By Eilene Lyon
“You load sixteen tons, what do you get?/Another day older and deeper in debt/Saint Peter don’t you call me, ‘cause I can’t go/I owe my soul to the company store.” – Sixteen Tons by Merle Travis
I marvel at the fact that so many Americans believe that healthcare should be a for-profit industry. When every other advanced society on the planet sees healthcare as a universal right and has better health outcomes with taxpayer-funded medical services, single-payer systems, etc., we cling to our expensive care…or go without.
I believe part of the reason we accept this system is rooted in the heyday of the industrial age in the 19th and early 20th centuries. Long before OSHA ushered in an era of workplace safety, many jobs were extremely hazardous. Also, factories, like schools and anyplace people are in close quarters, were great places to spread infectious diseases.
Because a healthy worker was a more productive worker, some companies hired in-house medical staff. This was especially true for dangerous occupations such as mining, railroad work, and sawmilling.
Durango and Silverton Narrow-Gauge Railroad in Silverton, CO. Working for railroads was notoriously risky. In some railroad jobs, one in twelve workers were injured or killed on the job.
Railroads were the exception in this regard. For the most part, it wasn’t until the early 20th century that other industries began following suit. Before that, injured and killed workers were just seen as expendable. Workers weren’t necessarily pleased with having a company surgeon, though.
Like the mine worker in “Sixteen Tons” who was paid in truck wages, which had to be spent for artificially expensive goods from the company store, railroad workers had to sacrifice part of their pay to fund the surgeon’s salary.
One of my distant cousins, Clayton L. Ransom, worked as a company doctor for the Curtis Lumber Co. in Mill City, Oregon, beginning in 1907. He later went on to build a hospital in Mill City. The sawmill workers and their families were still his primary patients, given that Mill City was essentially a company town.
Dr. Clayton L. Ransom (Courtesy M. Painter) and a 1920s sawmill (Wikimedia Commons).
Henry Ford understood that the people of Detroit, a large number of them in his employ, required good medical care. Though he spearheaded the movement to build a hospital, his original intention was not to own it. However, when construction stalled, he decided to take over the project and the Henry Ford Health System was born.
Mining companies were still employing company doctors up through World War II. Then the United Mine Workers union used their bargaining power to create an alternative healthcare system that would be funded by the coal companies, but directed by the union. Health services tied to employment had become ingrained in our capitalist society.
It wasn’t an enormous leap to go from having employer-provided doctors to employer-provided health insurance. This is the system by which the majority of Americans are covered today during their working years.
Self-employed people and those working for small companies find insurance policies outrageously expensive. In rural areas, the cost of policies are even higher and, due to the profit motive, services are harder to find.
There have been laws passed to make insurance policies more portable, but there are still times when people feel they are bound to the company they work for because of their health insurance benefits.
In particular, having a chronic or pre-existing condition in the family makes it even harder to change employers or insurers, despite the Affordable Care Act. The provisions to cover those are threatened by the current administration and Supreme Court.
Instead of owing our souls to the company store, if we have a serious health crisis we usually owe our souls to the for-profit healthcare industry.