What We Lost as a Nation: Healthcare
The Cost of Choosing "Whiteness" Over Solidarity
"I have had some bitter disappointments as President, but the one that has troubled me most, in a personal way, has been the failure to defeat the organized opposition to a National Compulsory Health Insurance program." — President Harry S. Truman
"If you can convince the lowest white man he's better than the best colored man, he won't notice you're picking his pocket." — President Lyndon B. Johnson
A Note on the Audience
This section asks white Americans a direct question: Was it worth dying younger, going bankrupt from medical bills, and watching your parents ration insulin — just to make sure Black people didn't get healthcare either?
Because that's the trade. That's what happened. And here are the receipts.
How We Got Here: A Primer
1945: Truman Proposes Universal Healthcare.
On November 19, 1945, President Truman sent a special message to Congress calling for a national health insurance program — universal coverage for all Americans, funded through payroll taxes.
Every other Allied nation was building or planning universal healthcare. Britain launched the NHS in 1948. Canada would follow. France, Germany, Scandinavia — all moved toward universal systems in the postwar period.
America was next. It should have happened. But it didn't.
1946–1949: The AMA and Southern Democrats Kill It.
The American Medical Association hired Whitaker & Baxter — the first modern political consultants — and spent $5 million (equivalent to $65+ million today) on a propaganda campaign calling Truman's plan "socialized medicine."
They distributed over 100 million pieces of anti-healthcare literature. They put pamphlets in every doctor's waiting room in America.
But the money wasn't the only weapon. Southern Democrats killed the bill because universal healthcare would have meant desegregating hospitals. In 1945, 31% of Southern hospitals refused to admit Black patients entirely. 47% segregated them to separate, inferior floors. Federal healthcare would have required integration — which was unacceptable to the segregationist bloc that controlled key Congressional committees.
The Hill-Burton Act of 1946 — which funded hospital construction — included an explicit "separate but equal" clause that entrenched Jim Crow medicine for another 20 years. White America didn't just lose universal healthcare. White America chose segregated hospitals over universal hospitals.
1961: Reagan Kills Medicare Expansion.
The AMA recruited Ronald Reagan to record a propaganda album — "Ronald Reagan Speaks Out Against Socialized Medicine" — warning that Medicare would lead to totalitarianism.
Reagan told listeners to write their congressmen, or "you and I are going to spend our sunset years telling our children and our children's children what it once was like in America when men were free."
This was about keeping healthcare away from Black seniors.
1965: Medicare and Medicaid — The Compromise.
Lyndon Johnson signed Medicare (for the elderly) and Medicaid (for the poor) into law. It was a compromise — universal coverage was still impossible because the insurance industry and the AMA had too much power.
But there was a hidden victory: Medicare required hospital desegregation as a condition of receiving federal funds. Within months, 99% of Southern hospitals integrated — not out of morality, but because they couldn't afford to lose Medicare payments. Federal dollars accomplished what decades of activism couldn't.
Proving the point: healthcare integration was always possible. It just required tying it to money.
1971: Nixon Proposes — Then Sabotages — Universal Healthcare.
Richard Nixon, facing pressure from Ted Kennedy's single-payer push, proposed an employer-mandate system. Kennedy rejected it as insufficient. Nixon's Watergate collapse killed the effort.
We were closer than most Americans realize.
1993: The Clintons Try, the Insurance Industry Wins.
Hillary Clinton's Health Security Act proposed universal coverage through managed competition. The insurance industry responded with the "Harry and Louise" ad campaign — spending $20 million to kill the bill. It worked. The ads convinced Americans that reform would take away their existing coverage.
40 million Americans remained uninsured.
2009: Obama Tries, the Insurance Industry Gets Richer.
The Affordable Care Act expanded coverage to ~20 million people — a real gain. But it was designed to protect the insurance industry, not replace it. The public option was killed. The individual mandate forced Americans to buy private insurance.
Insurance company stock prices rose on the day the ACA passed. The industry won again.
2020–Present: COVID Proves the System Is Broken.
1.2+ million Americans died of COVID-19.
The U.S. had worse outcomes than most peer nations — despite spending more than double per capita on healthcare.
Workers lost employer-based insurance when they lost jobs during lockdowns. Medical debt continued to be the leading cause of bankruptcy. And in 2026, Americans still can't afford insulin, still ration medications, and still die from treatable conditions — while the insurance industry posts $50+ billion in annual profits.
Link to Universal Healthcare Policy page
The Totals
Lives Lost and Ruined
| Category | Impact |
|---|---|
| Annual deaths from lack of insurance (ongoing) | 45,000 Americans die every year because they lack insurance (Harvard/Cambridge Health Alliance study) |
| Deaths from delayed/denied care (cumulative, 1949–present) | Millions — if universal healthcare had passed in 1949, 75+ years of preventable deaths would not have occurred |
| Medical bankruptcies (annual) | 530,000+ families/year — the leading cause of bankruptcy in the U.S. (not a factor in any peer nation with universal coverage) |
| Black maternal mortality | 3x the rate of white women — a gap that has widened since the 1990s, not narrowed |
| Black infant mortality | 2x the rate of white infants |
| Black life expectancy gap | 4 years shorter than white Americans (was wider historically — 7+ years in 1960) |
| Income-based life expectancy gap | 15 years between richest and poorest counties |
| COVID-19 deaths (U.S.) | 1.2+ million — disproportionately killing Black, Latino, Indigenous, and poor white communities |
| Opioid crisis deaths (1999–present) | 600,000+ (predominantly white working-class communities — killed by pharmaceutical companies the system protected) |
| Rural hospital closures (2010–present) | 150+ rural hospitals closed, leaving millions of rural (predominantly white) Americans without nearby emergency care |
| Veterans denied adequate care | 22+ veteran suicides per day; VA chronically underfunded while Pentagon gets $886 billion |
| Cumulative preventable deaths (1949–present, conservative) | Millions of Americans — disproportionately BIPOC, but increasingly poor white communities |
Money Stolen by the Oligarchs
| Category | Amount |
|---|---|
| Annual insurance industry profits | $50+ billion/year |
| Annual insurance industry administrative waste (vs. Medicare's 2%) | 30% of all private insurance spending = hundreds of billions/year in overhead, claims processing, marketing, CEO compensation |
| Insurance CEO compensation (annual, top 10) | $200+ million combined (UnitedHealth CEO: $20+ million/year) |
| Pharmaceutical industry overcharges (vs. peer nation prices) | $300+ billion/year — Americans pay 2–3x what Canadians, Europeans, and Japanese pay for identical drugs |
| Insulin price gouging | $300/vial in U.S. vs. $30 in Canada (same drug, same manufacturer) |
| Opioid industry profits (Sackler family / Purdue Pharma) | $13+ billion extracted before bankruptcy; 600,000+ dead |
| Hospital industry profiteering (for-profit chains) | HCA, Tenet, and Community Health Systems extract billions while cutting staff and closing unprofitable services |
| AMA/insurance lobbying against reform (cumulative) | Billions spent since 1945: $5M to kill Truman's plan, $20M for "Harry and Louise," hundreds of millions annually in the 2000s–2020s |
| Medical debt held by Americans | $220 billion outstanding |
| Student loan debt for medical/nursing education | Hundreds of billions (doctors graduate with $200,000–$300,000 in debt, incentivizing them toward high-paying specialties over primary care) |
| Total extracted annually by the healthcare industry | $1+ trillion/year in profits, waste, and overcharges above what peer nations pay for equal or better outcomes |
Lost Potential (Money and Advancements)
| Category | Estimated Loss |
|---|---|
| Excess U.S. healthcare spending vs. peer nations (cumulative, 1970–present) | $15–25+ trillion — the U.S. has spent roughly double per capita what comparable nations spend, with worse outcomes, for over 50 years |
| GDP lost to medical bankruptcy and debt | Hundreds of billions/year in destroyed household wealth and reduced consumer spending |
| Innovation lost to "job lock" | Millions of Americans stay in jobs they hate — or don't start businesses — because they can't risk losing employer-based insurance. The entrepreneurship the U.S. claims to value is suppressed by the healthcare system. |
| Productivity lost to untreated chronic illness | Hundreds of billions/year — workers with untreated diabetes, hypertension, mental illness, and chronic pain are less productive, miss more work, and die younger |
| Scientific talent lost to medical debt | Potential researchers who chose high-paying specialties over primary care or public health research because of debt — a brain drain from where doctors are needed most |
| Public health infrastructure never built | The U.S. pandemic response was catastrophic partly because decades of privatization gutted public health capacity that peer nations maintained |
| Total cumulative lost potential (1949–present) | $25–40+ trillion in excess spending, lost productivity, destroyed wealth, and suppressed innovation |
What Choosing "WHITENESS" over "SOLIDARITY" Cost Us as a Nation
Every time the United States had a chance to build universal healthcare, racial hierarchy was either the explicit reason it failed, or the weapon used to kill it.
The Result: everyone suffers. Here's how.
White America chose segregated hospitals over universal hospitals (1949).
When Truman proposed national health insurance, Southern Democrats killed it because it would have required desegregating hospitals. The AMA — which maintained whites-only membership — wrapped the opposition in "socialized medicine" fear-mongering.
But the core issue was race. Federal healthcare meant federal civil rights enforcement. White Southern politicians would rather their own white constituents go without insurance than allow Black patients into the same hospitals.
The Hill-Burton Act built new hospitals with a "separate but equal" clause — federally funded Jim Crow. Black patients died in waiting rooms while white hospitals across the street had empty beds. And white patients who couldn't afford care also went untreated, because the system that excluded Black people wasn't built to serve poor white people either.
White America chose the insurance industry over their own health.
The AMA's "socialized medicine" campaign worked because it activated racial fear. The subtext was always: government healthcare means your tax dollars paying for their healthcare."They" meant Black people. This framing turned white working-class Americans against their own economic interest, a pattern repeated for 80 years.
In 1993, "Harry and Louise" convinced white suburban voters that reform would take away their employer coverage. In 2009, the (mostly white) Tea Party screamed "government takeover" and "death panels" to stop the ACA. In 2026, white rural voters support politicians who block Medicaid expansion in their own states, leaving their own communities without healthcare.
Mississippi, the poorest and sickest state in the nation, has refused Medicaid expansion for over a decade. Mississippi is also the state with the highest percentage of Black residents, and the state where the ideology of "keeping government out" is deeply entrenched.
White Mississippians are dying of treatable diseases to ensure Black Mississippians also die of treatable diseases.
White America chose the opioid crisis over regulation.
The opioid epidemic, which left 600,000+ dead from predominantly white working-class communities, was created by the pharmaceutical companies (the Sackler family's Purdue Pharma) that the deregulated, privatized healthcare system protected.
The Opioid Crisis would never had been on the scale it was if we had universal healthcare like all of our peer nations have. OxyContin would have faced price controls, prescribing oversight, and public health intervention years earlier.
The same "free market" ideology that white America embraced to keep government out of healthcare allowed pharmaceutical companies to mass-murder white communities for profit.
White America chose employer-based insurance over freedom.
The employer-based insurance system exists because it was a workaround for wage controls during WWII that then became entrenched. It ties healthcare to employment meaning you lose your healthcare if you lose your job.
This is economic serfdom.
It suppresses wages (employers count insurance as compensation), suppresses entrepreneurship (can't start a business without insurance), and creates widespread panic every time a factory closes or a company downsizes. White working-class communities devastated by deindustrialization (Appalachia, the Rust Belt, and rural America) — didn't just lose jobs. They lost their healthcare.
Universal systems don't have this problem. A German worker who loses their job doesn't lose their doctor.
White America chose medical debt over taxes.
The average American family pays $22,000–$28,000/year for healthcare (premiums + deductibles + copays + uncovered costs).
Under Medicare for All, the average family would pay a 4% household income tax above $29,000, roughly $3,000–$5,000/year for a median-income family.
The savings: $15,000–$20,000+/year per family.
Americans pay more for worse healthcare to avoid a tax increase because "taxes" have been coded as "your money going to them." The insurance industry has spent billions to maintain this framing.
White Americans empty their pockets to avoid universal healthcare, and the insurance executives laugh all the way to their yachts and private jets.
What Peer Nations Built While We Were Bickering
While the U.S. was letting the AMA kill universal healthcare, letting insurance companies extract trillions, and letting pharmaceutical companies poison communities for profit:
The United Kingdom
They launched the National Health Service in 1948 — three years after Truman's proposal was killed. Universal, free at point of use, funded through taxation.
The NHS has problems (underfunding, wait times), but no British citizen has ever gone bankrupt from a medical bill. No British parent has ever rationed their child's insulin.
No British family has ever chosen between rent and chemotherapy.
Canada
They built single-payer healthcare (Medicare) province by province, completed nationally by 1971. Canadians pay roughly half what Americans pay per capita and live 3+ years longer.
No Canadian has medical debt.
Germany
They've had universal healthcare since 1883 — 143 years.
The German system uses competing nonprofit "sickness funds" (insurers) that cover everyone, with government price regulation. Germany has 4.7 physicians per 1,000 people (U.S.: 2.7).
Germans pay less, see doctors more, and live longer.
Japan
Has had universal coverage since 1961. Japan spends roughly $5,000 per capita (U.S.: $14,885). Japanese life expectancy: 84 years. American life expectancy: 77 years.
Japan pays a third of what we pay and lives seven years longer.
Taiwan
Has studied every healthcare system in the world in the 1990s and built single-payer in 1995. They cover 99.9% of the population. Administrative costs: 2% (vs. 30% for U.S. private insurance).
They did in two years what the U.S. has failed to do in eighty.
The United States
Currently spends $14,885 per capita on health — more than the OECD average of $5,967. This equals 17.2% of GDP, compared to the OECD average of 9.3%.
Switzerland, the second-highest spending nation, spends $9,963 per capita — and the average for comparable wealthy OECD countries, excluding the U.S., is $7,371.
America spends double and gets less.
THE NUMBERS THAT SHOULD END THE ARGUMENT
| Metric | United States | Peer Nations (Average) |
|---|---|---|
| Healthcare spending per capita | $14,885 | $5,967 (OECD avg) / $7,371 (wealthy peers) |
| Healthcare spending as % of GDP | 17.2% | 9.3% (OECD avg) |
| Life expectancy | ~77 years | 80–84 years (UK, Canada, Germany, Japan) |
| Infant mortality (per 1,000 live births) | 5.4 | 3.2–3.8 (peer avg) |
| Maternal mortality (per 100,000 births) | 32.9 | 3–10 (peer avg) |
| Medical bankruptcies | 530,000+/year | Effectively zero (every peer nation) |
| Uninsured population | 27+ million | Effectively zero (every peer nation) |
| Physicians per 1,000 people | 2.7 | 3.9 (OECD avg) |
| Hospital beds per 1,000 people | 2.8 | 4.2 (OECD avg) |
| Administrative costs (% of spending) | ~30% (private insurance) | 2–5% (public systems) |
Americans pay more. Get less. Die younger. And go bankrupt.
And the only countries with worse health outcomes than the U.S. are countries the U.S. is currently bombing or sanctioning.
Was ALL of This Worth It to Be "WHITE"?
Here is what white America bought with 80 years of refusing universal healthcare:
You bought $22,000/year in premiums and deductibles
So that insurance company CEOs could earn $20 million/year. UnitedHealth Group's CEO makes more in a week than most American families pay in a year for healthcare they can barely afford.
You bought 530,000 medical bankruptcies per year.
Two-thirds of those bankrupted had insurance. The coverage wasn't enough. It was never meant to be enough. It was meant to be profitable.
You bought the opioid epidemic.
600,000 dead — overwhelmingly white, overwhelmingly working-class, and overwhelmingly rural. The Sackler family made $13 billion pushing OxyContin while your neighbors overdosed in their bathrooms.
The "free market" healthcare system you defended protected the Sacklers for decades.
You bought 150+ closed rural hospitals.
If you live in rural America there may not be an emergency room within an hour of your home anymore. Those hospitals closed because the privatized system doesn't serve communities that aren't profitable.
Universal systems don't close hospitals because they aren't profitable. Universal systems serve people because people need care.
You bought insulin rationing.
Americans die every year because they can't afford insulin that costs $30 in Canada.
Same drug. Same manufacturer. Different system.
The system you chose charges $300 because it can, and because you've been told the alternative is "socialism."
You bought "job lock."
You can't quit the job you hate, can't start the business you've dreamed about, and can't take a year off to care for your aging parent(s) because losing your job means losing your insurance.
Every German, Canadian, British, Japanese, French, and Taiwanese worker has this freedom. You don't.
You traded it for the privilege of not sharing a system with Black people.
You bought a country where your children start GoFundMe campaigns for chemotherapy.
That sentence should be enough. In no other wealthy nation on Earth do children fundraise online to pay for their parents' cancer treatment. Only in America.
Only because of the choices made in 1949, 1965, 1993, 2009 — every time, choosing the insurance industry and racial hierarchy over universal care.
And here is what the oligarchs got:
$1+ trillion per year in excess profits, administrative waste, and overcharges. The insurance industry, pharmaceutical companies, for-profit hospital chains, and medical device manufacturers extract more wealth from the American healthcare system than the GDP of most countries.
Du Bois's "psychological wage of whiteness" applies here, too.
White working-class Americans accept a healthcare system that bankrupts them, lets their parents die, poisons their communities with opioids, and closes their hospitals — because they've been told the alternative means sharing with those people.
The oligarchs understood this from the beginning.
The AMA's 1949 campaign wasn't really about "freedom" vs. "socialism." It was about ensuring that white Americans feared integration more than they feared dying without healthcare.
Every year that passes without universal healthcare, 45,000 Americans die unnecessarily.
That's a 9/11 every 24 days.
But there's no war on the insurance industry. There's no "War on Medical Bankruptcy." There's no invasion of UnitedHealth Group's headquarters.
Because the deaths are slow, and scattered, and disproportionately affect people without power — and because the people who could demand change have been convinced that the real enemy is the government, not the corporation charging them $300 for insulin.
Newsflash! It was never worth it!
It was never worth it for the 45,000 who die every year.
It was never worth it for the 530,000 families bankrupted.
It was never worth it for the 600,000 killed by opioids.
It was never worth it for the Black mothers who die in childbirth at three times the rate of white mothers.
It was never worth it for the veterans who kill themselves at 22 per day because the VA is underfunded while the Pentagon gets a blank check.
And it was never worth it for you (white working-class America) who pay more than anyone on Earth for healthcare and get less than almost everyone.
The scam is the same one as education. The oligarchs get the money. BIPOC communities get the worst of the violence. And you get the "psychological wage" — the right to feel like the system is yours, even as it kills you.
Was it worth it?
Look at your premiums. Look at your deductibles. Look at the GoFundMe for your neighbor's chemo. Look at the closed hospital in your town. Look at Japan's life expectancy. Look at Canada's medical debt rate (zero). Look at Germany's maternal mortality rate (a fraction of ours).
It was always a scam. And you were always the mark.