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Two radical notions in the early 1970s, having a black president and permitting homosexual marriage, have pretty much come to pass.
Penasco, New Mexico. Doctor Onstine, medical doctor, making an examination in the clinic operated by the Taos County cooperative health association. Photograph: John Collier, Library of Congress.
It’s 1974. Richard Nixon resigns the presidency; Barbara Streisand is singing, “The Way We Were” all over the radio (that music-playing thing before the internet); and you could buy a hand calculator that could only add, subtract, multiply, and divide for, in today’s currency, $100. Someone asks you: Here are three pretty radical ideas—which do you think is likely to happen first, if ever?
I bet most Americans in 1974—and probably most social scientists—would have picked the third.
The first radical idea is just about come true. There is a headlong rush toward normalizing gay marriage going on almost everywhere. A recent poll found that most Republicans under forty-five support “same–sex marriage rights” and another found that more Republicans under thirty consider it a “good” rather than a “bad” thing—in spite of the fact that just a few years ago the Republican party deployed opposition to gay marriage as a powerful winning strategy. A few weeks ago, conservative Catholic columnist Russ Douthat discussed the “terms of surrender” for his side of the gay marriage debate.
We’ve now had a black president for five years and even though he pays a price in voter support because of his race, Americans are less ticked off at him because he is black than because of his effort to extend government health insurance, that third radical idea.
As the Obamacare deadline has (sort of) come and gone, what appeared to be the least radical idea of 1974, that we would have universal national health insurance, is still a long way off (if it ever happens). How come?
On gays: In the early 1970s, fewer than in one in eight Americans endorsed the idea that homosexual relations were “not wrong at all.” They were outnumbered over five to one by the 70 percent who said such relations were “always wrong.” By the start of the 2010s, the proportions saying not wrong and always wrong were about equal. Among those under forty-five, the not-wrongs outnumbered the always-wrongs by almost 10 percentage points.  In 1988, the first year that the General Social Survey (GSS) asked Americans about the then-novel notion that “homosexual couples should have the right to marry one another,” a mere 12 percent of American adults supported the idea; now about 45 percent do (54 percent of the young). Support is rising rapidly.
On having a black president: In 1958, the Gallup Poll dared to ask Americans for first time, “If your party nominated a generally well-qualified man for president, would you vote for him . . . if he happened to be a Negro?” 53 percent said “no.” By 1974, only about one in five Americans said “no” when asked an almost identical question. In the spring before Barack Obama’s 2008 election, a mere one in twenty respondents would admit that they would vote against a black man because he is black. 
On health care: Back around 1975, 53 percent of Americans told the GSS that they agreed more with the statement, “It is the responsibility of the government in Washington to see to it that people have help in paying for doctors and hospital bills” than they agreed with the statement that “People should take care of these things themselves.” That percentage favoring government responsibility has fluctuated up and down by no more than nine points ever since, reaching a high in 1990. Most recently, in 2008–2012, it was, as it was in 1975, at 53 percent. 
(By the way, here is a fascinating factoid: In 1975, 54 percent of GSS respondents aged 65 or older said that the government should help Americans pay their medical bills. In 2006–2008, before the Obamacare controversy, about 40 percent said that. And In 2012, only about 34 percent of the elderly—compared to 59 percent of those under 65—said that the government should help with medical bills. All of these older Americans, of course, actually have most of their medical care paid for by those under 65 through the federal government. Go figure.)
Two radical notions in the early 1970s, having a black president and permitting homosexual marriage, have pretty much come to pass—in terms of public opinion and public policy. But the idea that the government should be partly responsible for all Americans’ health care, not just care for the elderly and poor, has not.
To be sure, there have been steps toward more comprehensive government support. Medicaid has expanded, CHIP covers some children. Add in Medicare and the Veterans Administration and you find that a large proportion of Americans are, in reality, getting government health insurance. But Americans’ resistance to making it universal remains strong. One reason Obamacare is such an unwieldy kludge of a health care program is that establishing a simple European- or Canadian-style system here is still politically far out of reach.
How come American views and policies changed so much with respect to the hot issues of sex and race, but not health care?
One explanation is that gay marriage and a black president don’t cost affluent Americans any money in taxes; universal health care probably would.
Or perhaps, such a health system just runs up against Americans’ deeply held resistance to more expensive government or stronger government. Or it runs up against Americans’ deeply held insistence on individual self-reliance. Americans repeatedly compromise their philosophical stances against government and for self-reliance (say, by accepting disaster relief and mortgage subsidies), but each compromise is an uphill struggle.
Or, perhaps, acknowledging the rights of gays to marriage and the rights of blacks to election fits Americans’ libertarian streak.
Or perhaps universal health care has not arrived because the wealthy and the powerful—those who now get the best health care in world that money can buy—see no need to mess with the current system. (This may also explain the oddity about the elderly’s views: “I’ve got mine.”)
Or, perhaps the lack of political traction on this issue reflects the ability of vested interests, in this case the health industry, to “inform” the public and lobby the Congress against the simplifications and streamlining of health care.
Here a bit of yet older history is informative: In fall 1945, President Harry Truman proposed a government-based national health insurance plan. Shortly afterward, the Gallup Poll asked Americans, “Do you approve or disapprove of Truman’s plan for (compulsory) health insurance in this country?” Support was strong: 59 percent yes versus 25 percent no. In 1950, Gallup asked almost the identical question, “Do you approve or disapprove of this plan (the Truman Administration’s Compulsory Health Insurance Plan)?” Americans’ views had flipped: now 24 percent approved and 61 percent disapproved. What happened? Part of the explanation may be Truman’s stubbornness about compromising on his plan or his general loss of popularity in the intervening years. Also, Americans generally shifted to the right after the 1948 election. But most of that shift was probably the result of a full-bore campaign led by the doctors’ and the insurance companies’ associations to paint the Truman plan as socialist or even communist. By 1960, most Americans ended up with private, employer-based health insurance rather than coverage through a universal system. 
Whatever the explanation, it is striking that of these three radical ideas circa 1974 the one that would have seemed to be the least radical is the one that has not come to pass.
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