Market Mad House

In individuals, insanity is rare; but in groups, parties, nations and epochs, it is the rule. Friedrich Nietzsche

Historical Insanity

The Strange History of Single-Payer Healthcare in America

“Without adequate health care, no one can make full use of his or her talents and opportunities. It is thus just as important that economic, racial and social barriers not stand in the way of good health care as it is to eliminate those barriers to a good education and a good job.” – President Richard M. Nixon (R-California)

Bizarrely, the United States is the only major industrialized nation without a national single-payer healthcare system that covers all citizens.

Instead, America has several separate single-payer systems that cover different classes of citizens. Medicare, for instance, covers senior citizens. Meanwhile, Medicaid covers the poor, and the Veterans’ Administration (VA) covers veterans.

Most Americans, however, receive health insurance through their jobs or buy it. This practice creates the problem of uninsured Americans, people with no health insurance.

What’s Wrong with American Health Care?

The U.S. Census Bureau estimates 28.135 million Americans; or 8.5% of the population lacked health insurance in 2028, Kaiser Health News reports. To clarify the US population in February 2020 was around 331 million and 8.5% of 331 million is 28.135 million.

The uninsured are a problem because most of them have no means of paying for health care in a time of rising health care costs. Healthcare expenditures rose at a rate of 5.6% between 2012 and 2017, the Centers for Medicare and Medicaid report.

Additionally, medical bills are steep even for those with health insurance. For instance, Miami resident Osmel Martinez Azcue received a $3,720 bill for a coronavirus test, Business Insider claims.

Azcue got the bill because his insurance did not cover the test. Thus, Azcue is one of the underinsured Americans who have healthcare insurance coverage that does not cover many expenses.

Advocates; such as U.S. Senator Bernie Sanders (I-Vermont), argue that America needs one single-payer health insurance system for all citizens. Under a single-payer insurance system the government insures everybody and finances the insure through taxes.

Why America Does not Have Single-Payer Health Insurance?

Bizarrely, America still has no single-payer health insurance despite a 120 year battle for the benefit by politicians of both parties.

Some highlights of the long-fight for single-payer health insurance in America include:

1912 Theodore Roosevelt and the Bull Moose Party

In his 1912 third-party presidential run ex-President Theodore Roosevelt (R-New York) campaigned for “universal health insurance.”

Teddy was vague on details but he admired Germany’s single-payer insurance system implemented in 1883. Roosevelt lost the election to Woodrow Wilson (D-New Jersey). However, TR was the most successful third-party candidate in U.S. history.

Running on the Progressive, or “Bull Moose,” Ticket. Roosevelt won 88 Electoral College votes and outperformed incumbent President William H. Taft (R-Ohio). In comparison, Taft won only eight Electoral College votes.

1912-1917 The American Association of Labor Legislation (AALL)

The AALL was a progressive group that wanted America to emulate Imperial Germany’s welfare state. Notably, the AALL drafted model legislation offering $1,200 in insurance coverage to all citizens.

In 1917, the American Medical Association (AMA) House of Delegates voted in favor of the AALL legislation. However, many state medical associations opposed it. Eventually, the AALL collapsed because of opposition from unions and the insurance industry.*

1918 Proposition 20 California Health Insurance

In 1918, the California State Legislature referred Proposition 20 to voters. Proposition 20 authorized the state Legislature to create a state health insurance system.

However, 72.8% of voters voted no to Proposition 20, Ballotpedia estimates. Historians blame anti-German hysteria stirred up by World War I propaganda for the defeat. To clarify, the public associated single-payer with America’s World War I enemy Imperial Germany.

1935 FDR and Social Security

In 1935, the first draft of the Social Security Act contained a national health insurance program. However, President Franklin D. Roosevelt (D-New York) removed health insurance from Social Security because of opposition from the American Medical Association (AMA). Significantly, FDR never made another serious push for Single Payer.

1939 The Wagner Bill

In 1939 U.S. Senator Robert F. Wagner Jr. (D-New York) introduced the National Health Act, popularly known as the Wagner Bill.

The National Health Act provided federal funding for disability insurance, prepaid medical insurance, and hospital construction by the states. Wagner’s hope was that the National Health Act could lead to single-payer. AMA opposition caused the Wagner Bill to die in Committee.

1945 The Warner-Murray-Dingell Bill

In 1945, Senator Warner tried again with a full single-payer proposal. Warner joined with U.S. Senator James E. Murray (D-Montana) and U.S. Representative John D. Dingell (D-Michigan).

The Wagner-Murray-Dingell Bill proposed a medical hand hospitalization insurance program similar to Medicare. The Warner-Murrary-Dingell Bill died in committee because of lack of support.

1945-1946 Earl Warren fights for Single Payer

During World War II, single-payer health insurance found an unlikely champion in California’s Republican Governor Earl Warren.

Warren abandoned Single-Payer after winning reelection in 1946. Instead, Warren concentrated on his 1948 presidential run and Civil Rights as Chief of Justice of the US Supreme Court.

1945 and 1948 Harry Truman Fights for Single-Payer

President Harry S. Truman (D-Missouri) was a strong supporter of single-payer. Early in his administration in 1945 Truman proposed a single-universal comprehensive health insurance plan to cover all Americans. However, the plan had no support in Congress.

Truman persevered, prompting the AMA to charge a $25 fee to each member to raise money fight single payer. Ultimately, the AMA killed Truman’s plan with one of the most successful lobbying efforts in U.S. history. In fact, the American Medical Association spent $1.5 million ($16.06 million in 2020 dollars) fighting Truman’s proposal.*

1965 Medicare and Medicaid

In 1965, President Lyndon B. Johnson (D-Texas) and his allies created a partial single-payer system by making concessions to Republicans and the AMA.

Johnson’s Medicare comprises Part A and Part B. Part A paid for hospitalization for senior citizens. Meanwhile, Part B reimbursed providers for medical services rendered to seniors. The same legislation created Medicaid a federally funded and state-administered health insurance plan for the poor.*

1974 Nixon and Comprehensive Health Insurance

In 1974, President Richard M. Nixon (R-California) proposed his  Comprehensive Health Insurance Plan (CHIP) to Congress. Nixon’s CHIP expanded Medicare and required private health insurance for everybody else.

The CHIP was forgotten when the Watergate Scandal destroyed Nixon’s presidency and forced Tricky Dick’s resignation. Nixon’s CHIP is important, because it was the first effort to get Medicare to pay for prescription drugs.

1993 Hillarycare

In 1993, President Bill Clinton (D-Arkansas) created a Task Force on National Care Reform chaired by his controversial wife Hillary R. Clinton.

The Commission proposed the Health Security Act which offered universal health insurance provided by private health insurance companies. Critics demonized Health Security as “Hillarycare.” Hillarycare also created a national health board and regional health alliances to contain costs.

Health Security died in Congress because of intense opposition from the private health insurance industry. Health Security failed because of its association with the unpopular first lady and lack of popular support. After 1993, Clinton abandoned efforts at health care reform.

2003 Medicare Advantage

In 2003, President George W. Bush (R-Texas) achieved one of Nixon’s goals by signing the Medicare Modernization Act. The Act created Medicare Part D which financed private insurance that paid for basic prescription drugs. Medicare was the largest change to Medicare since the program’s creation.

2010 Obamacare

The Patient Protection and Affordable Care Act of 2010 (AMA) is the most controversial piece of health insurance legislation in American history. Americans call the ACA Obamacare because President Barack Obama (D-Illinois) signed it in 2010.

Obamacare is controversial because of an unpopular mandate requiring individuals to buy health insurance. Additionally, a Medicaid expansion designed to cover the working poor partially failed because 14 states opted out.

The original plans for Obamacare called for a “public option;” a government single-payer health insurance plan all citizens could buy into. However, insurance industry lobbying kept the public option out of Obamacare.

In 2017, Congress killed the insurance mandate by eliminating an income insurance penalty for those without health insurance. Also controversial were government exchanges designed to help citizens buy private health insurance.

Ultimately, Obamacare has been unsuccessful because of intense Republican opposition. However, some of Obamacare is still on the books.

2016 and 2020 Bernie Sanders and Medicare for All

In 2016 and 2020 insurgent presidential candidate U.S. Senator Bernie Sanders (I-Vermont) made single-payer a nation issue with his Medicare for All scheme.

Essentially, Medicare for All eliminates all private health insurance and replaces it with a single federal insurance plan based on Canada’s Medicare system. Sanders’ popularity, he won 1,831 delegates in the 2016 Democratic Presidential Primary and 3.642 million votes on Super Tuesday 2020.

In response, Sanders’ rivals; such as Joe Biden (D-Delaware), support the “Public Option.” Under the Public Option, the government offers single-payer to citizens besides private health insurance. I think the Public Option is single payer because it gives all citizens the ability to choose government health insurance. Since the government option will be cheaper, most citizens will chose the public option.

Therefore, Single-Payer Health Insurance is a major part of American political discourse and will remain so. However, creation of a national U.S. Single-Payer System is unlikely without dramatic changes in America’s political landscape.

What America’s Single-Payer History can teach us

America’s Single-Payer History teaches one lesson: determined minorities can thwart popular reform efforts.

Similarly, the health insurance industry’s lobbyists kept the Public Option out of Obamacare. Since 2010, the insurance industry has blocked the implementation of much of Obamacare. Likewise, some critics blame insurance industry money for Sanders’ recent setbacks in the Democratic Presidential primary.

Single-Payer will remain a dream in America until its advocates learn how to overcome determined minorities.

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