By Dr. Adam McConnel
Dr. McConnel teaches Turkish history at Sabanci University in Istanbul. He holds an MA and PhD in history from the same university.
The United States is the only industrialized society that does not have a comprehensive national health care system. That reality is a factor in the lives of many Americans even today, after the enactment of President Obama’s health care program, because tens of millions of U.S. citizens still lack basic health coverage.
When the topic turns to the U.S. health care system, or rather the lack of one, I can relate my own experiences. In the 1990s, when I was still an undergraduate university student, health insurance was an issue about which I had to worry. Most U.S. universities provide some sort of health care to their students and employees, but the plans often lack certain types of coverage.
My university, for example, did not provide dental care through its insurance package, so I had to find a way to pay for those costs on my own. Most of the time, I chose to find jobs in businesses or sectors that were unionized because unions provided better health care packages to their members. I also lived near Canada, which has a national health care program that makes affordable care possible even for non-citizens, so I identified Canadian dentists near the border in case I ever found myself in need of dental care but without insurance.
In other words, the need to find affordable health care affected what kinds of jobs I took as well as my calculations about to where I might turn for health care if the need arose. I knew that if I ever had a serious health problem without health insurance, I could end up with debt that would remain a burden for decades. At the same time, I also knew that the situation in the U.S. was not the norm, and that other countries provided far more support for their citizens’ health. While that was not a major reason for why I eventually moved abroad, I did so confidently, knowing that the countries I thought about living in had national health care systems.
The COVID-19 crisis in the U.S.
The current U.S. health care crisis caused by the COVID-19 pandemic has revealed the U.S. health care system’s weaknesses for the entire world to observe. The U.S. is a society of well over 320 million people, and COVID-19 has infected more than 670,000 people (as of 15 April), a tiny percentage of the population. However, that is enough to severely strain health care facilities across the country as shortages of everything from masks to hospital beds to morgue space have occurred. New York City is now burying victims in mass graves. Simply, the U.S. health care system does not have the planning, facilities, or supplies to deal adequately with an epidemic even of this limited nature. What would happen if an epidemic were to happen with a deadlier pathogen?
The U.S. still has such an inadequate health system despite the Affordable Care Act’s (ACA) implementation. The ACA, instituted during the Obama administration and known popularly as “Obamacare,” is not the same as a national health care system because not all citizens are automatically covered by the system. Around 30 million U.S. citizens still do not have health insurance of any kind. The details of Obamacare are elaborate, but domestic politics is the reason such complexity is required for a problem that all other industrialized societies developed solutions for several decades ago.
U.S. Health Care since WWII
The first U.S. president to introduce the idea of a universal national health care plan was Harry Truman, in office from April 1945 until 1953. In the 1930s, U.S. President Franklin Delano Roosevelt (FDR) had introduced limited public health care aid as part of the New Deal’s Social Security program, but his proposals for broader coverage met strong resistance from the medical community and other interest groups.
Truman, who was not as progressive as FDR, still saw health care as a vitally important issue for American society. In accordance with that ideal, he introduced universal health care in conjunction with his Fair Deal policy package. Truman explained in his memoirs how his concern for the issue grew out of the statistics that emerged from the U.S. military’s WWII experience:
“… diseases and epidemics are no respecters of city and state boundaries. Our experience in the handling of polio and other threats to national health has proved that no one community can take care of itself. But the most compelling reason for the need of assistance from the Federal government was dramatically revealed in the unfitness of millions of our young men and women for military service. … By April 1, 1945, nearly five million draft registrants between the ages of 18 and 37 had been examined, and thirty percent were rejected on grounds of poor health. … This is a blot and a disgrace for the greatest republic in the history of the world, first in everything but the basic responsibility of making healthful individuals mentally and physically.” (The Memoirs of Harry S. Truman, Vol. II, Years of Trial and Hope, 1946-1953, p. 19)
Truman’s effort to institute universal health care would ultimately not succeed, but programs initiated later, such as Medicare, did bring government-supported health care to certain vulnerable segments of the population. When President Lyndon Johnson signed Medicare into law in 1965, Harry Truman sat beside him. In the 1970s, multiple attempts by both members of Congress and by presidential administrations – Republican and Democratic – failed to establish significantly wider health insurance coverage. Later, an attempt early in the first Bill Clinton administration to create a universal health care system also met defeat in Congress.
Why such profound resistance?
Foreign observers might question why, if several U.S. presidents had backed universal health care plans, the idea was never realized. The answer has two main components. The first is the intense lobbying efforts pursued over the decades by the U.S. medical community. From the moment that FDR introduced his limited health care proposals, the primary U.S. medical doctors’ organization, the American Medical Association (AMA), launched a vigorous effort to oppose FDR’s plan and to maintain doctors’ autonomy from the public sector. The AMA has remained both steadfastly opposed to a government-supported universal health insurance system and one of the most powerful medical sector lobbying forces.
The AMA’s crusade would not have been as successful if the other important factor, American cultural ideals, did not reinforce the AMA’s goals. In essence, Americans value individualism in ways that most other societies do not. Along with that extreme individualism comes certain expectations, such as self-reliance, not taking charity from others, and an aversion to government, which have long been virtues that most Americans see as highly desirable and traditional.
One main result from those values is that reforms successfully labelled as “socialism” have great difficulty gaining widespread popularity in U.S. society. Long before WWII and the consequent Cold War with the USSR, the term “socialism” had become a negative label that could be used to attack and smear others. In turn, that made it possible for the AMA to launch scare campaigns labelling both FDR and Truman’s health care proposals as socialism. For instance, in the late 1950s and early 1960s, the AMA sponsored Operation Coffee Cup; that scheme used testimony from Ronald Reagan to spread the perception that government-supported health care was “socialized medicine.” In the end, even if President Johnson was able to enact the Medicare program, no universal health care system has been implemented in the U.S. despite repeated attempts.
Turning point: Reagan era
In the postwar era, U.S. society underwent an unprecedented period of growth, wealth creation, and prosperity. From the 1950s to the 1970s, almost all segments of U.S. society benefitted from laws and taxation that carried out limited wealth redistribution, regulated important economic sectors such as finance, and made social mobility more possible. For that reason, most Americans also did not feel a pressing need for government health care support. During the same decades, U.S. union membership plummeted.
In 1980, the Republican Party’s candidate, Ronald Reagan, was elected President. Over the following eight years, Reagan would initiate rollbacks of regulations in many different economic sectors, a policy reversal known to historians as the Reagan Revolution. Reagan’s policies fed off of certain ideological strains in conservative American values, a hodgepodge of Protestant, individualist, and anti-government themes that had coalesced in the previous twenty years.
Beginning with Reagan, for example, Republican ideology tended to purposefully neglect government investment in basic infrastructure, claiming that such expenditure was often wasteful – symbolized by the “Bridge to Nowhere” debate during the 2008 Presidential election campaign – and better left to the private sector. Over the long term, Reagan’s reforms had the effect of dramatically increasing inequality. Income taxes for the wealthiest Americans were slashed, which exacerbated the effect. The father and son Bush presidents would continue the same policies.
Since the 1980s, health care costs have also risen persistently, ensuring that acquiring necessary health care became more difficult, even financially prohibitive for a steadily increasing percentage of U.S. citizens. Hospitals are a type of infrastructure, but because Republican ideology turned against infrastructure investment, hospital construction also lapsed. According to the American Hospital Association, as of 2018, the U.S. had 6,146 hospitals, with a total of only 924,117 beds. OECD statistics indicate that the ratio of hospital beds to population in the U.S. has fallen rapidly over the past twenty years. Thus, not only has health care become less affordable for a large section of the U.S. population, it also became more difficult to find.
What will happen to U.S. health care?
The sum of the last 40 years of U.S. ideological and political trends is that the U.S. was almost completely unprepared for the COVID-19 pandemic. Whereas a Democratic administration may have responded with better leadership and more realistic assessments than the Trump administration, the state of U.S. health care infrastructure would still have rendered a comprehensive response extremely difficult to accomplish.
U.S. health care conditions right now look disastrous, but solutions do not appear imminent. COVID-19 infections and deaths continue to spread across the country while the Trump administration struggles to respond on a day-to-day basis. Unemployment has skyrocketed as the economy shut down. To make matters worse, the health care sector’s troubles do not seem to be sparking a wider debate about the state of U.S. health care. The current American political atmosphere of intense partisanship precludes calm assessment or negotiation. Meanwhile Trump, even as the COVID-19 pandemic continues to slice its way through U.S. society, continues his administration’s efforts to block, even entirely dismantle Obamacare.
Consequently, the crippled state of the U.S. health care system, coupled with COVID-19’s economic effects, mean a prolonged period of social trauma that the U.S. government is poorly prepared to deal with. In other words, seventy years after Harry Truman’s attempt to create a health system for all Americans, the U.S. government has still made only halting progress towards fulfilling its “basic responsibility of making healthful individuals mentally and physically.”
* Opinions expressed in this article are the author’s own and do not necessarily reflect the editorial policy of Anadolu Agency.