06/27/2010 05:12 am ET | Updated May 25, 2011

History Repeating Itself? Historical Context Can Help Us Better Understand Debate Over New Health Care Legislation

Once upon a time, the United States had a full-fledged national health care system. The federal government employed 120 doctors, constructed 40 hospitals, provided medical care to over 500,000 people, and even created special facilities for orphans and the elderly.
That health care system, which lasted only five years, existed long before Nancy Pelosi triumphantly led a group of congressional Democrats to Capitol Hill on Sunday, March 21, 2010 to vote for national health care reform. In fact, the creation of that federally run medical system occurred almost 150 years ago, after the American Civil War, in order to provide freed slaves and white Southerners with medical assistance. It garnered just as much opposition then as today's legislation is experiencing -- and for many of the same reasons.

Opposition to health care reform today is rooted in a fear of Americans becoming dependent on the government. This intense and often unwarranted fear of dependency has been at the core of a number of assaults on the federal government -- from contemporary relief efforts in Haiti after the earthquake and in Gulf Coast after Hurricane Katrina to historical developments from the reconstruction of the South after the Civil War to the creation of the Welfare State before World War II.

Today, as the nation heatedly debates the implications of the new health care legislation, we would do well to examine our nation's history to better understand the roots of current ideological opposition. Beyond partisan divisions, the creation of this health care plan questions the role of the federal government and its relationship to the citizenry. While part of the current debate certainly acknowledges this polemical connection (protesters outside of Capitol Hall loudly proclaimed "Doctors, Not Dictators!), the references to socialism, totalitarianism and the warning made by one Republican Congressman that "if you haven't made the necessary arrangements for coverage, armed IRS Agents will take your children away and kick your dog" should not be dismissed as mere hyperbole of a vocal minority.

These concerns -- as outlandish as they may seem to supporters of the new legislation -- have deep historical roots, and the same concerns often re-emerge when the federal government attempts to expand its power over American citizens.

In the 19th century, for example, Radical Republicans, who were champions of freed slaves and the dispossessed, attempted to extend medical assistance to people who could not afford medical care. Opponents to that legislation vehemently argued "the charity of the government must be guarded," even in the face of newspaper reports that warned the black population would "melt away in freedom" or, to borrow another popular 19th-century slogan, "would go extinct."

Then, in the early 20th century, when the federal government was still relatively anemic, Congressmen took to the floor of the House demanding support for immigrants and the working poor. Their opponents ranted about "survival of the fittest" and the corruption of the American dream.

As history has repeatedly revealed, whenever the federal government considers providing relief and support for those in need, the debate turns to whether federal interventions will corrupt American ideals and potentially jeopardize the basic tenets of American character: self-reliance, independence, and hard work.

In the 19th century, the federal government ultimately disbanded the 40 hospitals it had constructed in the postwar South. At that point it was an economic collapse we now know as the "Panic of 1873" and not ideological debate that shut down health care. With the advantage of hindsight, we can examine the fallout of that shutdown: tens of thousands of Southerners were without medical assistance and had nowhere to turn when a yellow fever epidemic tore through the South later in the 1870s.

Today, as the debate over national health care reform continues to simmer, let's hope that we can learn a few lessons from the past. We cannot let the concerns of some -- who fear health care reform is too expensive or government is too powerful -- stand in the way of progress for many.

In fact, history will tell us that the health care bill President Obama has so proudly proclaimed as the "call of history" might just be another case of "history repeating itself."

Jim Downs is author of the forthcoming book, "Sick from Freedom: The Unexpected Consequences of the American Civil War." He is an assistant professor of history at Connecticut College