16 Tons of Healthcare

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.

Railroads began hiring their own surgeons in the mid-1800s. But even if a surgeon had been close at hand in 1863, I doubt he could have saved my 3rd great-grandfather, Carl Gaszow.


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.


Feature Image: by Piron Guillaume on Unsplash

27 thoughts on “16 Tons of Healthcare

Add yours

  1. Thanks for the early history. My book club toured the restored Loray Mill in Gastonia NC, site for the best-seller “The Last Ballad “‘ by Wiley Cash. Mill conditions sparked one of the dangerous early strikes for the Unioon movement. Get injured on the job and you’d be fired. On the other hand, I worked a few years ago in Maine for an insurance co. that helped set up needed new systems for mildly injured workers. Some used the opportunity to claim lifelong unemployment ins.

    Liked by 1 person

    1. No matter what sort of system you have, there will always be some who find a way to game it because they are lazy or whatever. Insurance is part of the problem with our current system. I’d love for healthcare to be run like our electric coop.


  2. Insurance mandate by nature is a monopoly imo. Insurance is the healthcare problem. Where else are you forced to participate in a for-profit immoral business charging people for their very sanity? You touched on another of my interests—Railroads Panama railroad used to be the most expensive passenger fare per mile in the world. At it’s opening in 1855 it was about $22 for the 50 mile ride. Considering the alternative it was a bargain. 70,000 men died building the railroad from accidents and disease. That’s about one person for every railroad tie. Funds from the railroad pay for Panama healthcare, although elites are trying to change that now due to the cash. Shipping companies pay up to $1000 per foot of vessel to transit the canal. That’s $500,000 for a 500 foot boat, unless you travel on coupon day.

    Liked by 2 people

    1. I dropped my health insurance a couple years ago. Before ACA I had a $273/mo. policy with a $2500 deductible. After ACA, the cost went through the roof and deductibles were as high as $6300. I now just pay for my healthcare when I use it. Nine more years to Medicare!
      I have read a lot about the Panama crossing for my gold rush book, because most of my people crossed the isthmus on their way to California (generally prior to the railroad). Only a couple went home that way. The rest either went home overland or via Nicaragua. The number of men who died working on the transcontinental railroad in the U.S. was equally heinous, and most were essentially worked like slaves. I have been on the Panama train and seen the canal. It’s a pretty strategic monopoly, for sure.

      Liked by 1 person

    1. That’s a great video! We are really being scammed in this country. The ACA is not the solution, because it’s still an insurance-based, for-profit deal. It’s also a function of some people demanding certain services and drugs. Just say no! 😉

      Liked by 1 person

  3. Very interesting history! It is absolutely ridiculous that America holds onto this outdated, inefficient and expensive model. But as long as somebody’s making money from it, who cares if the people don’t get the health care they need? It’s all about the stock price and the share holders.

    Liked by 1 person

      1. It has to change or no one but the ultra rich will be able to afford it. I’ve seen it from the health provider side – the amount of paperwork imposed on the doctor is unbelievable. And the discretionary power given to the insurance company as to what they will cover is absurd. When I was in practice, I would have to prequalify each patient for three treatments, then re-examine and do it all over again for three more. Rather than let the doctor come up with a reasonable plan and execute it, they bury us in red tape! The video your other commenter shared was spot on!

        Liked by 1 person

    1. I think the condemnations of UK and Canadian healthcare are made by people who are invested in our ridiculous system and are trying to deflect scrutiny. The people who actually use the system, such as yourself, seem quite satisfied.


      1. In fact, I worry that we are becoming more Americanised, NHS England anyway, which has a knock on effect on us in Scotland. The word is that a post-Brexit trade deal with the US will come with strings attached including access for private providers to our health care system.

        Liked by 1 person

  4. I agree that health care is a right and not a privilege. Our system here in Italy is often ridiculed by the USA, At least here we can go to bed Sunday night and know that if a medical emergency strikes on Monday, we won’t be in complete financial ruin. We need true universal health care without the politics on the left or the right.

    Liked by 1 person

    1. I don’t know how we get enough people in the U.S. to agree that we need a different system and make it happen. It seems to be generally acknowledged that it isn’t working well. Translating dissatisfaction to action is a different ball of wax.


  5. Wow this was a very interesting and informative read. And I loved how you tied in some of your own personal history with this very complex question. I think we can all agree that health care in this country needs a major overhaul, and I’ve always been curious how it wound up this way. Very good post! 🙂

    Liked by 1 person

  6. I won’t get into the healthcare debate, we have a system up in Canada that works, it’s not perfect but it works, but your post is very informative and clarifies how the health care in America evolved.
    By the way, “sixteen tons” was a radio staple in Ireland way back.. As a kid, I couldn’t figure it out….how could the singer be “deeper in death” (sic) and what the hell was the “company store” going to do with his soul.


Please share your thoughts...

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

This site uses Akismet to reduce spam. Learn how your comment data is processed.

Create a website or blog at WordPress.com

Up ↑

Waking up on the Wrong Side of 50

Navigating the second half of my life

The Willamette Valley's Heritage through its Barns and Structures

A history of the people of the Willamette Valley as revealed through their structures.

A Dalectable Life

Doing the best I can to keep it on the bright side


You might think you understand what I said, but what you heard is not always what I meant.

Tumblereads: A New Twist on the Old West

A New Twist on the Old West

Eilene Lyon

Author, Speaker, Family Historian


thoughts about parenting and life from below the surface

Northwest Journals

tiny histories

Ancestral Writing in Progress

... stories of significant others in the Allery, Cutting, McCulloch and Robertson tribes ...

Coach Carole Ramblings

Celtic, Mythical and More ...

Shedding Light on the Family Tree

Illuminating the Ancestral Journey

Forgotten Ancestors

Tracing The Faces

The Patchwork Genealogist

Uncovering Family Legacies One Stitch at a Time

Family Finds

Adventures in Genealogy

What's Going On @ ACGSI

Allen County Genealogical Society of Indiana Blog

sue clancy

visual stories: fine art, artist books, illustrated gifts

Ask the Agent

Night Thoughts of a Literary Agent

Joy Neal Kidney

Family and local stories and history, favorite books


A History of the Famously Interesting and Mostly Forgotten

%d bloggers like this: