At the beginning of the 20th century, British health care was in shambles: fragmented, inadequate and largely propped up by private philanthropy. In 1911, the liberal government introduced the National Insurance Act, but it was very limited and covered only workers, not their dependents.
When the Labour Party ascended to power in 1945, its health minister, Aneurin Bevan, was prepared to defend a new system of health care provision that was opposed, in his words, to the “hedonism of capitalist society.”
Described as a “squalid nuisance” by Winston Churchill and a “medical Führer” by the British Medical Association, Bevan laid out clear principles for the creation of the National Health Service that were built neither around apolitical concerns about economic efficiency nor technocratic concerns of functionality. By funding health care through general taxation and making it free at the point of service, the primary goal behind the NHS was to abolish class privilege in health care.
In a leaflet distributed shortly before the NHS opened, the service was described as a program whereby: “Everyone ― rich or poor, man, woman or child ― can use it or any part of it. There are no charges, except for a few special items. There are no insurance qualifications. But it is not a ‘charity.’ You are all paying for it.”
These last two sentences capture the central vision of the NHS: social solidarity, not charity. The program required an equal liability for all to contribute and promised health care to all according to need.
Yet it was not won merely by the moral force of a just vision. Bevan was a Welsh miner who was active in the labor movement before taking his government post, and he knew well that the abolition of class hierarchy in health care needed the political impetus of a mass movement. It was only by riding the wave of Labour’s electoral victory in 1945 that he was able to fend off the business classes to provide free health care to the entire British population.
A Tale Of Two Countries
In 1943, and then again in 1945, U.S. Sen. Robert Wagner (D-N.Y.) introduced a bill that would have established a single-payer insurance system and proposed the nationalization of hospitals and clinics alongside direct public investment in medical schools.
The bill failed, and the reason is simple. As opposed to the European ruling classes, which emerged from the war discredited politically for their association with fascism and debilitated economically, American capitalists emerged triumphant ― their firms were more profitable than ever and their political legitimacy restored.
And while the British working class came out of the war with a powerful cultural and social sense of solidarity, with an ascendant Labour Party promising to usher in a new era of what Bevan called “real socialism,” the American labor movement suffered a coordinated and powerful postwar assault from the business community.
American business elites alongside pharmaceutical companies and medical associations were determined to crush the rising power of the working class, which sought to extend and deepen President Franklin Roosevelt’s New Deal. The Chamber of Commerce and the National Association of Manufacturers teamed up with the American Hospital Association and the American Medical Association to launch an all-out offensive against health care reform.
The failure to achieve universal health care was softened by the apparent success of the postwar compromise. The spread of Fordist mass manufacturing practices, stabilized by increased government spending, meant better conditions for the working class. But this temporary situation was predicated on the suppression of militant working-class politics, the corresponding growth of “business unionism” (a union mentality friendly to the bosses), and resigned acceptance of the ruling class’s obsession with preventing the passage of social health insurance.
Instead of a single social insurance system, the United States built a multi-payer, employer-dictated commercial insurance system, and as a result, the U.S. spends about three times per capita more for health care than other industrialized nations, including the U.K., and yet the U.S. maintains some of the worst health outcomes among rich countries.
To cover the $20 million-a-year salaries of health insurance CEOs and the record profits of their companies, Americans are forced to deal with a fragmented, alienating system that is increasingly providing less care for a greater cost.
In 2017, the U.S. think tank The Commonwealth Fund ranked the NHS as the best, safest and most affordable health care system of 11 wealthy countries. The U.S. came in at the bottom.
However, the NHS is struggling. The Conservative Party ― which Bevan described as ”lower than vermin” ― was dead set from the beginning on undermining the NHS. The austerity measures of successive Conservative governments, and also the “third way” Blair-ist Labour Party, has crippled what is at root an effective and economical system.
Though not quite as devastated as the American health care system, the NHS has not been immune from the storm of neoliberalism.
The Politics Of Solidarity
Thankfully, there are hopeful signs in both countries of the rise of the politics of solidarity.
In Britain, junior doctors, nurses and hospital staff have protested wage levels and working conditions, and Jeremy Corbyn’s Labour Party has vowed to halt cuts and restore funding. In the U.S., a Medicare for All, single-payer health insurance system has the support of a majority of Americans, reflecting a new working-class politics and democratic socialist mood.
“America is the richest nation in the history of the world, but the business elite has convinced people that 'how can we pay for it?' should be the first question that everyone asks.”
In the fight to win a truly universal social program in America, we should heed the lessons of the mid-century British labor movement.
First, Medicare for All won’t be won by middle-class liberals or businesses (large or small): These have been and will be the forces to propose watered-down measures that weaken the cost-saving provisions of a truly socialized program by opening it to the market.
Like the NHS, Medicare for All should be framed as what it is: a program that takes something from the private, commercial realm and turns it into a public, social good, and in so doing eliminates a corrupt and exploitative industry. It cannot be done incrementally and it will only succeed through the resolve and conviction of a mass working-class political insurgency.
Second, we shouldn’t be too quick to make policy excuses or cede the terrain of political principles. America is the richest nation in the history of the world, but the business elite has convinced people that “how can we pay for it?” should be the first question everyone asks. The truth is that we can always find a way to fund and administer a project of this size: We did so during the depression, and we can do so today.
What we need now is not the money but the political will to hold fast to an uncompromising demand: the demand for a single public program with comprehensive coverage for all U.S. residents that is free at the point of service, as well as a jobs training and placement assistance program for those currently employed by the private insurance industry.
Finally, we should avoid the language of moralism and charity. Medicare for All will greatly improve the lives of the vast majority of the population, but it will not be won simply because it is the right thing to do. It will be won because a strong working-class movement empowers clear-thinking people like Aneurin Bevan to fight the ruling elites.
This movement cannot be weighed down with a “charitable” mindset, where we think first about how we can help out the less fortunate. It must first and foremost be a movement not of charity but of solidarity, where the great mass of people who do most of the living, breathing, loving and dying in this society band together and take aim at a parasitic social layer of bureaucrats and billionaires.
Benjamin Y. Fong and Dustin Guastella are on the steering committee of the Democratic Socialists for Medicare for All campaign.
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