Timeline of Healthcare for All and Single Payer
(Caveat – There is a huge and rich history to the struggle for health justice and the underlying economic/technological changes that shape it. No way is this small snippet comprehensive, but maybe it’s a start – there are a few pieces of interest inserted but perhaps not directly relevant. And finally, on some ‘dates’, I have taken the liberty of narrating below some analysis).
1760: First Medical License issued: Most health care still provided by herbalists, holistic practitioners and, of course, women.
1763: Early Act of Biological Warfare in the USA: British commander gives a Native American tribe blankets laced with smallpox. Genocidal act.
1860-1865: Sojourner Truth develops wartime nursing. The institution of slavery defines the role of healthcare under capitalism: Dr. Richard Arnold provides health care to slaves because, “to save his capital was to save his Negroes.” Medical science is also used to calculate a life expectancy of 7 years once a slave was ‘sold down the river’.
1860’s: Germ Theory of health care advanced diminishing the role of sanitation, environment, and occupational factors in contributing to illness.
1906: Teddy Roosevelt supports national health insurance promoted by the American Association for Labor Legislation.
1909: Rockefeller Hookworm program in North Carolina: One of the first public health programs, it was initiated because textile workers infected with hookworms became lethargic and were less productive, therefore reducing profits of mill owners and their investors. (Reinforces role of health care under capitalism – to insure a productive workforce). *
1911: Flexner Report, financed by Rockefeller and Carnegie, is issued: Among other things, it calls for a “higher class of doctors.” Promotes increased costs for medical schools and fewer graduates. 5 of 7 Negro Medical schools are closed.
1916: The American Federation of Labor (AFL), Big Business and the AMA oppose National Health Insurance.
1927: Committee on Cost of Medical Care: Proposes group physician practice; and pre-paid health plans.
1929: First Blue Cross plan developed at Baylor University in Texas insuring that hospital bills can be paid. (Stock Market Crash – 30% of workforce unemployed).
1932: Tuskegee Syphilis Experiment started by US Public Health Service. Role of healthcare research’s impact on the African American community indelibly stamped. FDR elected.
1933: Kaiser sets up first prepaid health plan for Grand Canyon Dam workers. Blues go national in the 30’s – non-profit.
1934: Advent of Commercial Health Insurance plans.
1935/1938: Social Security passed – originally intended to include national health insurance. Dropped because of strong opposition from AMA & Dixiecrats.
1940: Blue Cross has 6 million subscribers.
1941: US enters WWII – millions of men medically unqualified to enlist in armed forces. Millions of others get their first access to health care in the army.
1946: Hill Burton Act: Pumps public money into hospital construction, but allows local control of hospitals. In the South, African Americans denied access to the hospitals that federal monies built.
1952: Polio is the #1 infection killing children in US.
1954: BC/BS covers 27% of population: Commercial insurers 29%, independents 7 %. Unions negotiate 25% of health plans – health insurance firmly bound to employment.
1964: Founding of Medical Committee for Human Rights. MCHR provides medical personnel for Civil Rights marchers and struggles in the South, free community based clinics.
1965: Voting Rights Act Passed. Medicare Passed – provides national health insurance for the elderly and disabled through Soc. Sec. – initially farm and domestic workers excluded. Medicaid Passed – means tested state administered health insurance with 2:1 federal match for some low-income people as a contingent workforce. Southern states most restrictive eligibility, and not fully implemented in the southern states until – 1970’s__.
1966: Mississippi Mound Bayou Clinic and community control struggles over healthcare facilities grows out of the Civil Rights Movement. Linkage of illness, hunger & poverty reasserted. California Nurses Assoc. ends its no strike policy.
(Note: After WWII, European and Soviet industry is in shambles. US industry and military dominate internationally. Growing percentage of insured are covered by employment-based health insurance, mainly due to strength of trade union negotiated health insurance and laws that restrict wages. The need for a productive industrial US work force (1930’s – 1960’s) fuels the growth of private health insurance and subsequently hospitals, technologies, university medical centers and what is coined as the ‘medical industrial complex’, {by Health PAC in 1968}. Medicaid provides coverage for a contingent workforce. Medicare funds also fuels the developing healthcare industry.
Former European colonies engage in struggles for independence. Neo-colonialism takes hold, increasing the wealth, power and ownership of an imperialist class. European healthcare has taken a different course, largely due to the struggles of a more class-conscious labor movement in Europe. (See Bismarck’s Germany). Impact of redbaiting post WWII; the role of white supremacy & the south; and an industrial workforce that has benefited {been ‘bribed}, from US hegemony, all serve to limit the political awareness of the US working class. Meanwhile, the health industry in the US is taking on more and more corporate characteristics. Not only functioning to preserve a productive workforce but to preserve itself.)
1968: Committee on National Health Insurance: Walter Reuther (UAW) and Ted Kennedy call for national health insurance.
1968: Health/PAC formed. NYC based. Mainly white educated professionals, docs, med students, lawyers, journalists, activists etc. Health/PAC Bulletin was a resource for grassroots struggles for community control and accountability of healthcare institutions in NYC. Embedded in social movements coming out of the Civil Rights Movement. Worked with communities, Young Lords, Black Panthers, 1199 union etc. Healthcare was integral to a larger social movement.
Note: some quotes from Health PAC folks: Ollie Fein – “Central to such understanding {knowing how the healthcare system works}, is the concept of the industrial-medical complex, pioneered by Health/PAC …”
1970: Health/PAC Bulletin publishes article – “National Health Insurance: The Great Leap Sideways” The article explained that the “problem with national health insurance was precisely that it was only insurance: it would funnel dollars to the same old actors on the health scene – doctors, hospitals, insurance companies without reorganizing how healthcare is delivered.” (Ollie Fein, Health/PAC 1993). Lincoln Hospital collective, Young Lords and 1199 take over hospital in midst of proposed cutbacks and quality of care issues.
1971: Nixon proposes employer mandated coverage; HMO’s and ‘federalizing’ Medicaid. Ted Kennedy holds hearings on National Health Insurance (never gets out of committees / both house and senate committees chaired by southerners.
1973: Many in Health/PAC support a National Health Service. Bill introduced by California Congressman Ron Dellums. Basically calls for a nationalization of health care delivery and elimination of role of health insurance. Health workers become salaried and treated fairly (up and down the food chain). Healthcare institutions and clinics publicly accountable and community rooted. Government responsible for healthcare – (‘life, liberty and pursuit of happiness’) Private physician practices permitted.
1977: 80,000 UMWA workers go on strike – health benefits leading issue.
1978: HMO’s rolling out, 26 million Americans without health insurance.
1980-1989: 860,000 factory jobs lost – largely due to the application of electronics to industrial production. Those jobs and millions of others never come back. 200 hospital mergers.
1986: Poverty and Health Retreat: Steffie Woolhandler and David Himmelstein argue for national health insurance at a retreat of healthcare activists. Model was Canada, not Cuba –avoided confronting negative impact of redbaiting on class-consciousness. CNA issues position paper supporting healthcare for all.
Mid and late 80’s were witness to more specific fronts of struggle in healthcare: reproductive rights/ACT-UP-1987/disability rights etc. ACT-Up challenges the unaffordable cost of AZT, a drug that was developed with public research funds and then privately patented.
1989/1991: Physicians for a National Health Program (PNHP) formed and the article for a National Health Insurance Program was published in the New England Journal of Medicine. The appeal was for a financial mechanism (national health insurance) as a way to solve the growing crisis of uninsured, costs, and the frustrations and increasing powerlessness of the private practice docs now at the mercy of the private insurance industry. The ‘conservative’ element of single payer was that the delivery system would remain essentially unchanged, (public, private, for-profit and not-for-profit mix). The message emphasized cost effectiveness of a single payer system and provider choice, rather than government responsibility.
Note: The bourgeoisie propaganda that dominated the 1980’s was laced with: 1) the government should be small and really only serve a military. It was not responsible for social health or well-being. 2) Private everything was better than public anything 3) a ‘John Wayne’ cowboy individualism was promoted and the ‘victim’ {of unemployment, poor health, poverty etc} was the criminal. 4) Regulation of corporations was bad. 5) Those permanently separated from work (minorities – last hired, first fired), were an ‘urban underclass’ – to be imprisoned. In short, a neoliberal agenda was taking hold in the US, something that the neocolonies had suffered for sometime. Healthcare issues were linked to survival issues – Up and Out of Poverty Now movement. Survival summits supported healthcare as a right not privilege. UOP runs some electoral independent campaigns. Georgians for a Common Sense Health Plan formed. Georgia electoral campaign 1989 has single payer as a platform plank.
1992: Clinton’s ‘regulated, cost control, HMO, private health care system, non-reform’ debacle. Interestingly, Clinton used a lot of the PNHP analysis of the health care system but not its conclusion. The Clinton proposal went down in flames, (resulting in no regulations). Sections of the progressive healthcare movement became ‘disenchanted’ that single payer not passed. Trade unions that supported single payer jumped ship for a seat at the table for NAFTA. They are ignored there too as the Clinton administration implements a neo-liberal agenda – cutting welfare, supporting deregulation and ignoring the unions that helped him get elected.
Note: High price was and is paid by labor and social movement for dependence on Democratic Party for reform. Failure to recognize same class interest of both Democratic and Republican Parties cost the movement credible leadership.
1992: UhCAN formed. Mobilizes, organizes and produces materials supporting single payer. Attempts to build mass organization for single payer. Holds multiple conferences, educationals etc from 1992-1996. Continues to day as monthly sum-up calls.
1993: Caravan of 2000 folks from across the south go to Little Rock, Arkansas to demonstrate for single payer in front of an-about-to-take office Bill Clinton. Georgians for a Common Sense Health Plan introduces single payer legislation in Georgia.
1994: The Mitchell Amendment failed igniting the biggest corporate mergers in US history. The uninsured were now 36 million. Giant hospital corporations and HMO’s concentrated power. Consolidation of the private health insurance industry occurred. Merger of Met Life and Travelers. Columbia Hospital Corp swallows Galen, HCA and more. Blue Cross / Blue Shield begins conversions from a ‘non-profit’ to for-profit all over the country. Increasing powerlessness of the private practitioner. More than 400 healthcare industry mergers occurred from 1996 – 2010.
1995: California Nurses Association becomes independent of American Nurses Association. This was preceded by several years of ‘staff nurse uprisings’ based on wages, hours of work, and nurse/patient ratio, that ANA leadership resisted. CNA supports single payer.
1996: Labor Party forms holds convention with 1400 delegates. Independent political organization encompassing grass roots unions, some international unions, and many organizations built around survival issues like welfare rights organizations. Democratic Leadership Council implements neo-liberal policies in Democratic Party. The old Roosevelt Coalition is no more.
1998: PNHP/CNA/Labor Party mount Just Health Care Campaign, with Committee of a Million. Publish materials, mobilize and organize. Labor Party does not run its own candidates but does push grassroots agenda for Health Care as a right and for public health insurance/private delivery system. Labor Party 1996-2007.
2003: Medicare Part D passed: pre-HCN significant conference at Howard Univ. brings dozens of healthcare and social justice organizations together.
2003: Congressman John Conyers introduces HR 676: 25 co-sponsors.
2004: RNC in NYC: ‘Healthcare Crisis and Election of 2004”, 8/31 -9/1, 2004. Healthcare-NOW launched (originally called the campaign for a National Health Program).
2005: Rebecca and Bernie walk across NY for Universal HealthCare. Hurricane Katrina strikes the Gulf Coast. Poor people of NOLA abandoned. Charity Hospital closed. Movement to save Charity begins.
Note: The world witnessed the US Government’s abandonment of the people of New Orleans. Many young activists begin to think of ways to build ‘infrastructure’ support for the growing class of dispossessed, disenfranchised and at disconnected from work or social supports.
2006: Day of Action in support of HR 676 – HCN organizes for co-sponsors to Conyers’ Bill. Win-Win Campaign launched – takes cost saving approach for local gov’t under single payer. Truth Hearings launched across the country. Grassroots building for SP. HCN strategy meeting in Chicago – 60 activists attended and Conyers. Massachusetts Health Plan passes.
2007: SICKO Road show. Health policy issues raised again as a presidential campaign starts. First United States Social Forum held in Atlanta with 12,000 grassroots, multi-generational and majority people of color. Health, Healing & Environmental Justice team coordinated workshops, speak outs, healing space, mural, and first aid & comfort for USSF. PNHP and HealthCare-NOW host SICKO showing during USSF. National HCN holds Speak Out at USSF.
Struggle to fight privatization of Grady Hospital. Links between fight for single payer and closure or privatizing of public health facilities made.
November 2007: Chicago National Strategy Conference of Healthcare-NOW
Note: Roughly 48,000,000 people in US now uninsured. ‘Safety net’ shredded. Large unions like the UAW, USW and more have more retirees than employed union members as robotics took those jobs. Retiree healthcare benefits held center stage in contract issues. NNU formed and eventually merged with the AFL-CIO. Initially CNA very strong on single payer but became more muted after the merger with the AFL-CIO. As less as less of the labor force was organized, more inter-union battles, mergers, raiding etc took place.
2008: Days of Action Against Insurance Company Denials – Civil disobedience used as a tactic. Medicare Anniversary Celebrations Nationwide. AMA issues ‘talking points’ for regulating the private insurance industry. Documents that “In 2000 alone, the two largest US health insurers had a total membership of 32 million lives…{by 2008} those same two health insurers now cover 67 million lives and control 36% of market place.” Further, between 2004-2005, there were 28 insurance company mergers valued at $53.8 billion. In sum, there were over 400 insurance company mergers from 1998-2008.
Note: Before the 2008 presidential elections, there were really only two policy pieces out there: “Consumer Driven Health Savings Accounts” and Single Payer.
The former was Wallstreet’s wet dream to get workers’ non-taxable HSA’s for investments – (thought to be biggest boon to banking since 401k’s and IRA’s were force on workers with the demise of defined pension benefit plans). In short, the benefits, securities, expectations, reforms that had been won both economically and politically when industrial production used living labor, were becoming a thing of the past. HSA’s represented the intersection between insurance companies, banks and eventually large corporate hospital chains. While we struggled for Medicare for All, increasingly young folks had no expectation Medicare would not be there for them. Though healthcare in the US has always functioned like a commodity, now that commodity was also tied to financial speculation. The distinctions between non-profit hospitals and for-profit hospitals were largely in name only.
2008: Obama elected after healthcare reform was a huge part of his campaign. HCN Chicago Strategy Conference. Healthcare for American NOW derails polarization between Single Payer and Corporate Health Care (HSA’s) by promoting deceptive case for ‘public option’. HCAN leadership functions as an arm of so-called liberal wing of DP. Win-Win campaign gains steam. Leadership Conference for Guaranteed Healthcare meets in DC mobilizes monthly calls, events, lobby days and forums.
2009: HITECH budget stimulus passed and sets basis for Accountable Care Organizations and the necessity of corporate healthcare to institute Electronic Medical Records.
May 2009: Baucus Hearings – Nurses, doctors, activists, unionists arrested in DC when they interrupt the deliberations and demand that Single Payer be put on the table. The action inspires civil disobedience campaign. 3000 activists come to DC on Medicare Anniversary. Tea Party attacks healthcare ‘reform’ from the right. But their message is against government responsibility for healthcare (even though Baucus/Obama legislation uses government to further enhance role of private insurance industry).
2009: Conyers and Kucinich pull vote on HR 676. Outrages activists – its not ‘their’ legislation to pull. Weiner tries to exclude undocumented from bill.
Fall 2009: Mobilization for Healthcare Reform – multiple national days of action with protests at health insurance companies and civil disobedience, activists locked in Humana headquarters in Louisville, KY for 24 hours.
2010: UAW institutes Voluntary Employee Beneficiary Association (VEBA) – pre-signals the end of health security for unionized industrial retirees.
March 2010: ACA passes. Social motion around healthcare reform fragmented, with many not wanting to challenge Obama and some thinking it’s a ‘step forward’. HCN/PNHP/CNA remain clear that ACA mainly represents corporate control of government rather than government (i.e., the people) control of healthcare.
2010: HCN and more than a dozen health activists organizations participate in a Peoples Movement Assembly process culminating at the Detroit USSF with around 300 people in healthcare PMA. Action also taken against Peterson’s ‘town hall meetings’ in Detroit.
2011: Vermont legislature passes a healthcare plan after massive effort coordinated by the Vermont Workers Center for healthcare as a human right and local PNHP work. The Governor refuses to support the legislation. Mobilization, organization and education focused on Single Payer. Tensions between state single payer work and national single payer afflict movement.
2011: Wisconsin workers and trade unionists takeover state capitol as governor tries to abort public employee contracts including health benefits.
2011: Occupy Wallstreet! Healthcare for the 99% emerges as an immediate link to the Occupy movement. In many cities, Occupy encampments include healthcare tents/medics/nurses/docs – often staffed by PNHP/CNA/HCN activists and others. Atlanta collective develops into Atlanta Resistance Medics.
2012: HCN national strategy meeting in Houston. Sets basis for southern regional network of healthcare activists: Divestment campaign meeting in DC.
2012: Supreme Court upholds ACA but reinforces States Rights by striking down mandated expansion of Medicaid. Mobilizations begin around the south, especially in Texas, to expand Medicaid. Undocumented explicitly excluded from access to healthcare except in an emergency. New forces tentatively emerging.
Note: ACA enshrines the relationship of the government as agent of corporate privatized healthcare. Underlying this is an economic system where labor is increasingly superfluous to production of commodities. Crisis in capitalism deepens and is irreversible. Public hospitals and clinics continue to close or be sucked up into private entities. ACO’s foster mergers and consolidations of healthcare delivery system. Physicians increasingly salaried – demise of private practice. Nursing deskilled. ‘Outcome’ based healthcare projected to become the norm for reimbursement, is now made possible with the decreasing presence of PPO’s and likely the universal decline of employment-based health insurance:
“Fire the patient” who is unable to meet ‘outcome’ based. Quality of care, health and circumstance of patient holds no consideration: only the cost of care. Over 50,000,000 people uninsured. In southern states, 20% and more of the population uninsured. Undocumented completely & ’legally’ excluded.
Final Thoughts: How does this reorganization of healthcare impact what healthcare activists do? Historically, the arguments for single payer minimized the role of government – is that now turning into its opposite as government hands healthcare over to corporations? The technologies that are now available clearly indicate an abundance of resources but the structure of healthcare under capitalism restricts delivery to profits only. How do we transform that? Many leaders have an understanding of what’s happening, but not a unity of strategy – what forum can we use to have that conversation? What do we need to prepare for and how do we organize for universal comprehensive healthcare for all (including the undocumented)?
- *December 2017, Hookworm epidemic again in the Southern United States. United Nations documents that 40-90% of the homes in Lowndes County, Alabama have no safe sewage system.
