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Plaything of the Rich – a History of US Health Insurance

I am half–Canadian and half–American. I grew up mostly in Canada and thus have always had public–run health care in my life. I knew nothing about health insurance companies and all of their fine–print and evil until recently. Since coming to the US, I have not yet come into close contact with the American system since I have been mostly healthy aside from a baseball–related injury here and there.

However, my mother, who is my Canadian half, has had much more difficulty in recent years. This August she found out she has breast cancer for the third time and will be required to go through chemotherapy (something she is enduring right now with amazing resiliency), a double–mastectomy, and then radiation. As this process has advanced, she has found a few deficiencies of the Canadian system: certain medications are not 100% covered in Canada (although alternatives are), and she has been frustrated on occasion with some of the specialists who got caught up in surgery and could not attend to her right away. However, the bottom line is this: with all the other shit she has to deal with surrounding hospitals, and doctors and treatment and feeling good about herself, she has never once had to worry if she would be covered or if she would get a big bill at the end of it. In early 2014, when she is done with all of this, the total direct cost for having withstood all of this will be $0.

That is an amazing thing. Myself, on the other hand, living in the States now and not having a “real” job with a good income nor an employer than can supply me with health care, well . . . my plan is simply not to get sick. Even with the much–discussed Obamacare plan, I personally still have no other option.

Since January 1st, 2014, millions of people in the United States have had access to health care that they previously thought impossible. Nearly forty million people who previously did not have care, can get it. Many on the Right believe that this new health–care plan, colloquially known as Obamacare, is the death knell of private enterprise as it pertains to health. On the Left, the reaction has ranged from praise for the Democrats for getting something done, to outrage that the new plan has no publicly funded option and is still dominated by the insurance industry. This partisanship over an issue as seemingly basic as health is perhaps more striking than discussing the details of the plan itself. I thought the best way to tackle the issue would be to go back to the history of the US health–care system and then to briefly compare it to the system of our neighbors to the north in Canada.

What became alarmingly clear when reading into the past was that the health of the American people has always been the plaything of the rich and powerful. No matter the era, health care policy has always been more about garnering votes and placating the masses than it has been about a genuine concern for having a healthy population in the US.

the early days (pre–1920)

It would be safe to say that in the early part of the twentieth century the United States was already lagging well behind its European counterparts in healthcare accessibility. Until the 1920s there was no organized coverage afforded to American citizens. Unsurprisingly, the first calls for coverage came not from governmental circles, but rather from the labor movement, which was gaining great strength in this period.

By contrast, male German workers were partially covered in 1883; Swedish workers in 1891; Danish in 1892; and the Austro–Hungarian Empire, Norway, Switzerland, Britain, Russia and the Netherlands followed suit in 1912. Ironically, almost all of these initiatives were enacted not from leftist governments, but rather by conservative administrations fearing the rise of the working person and potential revolution. This pattern was followed in the US, albeit at a much slower pace.

In 1906, the American Association of Labor Legislation (AALL) proposed a solution which would cover local workers in much the same way that plans had elsewhere (any male making under $1200 per year would be eligible). It took nine years, but in 1915 the bill was finally introduced into congress. It was crushed, and was never really seriously considered as an option by any of the major parties who retained seats. The core reason for the bill’s defeat is one that is still well–understood today: red–baiting. Much of the debate in the house during that year centered not on health but rather on “Bolshevism” and the concern that giving people publicly funded health care would inevitably lead to a communist takeover. In addition, the bill–writers made a grave error by including the concept of death insurance in the act, thus taking on not only apathetic politicians, but also the already–massive and powerful insurance industry. Health insurance did not exist at that time per se, but life insurance certainly did, and those corporations were not ready to give up their stranglehold on the industry.

One interesting note during this period is that this would be the first (and last) era where the American Medical Association (AMA) actually supported health care reform; from this moment forward doctors would be at the forefront of the anti–public health care crusade, concerning themselves more with their wallets than anything else.

the labor rights era (1920–40)

Health care coverage began in the 1920s in perhaps the last place you would expect it today: Dallas, Texas. It was there that Baylor University Hospital (later taking on the more famous moniker of Blue Cross) first conceived the idea of providing health coverage. However, the insurance was not initially intended to benefit the poor nor the sick, but rather was devised as a way for doctors to have limited liability should anything go wrong. Local teachers were given coverage for the low monthly fee of 50 cents per month, but it covered so little that there was little risk for the hospital. Doctors were then able to use the extra money as a pool against any future “mistakes.”

Nonetheless, people liked the idea of feeling protected even if the plans were full of holes (for instance, baby care was covered but not coverage for pregnant women), so by 1938 about 3 million people were insured by Blue Cross. It should be made clear that the coverage was not available to the general population, but was rather offered piecemeal to certain organizations (professional groups, clubs etc.) who were deemed “respectable” enough to be offered the plan. Doctors were now firmly entrenched in their position, having basically created a system designed to further enrich them at the expense of their clients.

the civil rights movement (1940–1970)

The first major shift in health policy occurred during World War II, as a labor shortage forced US companies to re–analyze their relationship with employees. Just as the women’s rights movement grew from labor shortages caused by massive amounts of men being shipped off to fight a foreign war, changing American demographics affected corporation–employee relationships. Many companies, hoping to lure potential employees away from competitors, offered corporation–paid health care for the first time from 1941–5. However, further paralleling women’s labor participation during these years, plans were eliminated at the end of the war just as women were fired en masse in 1945.

Initially these plans actually benefitted the workers a great deal as access was equal (despite still being run by profit–driven private businesses). However, many loopholes were quickly closed with the introduction of the premium system, which allowed the insurers to charge more or less based on age, gender, and previously existing health problems. Soon, it was only cheap for young, healthy, white men to get coverage. Everyone else was left with escalating premiums.

In the midst of all this, in 1943, a bill for true public health care was introduced for the first time. Known as the Wagner–Murray–Dingell Bill, it was debated for a short time and soundly defeated as the AALL Bill had been before it. This time, lack of funds was cited as the main reason for its downfall.

In the 60s and 70s, as poor and minority communities were increasingly seen as a source of votes, both parties shifted towards offering limited health care plans. This resulted in a system that offered government credits to companies that provided health care. However, the health insurance racket was simply too big at this point for any mainstream elected official to oppose it without risking their political future. As usual, the Congressional wranglings of the day did not represent popular sentiment: a poll in 1964 showed that 60% of Americans favored a full public system . . . a number that has held steady or increased over the past fifty years. Of course, none of this mattered. After all, when was the last time there was a referendum in the United States?

In 1965, the modern (this term should be used very loosely) US health care system was founded with the formation of both Medicare and Medicaid. The former was designed to provide coverage for US citizens over the age of 65, while the latter was created to help subsidize coverage for those with low income and resources. This was done with a mostly–privately controlled system in mind — not coincidentally because the insurance companies themselves were often writing the revisions.

the modern era (1970–present)

The major shift in health care over the last forty years or so has nothing to do with the coverage itself, but rather with the expansion of the corporate–health alliance into new areas. Today, not only are doctors’ associations and insurance companies spending millions to oppose real public coverage, but technological and pharmaceutical companies have been added to the mix. These various lobby groups literally derive ALL of their income from people’s ill–health. Any health system run by people who want people to be sick, hmm . . . that’s like running a prison system that wants lots of criminals.

Any small gains made during the 60s were virtually eliminated by the Nixon–Reagan–Bush–Clinton–Bush administrations of the coming years as, once again, federally funded health care was aligned with such shiver–inducing words as “Communism,” “Socialism,” and “anti–Americanism.” People who could not afford coverage were simply left by the wayside. (In 2013, that amounted to 46,000,000+ people or about 16% of the entire “legal” population.) The end–result is that the US now leads the so–called developed world in preventable deaths. What people may not realize is that this system is also ridiculously expensive for taxpayers even as it gives most of that federal money to corporations rather than actual human beings.

is obamacare different?

In a word, no (with some caveats). Essentially, the new system is an extension of all the schemes that came before it: it is based in classism, wholly supports the insurance industry, sees doctors as entrepreneurs rather than as public servants, and will not dramatically change things going forward. It is indeed a major accomplishment that millions of people now have access to health care and that people with pre–existing conditions can no longer be denied care. However, Medicare is still not a true public option, as it is still firmly entrenched in the private system. The other major alteration is the creation of the exchange system. This will allow all Americans to go to government–run exchanges where they can get an even–handed picture of which private company will provide the best services for their needs. So far, this system has shown to be woefully inadequate and too complicated for most people. Obamacare’s other glaring flaw, a uniquely American problem, is that states can choose to opt–out of the plan. Fortunately, a federal exchange system can replace the state–run facilities in this case much to the dismay of States’ rights advocates across the country. This has meant that many aspects of the plan have only been approved in Democrat–run states, while the Republican–run states have attempted to opt out. Whether or not this has affected coverage opportunities, it has had the sad result of making health, once again, a partisan issue. Now, as always, party politics and the wealthy decide health–care policy, and the people are left out in the cold.

Bibliography

1. Bauman, Harold, “Verging on National Health Insurance since 1910″ in Changing to National Health Care: Ethical and Policy Issues (Vol. 4, Ethics in a Changing World) edited by Heufner, Robert P. and Margaret # P. Battin, University of Utah Press, 1992.

2. Navarro, Vicente. “Why Some Countries Have National Health Insurance, Others Have National Health Service, and the United States has Neither”, International Journal of Health Services, Vol. 19, No. 3, pp. 383–404, 1989.

3. Reid, T.R. The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care.

4. Starr, Paul. The Social Transformation of American Medicine: The rise of a sovereign profession and the making of a vast industry. Basic Books, 1982.

5. Staysmartstayhealthy.com’s Health Care History in the US.

6. Wikipedia’s “Provisions of the Patient Protection and Affordable Care Act.”

7. Kboo.fm’s “Obamacare from ar adical universal healthcare perspective.”

8. Dailykos.com’s “Equip yourself to deflect Obamacare attacks,” August 29th, 2013.

9. Billmoyers.com’s “The rights Obamacare rhetoric is completely unhinged from reality,” October 13th, 2013.

10. Wikipedia’s “Comparison of the health care systems in Canada and the United States.”

11. http://hnn.us/article/146911

12. i2.cdn.turner.com’s May 28th, 2013 Health Care Poll.

13. Economix.blogs.nytimes.com’s “How much do doctors in other countries make.”

canada and the us (all stats 2010–13)

the US Canada

money spent per person on health $6714 $3678

% of health care that is run by the gov’t 46% 71%

% of seniors’ health care run by gov’t 53% 97%

number of uninsured citizens as a percentage 16.4% 0%

average doctor salary, in ‘purchasing power parities’ $230,000 $161,000

% of citizens with access to health care at work 59.1% N/A

% of personal bankruptcies relating to health care 49% 0%

money spent on drugs per capita per year 728 $509

World Health Organization Ranking (191 countries) 72nd 35th