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So Is Health Care for All Really Un-American?

Many countries have devised solutions to the most pressing problems we face in health care today – overwhelming costs and large numbers of uninsured and underinsured persons.  President Obama has made it clear that the only politically viable possibilities for reform in the United States must be consistent with traditional American ideals and practices.  Opponents of the “public option” have underscored this point in recent weeks, claiming that the plan would violate “market freedoms” and place  government bureaucrats in the middle of the private relationship between patient and physician.  Such a plan, they say, is un-American.

Despite such rhetoric, there is, in fact, a long history in this country of government provision for the sick.  Well before the arrival of Medicare and Medicaid in the 1960s and Social Security in the 1930s, Americans counted on government in times of extreme need.  As it turns out, the role of government in providing for the destitute poor reaches back to the founding itself.

Governing bodies at all levels in early America – from towns and parishes to provincial and state governments -- concerned themselves with the plight of those laboring under misfortune, including most especially the sick poor.   Illness was a common, wrenching experience in daily life, descending in the form of violent epidemics of smallpox, measles, and diphtheria; acute bouts of fever and flux; and numerous chronic infirmities.  The appeal to government was not the first resort for the sick and those attending them, to be sure. Families and neighbors tried their best to take care of their own.  Churches collected money for the most afflicted in their midst.  Benevolent members of the elite engaged in individual acts of charity, and medical charities, such as hospitals and dispensaries, were put into place from the middle of eighteenth century onward. But none of these measures was enough to provide for the ongoing, pervasive, and unsettling effects of living in a world in which any given individual or family might be devastated by illness.  For that, public aid was essential.

The impulse was especially strong in New England, where the commitment to the poor was part of a larger vision of community life.  We hear (particularly around election time) politicians talk about America as a “city upon a hill.”  Historians know that the words are drawn from John Winthrop, first governor of the Massachusetts Bay Colony, who preached them as a lay sermon in 1630 as he sailed to America.  Winthrop’s message had less to do with celebrating individual liberties than with encouraging community obligations.  He insisted that in a godly community “the care of the public must oversway all private respects,” with members “knit together” through an abiding interest in each other’s “every want or distress.”  Care for the poor, including the destitute sick, was part of this vision.  Towns were obligated to provide for legal inhabitants who fell upon hard times, paying for their care with local taxes.  In some cases, family members or other town residents were given allowances for medical care and other necessaries; in others physicians or other healers were hired by towns or paid directly for their individual services.

Higher levels of government were involved in providing assistance as well.  When individuals and towns were rocked by the calamities of early modern life, they petitioned their legislatures for help.  Legislatures fielded an astonishing range of petitions: sick soldiers asking to be compensated for medical bills that they paid out of pocket and by veterans and their families tending the wounded and chronically ill; towns reeling in the wake of epidemics that not only sickened their inhabitants but ruined local economies; immigrants and other “strangers” who fell upon hard times and those who cared for them.  Personal stories of anguish were assigned to committees, heard by individual legislators, and read before the assembly as a whole.  The assumption was that there was no great gulf separating society and government: as protectors of the people, and as persons well-versed in the trials of everyday life, the people’s governors were asked to provide a wise and sympathetic hearing and make financial allowances to ease suffering.

We need not glamorize this earlier world.   The costs could be considerable, and it is not surprising to find tensions.  Family squabbles over who should care for elderly parents, or between towns insisting that they had been unfairly saddled with bills that belonged elsewhere, could find their way into courts.  And later critics charged that the care afforded the sick poor could be so spare as to be cruel. 

But it is hard to view our founding generation without admiration for their attempts to care for the sick. They faced issues that are all too familiar to us – the sudden, unexpected dislocations of acute disease;  the enormous financial and social costs of caring for the chronically ill – and they did so squarely and resolutely.  They understood the province of affliction in daily life, and they did not trivialize its hold on everyday affairs.

Whatever the merits of recent objections to the public option, it is simply untrue that the plan is un-American.  We have only to turn to our founding generations to see that government provision for the sick is health care in the American grain. Despite significant differences between the size and scope of government in early America and today, both have been animated by a common principle: that self-government  includes the power, and the responsibility, to take care of ourselves and each other. 

This p[iece was first published by The Oregonian.