In my last column, I suggested that the election has forced activists to shift their strategy on campus. Lucha, a group usually associated with the struggle for immigrant rights, has decided to focus on health care this semester. In the coming months, Lucha will do outreach on the subways focusing on our health care system, will host a screening of Michael Moore's Sicko, and will also hold a community health fair, with free screenings, medical services, and information about how to get politically involved in the struggle for single-payer national health care for members of the Harlem and Washington Heights neighborhoods. Single-payer health care would eliminate the insurance industry and replace it with a single, tax-supported fund that would cover all medical expenses, from medicine, to hospital stays, to MRI scans. In the history of the struggle for health care as a human right, we have reached an important juncture at which real advances may be realized.
In many ways, it is remarkable that activists in the United States are still forced to fight for this major reform. National health care programs were first instituted by Otto von Bismarck in imperial Germany in 1883. Faced with the rising power of the German socialist party, Bismarck conceded certain social demands in the hope of co-opting the political power of the left. Following World War II, national health care insurance spread across Europe. Socialist and labor parties rose to power after the war, able to appeal to strong feelings of patriotic collective responsibility.
Similar attempts were made in the United States following WWII. Former President Harry Truman's often forgotten Fair Deal was the first major attempt to implement a national health insurance program in the United States. In his message to Congress on Nov. 19, 1945, Truman asked members to support his Economic Bill of Rights which included the "right to adequate medical care and the opportunity to achieve and enjoy good health." The principal problem Truman urged was that for both "needy persons" and "a large proportion of normally self-supporting" workers, the costs of health care were too high.
The coalition that arose to defeat Truman's proposals was led by the American Medical Association, which according to Jill Quadagno, author of One Nation, Uninsured, converted its local branches into a political machine to attack Democrats who supported national health care, defeating six senators in 1950. Marshalling Cold War rhetoric of "creeping socialism," the AMA along with the conservative Chamber of Commerce and the National Association of Manufacturers defeated the proposals, decisively closing the window of opportunity for the establishment of single-payer health care.
Fateful compromises by the labor movement also undermined national health care. American workers were led down the path to what historian Nelson Lichtenstein calls the "private welfare state." First, John Lewis of the United Mine Workers, disenchanted with federal programs after hostile interventions in several strikes, negotiated an employer-paid health program, and vocally opposed national health insurance. The United Steelworkers and the United Auto Workers followed suit, reflecting a lurch to the right, as organized labor purged its radical roots and came to tow the line of Cold War anti-Communism.
Yet notably absent from the opposition was the insurance industry, which at mid-century covered less than five percent of Americans, and had not yet emerged as a major lobbying force. This remained largely true in 1965, when Medicare was passed as part of Lyndon Johnson's Great Society initiative. The AMA again led the charge against reform, forcing the federal program to operate through private channels, a great boon to the insurance industry. Thus, in the next 30 years, in part through federal patronage, the insurance sector would grow to become a monstrous power in American politics.
When former President Bill Clinton proposed a plan including universal coverage in 1992, he had to contend with a potent adversary: the insurance lobby. The Health Insurance Association of America spent 15 million dollars on a broad advertising campaign, insurance companies increased their campaign donations to members of the House Committee on Ways and Means and the Senate Finance Committee. In sum, over $100 million was spent to defeat Clinton's proposals. Their propaganda worked. While universal coverage initially drew 59 percent support from Americans, after a year of relentless attacks and misinformation, support had declined to 44 percent.
It is clear that many Americans are again ready for a major change; more than three-quarters believe that the current system based on private employer-based insurance is failing and that the health care system needs to be fundamentally rebuilt. Some form of "health care reform" will be enacted, but there is great danger that pressures from the insurance industry and other business groups will dilute the measure, transforming it into an additional federal subsidy for an already bloated insurance industry. Health care is a human right, and activists on the left and in the labor movement are returning to rally around the principles defeated in the 1940s. The tragedy is that the detour through the "private welfare state" forces us to now confront the powerful sectors that profit disgustingly from our broken system.
Yet there are signs of other forces emerging. Many corporate elites are realizing that the inefficiencies of our private system are a hindrance in a competitive global market. Paul Menzel and Donald Light have recently argued that state-supported universal care is necessary to protect the conservative values, and more pressingly, in a "global competitive environment, companies like Nokia, Toyota, and Siemens, for example, enjoy a significant competitive advantage over their American competitors, Motorola, Ford, and GE." To protect the continued competitiveness of U.S. corporations, the interests of capitalist accumulation in general may triumph over the narrow interests of the insurance industry.
The experience of the past 60 years should make it clear that compromise with private insurance creates more problems than it solves, and that although we face powerful adversaries, there are also signs that the current moment might reveal real opportunities to achieve a lasting victory for workers, for freedom, and for the triumph of democratic choice over narrow corporate interests. It is time we abandon our costly, inefficient, ethically repugnant, profit-driven health system and enact single-payer national health care.