The Mecca of bad history

A friend posted this meme in Discord. It shows a sad George Washington, with the caption "spending today [July 4th] thinkin bout how we coulda had free healthcare and education if we lost." The message the meme sends is that, if the US had lost, its people would not have to pay massive amounts of money for education and healthcare as they would still be part of the United Kingdom.

This isn't necessarily a sub to criticise potential alt-histories, but the meme did get me thinking about why the UK has the NHS, and the US doesn't, and whether, in a potential future where the US lost the Revolutiontary War and had remained part of the UK for significantly longer, it would have universal healthcare. I dug around a bit, and came to the conclusion that the question of universal healthcare, the story of how it arose in the UK, and why it didn't in the US is far more complicated than this meme makes it out to be. However, it doesn't seem unreasonable to say that this meme is spouting some bad (alt-)history. If the US had lost the Revolutionary War, that doesn't necessarily mean Americans would have universal healthcare.

But first, the meme has two parts, and the first is easy to debunk. The meme claims Americans would have access to universal education. That's not even the case in the UK, where annual tuition can be up to £9,250 in England for an undergraduate degree. I'll grant you, it's a far cry from the amount an American student might have to pay annually for education, but it's by no means free.

What about healthcare, though? Would the US have universal healthcare if it had lost the Revolutionary War and remained part of the UK? We'll look at this in two parts. First, the promised history of the NHS and why the UK has universal healthcare, and second, why the US doesn't.

The NHS finds its roots in the Minority Report of the Royal Commission on the Poor Law of 1909. This report examined the impact and what reforms were needed to the Poor Laws systems that had served as social welfare in the UK. It was this system, for instance, that established workhouses and saw the poor as needing to be self-reliant to escape poverty. Though this report was ignored by the then Liberal government, its ideas caught on, with advocates and activists calling for reform throughout the first half of the 20th century. In 1929, the Local Government Act handed control of some healthcare services to local governments, and by the 1930s, the city of London took over a network of 140 hospitals, providing healthcare to those who needed it. Though this wasn't quite universal healthcare, there was clear significant public support, and a growing number of governments and institutions taking on healthcare themselves.

The true heart of the NHS lies in the Beveridge Report. Published in 1942, the Beveridge Report was written to evaluate how to solve the problems the UK would face in the wake of WWII, specifically with regards to national insurance and addressing the "five giants on the road to reconstruction," "Want… Disease, Ignorance, Squalor and Idleness." One solution he proposed to solve these issues was a system of universal healthcare, albeit through local health care systems. When the Labour Party won the 1945 election, they implemented many of the suggestions within the Beveridge Report, creating not only the NHS, but much of the modern British welfare state.

The NHS came into being not in isolation, or even to solve healthcare specifically, but as part of a general view to improve the lives of the impoverished. Those that championed it did so based on a view of a collective group of working class people that would benefit as a whole from the systems and structures a welfare state could provide. The reforms that allowed the NHS to come into existence were born from that desire for some degree of social equality. Coupled with the collective trauma of WWII, the NHS, along with other social reforms, provided a step towards a collective future. Without that push for rights for a clear and united working class, and without that collective trauma and the need to rebuild after WWII, the NHS would likely not exist.

There is an obvious factor here that the UK had that the US didn't. The NHS, I'd argue, came into being partly in response to the collective trauma of WWII. While the US had a collective experience with WWII as well, that experience is not the same as that of the UK, and did not generally include the need to rebuild bombed infrastructure. This is not to say there weren't significant changes in the US social security system in the wake of WWII - there absolutely were. However, part of why they were not as far-reaching as their European counterparts is because of the difference in collective trauma.

However, the more interesting factor here is the question of a collective and unified working class. I'd argue that this is the bigger reason why the UK ultimately has the NHS - that sense of collective good and a reasonably powerful working class and labour movement. If this is what's required for universal healthcare, where is the equivalent US version?

There are two potential explanations here, and I think both are worth discussing. The first is the idea that Americans in general are less trusting of authority in general and government authority in particular than their European counterparts. This article by Dr. Bruce Vladeck makes the case that the American culture of individualism is a result of immigration bias; those that came to America were those who had a reason to dislike the system they came from. This included the adventurous, the persecuted, the draft-dodgers, the huddled masses yearning to be free, basically all the people declaring "fuck the king" and wandering off to somewhere else. As a consequence, American culture is one that views government action and intervention with more suspicion, and similarly, would view a government-run healthcare system with suspicion.