the political risks of moving ahead with Kennedy’s progressive legislation, LBJ courageously decided to proceed quickly, leaving a legacy to the fallen leader. LBJ was a Texan, a southerner, a politician, a Democrat, a New Dealer, a deal maker and a bully. He became the “master of the Senate” by using his talents and being re-elected in a rural, conservative Texas district. He used all of these skills, especially his legislative skills, to buttonhole individual members of Congress and overcome the 33-vote filibuster.

LBJ, like JFK and other civil rights proponents of the last 30 years, mostly used relatively practical messages to appeal to the American public. “I’m going to fix it so everyone can vote, so everyone can get all of the education they can get.” “Who among us would be content to have the color of his skin changed and stand in his place?” “Helen Williams, an employee of the vice-president … would squat in the road to pee. That’s just bad. That’s wrong”. “We’re all Americans. We got a Golden Rule”. Meachem wrote, “The key thing, LBJ believed, was to make the moral case for racial justice so self-evident that the country could not help but agree”. Johnson was mainly pragmatic. How to get preachers to help. How to get politicians to see their own interest in equal rights.

His speech in support of the Civil Rights Act was more elevated. “I speak tonight for the dignity of man and the destiny of democracy. Our lives have been marked with debate about great issues. Rarely in any time does an issue lay bare the secret heart of America itself … to the values and purposes and meaning of our beloved Nation. The issue of equal rights for American Negroes is such an issue. For with a country as with a person, ‘what has a man profited, if he shall gain the whole world, and lose his own soul?’ It is the effort of American Negroes to secure for themselves the full blessings of American life. Their cause must be our cause too”.

LBJ knew that these Acts were historic but still just steps along the way. “It is difficult to fight for freedom. But I also know how difficult it can be to bend long years of habit and custom to grant it. There is no room for injustice anywhere in the American mansion. But there is always room for understanding toward those who see the old ways crumbling”.

Conclusion: The First Duty of an American Citizen

Teddy Roosevelt: “The first duty of an American citizen, then, is that he shall work in politics; his second duty is that he shall do that work in a practical manner; and his third is that it shall be done in accord with the highest principles of honor and justice.” The citizen should be like his “man in the arena”, fully engaged in important matters.

Eleanor Roosevelt: “Great leaders we have had, but we could not have had great leaders unless they had a great people to follow”.

Harry Truman: “I’m everybody’s president. Those – the Bill of Rights – apply to everybody in the country”. American scripture. Equal opportunity.

Meachem: “America of the twenty-first century is, for all its shortcomings, freer and more accepting than it has ever been.” Apply the historical perspective.

“Every advance must contend with the forces of reaction”. An eternal struggle. “The perfect should not be the enemy of the good”.

The better presidents do not cater to the reactionary forces. Reagan recalling the virtues of other presidents and outlining his shining city on the hill, “teeming with people of all kinds living in harmony and peace”. Clinton healing the nation after the Oklahoma City bombings and Bush, Sr resigning from the NRA when they tried to fundraise from the disaster. Bush, Jr clearly distinguishing Muslims and Arabs from terrorists after 9//11. Obama eulogizing the Bible study victims of a white supremacist, invoking God’s freely given grace and its potential to heal individuals and countries.

Some “equal rights” changes happen quickly: LGBTQ.

Resist tribalism.

Respect facts and deploy reason.

Find a critical balance.

Maintain a free press.

Truman’s description of Lincoln: “He was the best kind of ordinary man … he’s one of the people and becomes distinguished in the service that he gives other people. I don’t know of any higher compliment you can pay a man than that.”

Go Brandon: Record Low Unemployment Rates

https://fred.stlouisfed.org/series/UNRATE

In my adult lifetime, the minimum possible sustainable unemployment rate was said to be 5%. It could be a little bit lower without driving inflation much higher, but not much lower. Well … in 2018-2019-2020 we reached a solid sub-4% rate and stayed there, without triggering accelerating inflation. In a short 2 years after the pandemic shock, we returned to sub-4% unemployment.

At the state level, we have 19 states with less than 3% unemployment, a previously unimaginably low level. We have 40/50 states below 4%.

https://www.bls.gov/web/laus/laumstrk.htm

At the metro area level, the results are even more amazing. A majority of the 389 areas have unemployment rates of 2.9% or lower. 3 New Hampshire areas have unemployment rates of 1.1%. Seven Alabama metro areas show 1.6% unemployment!

https://www.bls.gov/web/metro/laummtrk.htm

Yes, we also saw good news 12 months ago.

American Presidents – 36 Great Biographies

https://www.laphamsquarterly.org/contributors/roosevelt

45 presidents. 36 great biographies. Just 20 presidents qualify. 9 presidents hog 24 of the 36 places with multiple entries. Washington, Jefferson, Lincoln, Roosevelt, FDR, LBJ, Nixon, Reagan and Clinton won multiple spots in my ranking. Grant, Adams, JQA, Jackson, Wilson, Hoover, Kennedy, Ike, Truman, Bush, Bush and Carter claimed a single entry each.

As Americans, we demand and deserve the very best. We must demand this level of greatness now and in the future. We have 330 million fellow citizens. The “1%” is 3.3 million residents! So may qualified and experienced people. The Fortune 500 has 500 CEOs, 500 presidents, 500 CFO’s, 500 CIO’s, 500 CMO’s. 50 governors. 3,000 university presidents. 500 hospital system presidents. 100 national law firm managing partners. 50 national CPA managing partners. 100 large national NFP presidents. 1,000 large privately held firms. 100 big city mayors. 500 medium sized city mayors. 50 religious organization leaders. 100 media firm leaders. 100 generals. 1,000 college and pro head coaches. 100 major think tank leaders. 100 investment bankers. 100 venture capitalists. 100 community organizers. 100 ambassadors. 500 Nobel prize winners. 100 senators and 365 congress persons. 500 large school superintendents. 1,000 award winning performing artists. 500 elite athletes.

We live in a meritocratic society. There are 10 to 100,000 people clearly qualified to be the American president. We should never, ever settle for anything less.

Good News: Healthy State & Local Government Finances

https://www.oecd-ilibrary.org/sites/c6217390-en/index.html?itemId=/content/component/c6217390-en

One-half of US government spending is managed at the state and local level. Only 3 OECD (developed economy) countries have a higher share at the local level. The median level is one-third of the total and some countries limit local spending to just 10-20% of the total. The US federal government model ensures that a significant share of government is managed closer to “the people”, which is even more important today with 330 million people than it was 200 years ago.

State and local expenditures as a percentage of GDP is 19% for the US, on the high side compared with other OECD nations as expected based on the 50/50 local/national split.

Government employment is even more concentrated at the more responsive state and local government level. State and local government employees comprise three-fourths of total government employment. This total increased from 21 to 23 million across 20 years while total US employment grew from 132 to 152 million. The share of government to total employment eased down from 16% to 15%. Note that this is much lower than the 38% government share of GDP.

https://fred.stlouisfed.org/series/PAYEMS#0

Federal government employment has been essentially flat for many decades.

https://www.cbpp.org/research/state-budget-and-tax/its-time-for-states-to-invest-in-infrastructure

Setting aside land and defense assets, states and local governments hold a supermajority of government assets.

https://en.wikipedia.org/wiki/Government_spending_in_the_United_States#/media/File:Federal_state_local_percent_of_gdp.webp

The share of total government spending to GDP is the most important ratio to track. Since the 1960’s the federal government has moved spending responsibilities to the state for many programs. Spending drifted up to 25% of a growing post-war GDP by 1966. The Vietnam War and the Great Society programs pushed this up to 29% in 1975. The oil crisis, Japanese competition, inflation and recession pushed it up to 32% in 1976. Spending was still 33% of GDP 30 years later in 2007. The Great Recession drove spending up to 40% of GDP and then it declined back to 34% in 2014. State and local government spending has been relatively constant since 1976.

https://www.usgovernmentspending.com/local_spending_chart

Local government spending reached its modern level at 9-10% of GDP by 1990 and has mostly remained at that level.

https://www.urban.org/policy-centers/cross-center-initiatives/state-and-local-finance-initiative/state-and-local-backgrounders/state-and-local-expenditures

federalism.us

https://www.pgpf.org/budget-basics/how-is-k-12-education-funded

State and local governments provide a wide variety of services.

https://fred.stlouisfed.org/series/L319411A027NBEA

States and local governments routinely deliver solid budget surpluses in normal years and greatly exceeding the deficits encountered in recessionary years. State and local governments rely more on property and sales taxes which do not vary as much as income taxes. States have proactively reduced spending budgets whenever they have encountered recessions.

https://www.pewtrusts.org/en/research-and-analysis/articles/2022/05/10/budget-surpluses-push-states-financial-reserves-to-all-time-highs

States have built up a nearly 3 month cushion of reserves to buffer recessionary periods. States and local governments did much better during the pandemic recession than anyone expected. They reacted quickly to ensure fiscal stability and found ways to put the federal government transfers to good use. Some states have provided rebates to their taxpayers.

https://www.pewtrusts.org/en/research-and-analysis/articles/2021/10/15/states-financial-reserves-estimated-to-surpass-pre-pandemic-levels

https://fred.stlouisfed.org/series/SLGTFFQ027S

https://fred.stlouisfed.org/series/SLGTANA027N

State and local governments have continued to accumulate valuable assets, especially in the last 10 years.

States have generally improved their credit ratings since 2006, before the Great Recession. At that time, 9 states had the very highest AAA rating. 39 held very strong AA ratings. Just 2, Louisiana and California held “upper medium” A ratings. Recent data shows 7 more states, for a total of 16, at AAA ratings. 29 have strong AA ratings. 3 are at single A: Pennsylvania, Connecticut and Kentucky. 2 have fallen a step lower to BBB: Illinois and New Jersey. The median rating has improved from AA to AA+.

https://en.wikipedia.org/wiki/List_of_U.S._states_by_credit_rating

States have improved their pension fund percentage funding ratios, although some states remain at some risk of defaulting on their obligations.

https://www.urban.org/policy-centers/cross-center-initiatives/state-and-local-finance-initiative/state-and-local-backgrounders/state-and-local-expenditures

federalism.us

https://www.taxpolicycenter.org/statistics/state-and-local-general-expenditures-capita

State and local government spending per capita varies widely, reflecting local preferences. The mideast and far west are 15% above the national average while the southeast and southwest are 10% below the national average.

State spending varies even more widely. The national average is $6,900 per capita. California is 12th highest at $9,000 but neighbor Washington is much lower at $7,000 (26th). Massachusetts is also at $9,000 but its neighbor New Hampshire is at a very low $5,000 (46th). New York is lower than might be expected at $8,600 (15th). Nearby New Jersey, Pennsylvania and Virginia spend $7,200-7,500, a bit above the national average. Michigan, Ohio and Illinois spend less than the national average at $6,100-6,300, but nearby Indiana ($5,500), Kentucky ($8,500) and West Virginia ($10,300) have much different priorities. Georgia ($5,700), Alabama ($6,300) and Mississippi ($6,700) spend less than the national average. Texas spends only $4,700 per capita (48th) while its neighbor Arkansas spends $9,200 (10th). Florida is the lowest spending state at just $4,000 per person, an amazing 42% less than the national average.

Another way to look at these differences is to compare the spending of 5 states. Rhode Island $10,400 (6th), Kentucky $8,500 (16th), Washington $7,000 (26th), Colorado $6,200 (36th) and New Hampshire $5,000 (46th). Rhode Island spends twice as much on state government than New Hampshire, a few miles away. This is the range in the US, reflecting vastly different local priorities.

Summary

In our federal system, state and local governments are called upon to manage one-half of total government spending. They routinely deliver budget surpluses and adapt during recessions, even the pandemic driven recession. They have accumulated significant real and financial assets to buffer difficult times. They have managed pension liabilities appropriately and improved their bond ratings and ability to borrow. They have taxed and spent to match local preferences. In aggregate, their spending has remained at the same percentage of GDP for many years.

Good News: Firms and Jobs

Many people complain that the US economy does not create enough new jobs or soon won’t create enough jobs or won’t create enough good jobs or … People worry about employment. Writers and politicians cater to that worry. Fortunately for us, the US economy creates jobs year after year after year, only briefly interrupted by increasingly less frequent and brief periods of economic recession. I’ll share the core numbers on healthy firms and new jobs and provide some context and history which indicates that this is inherent in the modern US economy. The economy is not relying upon any major political change or special insight to continue adding jobs. It just happens.

For 9 straight years, from 2011-2020, across 3 presidential terms and 5 congresses, the US economy added 2 million new jobs each year. In the 1980’s, it added 2-4M per year. In the 1990’s it added 3M per year. In the “oughts”, it added 2M per year. 30 years of expansion, 7 lesser years that averaged more than zero. 4 strong years for every 1 weak year..

The recovery since the pandemic has been even stronger, starting at 8M new jobs per year in 2021 before sliding to 6M per year and most recently 4.5M per year.

My post earlier this week focused on the role of start-ups in driving job growth. I’d like to build upon that post.

The total number of firms in the US grew slowly in the last 40 years, from 3.5 million to 5 million. The growth rate was much faster prior to the Great Recession (2007-9). Much of this growth was accounted for by single employee firms. Despite this tame 1% growth per year, the economy was able to add more than 2 million jobs per year.

The number of establishments (locations) grew almost twice as fast, just under 2% per year.

The US economy requires some growth in the number of firms or establishments each year to drive job growth. Fortunately, it does not require heroic growth rates.

The number of new establishments added per year is remarkably consistent, averaging about 700,000 per year on a base of 5-7M. Of course, this means that the RATE of new establishments is shrinking, from 14% to less than 10%.

Establishment exits have increased from 500K to 600K to 700K before returning back to 600K per year. Big picture, 700K new establishments and 600K lost establishments each year across 4 decades.

Firm deaths have also been consistent at 450,000 per year.

Data calculated from BDS data. Direct graph not available.

Firm births have also averaged about 450,000 per year but present a different pattern. Firm births were much lower in the troubled time around 1980. Births ranged from 450-500,000 per year in the next 25 years. The Great Depression destroyed businesses, access to capital, personal net worth and aggregate demand. Hence, new firm creation dropped back to the 400,000 level. It recovered back to the 450,000 per year rate by 2015. As with firm deaths, the rate has fallen from 14%+ to less than 10%. Most importantly, the birth and death rates have been relatively consistent and have both been relatively flat, leading to a slow increase in the number of US firms.

https://www.bls.gov/spotlight/2022/business-employment-dynamics-by-age-and-size/home.htm

The BDS database shows that job gains and job losses generally move together, but that in a recession job gains fall and job losses increase. This is a very important result. Without active government or policy intervention, the economy creates 12-14M jobs each year and destroys 11-13M jobs each year. There is no guarantee that net jobs will be created in any given year, but overall that is the normal result.

https://bipartisanpolicy.org/blog/trends-in-new-business-creation/

Writers who wish to emphasize the decline of entrepreneurship focus on firms instead of establishments because of the slower growth rate. They emphasize the growth rate rather than the growth numbers because this is less positive. They don’t compare the growth and death rates or numbers, which move together. They focus on the aftermath of the Great Recession which did greatly slow firm creation, resulting in slower than historical numbers and rates of job creation from new firms. Nevertheless, the economy created 2M new jobs per year for 9 years. During that period, existing firms captured a larger than usual share of the job growth required to provide demanded goods and services.

New establishments have driven 5-6M new jobs each year. The late nineties to early “oughts” reported the higher 6M per year figure.

Existing (continuing) establishments have added 10-12M gross new jobs each year.

Establishment deaths (including firm deaths) resulted in 4-5M jobs lost each year.

Continuing establishments trimmed 8-9M jobs each year, and many more during recessionary times. Although there are many moving parts, continuing firms eliminate more jobs than they create, especially during recessionary periods when they are adapting to lower demand. Firms die and they close locations, removing 4M jobs each year. New firms and new establishments add the new jobs required to fill the 2M net new jobs each year. This does not happen automatically or precisely, but overall, through time, the pattern is clear.

The US job market has grown from 90-150M positions during the last 40 years.

Firms hire 75M people each year. The typical job tenure is just 2 years.

Separations and hires generally move together. The net 2M jobs added annually is a small fraction of employment, hires, separations, gross job adds and gross job losses.

Establishment births exceed establishment deaths except during deep recessions.

New firms have high failure rates. Fortunately, firms that survive their first year have high percentage rates of new hires. They start with a small number of employees (4) and grow rapidly. The survival rate improves with the age of the firm and the employment growth rate of surviving firms tends to decline as they grow. The combined effect is that 80% of the new employees added by startup firms remain after 10 years. This employment survival rate has been improving in the last 15 years, partially offsetting the reduced number of start-up businesses.

https://www.bls.gov/spotlight/2022/business-employment-dynamics-by-age-and-size/home.htm

The first-year survival rate has remained roughly the same at 80% for 25 years.

The percent of non-business owning adults who start a business each month has shown a small upward trend before jumping up in 2020 and 2021.

The ratio of new employer businesses to population dropped significantly after the Great Recession, but has recovered in the last 4 years.

The share of “new employer businesses” dropped after the Great Recession and has not fully recovered.

The number of application for new business tax ids increased significantly after the Great Recession and jumped by 50% after the pandemic.

The Census Bureau also tracks a subset of the total new business applications based upon industry classification that is a better predictor of actual businesses eventually started. This measure shows modest growth after the Great Recession and a 30% spike after the pandemic.

About 10% of new business applications become new businesses. Hence, the rate of new business formation to be reported for 2022 is expected to be very high.

https://www.silive.com/business/2022/08/new-business-applications-are-on-the-rise-heres-what-led-to-a-record-setting-year.html

https://www.nber.org/digest/202109/business-formation-surged-during-pandemic-and-remains-strong

https://www.oberlo.com/statistics/how-many-new-businesses-start-each-year

https://bipartisanpolicy.org/blog/trends-in-new-business-creation/

https://bipartisanpolicy.org/blog/trends-in-new-business-creation/

About 80% of new businesses are formed based on opportunity and 20% based on necessity. Kauffman estimates that 2020 business formation was 30% based on necessity.

Summary

The US economy continues to generate 2 million new jobs in each non-recession year, even more in boom periods like the last 2 years. Firms and establishments are born, grow and die. The net employment growth rate for established firms is less than zero in their first 5-10 years and then slightly positive. The annual death rate of existing firms and establishments is relatively low, but on a 150M employee base it is 4M per year. The new jobs added by startup firms and new establishments allow the total number of employees to grow in normal years.

There is no “iron law of employment” that requires new firms or establishments to be created in numbers greater than the job losses. There is no law that requires surviving young firms to nearly offset job losses by young firms that die at a high rate. There is no law that requires mature firms (10 years old+) to add new employees or to die at slow rates. But these results have been consistent or improving for the last 40 years. I look forward to continued success.

Good News: US Startups Still Create Many Jobs (!!!)

I’ve always been a sceptic about the many claims that entrepreneurs, startup firms and venture capital are the “most” important drivers of improved quality of life in the US in my lifetime. I remain a sceptic. I believe that large firms deliver even more added value (driven by self-interest). I believe that the government and not-for-profit sectors play an equally important role. I believe that the government’s definition of the “rules of the game” and our culture’s influence on how people live their everyday lives are also very important. I’ll come back to the role of small firms in a separate blog post. I’ll try to tie together all of the strands of our amazing US labor market in another blog post.

But today, I want to tip my hat to the truly amazing role that startup firms play in driving the US economy and labor market.

https://www.bls.gov/bdm/us_age_naics_00_table1.txt

The US Bureau of Labor Statistics (BLS) tracks new jobs added (gains) and jobs lost (losses) each year in detail by firm and establishment (branch), including links to the year the firm was first created. At the total country level, we see that job creation and destruction follows the business cycle. The Great Recession, subsequent expansion and pandemic periods are obvious above. In the Clinton years, job gains averaged a great 15 million per year. The Bush, Jr. years showed still solid 13-14 million annual new jobs added. The Obama recovery increased new jobs from 10 to 13 million per year and Trump maintained this positive level at the end of a very long period of economic growth.

Job losses generally followed the pattern of job growth. Job losses are even more volatile. They peaked in the recessions of 2002, 2009 and 2021.

In the last 3 decades, the US economy added 2 million new jobs each year during periods of expansion.

Many economists, journalists and politicians claim that startups account for ALL new job growth. This is an “amazing” claim that deserves deeper analysis, investigation and description. I’ll chase this separately. The claim is “largely true”.

Startup firms delivered 4-5 million new jobs each year in the 1990’s. This declined to 2.5 million jobs during the “oughts”. It increased back to 3 million new jobs per year in the teens. In non-recessionary periods during the nineties and “oughts”, existing firms destroyed 2 million jobs each year. In the teens, the job destruction rates were much lower, roughly 1 million jobs per year. The startup jobs minus existing firm jobs number was typically 2 million net new jobs per year in positive economic years.

The BLS separates job gains from job losses and categorizes them by the firm’s first year of existence. Job gains at existing firms were roughly flat at 10 million per year. Startup firm new jobs declined from 4.5M in the nineties to 2.5 M in the “oughts”, recovering to 3M per year afterwards. Startup job creation declined from 45% to 31% of existing firm job creation, a one-third reduction.

The BLS provides data on the subtotal of all firms founded before 1993. These “mature” firms display a similar pattern. Annual job gains fell a bit from 4.5M in the “oughts” to 3M in the teens. Annual job losses fell even faster, from 6M in the “oughts” to 3.5M in the teens. Net job losses averaged 1.5M annually in the “oughts”, but just 0.5M in the teens.

The number of new jobs created by startups declined by one-third during this period, from 4.5 to 3 million per year.

The BLS data allows us to track the gains, losses and net jobs added by first year of existence for firms. First year startup jobs declined from 4.5M to 2.5M. The cumulative jobs created measured 10 years after startup is more positive. Cumulative new jobs, measured 10 years after startup, increased from 3M to 3.5M then dropped back to 3M in 2001. The startup classes of 2009-12, despite the Great Recession, report 2.5M net jobs added each year, as measured after 10 years.

Job losses have fallen much faster than job gains in the last 20 years, measured by a full decade of performance. The ratio of job gains to job losses has improved markedly. This ratio averaged 83% in the nineties, indicating that 1/6 new jobs was destroyed within a decade. This ratio has greatly recovered to the mid-90’s. indicating that new startups, in total, essentially maintain their initial jobs count a decade later. Other data shows that one-third of startups don’t exist after 10 years. Hence, this means that the successful remaining one-third have roughly tripled their employment in their first decade.

Firms die much faster than employment. There are many studies that claim that one-half, three-quarters, fourth-fifths or nine-tenths of employees at startup firms are eliminated in 10-20-30 years. These are mostly exaggerations.

Ten years after their founding, startups still employ 80-90-95% of their initial year hires. Job losses fell during the teens. Job gains grew rapidly after the Great Recession.

For the 18-year period where we have ten years of data on startup firms, we have a clear pattern of net employment decline at the end of the decade, on average. The ten-year retained employment level at almost 80% of the initial level is far higher than the 50% claimed by some commentators.

The years since 2009 show a clear pattern of startups maintaining 90-95% of their initial employment levels after 10 years.

Summary

The US economy typically added 2M net new jobs each year during periods of economic expansion. Historically, startups added 4M jobs annually to offset the 2M jobs eliminated by existing firms. The job destruction rate of existing firms has slowed. The jobs retention rate of startups has improved. Net, net, the US economy still generates 3M+ new jobs each year which essentially still remain a decade later. One-third of the firms are gone, but the winners employ 3 times as many as when they started.

Good News: The US Economy is Still Firing on All 12 Cylinders

Allison V-1710-7 (V-1710-C4) V-12 engine (A19600125000) engine. One-half left front view.

New hires remain above 6 million at the end of 2022! The high in 2002-7 was 5.5 million. The economy barely reached 6 million during the historic 10-year expansion from 2009-2020. New hires in 2021 were above trend, but 2022 remains on the positive track. We’ve been in a “negative” economic climate for 18 months, but the economy has just slowed a bit.

The “distribution” business is doing very well. People are embracing the Amazon model of home delivery. This requires more staff here and less in retail and wholesale trade. 1.1M new hires prior to the Great Recession. Drop to 0.8M afterwards, recovering back to 1.1M for 2015-19. Growing to 1.3M after the pandemic!

The “leisure” industry continues to grow as a share of the US economy, from 900K new hires to 1.2M new hires. There is some slowdown in the second half of 2022.

The broadly defined business and professional services industry continues to grow as a share of the US economy, from 800K new hires in 2004 to 900K by 2011 and 1.1M in 2016. This industry continues to grow, although it has clearly backtracked a bit at the end of 2022.

The retail trade sector has generally been weak for the last 2 decades, with new hires plummeting from 800K to 550K after the Great Recession before recovering to 750K from 2015-19. Retail hiring actually increased after the pandemic before falling back to its historical level of 750K hires.

Health Care continues its forward march to consume all of the US economy. 😦

Manufacturing new hires dropped by one-third after the Great Recession, but very surprisingly recovered from 250K to 350K new hires by 2018-19. Manufacturing new hires grew even faster, above 400K after the pandemic.

The government sector has less variability. New hires have increased to 400K after the pandemic.

New hires in the Construction industry peaked before the pandemic and have drifted downwards ever since.

Hiring in the Financial Services industry dropped by one-third due to the Great Recession, but has slowly recovered to almost the 240K level.

The Arts sector has recovered to its pre-pandemic level of hiring.

Hiring in the Wholesale Trade industry fell from 180K to 120K with the Great Recession but has since recovered to 160K.

The Education industry has continued with its increased hiring.

Summary

The annual rate of new hires has dropped by 10% from 6.6M to 6M. 9 of the 12 sectors have drifted sideways. 3 have fallen significantly in the last 9 months: professional and business services, retail trade and transportation, warehousing and utilities. The economy is clearly in a slow-down period, but the ongoing trend of growth is clear.

Good News: Emergency Medical Services (EMS) Today (1972-2022)

Positive Media Coverage

https://www.imdb.com/search/keyword/?keywords=medical-drama

Since the pioneering 1972 drama Emergency! there have been dozens of TV shows highlighting the critical role of emergency medical services (EMS) personnel.

https://www.imdb.com/search/keyword/?keywords=medical-drama

Vehicles

Modern Emergency Medical Services (EMS) vehicles today are designed to help EMS medical professionals provide world class care. They now meet national standards (1974, 1990) for space, equipment, supplies and client care. These vehicles are stocked with supplies and equipment to meet all typical emergency care needs.

https://www.nremt.org/about/history

Air Medical Services

Helicopter based emergency services started in 1974 in Baltimore, Jacksonville, Pittsburgh, Seattle and Denver leveraging the equipment and pilot experiences of the Vietnam War. Emergency helicopters are staffed with qualified personnel and equipment to handle the most extreme situations. Emergency personnel are staged across the country to respond to emergency situations.

In 2020, there were more than 1,600 helicopters and 700 fixed wing aircraft participating in emergency medical services in the US, making more than 200,000 responses to service requests.

https://www.hmpgloballearningnetwork.com/site/emsworld/article/1223054/air-medical-services-then-and-now

Emergency Medical Profession

The National Registry of Emergency Medical Technicians (NREMT) was established in 1970. This organization has driven the development of a true profession.

https://www.nremt.org/about/history

In 1975 the AMA recognized emergency medicine as a physician specialization and recognized paramedics as allied health professionals. Prior to this time, the training, skills, employers, supervision, equipment and medical protocols of the emerging profession were so varied that initial efforts to define and enhance the professional identity and roles of paramedics and EMTs were often opposed by physicians, nurses, lawyers and hospital administrators. In the 1970’s states began to pass legislation that defined the legal roles which paramedics and EMTs could play without concern for lawsuits from their customers. Specialized emergency physician training was also developed during the 1970’s highlighting the role of paramedics, immediate care, transport care, triage issues, communications and the emergency room admitting and medical services. Emergency medical dispatching programs started in the 1980’s. Military paramedics/EMTs adopted national standards in 1986, aligning the two groups. Paramedic manager standards for training have been defined for most states.

Paramedics and EMTs are regulated at the state level. Definitions of roles, titles, allowable drugs/procedures, supervision requirements, certifications, examinations, renewals and education programs varied widely in the 1970’s. The role of national certification as an option or requirement grew throughout the 1980’s and 1990’s. Today, differences between states remain, but most states (45+) largely conform to recommended national standards for all dimensions.

While most people think of paramedics and EMT’s as specialized staff or extra skills held by first responders, the profession now includes military personnel, dispatchers, air staff, emergency room, jail, blood bank, medical labs, education and interhospital transportation roles. This increased breadth of experiences has helped the profession to improve the content of its services, education, certification and allowable procedures.

https://en.wikipedia.org/wiki/Paramedics_in_the_United_States

Professional Certification

As states defined various paramedic and EMT legal roles, they created state professional certification agencies. The first national EMT exam was administered in 1971 to 1,500 applicants. By 1984 one-half of states required the national exam for certification. By 2005, 46 states recognized or used the standardized national exams.

The national exams incorporated American Heart Association standards in 1986. Major national standards changes were implemented in 1994-95 to include 2 decades of lessons learned, a systems approach to paramedic/EMT roles and a dual focus on theory and practice.

A single national organization (NREMT) sets national standards and reviews those states and programs which adopt them. Certification standards are defined for 5 typical levels in each state and at the national level. A majority of states simply adopt the national standards and almost all accept candidates who met the national standards rather than specific state standards. The “level” of skills, training and experience in states that do not adopt the national standards are generally comparable, with a few exceptions. A national standard curriculum is available which is aligned with the testing requirements. Candidates are evaluated on theory and practice, individual diagnosis/treatment and situation/scenario evaluation. Certification requires a period of field internships. A majority of firefighters earn some level of EMT certification. Almost all states recognize certifications from other states. The national agency accredits training programs and agencies.

https://www.emsmemorial.org/ems-history

https://indianahealth.care/history-of-ems

https://wvde.state.wv.us/abe/Public%20Service%20Personnel/HistoryofEMS.html

Professional Education

Ambulance staff training was first defined in the late 1960’s. The first EMT curriculum was nationally recognized in 1969. Prior to this time, ambulance staff had basic first aid training. National training standards were set in 1973 together with the emerging certification exams. A full national paramedic curriculum was released in 1977. A comprehensive “emergency care” manual was published in 1979. Early training was largely done by individual hospitals in urban areas. Training soon moved to universities and community colleges where it is focused today. While associates and bachelor’s degrees are not required for most paramedic/EMT licenses, they are now commonplace. The number and variety of procedures provided by paramedics and EMTs has grown throughout the period. As emergency room physicians became commonplace and their confidence in EMS staff increased, they supported this growth in “standing procedures” to be taken without physician coordination. With increased experience, documentation, best practices and scientifically based standards improved. The medical profession adopted a “systems approach” to health care beginning in the 1990’s and EMS staff have adopted this approach.

Cardiac Care

Prior to 1972, CPR training was defined and more broadly offered in the US. Portable defibrillators were invented but not broadly available. Emergency cardiac treatment programs were rare.

In the 1970’s heart resuscitation guidelines were published, more portable defibrillators were available and related EMT training began.

Cardiac care has been a key curriculum and certification exam component for paramedics/EMTs since the 1980’s.

The American Red Cross introduced defibrillator training into its first aid course in 1999.

The easier to use AED defibrillator was approved for sale in 2004 and is now widely placed in many communities and millions have been trained to use them.

Pediatric Care

Pediatric care was upgraded in the 1984 curriculum and exam standards for EMS staff. Specialized pediatric care hospitals were clearly established.

Emergency Rooms

Hospitals invested in emergency room space, equipment and staff after 1975 when emergency room physicians became a specialty. In 1983 Level 1 trauma centers and pediatric critical care centers were defined and began to be implemented. Disaster resource centers were defined in 2004. Stroke centers were defined in 2009. While these specialty care centers were defined, a wide variety of immediate care centers were established in many areas, providing additional options for EMS services.

Medical Protocols

EMS professionals have benefitted from the global “process revolution” of the 1980’s. Health care professionals view each patient and situation within a “process framework”. This has allowed paramedics and EMTs to increase the variety and depth of first response diagnosis and treatment which they can legally and effectively provide. Evidence based medical standards replaced the previous “trial and error” standards in the 1990’s. Standard operating procedures were defined for most situations. This allowed EMS staff to act immediately without emergency physician approval in more situations. “Standing field treatment protocols” were widely defined and adopted in 1997 clarifying the roles of paramedics/EMTs. EMS standards were further revised in 2000 using the “medical systems” approach. Standardized EMS data recording and sharing began in 2000 and has expanded since then, allowing improved systems, evidence and medical based changes to accumulate. States generally approve both procedure and medical treatment options for individuals holding each level of EMT/paramedic certification.

Communications

In 1972, police and fire vehicles had basic special purpose radio communications and dispatchers as did taxi fleets. Improved medical dispatching skills accompanied the growth of EMS resources. Revised EMS radio communication standards were adopted in 1973. EMS staff benefitted from the expansion of cellular phone services. 911 emergency call services began in 1968 and expanded nationally throughout the 1970’s. Dedicated EMS to hospital communications as increasingly adopted in the 1990’s. Video services were added after 2000.

Funding

In 1966 a National Academy of Sciences study titled “Accidental Death and Disability” highlighted the comparatively high casualty rates of domestic vehicle accident victims versus those with war injuries! Thousands of Americans were disabled, mistreated and died each year versus the standard treatment offered by the military in combat zones. Congress responded by moving lead responsibility for EMS from the US DOT to US HEW in 1972. 5 demonstration EMS programs were funded in 1972. Further federal investments were made in the 1970’s. However, by 1980, Congress and the president decided that states should manage and fund this component of the health care system.

EMS Professional Skills

Today, when you dial 911 in an emergency, you can expect a nationally certified, trained and supervised team to quickly arrive and provide a high-quality level of services.

Assessment of incident, accident, patient situation.

Compliance with standard care protocols and escalation to physicians.

Triage in mass casualty situations.

Safe movement and extraction of patients from accident situations.

First aid treatment.

Intravenous fluid administration.

ECG, EKG administration and defibrillation (manual and electric).

Intubation.

Drug administration.

Acute asthma treatment.

Heart rhythm assessment and rate correction.

Spinal immobilization.

Transportation to the best next level care facility.

One Million EMS Professionals!

There are 1 million certified emergency medical system (EMS) personnel in the US today, up from basically ZERO in 1972. One-fourth are highly skilled paramedics. A little more than one-half are certified EMTs.

https://www.nremt.org/maps

About one-half of the total were certified at the national level.

Pre-1972