One of the great tragedies of the bitter partisan battle over keeping or repealing and replacing the Affordable Care Act is that it brings to the mind of the historian that America’s past afforded a lost opportunity a century ago to implement national health care. Indeed, in the early 1900s, reformers advanced prudent legislation dealing with matters of safety and health that drew bipartisan support. Only in the heat of emotion-laden foreign policies were these measures tossed aside.
The story begins with state reformers faced with pressing health issues: first, reducing on-the-job accidents that adversely affected workers and, second, promoting workers’ compensation for such accidents through the states. As early as 1902, Maryland enacted a workers’ comp law, with Montana and New York following eight years later. Although these measures were declared unconstitutional, Illinois in 1911 effected a law that passed constitutional scrutiny. Numerous states followed Illinois’ example, and workers’ comp would become an ingrained part of America’s safety and health structure.
Next, reformers used the state model to call for universal health insurance. Based mostly on German social legislation, the proposals covered all medical costs for workers and their dependents earning less than the average annual income in each state (ranging from $800 to $1,200). The measures were to be funded by a payroll tax on employers and employees, with states picking up 20 percent of the cost. In short, sick workers absent from their jobs would receive all medical care without cost, and two-thirds of wages up to a maximum of 26 weeks.
Starting in 1913, these programs were formally proposed to legislatures in 16 states. They encountered no opposition from the American Medical Association, whose members represented about half of the nation’s doctors. In fact, at its annual meeting in San Francisco, the AMA accepted a favorable report on these state schemes.
What killed universal health insurance was the hysteria over World War I — and anything relating to the prime enemy, Germany, which had the oldest and most advanced social legislation at the time. No state was more progressive about health reform than California, which, in a referendum in 1918, a year after the United States entered the war, saw health insurance soundly defeated 358,324 to 133,858.
Anti-German feeling spread in an irrational manner. German foods were declared unpatriotic, including sauerkraut, beer and pretzels, and one physician even started a campaign to get the name of German measles changed to Victory or Liberty measles.
Little wonder that in California and all other states, universal health care was associated with being pro-German. Or, as the Los Angeles Times put it on November 3, 1918, health insurance was a “device borrowed from the imperial laws of Germany.”
To be sure, in the 1920s reformers worked to restore interest in universal health care, and when Franklin D. Roosevelt became president in 1933, hope was restored. For FDR’s prestige within months suggested he could get anything he wanted. Thus, when Social Security legislation was proposed in 1935, which covered not only old-age insurance but unemployment compensation and aid to the disabled, widows and children, health insurance advocates urged that he add their program to the act.
Roosevelt chose not to do so, nor did he support a national health bill in 1939 that provided federal grants to states for coverage. The reason: German leader Adolf Hitler was firmly entrenched in power, and the specter of health-insurance opponents raising anti-German rhetoric once more was in his mind.
Even when another popular, get-anything-done president, Dwight Eisenhower, came into power in 1953, the quest for health insurance was doomed, with the Soviet Union’s form of government giving rise to opponents reveling in the fear of “socialized medicine” being transported to America.
Say all you want about the imperfections of the Affordable Care Act, President Barack Obama borrowed from German models by moving in the direction of compulsory participation and a heavily regulated system. With President Trump’s “America First” orientation, it’s no wonder that Republicans look only to their own limited knowledge about health care.
Thomas V. DiBacco, a 1959 Rollins College graduate, is professor emeritus at American University in Washington, D. C.