"Why are we the only democracy that doesn't see healthcare as a right, not a privilege?"
The answer, surprisingly, stems from American racism.
Modern healthcare really didn't come about until the early 20th century, and racist segregation was still quite powerful back then. When we look elsewhere in the world, we find that national healthcare systems didn't come about until after World War II. The U.K. enacted its healthcare system in 1948, though it experimented with it earlier. Norway, Sweden and Iceland enacted theirs in the 1950's. France's national healthcare system began in 1930, but wasn't formalized for most citizens until 1945. Germany was the only country with a pre-war national healthcare system, dating all the way back to Otto Von Bismarck's social legislation program of 1883.
But one would think that in the years between World War I and World War II, under FDR, with so many other government-funded programs being enacted, that healthcare would be a natural extension of such legislation. Why, oh why, in an alphabet-soup world of the WPA, the CCC, and the TVA, was the NHS left out?
Put simply, the political willpower wasn't there. Any national healthcare system would need to take care of black people as well, and whites simply didn't want their hard-earned tax dollars going to support black families. Back then, that was political suicide, even for FDR.
In fact, America could have had a national, single-payer healthcare system as early as 1916! But it was thwarted.
Here's why:
Enter Friedrich Ludwig Hoffmann. He arrived in America from Germany in 1884, a 19-year-old German immigrant with only a few dollars in his pocket and not speaking a word of English. But he eventually arose to become one of the most influential statisticians and public health analysts in American history.
And you probably never heard of him.
He learned English so well that his accent became nearly indistinguishable. He dropped the second, German "n" from his last name, started going by the first name of "Frederick," and married into an upscale Georgia family. The American Dream.
In 1908, he published a statistical-analysis article, called "The Mortality From Consumption in the Dusty Trades," published by the U.S. Department of Labor. This linked lung damage to industrial smoke and/or coal dust. He then turned his excellent statistical analysis skills towards the tobacco industry, and by 1915 published the first-ever article linking tobacco use to lung cancer. His reputation from these achievements earned him the title of vice president of the American Tuberculosis Foundation (known today as the American Lung Association). He was truly ahead of his time in this regard.
But in other areas, he was truly retrograde. He bought into the racism prevalent in Georgia at the time, and came to think of black people as "genetically inferior." He came to believe that blacks, if left to nature, would naturally die out due to a greater propensity towards disease. This became known as the "racial extinction thesis."
To bolster this opinion, he brought his skillful statistical analysis to bear, and codified numerous studies to show how areas with black populations had higher mortality rates than white areas.
In August 1896, the American Economic Association published Hoffman's very first book, called, "Race Traits and Tendencies of the American Negro," summarizing decades of black-vs.-white mortality statistics. From this he deduced that any nationalized health care system would be an absolute waste, essentially throwing tax dollars away on the lost cause of black peoples' health. Why enact a nation-wide healthcare system when black people will simply die out anyway? Any such system would simply delay the inevitable, resulting in nothing more than lost revenue and prolonged suffering.
His solution? A private insurance-based system. One which whites could afford, but would price poor, black families out of the market.
Now, any modern reader of Hoffman's works would spot his fallacy immediately. The higher mortality rates and propensity towards sickness were caused by poverty, not by race. And the poverty was caused by racism, which lead to more poverty, which lead to more sickness, which lead to more racism, which lead to more poverty, which led to more sickness, and round and round the goddamned cycle went! This has since been proved by similar statistics being shown among poor white people! But Hoffman, for all his brilliance, didn't see things that way. His racist thesis, borne up by the statistical-analysis that made it seem legitimate (institutionalized disinformation again!), was devoured and championed by the segregationist South.
Naturally, the insurance industry loved Hoffman's "scientific racism" (a misnomer if ever there was one). After all, they stood to make millions off of it, and not just by charging higher premiums to black people (a practice Prudential continued as late as 1986!). By 1891, he became the official statistician for the Prudential Insurance Company of America. (Prudential didn't offer health insurance at that time, and wouldn't until 1925, but they could see the handwriting on the wall, and Hoffman's analysis was at the forefront of their business plans.)
By 1916, something known as the American Association for Labor Legislation (A.A.L.L.) had sponsored a bill to offer medical coverage and paid sick leave to all Americans. It was a plan which had the support of heavy-hitting politicians such as Teddy Roosevelt. Insurance companies couldn't oppose this effort directly, as this would be seen as brazen self-interest. So the champion they turned to was Frederick Hoffman.
Hoffman journeyed to his home country of Germany and toured the hospitals there, documenting every little thing he saw as wrong with the Kaiser's healthcare program. He made a similar tour of Britain's burgeoning healthcare system, too. He then took these criticisms back to the U.S. and widely publicized them in a book called, "Facts and Fallacies of Compulsory Health Insurance" (1917). He even published a sequel. Much of what he wrote was anecdotal, but that mattered little. As the man who was so well known for being a public health advocate, thanks to his publications on smoke, coal dust, and tobacco, he was the ideal spokesperson.
His efforts worked. By 1920, attempts to enact nationwide healthcare had ended. Prudential rewarded Hoffman richly. His propaganda was so successful that it had a residual effect, lasting even after Franklin Delano Roosevelt's election to president in 1932. His writings continued to be championed by segregationists and the Ku Klux Klan as late as the 1940's.
In the post-World-War-II years, government-run healthcare was seen as "socialism." So, naturally, in the "red scare" anti-Soviet years, any further attempts at single-payer healthcare were also shot down.
It was these two conservative elements, the racist tendencies of the Deep South, and the post-war anti-communist rhetoric, which would later form the neocon movement that degenerated into the Trumpism we see today.
The pro-healthcare sentiment didn't entirely fail. America saw such programs as Social Security (1935) and Medicare (1965) get established. But that's where it both began, and ended. Since then, we have all been doomed to suffer at the whims of insurance companies who are oh-so-eager to screw over you in favor of their shareholders.
And that's why sickness bankrupts you, and makes CEO's ultra-rich.
Our citizens carry a current total of about 220 billion in medical debt. If that seems insane, it's because it is! We all live under the proverbial Sword of Damocles, where any potential illness could ruin us and render one's entire family homeless. It's the very definition of insanity to not rebel against such a system. But this is the structure white people imposed upon themselves in order to make it more difficult for black people to see a doctor.
Was it really worth it?
As a parallel, look at South Africa. Their deep racial divide resulted in a similar insurance-based healthcare system which primarily benefitted white people. This lasted all the way until Apartheid ended in 1994. By 1996, combatting this inequality was so paramount that the right to healthcare had become enshrined in the South African Constitution. No one could be denied emergency medical care afterward, by rule of law. Yet even today, a two-tiered healthcare structure exists, with a national healthcare system benefitting primarily the poor, and an insurance-based system which benefits primarily the rich. Even today, South Africa struggles with this racist-based inequality.
A national healthcare system isn't just some liberal ideal. It benefits us all by making a healthier workforce, reducing crime, relieving homelessness, and increasing the lifespans of our elders who can provide their families free child care and other forms of support. We all live in a better world where, instead of the patient getting screwed over in favor of the shareholder, the taxpayer pays a little more to benefit the patient. In fact, we would all pay much less, just like other nations have been shown to do.
When your body is on the gurney, which system would you prefer?
Eric
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