I just recently came across this essay in OpEd News by Cecile Lawrence titled “Universal health care in the U.S. v. the peculiar institution,” connecting the absence to the right to health care in the United States to the legacy of slavery. Furthermore, America’s troubled racial history is a major reason for the country’s paltry social safety net. That relationship has even more resonance now as uprisings over the killings of unarmed black people by police and vigilantes roil from Oakland to Ferguson, Mo., to Baltimore. America has always projected an image of itself to the rest of the world that is false: that of the land of freedom, liberty, opportunity and equal rights. The country is being forced to confront the truth about itself: that it is and has always been the “land of freedom and opportunity” only for some. The right to “life, liberty and the pursuit of happiness” as written in the Declaration of Independence was only meant for the white men who established the United States and those like them.

As the essay above mentioned, inequality was built into the DNA of the U.S. Constitution, and slavery built American capitalism (a book outlining the latter point in detail, but not mentioned in Lawrence’s essay, is Edward Baptist’s The Half Has Never Been Told: Slavery and the Making of American Capitalism). Lawrence notes that the cultural attitude in America is that everyone living here who isn’t wealthy is only useful for doing

wage work…for the benefit of the capitalist system.

I would add that those who, for various reasons, don’t work, can’t work or can’t find work are seen as “less than,” “surplus” or “useless” (with the exception of retirees). American society makes it extremely difficult for such people to survive, let alone thrive, and they are resented by others for taking public assistance, the reason being that they “haven’t earned it.” Never mind that every American uses at least one government program of some kind (the mortgage interest deduction is a popular middle class government program).

Having to “earn” health care – rather than it being a right conferred to people by virtue of being born and/or living in America – is a principle embedded in racist culture. I believe it is the principle by which the U.S. stubbornly clings to the inefficient and unfair system of employer-provided private health coverage. One must “work” to have access to high quality health coverage, preferably at a good-paying, middle class job. If you are unfortunate enough to only land low-wage work, because of lack of education or a bad economy, and your employer doesn’t provide health coverage, you were left with nothing at all before the Affordable Care Act passed, or with lower-tier Medicaid after the law passed. For many poor people living in states where Republican-controlled legislatures have refused to expand Medicaid, the situation is the same as before health reform.

Since black people have been, and are still, subject to employment discrimination, it has been harder for them to access health coverage. In addition, Latinos, because of immigrant status, perceived status, and/or discrimination, have found it difficult to obtain health coverage. Poor whites who live in GOP-dominated states are racism’s collateral damage. Certainly, the situation has improved somewhat under the ACA, but problems remain for people of color. It is very convenient for reactionaries to demand that health coverage be “earned,” rather than conferred as a right, especially if one wishes to keep certain disfavored groups unhealthy and, therefore, unable to compete economically with the dominant (white and affluent) group.  Access to quality health care lifts people out of poverty and helps them start to accumulate wealth. It’s much harder to be productive if you aren’t healthy. What better way of keeping wealth and resources away from marginalized people than by keeping them away from health care? What better way to make sure they can’t leave low-paying jobs, and start innovative businesses? Makes life a whole lot easier for those who oppose health care as a right.

American-style capitalism owes its existence to and has always been dependent upon a desperate underclass. Establishing real social democracy with a European-style welfare state that benefits everyone would eradicate the toxic remnants of the slaveocracy in America – physically and culturally.