Ever since the fatal shooting of United Health CEO Brian Thompson, the whole issue of the ridiculous unaffordability of health care and the capricious, cavalier attitudes of health insurers has been much on people's minds here in the United States. Around ten percent of Americans have no health insurance at all, meaning they are one health crisis from bankruptcy -- and very likely to forego medical care completely for anything that isn't immediately life-threatening. Many others are woefully underinsured.
Of the twenty-five wealthiest nations in the world, only three -- Qatar, Saudi Arabia, and the United States -- do not have some form of government-paid health care for all citizens. With regards to human rights, not really the company we want to be keeping, is it?
As far as the other wealthy nations go -- well, allow me to cite just one example.
My writer friend Andrew Butters, who lives in Canada (and has given me permission to relate this story), went through the agonizing experience of having his daughter develop a devastating medical condition -- progressive scoliosis. The disorder was inevitably leading toward debility, nerve and organ damage, and ultimately would have been fatal without significant (and urgent) medical intervention. Eventually she required twelve hours of surgery, a long hospital stay, and extensive care for months afterward, but made a complete recovery and is now a healthy and happy adult.
The family paid less than $2,000 out of pocket total. In fact, out of gratitude to the Canadian health care system, Andrew wrote a book about the experience called Bent But Not Broken (highly recommended reading, it's incredibly inspiring) and is able to donate every cent of the proceeds to charities helping other parents in similar situations.
In the United States? Even with health insurance, this exact same situation would have created massive medical debt they'd be paying off for decades. For many families, it would have permanently destroyed them financially.
The fact that the other twenty-two wealthiest countries in the world are making health care for all work, and we're not, seems to indicate that we could be doing this, but we just don't want to. So why is that? How did all the others come to look upon health care as a right, not a privilege restricted to the rich, and we didn't?
Well, allow me to introduce you to Frederick Ludwig Hoffman.
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Hoffman was born in 1865 in the town of Varel, Oldenburg, Germany. His performance in school was rather dismal, and ultimately he realized he wasn't going to make a decent living in Germany, so he emigrated to the United States in 1884, where shortly afterward he was hired as a statistician for the Prudential Insurance Company of America.
Around this time, African Americans were gaining ground in terms of rights and opportunities, and Hoffman thought this was just terrible. He was convinced that Blacks were genetically inferior -- not only less intelligent and more prone to crime, but had shorter life spans and more health problems. That the last-mentioned had to do with mistreatment, poverty, poor nutrition, and lack of access to medical care, didn't seem to occur to him. But he saw other countries moving toward considering good-quality medical care to be a right; in fact, his native Germany instituted a national health care program in 1885. Despite the inherent immorality of forcing sick people to pay, as if becoming ill was somehow their fault (or a choice at all), Hoffman was appalled at the thought of this becoming policy in the United States. He realized that if this happened here, wealthy White people would be shouldering the financial burden of paying for the health care of poor Blacks.
And we couldn't have that.
He wrote a book called Race Traits and Tendencies of the American Negro which was a mishmash of huge amounts of statistics on illness and death rates, along with a heaping helping of racist tropes, eugenics, arguments against miscegenation, and deliberate avoidance of any mention of the role of social status and environment in human health. Of course, it played right into the panicky bigotry of the time, not to mention the greed über alles attitudes of the people in charge (remember, this is the era of the Robber Barons). So rake in the profits and simultaneously make life miserable for Blacks?
Prudential, and other insurance companies, said, "Hell yeah, sign me up!"
Megan Wolff, in the journal Public Health Reports (link provided above), writes:
Insurance is a highly lucrative business, and in the latter 19th century it factored among the biggest, fastest-growing, and most aggressive corporate entities in existence. Between 1860 and 1870 alone, the number of policies active in New York State jumped from 50,000 to 650,000; by 1868 the sum of insurance throughout the nation exceeded the national debt. Cutthroat business practices guided corporate policy. By the mid 1870s, the three largest companies—Metropolitan Life, the Equitable, and Mutual Life—had expanded into a corporate oligopoly that dominated sales in the cities of the northeast United States and maintained an impressive reputation worldwide...
The relatively equal access of African Americans to main-line industrial policies came to a halt... when Prudential announced a decision to reduce life benefits to African Americans by a third, though they would continue to pay the same premiums. Citing elevated mortality rates among Blacks, the company insisted that its decision was “equitable” and based “solely on the basis of facts.” Some evidence suggests, however, that the prospect of Black policyholders simply had not occurred to commercial insurers when they launched their industrial policies—at least not in the volumes with which African Americans applied for coverage—and the reduction of benefits was a response to an unanticipated and socially undesirable demand.
There was some effort by states to institute anti-discrimination laws regarding insurance, but Prudential trotted out Hoffman, who was happy to explain his reasoning (backed up, of course, by plenty of statistics). Few White lawmakers felt all that inclined to argue on the behalf of poor Blacks, who after all had no legal clout, and in fact very little say in anything.
Hoffman, on the other hand, became an overnight celebrity. In 1901 Prudential started its Department of Statistics -- what we would now call the actuarial department -- with Hoffman at its head. There's some evidence that his views softened toward the end of his life (he died in 1946), and that he eventually acknowledged the role of social stratification in Blacks' lower life expectancy and higher rate of health problems, but by that time the damage was done. The corporate control of medical care in the United States was already set in stone, and that was largely due to Hoffman's tireless efforts to prevent African Americans from having health and life insurance.
And as we've seen over and over, once the corporations see a profit to be made, there's no power on Earth that can stop them from doing whatever it takes to achieve it, even if they leave thousands of dead bodies in their wake. In what kind of crazy, bass-ackwards system can your doctor say, "You must have this treatment or you won't recover," and the insurance company gets to say, "Nah, you don't really need that"?
Not that it's likely to improve under the incoming administration, which puts corporate profit above anything else. So we've got at least another four years of poor people going broke because they had the audacity to get sick at the wrong time.
And it all traces back to the specious research of a racist German statistician who told the insurance companies and other business leaders exactly what they wanted to hear. The wealthy then twisted the arms of the elected officials -- as they still do -- and the result is an inherently unfair pay-or-die system that is nearly unique amongst industrialized countries.
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