Much of the heated debate leading up to passage of health care reform revolved around whether government, as a matter of principle, should have an expanded role in Americans’ health. To many people, it seemed a radical departure from American tradition. The historical truth is that government has long been enmeshed in Americans’ health. Indeed, government is largely why Americans came to live long lives.
Americans in the 19th century faced short horizons. Babies died at such high rates that American mothers could expect to bury one or two newborns or infants. But even adults did not live that long. In 1850, a male who made it through childhood to the age of 20 could expect to live, on average, only to about 60. Many factors, from poor nutrition to pervasive violence, shortened American lives. But the major single cause was disease, especially water-borne disease.
Delivering water to and removing wastes from town homes used to be done in the 19th century by private entrepreneurs. That failed miserably, especially failing those who were not affluent. In the late 19th and early 20th centuries, local and state governments undertook vast public works projects, much on borrowed money, to build water treatment plants and sewage disposal systems. Governments also required households to hook up to the water and sewage pipes. It took a while for the infrastructure to reach the working-class neighborhoods, but they eventually did. Aided by projects such as mosquito abatement, the “big government” programs dramatically drove down illness and death rates, especially for the young — as shown in this graph. American lifespans went up particularly quickly during this period of public investment.
Vastly more productive agriculture is also part of the story. But, here, too government, especially the federal government, was critical. Aside from giving away land to settlers – Lincoln’s homestead act, notably – the federal government advanced farm productivity in various ways. Land-grant colleges conducted agricultural research and sent out extension agents to teach farmers modern methods. Repeatedly, the government intervened to protect farmers, even directly subsidizing crop prices. Publically-financed transportation – from the canals of the 19th century to the interstate highway system of the 20th — brought more food to more people much more cheaply.
And then, there is government regulation. One chronic health problem in the 19th century was adulterated food, especially tainted water in the milk which, simply put, killed babies. In the 1890s alone, New York City cut its death rate by about one-fourth, in part thanks to over 300 bureaucrats – er, sanitary inspectors; Boston cut its death rate by about one-seventh, in part by examining thousands of milk samples a year. Many other examples could be added, as could cases of government “encouragement,” such as having bakers and dairies fortify bread and milk with vitamins and minerals.
The particulars of the health care issue are one thing, but the assertion that when the government gets its hands on health it messes things up is exactly the opposite of the historical record. (And I haven’t even touched on Medicare, the biggest single case of government intrusion.)