VILIFYING “SOCIALIST” MEDICINE
Emily K. Abel
Krista, a photographer and videographer in Santa Cruz County, California, told a Los Angeles Times reporter that her insurance premium rose from $285 a month to more than $1,000, the result of the loss of her subsidy for the American Care Act (ACA) combined with an increase in her Blue Shield premium. She finally found a plan with a $522 monthly premium and a $5,000 deductible. She would have chosen a cheaper plan had her treatment for a rare blood disease not cost $30,000 a month.
KFF, a health news site, discussed John Galvin. Although he needed a colonoscopy, he was waiting to schedule it until his 65th birthday when he would qualify for Medicare. His ACA insurance premium had tripled to $2,460; his deductible had risen to $2,700.
On May 1, 2026, The New York Times reported that approximately 20 percent of enrollees in ACA plans are expected to lose coverage.
Why do these stories keep coming? The most immediate reason, of course, is that congressional Republicans refused to extend the ACA subsidies established by President Biden during the pandemic. The larger issue is that we lack a right to health care. Although the 1986 Emergency Medical Treatment and Labor Act requires hospitals to provide stabilizing treatment to everyone seeking care in the ER, the United States is virtually the only high income country without universal access to ongoing care for both acute and chronic illnesses.
When I used to ask my public health students why that is the case, they invariably responded that we are not a socialist country. When I pointed out that every child in the US has a right to education, they were stumped.
Unsurprisingly, racism was a major factor in preventing the US from guaranteeing a right to health care. A critical reason President Franklin Delano Roosevelt did not include a national health plan in the New Deal was that he needed the support of southern Democrats in Congress, who feared that such a plan would undermine segregation. (The New Deal policies that Congress accepted were designed to exempt workers in jobs held overwhelmingly by African Americans, such as domestic service and farming.)
The weakness of the US labor movement also helps to explain the nation’s unique arrangement for health care financing. In Europe, political parties aligned with the working class successfully fought for a wide range of social benefits. But in 1915, when the American Association for Labor Legislation (AALL), a progressive organization, proposed compulsory health insurance for low-waged workers, Samuel Gompers, the president of the American Federation of Labor, condemned the plan as “a menace to the rights, welfare, and liberty of American workers.” In 1938 organized labor finally reversed its stance. At a government-convened conference, union leaders finally acknowledged that health care should be guaranteed as a fundamental right. But the labor movement in the US never became the commanding presence it was in Europe and thus could not move the government to action.
When World War II began, labor unions supported the growth of job-based health insurance. Because the government imposed wage controls to prevent inflation, unions began to bargain for fringe benefits instead. Employment-based health insurance became especially attractive in 1943, when the IRS ruled that payments for health insurance were exempt from federal income taxes.
Physicians mounted the fiercest opposition to national health insurance. Even the establishment of the nonprofit Blue Cross and Blue Shield companies in the 1930s so alarmed the American Medical Association (AMA) that it declared, “No third party must be permitted to come between the patient and his physician in any medical relations.” Like the labor movement, the AMA began to alter its position on health care in the late 1930s, but the organization never went so far as to agree that everyone has a right to health care. Realizing that opposition to all health insurance was futile, the AMA decided to support voluntary plans--so long as they did not interfere with the physician/patient relationship.
The greatest threat to physicians emerged after the end of WWII, when soldiers returning from saving democracy abroad wondered why the values they fought for did not extend to the US. In 1945 Truman became the first president to propose universal health insurance. In words that might have enlightened my public health students, he stressed that “the health of American children, like their education, should be recognized as a definite public responsibility.” A week after Truman submitted his bill to Congress, Morris Fishbein, the longtime editor of the Journal of the American Medical Association, condemned the bill as embodying the worst elements of “socialized medicine.” The AMA warned that “Armageddon” had arrived.
Because Truman’s bill enjoyed widespread popularity, the AMA retained the first political public relations firm, Whitaker and Baxter, to aggressively campaign against it. The firm charged a hundred thousand dollars a year; the annual operating budget for the campaign against health insurance exceeded a million dollars, an astronomical amount in 1945. The AMA raised the funds by assessing its members a fee of twenty-five dollars a year.
Whitaker and Baxter’s crusade probably did more than anything else to cement the idea in the American mind that national health insurance was tantamount to socialism. An initial plan for the campaign read in part that the “immediate objective is the defeat of the compulsory health insurance program pending in Congress” and that the “long-term” objective is to put a permanent stop to the agitation for socialized medicine in this country.” Speaking before two hundred New England doctors, Whitaker stated, “Hitler and Stalin and the socialist government of Great Britain all have used the opiate of socialized medicine to deaden the pain of lost liberty and lull the people into non-resistance. Old World contagion of compulsory health insurance, if allowed to spread to our New World, will mark the beginning of the end of free institutions in America. It will only be a question of time until the railroads, the steel mills, the power industry, the banks and the farming industry are nationalized.”
After persuading a hundred members of Congress to allow him to read their constituents’ mail, Whitaker reported that at the start of the campaign, the mail “was running four and half to one in favor” of Truman’s bill. “Nine months later it was running four to one against.”
When Truman’s plan went down in defeat, he erupted in fury, telling reporters that there was “nothing in this bill that came any closer to socialism than the payments the American Medical Association makes to the advertising firm of Whitaker and Baxter to misrepresent my health program.”
As the AMA’s power gradually diminished in the late 1950s, insurance firms and employers took up the mantle. They were successful for nearly sixty years, lobbying so successfully against President Bill Clinton’s health plan that it never reached a vote in Congress.
Then, in 2010, almost a century after the AALL first proposed health reform, Congress passed the ACA during the Obama administration. To hear Republican denunciations of the act, one might think that socialism had arrived. Far from ushering in socialized medicine, however, the ACA is consistent with the nation’s capitalist and individualistic political culture. It is a market-based program relying on private insurance companies. Although the act expands access to healthcare, it fails to provide universal coverage. Nevertheless, since its passage, Republicans have tried to repeal or defund the act sixty times. The government’s failure to extend the subsidies is only the latest assault.
Even my students eventually acknowledged that the right to healthcare is NOT un-American. Somehow we have to convince the rest of the population.
Sources:
David Rothman, “A Century of Failure: Health Care Reform in America,” Journal of Health Policy Politics, Policy and Law, 18, no. 2 (1992): 273.
Jill Lepore, “The Lie Factory,” New Yorker, September 17, 2012.
Nancy Tomes, Remaking the American Patient: How Madison Avenue and Modern Medicine Turned Patients into Consumers (University of North Carolina Press, 2016).
Paul Starr, The Social Transformation of American Medicine: The Rise of a Sovereign Profession and the Making of a Vast Industry (Basic Books, 1982).
Meg Tanaka and Melody Petersen, “When a Doctor Visit Is Out of Reach,” Los Angeles Times, February 7, 2026.
Sam Whitehead, “Rising Health Costs Push Some Middle-aged Adults to Skip the Doc until Medicare,” KFF, March 23, 2026.
Reed Abelson and Margot Sanger-Katz, “Since Congress Let Obamacare Subsidies Expire, Millions Are Dropping Coverage,” New York Times, May 1, 2026.