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What US Medical Care SHOULD Look Like   Leave a comment

My cousins research group continues and right now we’re reading David T. Beito’s  history From Mutual Aid to the Welfare State: Fraternal Societies and Social Services 1890-1967, published by the University of North Carolina Press in 2000. Having finished reading it before the guys, I wanted to share my unprocessed feelings about it.

Image result for lodge provided medical careReaders who want to know how medical care should operate and what is wrong with today’s system should read Mr. Beito’s book.

The premise of the book is that the US rejected Obamacare in 1918 and it took almost a half century for its supporters to finally win, take over and destroy the US medical care system.

For a quarter century before WWI, many of the nation’s well-to-do young people went to Germany to complete their college education and some of them returned determined to recreate the US in the image of socialist Germany. Richard Ely founded the American Economic Association for that sole purpose. He and economist Irving Fisher would lead the drive for universal, mandatory health care insurance.

In those days, while middle class and wealthier Americans paid for doctors directly, such fees were too high for the working poor, who instead organized into mutual aid societies such as the International Order of Odd Fellows, the Freemasons, the Eagles, the Moose, the Elks, etc. The lodges started offering burial insurance because poor people were terrified of suffering a pauper’s burial. Later, they added healthcare and life insurance, built orphanages and hospitals, and provided banking services and even pensions. Many of these groups had existed for centuries under other names and followed the ancient guild practices of mutual aid to craft members. The Shriners, a branch of the Freemasons, still maintain children’s hospitals. Back in the day, most lodge members couldn’t afford to pay fee-for-service doctors and would otherwise go without medical care, but the lodges provided this care as part of their membership fees.

So what happened?

Socialists were wary of lodges and fraternal societies because they employed security measures to prevent non-members from defrauding them for the benefits of membership. Back in the day before data bases and phone calls — two hundred years ago, say — organizations employed passwords and secret handshakes to prevent such scams.

 

The American Medical Association began attacking the lodges as early as the 1890s because the lodges would contract with doctors for a flat fee per year per member to provide medical care for lodge members. Oddly, this practice of “capitation” is making a comeback with the federal government as a means to restrain the explosive growth in the costs of medical care. Lodges usually contracted with doctors from private medical schools set up by other doctors to fill the deficiency in the supply of new doctors by the state schools.

The AMA claimed that the lodges kept doctor pay too low, causing some to starve. So they launched public relations campaigns to stigmatize the lodge system and the doctors who served the working poor. They bribed politicians to shut down the medical schools they didn’t approve of, insisting that they cared about “public health and safety”, thus creating a shortage of doctors. They bribed hospitals to reject doctors who worked with lodges and convinced medical organizations to ostracize them. AMA doctors refused to work at lodge-owned hospitals and the AMA worked tirelessly to shut those hospitals down. The AMA’s assault on “low pay” for their doctors finally worked,

Lodge practice was also a victim of an overall shrinkage in the supply of physicians due to a relentless campaign of professional “birth control” imposed by the medical societies. In 1910, for example, the United States had 164 doctors per 100,000 people, compared with only 125 in 1930. This shift occurred in great part because of increasingly tight state certification requirements. Fewer doctors not only translated into higher medical fees but also weaker bargaining power for lodges. Meanwhile, the number of medical schools plummeted from a high of 166 in 1904 to 81 in 1922. The hardest hit were the proprietary schools, a prime recruiting avenue for lodges.

When socialists and the AMA proposed mandatory health insurance for every citizen in the early 1900s, the lodges saw it as an attack on their system of self-reliance and mutual aid. Enough Americans shared the same values as the lodges that they defeated the proposals in two referenda. In 1918 the citizens of California voted three to one to reject mandatory health insurance. It failed again in New York in 1919.

Still, times were changing, and Americans were abandoning traditional Christianity rapidly and its values of self-reliance and mutual aid. Churches had always provided charity to the poorest since the early days of Christianity recorded in the Book of Acts in the Bible. Until the 1920s, Americans resisted accepting charity as much as they could out of a sense of honor. The lodges intended to help the working poor, not supplant charitable work. But by the 1920s Americans interpreted self-reliance as selfishness. As Beito wrote,

The traditional fraternal worldview was under attack. Age-old virtues such as mutual aid, character building, self-restraint, thrift, and self-help, once taken for granted, came under fire either as outmoded or as drastically in need of modification.

In 1918 Clarence W. Tabor used his textbook, Business of the Household, to warn that if savings “means stunted lives, that is, physical derelicts or mental incompetents…through enforced self-denial and the absence of bodily comforts, or the starving of mental cravings and the sacrifice of spiritual development – then the price of increased bank deposits is too high.” An earlier generation would have dismissed these statements. Now they were in the mainstream. Bruce Barton, the public relations pioneer and author of the best-selling life of Christ, The Man Nobody Knows, espoused the ideal of self-realization rather than self-reliance, declaring that “life is meant to live and enjoy as you go along…. If self-denial is necessary I’ll practice some of it when I’m old and not try to do all of it now. For who knows? I may never be old.”

JM Keynes echoed Barton in the 1930’s with his famous line, “In the long run we’re all dead,” and with his continual assault on the evils of the Protestant work ethic and savings. The ideal of “service” replaced that of self-reliance. By “service” socialists meant that the wealthy should give to the poor. They helped remove the stigma of charity by convincing the poor that they shouldn’t be ashamed of receiving aid because the wealthy owed it to them.

In addition to the efforts of the AMA to destroy the excellent system of medical care insurance set up by the fraternal societies, the progress of socialism continued to erode the appeal of self-help. The federal government gave favorable tax treatment to corporations who offered group insurance without extending that to individuals while members of fraternal organizations received no tax deductions for their medical care insurance. This meant corporations paid the premiums so workers were fooled into thinking their insurance was “free”.

Good economists understand that corporations, then as now, merely deducted the premiums from future pay raises. The lodges argued that group insurance from the employer would enslave workers to a single company because they would lose their insurance if they lost their job whereas lodge insurance traveled with the individual. You see, that whole “portability” argument had already been addressed and a solution worked out. The lodges were right, but we forgot it over the decades.

The Great Depression weakened lodges as the bulk of the 25% unemployment came from the working poor. More assaults on mutual aid came with the passage of Social Security legislation, company pensions, and worker’s compensation insurance. Again, the government allowed corporations to deduct expenses for those from their taxes without extending the privilege to individuals in fraternal organizations. Then came Medicare and Medicaid in the 1960s.

The book exposes the lie that socialists proposed their welfare measures because they saw a desperate need for them. Churches and charities had provided for the poor who couldn’t work since Biblical times, while the fraternal societies took care of the working poor very well. In 1924, 48% of working-class adult males were lodge members.

Socialists opposed the lodge system, not because it failed, but because they wanted the services provided by the state as they were in Germany. They convinced the American people that socialism would not just help the poor, as the churches and fraternal organizations were, but would eliminate poverty. And as Helmut Schoeck warned us in his Envy: A Theory of Social Behavior, the lust to destroy successful people served as fuel for the fire. Beito’s concluding paragraph is worth reprinting in full:

The shift from mutual aid and self-help to the welfare state has involved more than a simple bookkeeping transfer of service provision from one set of institutions to another. As many of the leaders of fraternal societies had feared, much was lost in an exchange that transcended monetary calculations. The old relationships of voluntary reciprocity and autonomy have slowly given way to paternalistic dependency. Instead of mutual aid, the dominant social welfare arrangements of Americans have increasingly become characterized by impersonal bureaucracies controlled by outsiders.

Jacquie Biggar-USA Today Best-selling author

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