So Is Health Care for All Really Un-American?

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Mr. Mutschler is Associate Professor, History Department, Oregon State University, and author of The Province of Affliction: Illness in Eighteenth-Century New England (forthcoming, Omohundro Institute of Early American History and Culture).

Many countries have devised solutions to the most pressing problems we face in health care today – overwhelming costs and large numbers of uninsured and underinsured persons.  President Obama has made it clear that the only politically viable possibilities for reform in the United States must be consistent with traditional American ideals and practices.  Opponents of the “public option” have underscored this point in recent weeks, claiming that the plan would violate “market freedoms” and place  government bureaucrats in the middle of the private relationship between patient and physician.  Such a plan, they say, is un-American.

Despite such rhetoric, there is, in fact, a long history in this country of government provision for the sick.  Well before the arrival of Medicare and Medicaid in the 1960s and Social Security in the 1930s, Americans counted on government in times of extreme need.  As it turns out, the role of government in providing for the destitute poor reaches back to the founding itself.

Governing bodies at all levels in early America – from towns and parishes to provincial and state governments -- concerned themselves with the plight of those laboring under misfortune, including most especially the sick poor.   Illness was a common, wrenching experience in daily life, descending in the form of violent epidemics of smallpox, measles, and diphtheria; acute bouts of fever and flux; and numerous chronic infirmities.  The appeal to government was not the first resort for the sick and those attending them, to be sure. Families and neighbors tried their best to take care of their own.  Churches collected money for the most afflicted in their midst.  Benevolent members of the elite engaged in individual acts of charity, and medical charities, such as hospitals and dispensaries, were put into place from the middle of eighteenth century onward. But none of these measures was enough to provide for the ongoing, pervasive, and unsettling effects of living in a world in which any given individual or family might be devastated by illness.  For that, public aid was essential.

The impulse was especially strong in New England, where the commitment to the poor was part of a larger vision of community life.  We hear (particularly around election time) politicians talk about America as a “city upon a hill.”  Historians know that the words are drawn from John Winthrop, first governor of the Massachusetts Bay Colony, who preached them as a lay sermon in 1630 as he sailed to America.  Winthrop’s message had less to do with celebrating individual liberties than with encouraging community obligations.  He insisted that in a godly community “the care of the public must oversway all private respects,” with members “knit together” through an abiding interest in each other’s “every want or distress.”  Care for the poor, including the destitute sick, was part of this vision.  Towns were obligated to provide for legal inhabitants who fell upon hard times, paying for their care with local taxes.  In some cases, family members or other town residents were given allowances for medical care and other necessaries; in others physicians or other healers were hired by towns or paid directly for their individual services.

Higher levels of government were involved in providing assistance as well.  When individuals and towns were rocked by the calamities of early modern life, they petitioned their legislatures for help.  Legislatures fielded an astonishing range of petitions: sick soldiers asking to be compensated for medical bills that they paid out of pocket and by veterans and their families tending the wounded and chronically ill; towns reeling in the wake of epidemics that not only sickened their inhabitants but ruined local economies; immigrants and other “strangers” who fell upon hard times and those who cared for them.  Personal stories of anguish were assigned to committees, heard by individual legislators, and read before the assembly as a whole.  The assumption was that there was no great gulf separating society and government: as protectors of the people, and as persons well-versed in the trials of everyday life, the people’s governors were asked to provide a wise and sympathetic hearing and make financial allowances to ease suffering.

We need not glamorize this earlier world.   The costs could be considerable, and it is not surprising to find tensions.  Family squabbles over who should care for elderly parents, or between towns insisting that they had been unfairly saddled with bills that belonged elsewhere, could find their way into courts.  And later critics charged that the care afforded the sick poor could be so spare as to be cruel. 

But it is hard to view our founding generation without admiration for their attempts to care for the sick. They faced issues that are all too familiar to us – the sudden, unexpected dislocations of acute disease;  the enormous financial and social costs of caring for the chronically ill – and they did so squarely and resolutely.  They understood the province of affliction in daily life, and they did not trivialize its hold on everyday affairs.

Whatever the merits of recent objections to the public option, it is simply untrue that the plan is un-American.  We have only to turn to our founding generations to see that government provision for the sick is health care in the American grain. Despite significant differences between the size and scope of government in early America and today, both have been animated by a common principle: that self-government  includes the power, and the responsibility, to take care of ourselves and each other. 

This p[iece was first published by The Oregonian.

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Nigel Anthony Sellars - 9/11/2009

So the choice is not to try a system that works elsewhere and relies more on preventative medicine and one that favors a tiny minorities and let's everyone else fend for themselves?

As for historical perspective, it's definitely important. Yes, communities were small in the past, but the nation was also poorer. We pride ourselves on the size of economy. After all, we have 5 percent of the world's population and use 25 percent of its resources, and we can't find the money to protect all our citizens?

Frankly, the opposition to a health care system (and public or private, they're both ruin by bureaucrats) is actually tied to an anti-government (more properly anti-statist) ideology that is absolutist and inflexible. As Jefferson Davis told the Confederate Congress when it refused to even consider freeing the slaves and arming them: "Our epitaph should read, 'Died of a Theory.'"

I hope that won't be our epitaph, too. But if we allow absolutist ideology and not rational pragmatism to guide us, then we should start carve the gravestone now.

Bryan Mullinax - 9/9/2009

While towns and people came together to support their fellows with charity - the founders would be flabbergasted at the thought that people would be forced to provide what is laughingly called charity today.

If you feel so strongly about providing health insurance for your fellow citizens and illegal immigrants, then you might follow another example.

Sell all you have an give to the poor. If this is so absolutely critical, why do you and your family have one cent more than the poorest? Have you paid more in taxes than is due? After all, the government is so wonderful that it can spend your money better than you can yourself - why do you have any?

Of course the point is taken to an extreme, but it demonstrates the hypocrisy of liberalism. You want what you have, but will take from others because you think its moral. Its just dressed up theft of course.

And there isn't any information that any of the Founders would think otherwise.

Maarja Krusten - 9/9/2009

A big difference between then and now is the exposure the Internet provides Americans to each others’ views. I don’t think there are many Americans who totally reject their fellow citizens, but those who do are vehement about it. And their views are out there, smacking those with different perspectives in the face day in and day out. That pulls at the civic fabric. It also has the potential to put up barriers to thinking of “the common good” that were not there, at least on a daily basis, in the 18th and 19th centuries. (Obviously, there were werious divisions back then, including a Civil War.) It’s sobering to realize the extent to which some Americans hate their fellow Americans nowadays. Read the Internet and there's no way to avoid seeing that.

An anonymous poster on the Washington Post’s message boards recently spoke about President Obama and the fate that should befall him in terms that made me shudder and which I won’t repeat here. The poster explained that he had a rural upbringing. He said he would like to see the U.S. return to old values, to the extent that he thinks urban liberals don’t deserve to live and that all U.S. towns with populations over 1,000 should be wiped out. It reminded me of what a poster on HNN had said in 2003 when he shrugged at the thought of Washington, DC and what he called its “parasites” being wiped out. According to the HNN poster, he and his fellow Westerners were “none to fond” of the “city-states” on the two coasts.

I haven’t seen as extreme rhetoric about wiping out sections of the nation from liberals. But I have seen gratuitous putdowns of conservatives as being knuckle draggers, mouth breathers, Neanderthals, and that all purpose term that is flung around with too much ease in the U.S. – fascists. Some progressives reach for hyperbole just as some conservatives do. It may feel good to them to do so – and serve a short term goal – but what is the effect on public discourse and ability to pull together in the long run? The feeling of unity that we had for a while regardless of party after 9/11 and to some extent after Katrina has faded.

What does repeated exposure to extreme rhetoric do to the concept of “the common good?” Bill Bishop posits that there is a “Big Sort,” with some people withdrawing physically and intellectually to comfort-inducing enclaves of like-minded people. News and entertainment also are much more fragmented and niche-oriented than they once were, when most families watched the same evening news broadcasts on CBS or NBC and enjoyed the same sitcoms and dramas on prime time.

But it’s a mistake to look at issues solely through a red and blue state, right and left divide. CNN reported at the end of August that a whopping 41% of voters identify themselves as Independents, not Republicans or Democrats. A CNN commentator noted that “Independents are nonideological problem-solvers. They are sick of Washington's harsh and cynical hyper-partisanship, but they do not have a split-the-difference approach to politics. Independent voters are decidedly closer to Republicans when it comes to economic issues and closer to Democrats when it comes to social issues. To put it another way, they are fiscally conservative but socially progressive with a strong libertarian streak.”

Interestingly, Laura Bush also pointed yesterday to what she views as increased partisanship as a factor in trying to solve complex issues. As CNN noted of the interview she gave yesterday, “Bush indicated that she didn't think it was fair for Obama to be labeled a ‘socialist’ by critics and expressed her disappointment with the intensely polarized nature of contemporary American politics. Part of the reason for the polarization, she said, was the increase in the number of congressional districts dominated by either strongly conservative or liberal voters. ‘We've seen that for the last eight years, certainly, and we're still seeing it,’ she said. ‘That's just a fact of life.’ Bush conceded that after her husband was elected president, he was unable to replicate his success as governor of Texas in reaching across the aisle to Democrats. ‘He was disappointed that that was not the way it worked out in Washington,’ she said. ‘I'm sure President Obama didn't expect it to be that way [either]. ... All of us need to do what we can to come together on issues.’"

Michael Barton - 9/7/2009

I'm afraid historical perspectives are fairly irrelevant on the matter of government responsibilities for health care. The government's burden in the past (which is to say, the taxpayer's burden, because there is really no such thing as "government money") was relatively low because there was relatively little that could be done for the sick, rich or poor. In the 20th century, the cost of health care has ballooned, mainly because there are so many more elderly to care for and because there is so much more that medicine can do for patients (and that patients therefore want medicine to do). The fact that "insurance" (really, just third party payment) pays for much of this care does not keep costs down; indeed, it inflates costs. There is also the salient fact that in America we pay our physicians, nurses, etc. a good deal more than they are paid in other countries. If government were to become the single manager of health care costs, covering everyone and compensating all providers of all kinds,then the total bill (and taxes) will skyrocket even more, whereupon the government will eventually do two things: pay all providers quite a bit less, and then limit health care to that which the government regards as "effective" and "necessary." There is no escaping the irony that "socialized medicine" provides, at first, more health care for more people, but eventually, produces more limited health care for everyone. In sum, if you want Euro-style health care, you will almost certainly pay Euro-style taxes and get Euro-style results, which cannot help but lead to a government controlled system with much less American-style excellence. After all, this country doesn't make the lion's share of advances in medicine because we have Medicare and Medicaid. We make them because the present system attracts the best talent and offers them a good deal of money, public and private, for providing health care and research. I say if Euro-style health care is what you want, move to Europe. You are unlikely to get it here because Americans are not (yet) Europeans.

Donald Wolberg - 9/7/2009

Mr. Mutschler makes some interesting observations worth consideration. Indeed, community involvement was certainly an important part of early America, worthy of praise and in some ways imitation. Unfortunately, I suggest there are serious factual considerations that makes his connection between this early community help and modern America. First, most American communities of the distant past were very small, well integrated in terms of individuals and families knowing each other, and were bound by commonality of language, religion,friendships, world views and personal associations. Today, America has become what to some seems to be a "bloated" nation of 330,000,000 citizens and many millions (10-15?) of illegals who should not even be here. There are limited opportunities for the very close associations at the community level seen in the past. There is a amazingly large (millions) cadre of bureaucrats who can determine how we act alone, or in association with others, how much of our wealth we can keep, or give to others to help them. Supposed social welfare efforts are government driven with dollars taken, not requested, from wage earners.

The current unease with the proposed changes regarding health care arise from the perception that government (those faceless bureaucrats) will be mnore intrusive in American lives and behavior, take more money from some who work and give it to those who do not, and tell us what we can or cannot do with regards to our self-perceived health needs. I also suspect the growing unease reflects the failure of the current Obama administration to market itself well, and from the fear that the administration is as inept and lacking in skill as it appears. Health care or reform, whatever label is used, is but the tip of the iceberg of incompetence that the administration seems to be.