Why doesn’t the U.S. have universal healthcare?
It turns out our old pal, racist statistician Frederick Hoffman, got in the way of one of our best attempts ever at reform.
Welcome back to Skipped History, a web series looking at events, moments, and people conveniently skipped in U.S. history—presented by me, Ben Tumin. Want to receive these videos in your inbox three times a month?
Every story in Skipped History is meant to move you a smidge closer to answering one super easy question: How did the U.S. get so screwed? While we’re on the journey, I’d love to hear from you. Questions, thoughts, ideas, bird sightings—hit me up at benjamin.tumin@gmail.com.
Good morning!
Last week, we looked at how police departments use flawed stats to justify discrimination, a tactic engineered by statistician Fred Hoffman. Imagine my not-so-pumped surprise when I learned that Fred and his employer also put the brakes on the U.S.’ first attempt at passing universal healthcare. Click on the video below to watch:
This story comes from Professor Paul Starr’s book, The Social Transformation of American Medicine, and Professor Ronald Numbers’ book, Almost Persuaded. And for a refresher on Frederick Hoffman, here’s last week’s post.
Here’s my takeaway from this week’s story
Maybe it’s less about whether or not universal healthcare could work—anything could work, y’know, unless it’s a car that for some reason you asked me to fix—and more about who has stopped universal healthcare from working in the past.
In his book, Professor Starr adds, “It is not difficult to imagine how American state legislators might have passed a health insurance program that would have enriched both insurance companies and doctors and, in the long run, strengthened the economic system.” According to him, universal healthcare in the 1910s would have benefitted a variety of stakeholders, at least on the state level.
We’ve seen a few more attempts at passing universal healthcare since then, notably in the 1970s, in efforts spearheaded by Senator Ted Kennedy. However, the Vietnam War, Watergate, and opposition from similar insurance-y private interest groups as in the 1910s shifted attention away from reform efforts.
So, now that you know more about why we didn’t adopt universal healthcare in the first place, I’d suggest shifting intra-family squabbles about Medicare for All from whether it can work to who doesn’t want it to work, which is what it’s always been about.
The full script of this week’s story is below. See you next week!
Hello, I’m Ben Tumin, and welcome to Skipped History.
Today’s story is about the U.S.’s first attempt at passing universal healthcare, which I read about in The Social Transformation of American Medicine by Professor Paul Starr and Almost Persuaded by Ronald Numbers. You kinda get the picture from that title: around 1915, the U.S. came maybe the closest it ever has to universal healthcare, but things went awry largely thanks to a racist German and his employer, Prudential Insurance.
Oh, the early 1900s, back when women were really mad at the president, the US was engaged in a long war overseas for unclear reasons, and many people were dying of flu-like symptoms. The U.S. gathered a lot of lessons from that time. Unfortunately, we don't know where they are.
The turn of the 20th century also saw a lot of medical breakthroughs, and as the price of medicine went up, governments in Europe were like maybe we should lower it. Germany rolled out universal healthcare in 1883, and the rest of Europe soon followed suit, leading to the most surprising sentence I’ll ever say: It was an exciting time to talk about insurance!
And after reports that universal healthcare was working surprisingly well in Great Britain—that more patients were benefiting, and doctors were profiting—there was a growing sense that it was only a matter of time before it was our turn in the U.S.
Statistician Frederick Hoffman said not so fast.
You might remember Fred as the German Southerner who wrote a book in 1896 called Race Traits of the American Negro, which argued that Black people were more likely to be criminals because of their “inherent moral traits.” As it turns out, Fred was still racist 20 years later, but thanks to his book, by 1916 he had also earned a reputation as “the most reliable statistician in America (if not the world).”
That’s how he managed to get on the committee of an influential organization called the American Association for Labor Legislation that by 1914 had drawn up the first universal healthcare legislation in the U.S. Fred however quickly resigned in disgust, because the AALL Committee’s plan called for things like covering the medical costs for all wage workers earning below a specific yearly amount, and that would cut into insurance company profits.
Fred did not like that. He denied having any “business motives” and argued that his opposition to healthcare was “disinterested” and “patriotic”—rationale alarmingly similar to my neighbor’s reasoning for not wearing a mask to the grocery store—but, um, hello, Fred worked for Prudential, whose medical insurance business was beginning to prosper. With their backing, Fred launched a vociferous propaganda campaign against universal healthcare.
At the 1916 Conference on Social Insurance—a “must-attend” according to then-Senator Bernie Sanders (he’s never looked a day over 75)—Fred testified that everything was working fine! And that his “own investigations have conclusively shown that… the needs of our wage earners… are [already] adequately met,” a statement almost as insane as Jeff Bezos claiming the needs of Amazon’s wage earners are adequately met, or as saying “I do” to Ted Cruz, but hey, people do it.
Then, Fred went full Kavanaugh. He leveraged his reputation to discredit an economist named Olga Halsey who had been reporting positively on universal healthcare in Europe. He said it was “preposterous” that so much weight would be given to reports by “some little girl.” If nothing else, she proved that you could “flim-flam anybody if you have been to Germany,” which I can attest is true—I’ve been to Germany and do now have the power to flim-flam you into thinking I’ve never taken one photo of schnitzel, and I mean ever—but in 1916, unlike Olga Halsey, Fred had not been to Germany or to Great Britain to assess the insurance situations. Even the polite British Medical Journal took issue with Fred, saying his “statement that insurance in England is a failure is certainly open to dispute”—which is British for off with his head, baby!
But in the U.S, lies spread fast, and Fred muddied the waters so much that many people who’d supported universal healthcare no longer knew what to think. Fred’s case got an unexpected boost after the U.S. entered World War I in 1917. The U.S. government, eager to distance itself from anything Deutsch-y, including having an efficient healthcare system, adopted Fred’s criticisms of universal healthcare, as did a host of publications.
Soon, a lot of the people who’d been for universal healthcare were against it, the sense of inevitability that the U.S. would be the next country to adopt universal healthcare disappeared, and the reform movement petered out. Prudential and Fred, to whom almost all of the anti-insurance propaganda at the time can be attributed to, had won again—or as the British might say, It looks like somebody here came out on top, baby!
Could the U.S. have passed universal healthcare in the 1910s? Maybe. Would we have universal healthcare today if not for Fred? It’s hard to say for sure, but one thing is certain. Prudential, buoyed by its triumph over universal healthcare, only continued to grow, and today is the largest insurance company in the United States, proving that you can flim-flam anyone if you have ties to a racist German and billions of dollars.
And as it turns out, Prudential’s not the only who fits that billing. The Koch brothers do, too, and in more ways than one. Tune in next time to learn about that bit of skipped history.
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Look at some trees, keep the faith, and have a nice weekend!