As another infectious disease reshapes American life, is now the time for this century-old argument to finally convince Americans that collective health security benefits everyone? I called up Beatrix Hoffman, a historian who has written about health care social movements in books including The Wages of Sickness: The Politics of Health Insurance in Progressive America and Health Care for Some: Rights and Rationing in the United States Since 1930, to talk about the precedents. Our conversation has been edited and condensed for clarity.
Slate: I’ve seen a lot of people online making the point that the coronavirus is a good argument for social programs like “Medicare for All” and paid sick leave. I was very curious to know more about other times this argument might have been made, in connection with other infectious diseases.
Beatrix Hoffman: Yes, what you’re describing has come up a lot in the last century. But when you ask me, has the United States ever expanded services based on this argument that epidemics can affect everyone? My answer is, the argument has been made, but it has not been successful. There have been a few times when it’s been partially successful, but it’s mostly been a losing argument, because of our political culture and the forces against universalism.
But yes, in the Progressive Era, this argument was floated a lot by people proposing health coverage and paid sick leave. This was the movement for compulsory health insurance, which overlapped with the public health movement, but was more in the spirit of some of the Progressive Era reforms that were successful, like workmen’s compensation.
It’s so interesting that this is coming to the fore again, because the compulsory health insurance movement was actually more about sick pay than it was about health care. That’s because early-20th-century medical care just wasn’t all that expensive, and it wasn’t all that effective. So the main concern of workers—and this was a movement by, and on behalf of, working people—was that when they got sick, they didn’t get paid. Sickness could lead to poverty; sickness was terrifying for that reason, as well as the physical reason.
Were they making the argument to elites that they should care—if not out of charity for their fellow man, then at least out of self-protection?
Yes, people did make that argument. There was something called National Negro Health Week, a public health movement spearheaded mostly by African American women in the South around the turn of the century. They had a slogan: “Germs know no color line.” The argument was, OK, you don’t care about us, but if our communities get sick, then yes, it can spread to more affluent communities. It was a very calculated way for them to bring in the self-interest of elites, to get them to provide more funding for sewer and water facilities in poor neighborhoods.