The U.S. Senate’s failure to either repeal or repair the Affordable Care Act (Obamacare) means that the existing law, its strengths and flaws, will be around for the immediate future. A half-century ago, President Lyndon Johnson signed amendments to the Social Security law that the then Democrat-controlled House of Representatives and Senate passed with large majorities. Thus, Medicare became the law of the land in 1965 for Americans 65 and older and Medicaid for the very poor. It was a single payer system of what was then called “socialized medicine.”
The first enrollee for Medicare was former President Harry Truman. Truman had initially promoted health insurance for all in 1945 and 1949 as had President Franklin Delano Roosevelt before him and President John F. Kennedy after him. So it took decades to get health insurance for the elderly.
For those under the age of 65, however, health insurance was largely managed by private companies with prices set by the market. Even though most democracies in the world already had national insurance for all, the plans were funded differently (e.g., Britain, Netherlands, and Australia). Not until 2010–nearly a half-century later–when President Barack Obama signed the Affordable Care Act did the U.S. provide ways for millions of uninsured Americans under 65 to get health insurance.
The Affordable Care Act aimed at the 48 million Americans without health insurance in 2010. That number of uninsured Americans fell to 28 million in 2016, a drop (the highest ever) from 18 percent to 10 percent uninsured. Uninsured poor Americans in 31 states got Medicaid. Still there were defects in Obamacare that both Democrats and Republican legislators saw needed correcting.
Neither the bill passed by the House in 2016 and the bills that failed in the Senate in 2017 corrected the major flaws and even threatened to double the numbers of uninsured. With the recent Congressional debacle over health care bills, Obamacare remains intact but still millions of Americans under the age of 65 cannot afford market-driven prices for insurance.
To recap then: between the mid-1930s to 2017, nearly nine decades, old and young, economically comfortable and poor Americans have slowly gained health insurance in increments but Medicare for all or universal health care–is still in the distance. Although a majority of Americans polled (53 percent) say they want a single-payer plan, that would take a unified U.S. Congress and a determined President who could shove that ball yard-by-yard over the goal line. When that will happen, I surely do not know.
Affordable health care covering all Americans is, I believe, similar to the slow but steady incremental progress of tax-supported public schools that moved from private tutors, tuition-paying academies, and “Dame schools” in the 17th and 18th centuries to property owners being taxed, voters authorizing the “common” public school before the Civil War, and states later passing compulsory attendance laws in the late-19th and early 20th centuries (see here here, and here). Today, free public schools in the U.S. enroll over 50 million children and youth between the ages of 4 through 17 (depending on the state) in over 13,000 districts housing over 100,000 schools. The process of insuring that all boys and girls will go to school took many decades just as health care has in the 20th and early 21st centuries.
This is the analogy I use in this post. But historical analogies are dicey.
Uses of the Past
When policymakers, practitioners, and public school students ask about the usefulness of history they want guidance from the past to avoid making mistakes now; some even want predictions. Invariably, historians disappoint them.
Most historians believe that the past can surely inform current policy but extracting direct “lessons” and making confident predictions, while playing well on cable news, last little longer than the 24-hour news cycle and are often, there is no other word, wrong (see here and here).
So historians of education, for example, (and I include myself in that group) argue that even if “lessons” cannot be extracted from the past, policymakers and practitioners can surely profit from looking backward when, say, earlier generations of well-intentioned reformers worked hard to improve schooling. These scholars say that they can aid contemporary policymakers by pointing out similarities and differences between previous and current situations (i.e., analogies). Finally, historians can alert policymakers to what did not work, what might be preferable and what to avoid under certain conditions.
In historians offering their knowledge of how previous generations approached the problems of the day and crafted solutions, they can inform contemporary, serious reformers as they wrestle with a different context from their cousins a half-century to century ago.
The Spread of Tax-supported Public Schools
Beginning in colonial years, proceeding through the Revolutionary decades and responding to the social and political reform of the early 19th century, funding public schools in a mostly rural nation was seen as crucial to the political, social, and cultural health of the new nation. Reformers such as Thomas Jefferson, Horace Mann, and Noah Webster in these years spoke often of creating Americans who knew and performed their civic duties, understood the Bible, could read and write to get jobs, improve their moral character, and create a republican society that Americans prized. Yes, more than two centuries ago, there were multiple (and conflicting) purposes for schooling the young (see here, here, and here).
Slowly, the idea of tax-supported public schools took hold in New England spread to the Midwest but barely penetrated the pre-Civil War South. In rural and urban areas, primary and grammar schools grew. After the Civil War, more and more parents voluntarily sent their sons and daughters–racially segregated, however, by law until the 1950s–to school (see here and here).
Not until the early decades of the 20th centuries had all states passed Compulsory attendance laws mandating parents to send their children to school. The ever-shifting but crucial purposes for schooling the next generation in a democracy required everyone to pay taxes and send their children to school.
By the middle of the 20th century, kindergartens, junior high and senior high school had been added to the age-graded elementary school. Increased graduation rates meant that the high school diploma became common. While the purposes for public schooling shifted from time to time (e.g., dropping Bible study, increased attention to job preparation) and while a private school K-12 sector grew slowly–about 10 percent of public school enrollment now–going to school became the dominant experience for children and youth.
By the end of the century, reformers called for all students to go to college (although most of higher education both public and private required families to pay tuition) bringing into daily conversation the question of whether youth would go 16-plus years to tax-supported institutions.
The point of this brief sprint through history of tax-supported schools and their purposes in a democratic society is that much time was taken and incremental steps occurred to make tax-supported public schools a virtual right for every U.S.family.
I believe a similar process is at work in providing universal health care as well.
*I thank Beverly Carter for suggesting this analogy.