BackStory

Body Politics: A History of Health Care

FightTB In 1912, Teddy Roosevelt became the first presidential candidate to stump for national health insurance. He lost that election, but a century later, the issue continues to divide Americans.

On this episode, the History Guys explore the origins of the health care debate, and try to explain how we wound up with a system so different from the European model. They hear from Jacob Hacker, author of the “public option” plan, about why lobbyists hold so much sway over health policy, and travel back to 1611 to visit colonial America’s first hospital. They also hear the story of how inoculation first came to the New World.

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Full Transcript

Guests Include:

Show Highlights

  • The Health of the Nation — Jacob Hacker explains how we wound up with a health care system so different from the European model.
  • Heathen Health — Nate DiMeo tells the story of how inoculation first came to the New World.
  • Health Care in the New World — Catherine Moore visits Virginia’s Mt. Malado, the first hospital in the New World.

Cited:

  • Photos of the recreated 17th century hospital at Mt. Malado: 1, 2, 3
  • “The Memory Palace,” Nate DiMeo’s podcast about American history

Web Exclusive

Little girl talking on the telephone (Library of Congress)Call of the Week
Abe from Montreal wants to know more about the military metaphors we use to talk about public heatlh

Further Reading

Want to dig deeper into the history of health care? Check out this list of resources compiled by the History Guys to learn more.

17 Responses

  • I have two questions for the history guys:
    1) Since the publication of Theda Skocpol’s \Bringing the State Back In\ and her \Mothers and Soldiers,\ historians have been arguing that the story about the American state we
    all learned in public school–that it is traditionally minimalist and non-activist–is wrong.
    Given that every campaign for universal health insurance since WWI has been defeated,
    what kind of a story about the American state would you like to tell in place of the new
    orthodoxy?
    2) Historians Colin Davis and Jennifer Klein have skillfully shown that since WWII, we have been locked into a system where most of us get our health insurance through our employers. That in turn has limited the role of the federal government to providing insurance only to those who don’t get it through work. But the German insurance system, and to a lesser extent, the French, both work through the employment-union system. Yet
    their coverage is universal and gives a major role to the government. What does this do to the argument that employment-linked health insurance has been a major obstacle to health reform in the US over the last 60 years?

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    Harry M Marks
    8/16/2009 at 7:17 am

  • Tommy Douglas form Canada warrants being mentioned.

    It also might help the ignorant masses to have the meaning of “socialism” be clarified (and separated from “social concern” – also explain “fascism”…).

    But yeah, the Canadian system would be a good eye opener – what made it happen and how things could be similar in the US.

    -G.

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    juepucta
    8/17/2009 at 9:18 pm

  • I’d like to see you address the profit motive in health care. Since the people who run for-profit publicly traded companies have a fiduciary duty to shareholders to make maximum profit and paying for health care is not directly profitable to them (hence the term, “medical losses”), aren’t the current problems (of cost-shifting, medical bills forcing people in bankruptcy, rising numbers of uninsured, pre-existing conditions, etc.) unavoidable under such a model? Isn’t a for-profit health insurance industry antithetical to quality health care for the entire citizenry?

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    Brenda Trickler
    8/22/2009 at 6:44 pm

  • Does the much-vaunted American individualism stand in the way of health care reform? Does the Calvinstic streak in American religions (particularly the Protestant ones) enter into it? How much “red scare” is still behind the current cries of “socialized medicine”?

    And what exactly is adequate health care, anyway? I’m uninsured and asthmatic. I don’t have any health care, but you wouldn’t know about my health issue to look at me (It’s not as if I’m limping about on an unset broken leg.). I survive day to day, but many if not most people would say my situation shouldn’t continue. Where do we as a society draw the line? I’m sure that Americans’ expectations for health care have risen over time, but how far? Is health care a personal right or a personal responsibility?

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    Brenda Trickler
    8/22/2009 at 7:18 pm

  • I’d like to ask how mental health care fits in to this picture. We tend to think of ourselves as much more enlightened now when it comes to attitudes about psychological disorders and mental disabilities as compared to those folks of yesteryear, but are we really? We still expect people with conditions such as depression and bipolar disorder to take their medication (which often has very undesirable side-effects) and get over it.

    When we think of mental health care in the past, the image that comes to mind is of stark institutions where people were placed to be forgotten. We have ideas of horrible mistreatment of the patients in these places, including stories of rape and forced abortions. But would such treatment have existed outside of these institutional environments? How were people with psychological disorders cared for before the inception of institutions and drug therapies (they can’t all have been locked up in Mr. Rochester’s attic).

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    Lindsay Barker
    8/25/2009 at 9:27 am

  • The History of Healthcare brought to light the paradox between Americans’ lust for individualism and Americans’ need for collective social responsibility that seems to be a major stumbling block in passing healthcare reform legislation. This dichotomy seems to linger subclinically in each of us much like an undiagnosed slow growing mycobacterial infection — one that politicians today are reluctant to address. This realization was particularly eye opening to me as someone dealing with the social repercussions of having become disabled unnecessarily because doctors’ best efforts at diagnosis amounted to little more than referrals to other doctors and for more tests. Apparently under our present insurance-designed health care system, no one is responsible for diagnosis and treatment. This makes it easy for doctors to get paid while failing to address the health needs of chronically ill patients with systemic infections that fall within many specialties. To my astonishment, my exhaustive efforts to get public focus for this pitfall within our health care system has been met with an attitude of “that’s something patients have to deal with on their own.” This sentiment came from otherwise supportive friends, neighbors, my elected officials, their staff… Although President Obama mentioned on occasion patients being shuffled from doctor to doctor, I believe there was always an assumption that the patient eventually received a diagnosis and treatment. No one wants to investigate how pervasive the problem is and the likelihood such practices will become worse as our aging population becomes sicker with chronic and systemic diseases. The health care business model doesn’t allow the time necessary to diagnose illnesses complicated by secondary conditions because the illness was never diagnosed initially. My experiences with doctors from 2003 through 2008 are chronicled in posts 1-20 on my blog http://doctorblue.wordpress.com. Now on SSDI and Medicare, I’m continuing my search for competent medical care and justice — not just for me but for all of those in the same boat I encountered. People shouldn’t be put out to pasture and given up on just because they no longer fit into another’s profitable business model. This is something our current healthcare reform bill still doesn’t address, and it is the reason that the proposed legislation won’t reduce increasing health care costs. Vast sums of money have been spent on my so-called health care, and I have yet to receive a comprehensive diagnosis and treatment.

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    Anna Gardiner
    11/15/2009 at 7:31 pm

  • I thought of what may be an interesting historical analogy in the current health care debate – early fire departments. They were private institutions charged with the protection of the lives of the citizens who paid for their service. However, since these fire departments were private, for-profit institutions in competition with each other and not philanthropic organizations, it became quite apparent that they were not serving the public in a socially responsible manner. Fire insurance payments could almost be seen as ransom. By the end of the 19th Century, cities worked to establish government-run fire departments.

    Is there perhaps any parallel in the opinions of some that today’s health insurance companies need to be government run? Please let me know what you think, and if my facts/interpretations are off.

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    Beau
    3/8/2010 at 2:18 pm

  • Sometimes I wonder if we’ll EVER get healthcare figured out in this country. It seems like some people go into the arena with great hopes of change, like Peter Orszag, but leave defeated. This need to remain a TOP priority, not just something we can put off for 100 years and “deal with it later!”

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    Jane
    4/4/2011 at 12:56 pm

  • Your very instructive presentation of the attitudes and history behind Americans’ dissociative attitudes toward nationwide health care was just repeated on the air — at least by the station of which I’m a member, WCQS in Asheville NC. Today is 03/31/12. Okay, that’s my introduction.
    I’m a social psychologist as well as a supporter of universal health care. Thus I am ever-baffled by people’s — Americans’ — passion against caring for each other. You noted near the end of this program that human beings are social, so we’re “supposed to” care about each other, value altruism, etc.
    Earlier you pointed out regional attitude differences that underlie the particular hypocrisy (my word) of the South (counting Florida — okay, maybe not coastal communities populated by transplants, but certainly interior and panhandle cultures): sucking up most of the nation’s health care dollars but condemning government expenditures to ensure that every citizen and then some will experience health care and rescue as a right.
    Another zinger was the distinction — a show in itself, hell, a series! — that veterans feel they have EARNED health care and public tribute, and non-veterans accept it (though they don’t rally, do they?, to do much about the VA…). Apparently one theme of health-care dissonance is whether or not the recipients “deserve” or have “earned,” well, life and health. Americans seem generally to feel that they as individuals do/have, but “all those people” (the rest of us) don’t/haven’t.
    Finally, one caller wondered aloud about the seeming conflict between our own INDIVIDUAL needs for health care coverage (me, me, me!) but our deep-seated suspicions about having anonymous bureaucrats control our bodies.
    That one in particular provoked my thinking: that Americans worry most about others’ intrusion into their intimate realms. Research shows that other prejudices — against interracial marriages, for example — ebb from the outermost periphery inward: public interactions, then business, then local social, and the last holdout is “not MY daughter, you aren’t!”
    Now, I’m a liberal progressive vegetarian tree-hugging Yankee, transplanted to the Southern mountains (not really the South, not in town, but recognizably a live in contiguous counties and our current legislature). It’s been 35 years and I LOVE it here, best place I’d ever lived or ever could (within a 10-mile radius). I’ve made a most-of-life study of this bizarre duplicity:
    People feel personally “deserving” of that which they feel they have “earned.” THIS, I have suddenly realized (thank you!), is the critical color that distinguishes the Me from Them.
    First, let me point out that while humans are decidedly a social species, that is nowhere nearly the same as being a “sociable” species, which is what your commentator seemed to be saying. (Sorry for missing names, here, it was all so fast!)
    That is, we do indeed NEED each other, but this is demonstrably not the same as CARING for each other. Unquestionably, and based on decades of scientific research from ever angle imaginable, humans need and seek to belong and become close to others.
    But the parallel paradox is that altruism or, operationally, helping OTHERS without remuneration, is not an individual motivation. It does appear group-wide, that is, at the level not of individuals but of related groups, cultures, and obviously other (non-American) societies, where helping others who need it, irrespective of their ability to pay, is an assumed obligation.
    Pulling this all together, I recognized the familiar self-interest of so many other behaviors, balanced against the needs of the social group. I earned this (in my mind); you didn’t (for all I know and I’m not listening otherwise); so I get care and you do not deserve it. Pointedly, who gets it, is well-off white men; and who don’t get it are girls and women, other children (not sons of the aforementioned WOWM), non-Whites, and non-ingroup (especially non-”Christian” whose borders shift and blur with the latest media passions.
    So here, at last, I’m stumped, as both a regular person and a social psychologist: Why do you think so many people — apparently a majority — in our nation are so mean, and so ready to be mean? Their doctrinal words seem to preach otherwise but one doesn’t see it in such discussions as about national health-care.
    I do believe your points are valid and important about intimate realms, regional histories and values, and the self/other distinction surrounding merit and deservingness. So I can almost comprehend disinterest. But why the MEAN-SPIRITEDNESS? Why the abundant CRUELTY of discarding those who are old, sick, little, weak, Other — as useless, unimportant? What parts of cultlure and “religion” have engendered such greedy disdain?
    Obviously, I’m no sociologist, and while I love history, I discovered as an undergrad that the feeling was not mutual. So I look to you.
    Sorry for the length. To paraphrase Twain and others, I’d have written a shorter message but I didn’t have time!
    Thank you so much for the information and the insights!

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    Ann
    3/31/2012 at 3:39 pm

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