While we in the single payer movement fight to dismantle the fragmented, for-profit healthcare system, it helps to know how we got here in the first place. Jacobin Magazine‘s The Neoliberal Turn in American Health Care by A.W. Gaffney is a worthy longread about how the political climate in United States led to the emergence and entrenchment of the idea that health care is a commodity, rather than a human right – the complete opposite ideology of the more socially democratic nations of Europe.

Gaffney traces the history of American health care from President Harry Truman’s failed effort to establish a national health insurance plan, to the creation of Medicare, to the rise of health savings accounts to the current private insurance-centered Affordable Care Act. The fact that the U.S. still doesn’t have a healthcare system that is free and available to all at the point of service is, as outlined by the article, due to a combination of Cold War politics, corporate pushback against the New Deal, the influence of libertarian think tanks, and rising healthcare costs.

The fundamental social-democratic idea of universalism — of an entire population with the equal right to equally comprehensive health care benefits — has all but disappeared from the political center. Hayek’s dismissal of an “objectively ascertainable standard of health,” perhaps a fringe idea at the time, now seems to be the reigning paradigm.

The doctrine of consumer choice, whether with respect to the selection of tiered “bronze, silver, or gold” health benefits, or of choosing to divide one’s “own money” between health care and other goods, has been almost quietly triumphant. Of course, this great neoliberal transformation in the political economy of American health care wasn’t the result of the vagaries of nature or the unique cultural proclivities of Americans: it was part and a parcel of a much larger corporate-driven transformation, which, over these same years, has drastically exacerbated inequality while simultaneously fraying the substance of American civic democracy.

I wish the article had covered the role that race and racism played in America’s failure to establish universal health care and continues to impede efforts in doing so. After all, divide-and-conquer tactics are especially effective ways to stop social change. Toxic economic theories that celebrate a “you’re on your own” mentality and ridicule the ideas of “community,” “social justice” and “togetherness,” are much more likely to find sympathetic ears among a populace who  see their neighbors as “the Other.”