U.S. Intellectual History Blog

The Conspicuous Exception: History and Healthcare in Germany and the United States

[Editor’s Note: Today’s entry is a guest post from Fred W. Beuttler of Carroll University (WI). Fred is a S-USIH member and long-time supporter of the conference and blog. – TL]


This past summer semester, I had the honor of teaching on a Fulbright at the University of Tuebingen, in Germany, returning at the end of July. Reading Elisabeth Lasch-Quinn’s reports from her Fulbright in Rome left me somewhat intimidated to add my thoughts to the mix, but I wanted to get some sense of how other historians approached a couple of key topics in American history.

One of the main themes of my lecture course at Tuebingen was the question of American exceptionalism. I was there as a political rather than an intellectual historian, but I was trying to approach political topics from the perspective of the history of ideas. Coming back to academia after a number of years working for the Federal government, I wanted to raise issues of national policy to my students in Germany, seeking to get a different perspective.

The obvious point of difference between Germany and the United States is over the question of national or universal health care. Universal health insurance originated from the Right in Germany, from Chancellor Bismarck seeking to undercut socialist movements through state sponsored social insurance. American Progressives looked closely at German models for many of their policy proposals, a history that is well known to members of the USIH.

But that leaves an open question: Why is it that the platform of the Progressive Party of 1912 has been almost entirely enacted in American law, except for health insurance?

Clearly America is an exception to the European consensus: one of the biggest differences is the almost unquestioned acceptance of universal health insurance in Europe, and the strong opposition to universal coverage in the United States. This is not just reflected in current public opinion polls on the Affordable Care Act, but also in the long history of opposition dating back at least to Franklin Roosevelt’s Economic Bill of Rights speech in 1944, if not to 1912 itself.

My question to the USIH, is what is the explanation for this? Why the opposition, for so many Americans, to the idea of national or universal health care?

What I am interested in is our thinking on particularly intellectual reasons for the opposition, rather than merely financial reasons, such as lack of affordability, or costs, etc. Questions of “interests” should probably be excluded too – for example, the opposition of the American Medical Association to President Truman’s attempt to create national health insurance in the late 1940s. It is also too easy to give some variation of the argument that the American people are trapped in false consciousness, or are too stupid to know their own interests, or other such explanations. Yes, some are, but that does not explain the persistence over decades, of significant opposition.

One thing that I did notice while I was in Germany was a strange lack of curiosity as to why so many Americans were opposed to national or universal health insurance. Typical was an article that appeared in the English version of Der Spiegel, in May, before the Supreme Court decision.

Under a picture of a Tea Partier dressed in American revolutionary garb, the opening paragraph read: “In Germany, people are baffled by how hostile a country as religious as the United States can be to the principle of mandatory healthcare insurance. Not even conservatives question the system, which businesspeople say gives Europe’s largest economy a competitive advantage.”

That was basically the point of the article – how Germans were “bewildered” about why so many Americans “appear to be against universal coverage.” Yet there was not even a reason given to this opposition – the article just said that Germans were bewildered by it, but it basically stopped there, after interviewing an expat American who was also bewildered.

In lecturing a number of times on the politics of health care to German audiences, I found similar attitudes. Germans were mystified over this American opposition, but they were also uncurious as to reasons why. Most were content to just raise the issue, rather than seeking to discover what about Americans had led them to this opposition.

It was strange, having German students doing presentations on it, which turned into advocacy for such universal coverage, rather than seeking as historians to understand the intellectual issues present there.

Part of our job as intellectual historians, it seems to me, is to get beyond this bewilderment, and actually explain to our audiences the reasons for the significant opposition of Americans to what to Europeans is a settled issue. Regardless of where we stand politically, it seems important that we understand this. For the politics of health care reform are central, I believe, to what makes America an exception.

I have some ideas on this, and if there is interest in the USIH community, I would like the opportunity to expand a little on what I sketched out in my lectures in Germany. But first, I would be interested in how others approach this topic. What reasons do intellectual historians give for American popular opposition to national or universal health insurance? Are there significant intellectual rather than economic or financial or interest-based reasons for such attitudes? Or are the reasons given simply reducible to economic interests?

Unlike the bewildered Germans, I’m very curious as to what we think about this conspicuous exception.

4 Thoughts on this Post

  1. As one of the bewildered Germans, but curious about it, I wonder, if this is only related to health care or also to social care in a broader perspective? I simply do not know, if there are similar debates in the U.S. about insurance against unemployment, about national retirement fonds, or about welfare?

  2. Professor Beuttler, thank you for your post. I need some more context to get a good grasp on the subject. i am curious exactly how health costs compared in early 20th century America and Germany. For most American consumers, there health care costs were quite low. I know that in this early era, demand for health insurance was quite low compared to “Sickness” policies for income replacement due to disability and companies had no method to accurately calculate risks or even to define “health” or “illness.” Death was easily defined.

    With low demand for health insurance and in the face of industry interests, I do not find it surprising that a nationalized health care plan was defeated. Even with people leaving the farms for the cities, and with the increasingly professionalized medical industry, I don’t see any real demand for the health industry as whole until after World War II.

    I am also curious in how you categorize “American exceptionalism?” Is there a direct continuity between the Federalists of the 1790’s arguing that America was too different from Europe to have any need to imbibe the radicalism of the French Revolution to the modern Tea Party’s rejection of a 1990’s conservative market orient solution to contain healthcare costs? Are there differences in American and German federalisms?

  3. Dear Fred W. Beuttler,
    I’m glad you contributed this post. You raise interesting questions. I especially like the way you identified the response as one of bewilderment. I had not tried to observe so closely in order to identify the precise emotional/intellectual tenor of a response to issues and ideas and now look forward to doing so in the event of those things as I see them presented or present them myself in the future. By doing so, you made me more interested in a topic I had thought about in only a limited way before, as a strict large versus small government conflict. It just happens that I’m reading up on this question for an interdisciplinary team-taught course I am teaching, the aim of which is to take the instructors out of their particular specialities and speak on issues of pressing current interest as generalists or, better yet, informed citizens. Although I know next to nothing about the issue of health insurance, I was assigned to debate the side opposed to Obama’s plan! Thus I must figure out at least a little of the answer to this very question (all I have time for in this context). I have a set of articles to read on this in the coming days, and the serendipitous timing of your post makes me much more excited about doing so, now that you have given me a quest more in line with my interests by asking about the ideas involved. I will share anything I find out that might help, but in the meantime if you or anyone else has a (brief) reading or two to suggest, I’m all ears. Thank you for your post; I look forward to anything further you care to contribute in the future.
    Elisabeth Lasch-Quinn

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