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How do we talk about a right to health care in the U.S.?

October 14, 2010




img_53991It was little more than a decade after the Constitution was adopted when the U.S. Congress debated a role for the government in providing health care for some U.S. citizens. It was argued that when merchant seamen, who acted on behalf of the welfare of all U.S. citizens, became ill and/or disabled, it was only “just” to pay for their health care. In accord with this premise, Congress passed an act to provide for merchant seamen’s medical care in 1798. Congress used the authority of Article I, Section 8 of the U.S. Constitution to support this policy. It empowers the federal government to regulate commerce with foreign nations and to tax for the general welfare as a means to that end.



So–the health and well-being of individual seamen was not the argument used to support a role for government. The need for a government role in health and health care resided in a focus on commerce. If the seamen could not do their jobs, it could harm the nation’s commerce. Other early federal debates led to the provision of health care to the armed forces. It was argued that a healthy army and navy were necessary for national defense. Then, in the first two decades of the 20th century, middle class progressives realized that the American industrial society’s working-class citizens suffered ill health and injury, affecting their ability to work–harming the nation’s productivity levels. 




Workplaces were often unsafe, causing injury to workers and their ability to work. In recognition of these facts, a number of economists formed the American Association for Labor Legislation (AALL) in 1905 for the purpose of studying labor conditions and labor legislation. The group advocated for health reforms in industry and sought compulsory health insurance. Initial efforts to argue the merits of such legislation focused on workmen’s compensation. This strategy aimed to provide access to care for workers injured on the job. Woodrow Wilson joined the AALL. He included their social insurance plank in the 1912 Progressive party’s platform. In 1915, they published a model health insurance bill in legislative language to be considered by State legislatures, with California, Massachusetts, and New Jersey supporting the proposal out of the 12 States that discussed it.



As debate continued within the States, so did opposition to a proposal for government health insurance. World War I produced the War Risk Insurance Act that established a comprehensive system of benefits for servicemen and their dependents. A broader policy was defeated, however, with AALL leaders naively assuming that such reform would be viewed as beneficial to all.



Once access to health care is argued around the role of commerce, the challenge becomes how to separate whose ill health and injury would not fit within that realm. If each citizen who works–and this includes those who work inside the home to enable others to work outside the home–contributes to the economy, then the argument appears to support the need to guarantee health care for all. Children will be the next generation of ‘workers’, so their care should be supported as well. 



The Congressional Committee on Costs of Medical Care in 1927 proposed Health Maintenance Organizations [HMOs] as a strategy aimed to provide affordable health care to all citizens. A minority report written by doctors and adopted by the American Medical Association took the position that HMOs would hurt the quality of health care. As a result, the Committee’s recommendation was not seriously considered. Congress, however, initiated a program to cover its own members’ health care. And so, talk about a right to health care in the U.S. a century ago…not very much different from talk about a right to health care in the U.S. today. 


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Author: Roxanne

I have always loved to learn. After years of trying to pick a major as an undergraduate, I met a professor who guided me to graduate school. And from graduate school, I learned that I could always go to school and keep on learning. And so I have...

2 thoughts on “How do we talk about a right to health care in the U.S.?”

  1. I am shocked at Americans ruthlessness in not honouring basic health care and the extortion of business and doctors with their vunerable. The need for a system that provide a safety net of wellbeing and health. This provides safety in the community and an ability to maximise function and health in the work force increasing productivity with out the social disruption caused by illness to the family. The skewed distribution of resources seems to be a historical belief from slavery times where all people worked, but one group or family reaped the benifits and the others died and/or lived impoverished lives.
    The principles of democracy seemed skewed only the powerfull and monied have a voice in politics. The world is now paying for the debts through the economic crisis, to give the poor housing rather than fair distribution of resources allowing the poor housing and health within their fiscal system.
    The minimal wages paid outside the country for good and services is a different for of enslavement to accommodate the greed of a group. Wellbeing seems to imply the group not just the individual If health issues occur through . It does not have to be socialism but capacity to pay for social capital has to be factored into a wage structure as we exchange money for good and services The economic policies seem to be bent on screwing people
    rather than developing them. Investment in children is critical for the future including their wellbeing. America once had ideals from someone watching on the outside greed
    not development seems to be the mantra and this is toxic to health.

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