Dreams deferred

line of school children to get on bus
CDC/Reuel Waldro

Women and children wait for and receive vaccinations in a housing-project mobile clinic, 1972

Not until the twentieth century, when medicine emerged as an effective tool for curing diseases and extending life, did Americans begin pushing for that fundamental—and, so far, elusive—goal of health care for every citizen. In his new book, Penn State history professor Alan Derickson charts the diversity of proposals that union organizers, social scientists, progressive politicians, civil rights activists, and health care professionals have put forth over the last 100 years, all aimed at ending what Derickson terms "a tragedy of human sacrifice" caused by a lack of universal health care.

An early proponent was Charles-Edward Winslow, chair of the Department of Public Health at Yale, who wrote, "I look to see health centers, local district foci for the coordination of every form of health activity, scattered through our cities, as numerous as the school houses of today." During Franklin Delano Roosevelt's administration, Martha Eliot of the Children's Bureau pushed for federal grants to enhance access to care; individual states would have the option of offering health insurance, public medicine, or both. In 1958 Eliot—by now a professor at Harvard—urged organized labor to make universal health care a priority, again to no avail.

When running for president, Jimmy Carter pledged to deliver national health insurance, but once in office he delayed developing a concrete plan, afraid that the added expense would fuel inflation. He finally proposed insurance against catastrophic illnesses and injuries, plus universal services for babies and mothers, but more-liberal opponents wouldn't sign on to what they considered an inadequate program. Concludes Derickson, "The dark side of zealous commitment to the cause, irrespective of expense, [has been] an inability to compromise on grandiose visions of transforming health care."

Bill Clinton tried to reorganize the delivery and financing of health services through a centrist approach that would have blended marketplace forces and federal intervention. (Derickson describes the plan as "exceedingly complex.") Clinton and his wife Hilary Rodham Clinton, who chaired the White House task force on the issue, understood that ours "is a society distrustful of government," writes Derickson, "and in which the insurance industry and other conservative interests wielded great influence"—influence that ultimately derailed the reforms, even though Clinton expressed a willingness to compromise by accepting legislation that would have fallen short of universal protection.

Derickson suggests that wealthy, insured Americans may need to suffer illnesses from diseases transmitted to them by uninsured persons in the service occupations before the upper crust gets get involved in the difficult work of forging a health care system for all. In the meantime, the United States lacks "one of the essential elements of a humane society," avers Derickson, as it remains "the only affluent nation in the world that does not guarantee its citizens access to basic health care."

Alan Derickson, Ph.D., is professor of American history in the College of the Liberal Arts, 311 Weaver Building, University Park, Pa 16802; 814-863-7303; avd3@psu.edu. Health Security for All: Dreams of Universal Health Care in America was published in 2005 by Johns Hopkins University Press. Charles Fergus is a freelance writer in Vermont and a former staff writer and editor for Research/Penn State.

Last Updated August 11, 2006