Here’s the longer historical explanation, going back step by step, showing how race shaped the U.S. healthcare system and why universal healthcare repeatedly failed.
1. Slavery & Early Medicine (1700s–1800s)
From the start, healthcare in the U.S. was racially stratified.
Enslaved Black people were treated as property, not patients. Medical care existed mainly to preserve labor value, not wellbeing.
White doctors often experimented on enslaved people without consent. This helped advance U.S. medicine while denying Black people autonomy or humane care.
There was no concept of shared public responsibility for health—care was individual, private, or tied to ownership.
This laid an early foundation: healthcare was not a universal right.
2. Reconstruction & Jim Crow (late 1800s–early 1900s)
After slavery ended, the question became: Would the state provide care equally?
Reconstruction-era efforts to create public hospitals and welfare systems were violently resisted in the South.
When federal troops withdrew, Southern states built segregated healthcare systems:
Underfunded “Black hospitals”
Limited access to medical schools for Black doctors
White political leaders argued that public health programs would force racial equality.
The idea that government-provided care = racial integration became politically toxic.
3. Progressive Era & Early National Health Insurance (1900–1930s)
The U.S. almost adopted universal healthcare during this period.
Reformers proposed national health insurance similar to Germany’s system.
These proposals were attacked as:
“Socialist”
A threat to white workers being “forced” to support Black people
Southern lawmakers opposed any program that:
Could not be locally controlled
Might undermine segregation
As a result, national plans died. The U.S. instead moved toward private, employer-based solutions.
4. The New Deal (1930s)
This is a critical moment.
FDR needed Southern Democrats to pass New Deal legislation.
To secure their votes, key programs excluded occupations heavily held by Black workers, such as:
Agricultural labor
Domestic work
National health insurance was removed entirely from the Social Security Act because:
It threatened segregated hospitals
Southern lawmakers feared federal enforcement of equality
So the New Deal expanded welfare—but deliberately avoided universal healthcare.
5. World War II & Employer-Based Insurance
This is where today’s system really took shape.
Wartime wage controls led employers to offer health insurance as a benefit.
These benefits mostly went to white, unionized workers.
Black workers, often excluded from unions and good jobs, were left out.
Healthcare became tied to employment—not citizenship—locking in inequality.
6. Civil Rights Era & Medicare/Medicaid (1960s)
Universal healthcare was still blocked, but partial programs passed.
Medicare and Medicaid were compromises:
Medicare: elderly (seen as “deserving”)
Medicaid: poor (racialized and stigmatized)
Hospitals were finally desegregated only because Medicare funding required it.
Even then, Medicaid was designed to be:
State-controlled
Uneven
Easy to restrict
This preserved racial and regional disparities instead of eliminating them.
7. Late 20th Century to Today
By the time race-based exclusions were openly challenged:
The system was already fragmented
Private insurers had enormous power
Universal care was framed as:
Helping “others”
Encouraging dependency
Taking from “hardworking taxpayers”
Racial resentment—often coded rather than explicit—remained a powerful political force.
The Result
Because of these choices:
The U.S. never built healthcare as a shared public good
Other Western nations did
The U.S. pays more for worse outcomes
Everyone suffers, but marginalized groups suffer most
This isn’t accidental. It’s the long-term consequence of repeatedly choosing exclusion over universality.
If you want next, I can:
Show quotes from lawmakers at the time
Compare this directly to how the UK or Canada avoided this path
Or explain how racial politics still show up in healthcare debates today
alexmanhatten 