The US is the only rich democracy that lacks a system of universal health care provision. This weak public health infrastructure has severely constrained the country’s pandemic response: since May, it has suffered the highest mortality rates of all countries reporting adequate data. Even before the outbreak of the global pandemic, the United States was experiencing a health care crisis, with 87 million people uninsured or underinsured, more than 137 million people struggling to pay off medical debt, and among the weakest population health outcomes in the Organization for Economic Co-operation and Development (OECD).
The absence of public health care provision in the United States is commonly traced to 1948, when Harry S. Truman’s national health care proposal was soundly defeated through extensive lobbying efforts by the American Medical Association (AMA). But the battle for universal provision reached an earlier peak during World War I, when a coalition led by the American Association for Labor Legislation (AALL) put forward a bill for mandatory health insurance in fourteen states.
In this early campaign, women trade unionists in the International Ladies’ Garment Workers’ Union (ILGWU) and the Women’s Trade Union League (WTUL) powerfully broke with the strategy of the American Federation of Labor (AFL), advancing a political vision that unified skilled and unskilled workers, and integrated feminist demands with the interests of the working class as a whole.
Rise of Company Health Care
In the United States of the nineteenth century, health care provision was, like other forms of reproductive care, performed by women within the confines of the home. Unlike its counterparts in Europe, the American medical profession remained weak and divided; lacking professional qualifications or protections, doctors operated as independent practitioners who traveled for work and often found themselves entangled in a web of debts and unpaid obligations.
Skepticism of standardized expertise within the American public gave way to a popular culture of lay medicine, with medical advice from homeopaths and druggists competing against the recommendations of general physicians in popular magazines.
But the industrial transformations of the late nineteenth and early twentieth century dramatically altered the health care needs of the public, and the form in which those needs were met. Key among these transformations was the incredible rise in women’s labor-market participation, which nearly doubled between 1880 and 1890. As more and more women began to work, health care transitioned from the realm of the home to the realm of the market.
These demographic shifts in the labor market were compounded by increased industrialization and faster modes of transportation, which, by the end of the nineteenth century, transformed America’s decentralized and locally driven economy into a single national market, marked by industrial concentration and the proliferation of working-class organizations that were militant in their demands for basic welfare.