Last Thursday, the Republican controlled House of Republicans passed the American Health Care Act, repealing the Affordable Care Act of 2010. The vote came after months of GOP infighting over the best way to repeal the President Obama’s signature domestic achievement. Different wings of the party debated what role the government should play, if any, in ensuring that Americans have access to affordable health insurance. Members of the far-right Freedom Caucus advocating for repealing the ACA and getting the Federal government entirely out of the health care business. Other Republicans feared cutting the popular provisions of the ACA, including forbidding companies from denying coverage for pre-existing conditions and the expansion of Medicaid benefits. These debates over the role of the Federal government and its role in providing health insurance are not new in American history. Last week’s AHCA vote is just the latest chapter in more than a century’s worth of debate over providing health insurance coverage to all Americans.
The first tentative efforts towards a national health care system began in the 1910s with Theodore Roosevelt and the Progressive Movement. In 1912, Roosevelt, dissatisfied with the GOP’s rightward turn under his successor, William Howard Taft, created his own political party, known as the Progressive Party. The Progressive Movement of the late 19th and early 20th centuries favored government intervention to address poverty, improve working conditions, and other social reforms as a result of the Industrial Revolution. As part of his Progressive philosophy, Roosevelt embraced the idea of some kind of health insurance for working Americans:
It is abnormal for any industry to throw back upon the community the human wreckage due to its wear and tear, and the hazards of sickness, accident, invalidism, involuntary unemployment, and old age should be provided for through insurance. This should be made a charge in whole or in part upon the industries, the employer, the employee, and perhaps the people at large to contribute severally in some degree.
The Progressive Party platform similarly called for “The protection of home life against the hazards of sickness, irregular employment and old age through the adoption of a system of social insurance adapted to American use.”
Roosevelt and the Progressives’ vague plans for broader access to health insurance came when few Americans had health care of any kind. As Slate’s Brian Palmer explained, “In the first years of the 20th century, income-replacement insurance was far more common than health insurance, since medical costs were relatively low.” The 1910s coincided with a growing professionalization and expansion of the health care industry. As doctors underwent more rigorous medical training and hospitals became increasingly professionalized, more and more Americans sought access to this better health care. As a result, health care costs began to rise and Americans began considering purchasing health insurance in greater numbers. Roosevelt, however, never managed to implement any sort of national health insurance program. By drawing Progressive voters away from the Republican party, Roosevelt split the GOP electorate and handed the White House to Democrat Woodrow Wilson.
In 1915, the American Association for Labor Legislation, founded by a group of economists interested in improving labor conditions in the U.S., introduced health insurance bills across the United States. Echoing modern debates over the ACA and the AHCA, the AALL outlined what types of benefits health insurers had to provide to their customers. One proposed bill outlined the minimum benefits in any health insurance plan. These included:
MINIMUM BENEFITS. Every carrier must provide for its insured members as minimum benefits:
Medical, surgical, and nursing attendance;
Medicines and surgical supplies;
Medical and surgical attendance and medicines for dependent members of their families.
The AALL’s efforts, at first, garnered support from the American Medical Association. The AMA’s president, Rupert Blue declared that “There are unmistakable signs that health insurance will constitute the next great step in social legislation.”
The AALL, however, failed to win support from the organized labor movement. Samuel Gompers, the powerful head of the American Federation of Labor, opposed any government role in the creation of health insurance. He believed that unions and their workers were best suited to win insurance from their employers. Gompers argued that
The organization of labor, which has secured reductions in the hours of their daily toil, which has secured higher wages and better standards of life, which has secured safety and sanitation, has done more to eliminate poverty and misery and unemployment and sickness than all other agencies of government and private individuals combined.
He also feared that granting the Federal government power over health insurance could harm workers. Gompers believed that “The introduction of compulsory social insurance in cases of sickness, or compulsory social insurance in cases of unemployment, means that workers must be subject to examinations, investigations, regulations, and limitations… To that we shall not stand idly by and give our assent.” Soon the AMA withdrew their support as well, citing the complexities of such a program. Without the support of organized labor or medicine, the AALL’s efforts went nowhere.
The actions of Roosevelt and the AALL were the first chapters in the history of efforts to provide all Americans with universal health care. In the next installment, we’ll move forward to the 1930s and look at the work of Franklin D. Roosevelt and his administration.