In January 1948, British Prime Minister Clement Attlee gave a radio address to explain the introduction of the National Health Service (NHS), part of the “most comprehensive system of social security ever introduced to any country“. Notably, the Labour leader said during the creation of these new social services, “all parties in the state have borne their part and I am therefore not speaking to you in any controversial spirit.“
Three years earlier, President Harry Truman had come to power in Washington, lending his full support to similar provisions of publically funded healthcare. However, unlike Attlee, Truman had met with staunch opposition, most notably from the American Medical Association (AMA), who were quick to entangle the debate with the Cold War politics of the day.
As such, Truman’s vision of compulsory health insurance was quickly mired in anti-socialist fear mongering, so much so that during a 1946 Senate hearing on the National Health Insurance Bill, Republican Senator Robert Taft shouted out: “I consider it socialism. It is to my mind the most socialistic measure this Congress has ever had before it,” before leading his party members out of the room.
An AMA pamphlet printed two years later suggested the tone had not changed: “Would socialised medicine lead to socialization of other phases of life?” it read, adding: “Lenin thought so. He declared socialised medicine is the keystone to the arch of the socialist state.” Despite Truman’s victory in the 1948 election, his healthcare plan remained sidelined, unable to counter the influence of interest groups or to corral a public seemingly happy with its health system.
Resistance to healthcare reform in the ’40s mirrored that faced by FDR and his social security expansion of the 1930s; the debate over Medicare in the ‘60s proved equally fractious, likewise the Clintons’ push to pass the Health Security Act in the ’90s. More recently, the Affordable Care Act (ACA), famously referred to as “the crown jewel of socialism” by Michele Bachmann, has drawn out similarly toned opposition, with Louie Gohmert, a Republican congressman from Texas, finding the bill so repulsive he felt compelled to ask: “How much more socialist can you get than the government telling everybody what they can do, what they can’t do, how they can live?“
According to Iwan Morgan, the Commonwealth Fund Professor of American History at University College London, GOP right-wingers’ use of Socialism to instil fear about healthcare reform “is nothing new”.
“Their patron saint [Ronald Reagan] did it a half-century ago when the Cold War was at its height,” he told HuffPost, highlighting a record cut in 1961 entitled, ‘Ronald Reagan Speaks Out Against Socialized Medicine,’ which was sponsored by the AMA as part of its campaign against the pre-Medicare Herr-Mills bill.
“In this, Regan asserted that ‘one of the traditional methods of imposing statism or socialism on a people has been by way of medicine’,” said Morgan, adding: “If you read the speeches of modern day conservative Republicans, they continually condemn healthcare reform in particular and, more generally, any expansion of the federal government’s socio-economic responsibility (but not socio-moral responsibility) as socialistic in intention.”
For Dr Jonathan Bell, a specialist on US social change at the University of Reading, there was a critical moment in the ’40s when healthcare reform in the US looked likely, however because of the Cold War and the “way the American political system was so receptive to extreme ideas”, particularly a fear of totalitarianism and communism, it “allowed opponents of the New Deal state to take control of the political agenda.”
Yet scaremongering is not the only reason why the US has proved so resistant to progressive healthcare policy, while Britain, France Canada, Japan, Australia and many others have long-since moved to wards a more egalitarian system.
According to Bell, one of the main hurdles to a single-payer system is the way the US medical profession has developed into a powerful and strong private sector lobbying presence in government “that’s very much been concerned to ensure private healthcare has predominated.” As such, lobbying groups have not allowed government to get a foothold in the provision of medical care. “It has been very strongly felt by the AMA and medical lobbyists that their control over their own ability to decide medical procedures and finances would be damaged by government,” said Bell.
That was also true in Britain – the British Medical Association (BMA) was initially hostile to the NHS – but that opposition was quickly abandoned. “The medical lobby has to be put into the context of the American political system,” said Bell.
It is also worth noting that in the ’40s and ’50s, healthcare in the US was not the sprawling mass of conglomerated hospitals and medical maintenance organisations underpinned by private insurance it is today. It was often smaller practises, usually family run, while the expansion of the insurance industry in the decades after the war meant that most people were covered via their employer.
“There was the sense that people didn’t need a public option,” said Bell. “It was only when that health insurance system started unravelling and coming under strain in the ’70s and ’80s that the issue raised its head again.”
Following Obama’s victory in 2008, the Democrats used their sizable majority in Congress to pass the ACA, patching up the US system by adding government regulation to remove inequities and by increasing coverage. However, as a consequence of finally pushing through healthcare reform, Republican opposition was able to wipe out the Democratic majority in the House of Representatives in 2010, from where they’ve been conducting a massive and quite personalised, bitter war with the President ever since.