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The United States is the only economically developed nation without universal healthcare.  This shouldn’t surprise anyone, because the United States is a land of oddities. After all, we have baseball and football, and we invented both of them. We had slavery well after other developed nations had ended it. We have a political system with two houses of Congress and separate states, when most developed nations have a parliamentary system and only a few have separate regional governments.

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I have come across two recent articles, which insist that our racist streak causes our opposition to universal healthcare. On the other hand, Brazil is a country with mixed races, and yet healthcare is a constitutional and universal right.  So we need to study how racism became a tool of opposition here.

The Freedmen’s Bureau, established in 1865, was an early attempt at providing free healthcare to a large group of people in the United States. “However, the bureau was prevented from fully carrying out its programs due to a shortage of funds and personnel, along with the politics of race and Reconstruction.”

Federal health care policy was designed, both implicitly and explicitly, to exclude black Americans.

Similarly, “undefinedn 1945, when President Truman called on Congress to expand the nation’s hospital system as part of a larger health care plan, Southern Democrats obtained key concessions that shaped the American medical landscape for decades to come. The Hill-Burton Act provided federal grants for hospital construction to communities in need, giving funding priority to rural areas (many of them in the South). But it also ensured that states controlled the disbursement of funds and could segregate resulting facilities.

“Professional societies like the American Medical Association barred black doctors; medical schools excluded black students, and most hospitals and health clinics segregated black patients. Federal health care policy was designed, both implicitly and explicitly, to exclude black Americans. As a result, they faced an array of inequities — including statistically shorter, sicker lives than their white counterparts. What’s more, access to good medical care was predicated on a system of employer-based insurance that was inherently difficult for black Americans to get. “They were denied most of the jobs that offered coverage,” says David Barton Smith, an emeritus historian of health care policy at Temple University. “And even when some of them got health insurance, as the Pullman porters did, they couldn’t make use of white facilities.”

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Black communities established their own healthcare systems, including an organization of black doctors. “By the 1950s, [black organizations] were pushing for a federal health care system for all citizens. That fight put National Medical Association (the leading black medical society) into direct conflict with the A.M.A., which was opposed to any nationalized health plan.”

In the 1930s and 1940s, the A.M.A. called a federal health care system socialist, un-American, and government intervention in the doctor-patient relationship. The N.M.A. called health care a basic human right.

Finally in the 1960s Medicare was established for Americans over 65 under President Johnson, but thereafter there continued a struggle for a coherent federal plan. When President Obama finally proposed one, Glenn Beck said that the proposal was driven “by one idea: reparations.”

Obama’s health plan was enacted, with flaws. Given that the idea of reparations for blacks has become an important policy dispute in the 2020 election cycle, there should be a concern that the reparations argument might stand in the way of “Medicare for All,” which has a much higher rate of desire among Americans (at last).

Those of us who accept both the idea of reparations for blacks and “Medicare for All” for everyone should be clever enough to push for both and then compromise on the reparations idea in favor of the healthcare idea. The reparations idea should result in a coherent study of how reparations might be best introduced. After all, “the history of slavery and discrimination have fueled disparities like the racial wealth gap, which shows that the median white household is 10 times wealthier than the median black one.” But if Medicare for All is enacted, the racial wealth gap may become less prominent. The reparations study may or may not show that. But Medicare for All will diminish wealth inequality overall, and that may make the racial wealth gap easier to cure.

America is supposedly a land of great opportunity. But the lack of universal healthcare, plus the existence of extreme wealth inequality and racial wealth inequality, shows that the “opportunity” hallmark is something of a lie. America needs to cure these deficiencies and make the possibility of “opportunity” a reality.

michael hertz

Michael T. Hertz