(Describer) Titles: PBS Digital Studios.

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What happens when you combine a weird history of makeup, World War II, and the threat of communism? Well, oddly enough, you end up with an employer-based health insurance system.

(Describer) A shifting grid of animated sketches. Title: Origin of Everything.

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Now, I know I can't stop you from engaging in the polite, civil debate YouTube comments are known for, but arguing about the current state of our healthcare system isn't really what this episode is about. Instead, we're gonna focus on how the U.S. healthcare system emerged due to a strange set of historical circumstances. Now, in the U.S., almost 50% of people with health insurance are covered through their employers. But considering jobs don't pay for other vital expenses, like car insurance, utilities, or Amazon Prime, it's worth asking: why did they provide healthcare at all? Well, to understand the history of employer-based healthcare, we have to understand what medicine was like about 100 years ago. Spoiler alert, it was messed up. Before the 20th century, most people couldn't afford a doctor, and that might have been a good thing. Doctors were doing all sorts of kooky procedures, like inserting goat glands into the patient's bodies, or displaying premature babies in incubators at Coney Island Freak Shows. Plus, people usually went to the hospital to die rather than get better. So most Americans didn't really worry about health insurance. Fast forward to the early 20th century, and medicine is actually getting good. There's vaccinations, antibiotics, and better training in medical school, so doctors weren't just hacking people up. Now, people actually want to go to the doctor. Only problem, as always, is that real treatment costs real money. But even as late as the 1920s, most hospitals still had lots of empty beds because, in spite of improved outcomes for patients, people couldn't pay. What was the solution? Makeup. Okay, stay with me. An official at Baylor University Hospital noticed Americans were paying more, on average, for cosmetics than healthcare. That gave him a major lightbulb moment when he said, "We spend a dollar or so at a time for cosmetics "and do not notice the high cost. "Yet it would take about 20 years to set aside money for a large hospital bill." This was a big development because then Baylor started selling plans to Dallas Public School teachers at work. The teachers started paying for health insurance the same way people pay for makeup-- in small increments. The plans became really popular, and Blue Cross was born. As a result, health insurance started making headway in America. But this brings us to our next question. Why did the employer-based system become so widespread in the U.S.? It's odd because by 1920, 16 European nations had adopted some kind of national compulsory healthcare. Why didn't the U.S. follow suit? Well, because the more things change, the more they stay the same. In 1933, Franklin Delano Roosevelt and the Democrats pushed for a national healthcare system as part of his social-security legislation. But Republicans, with the help of the American Medical Association, were able to shoot it down by calling it "socialism" and arguing that healthcare program was government overreach. Basically, if your grandparents and great-grandparents had Facebook, they would've been having the exact same arguments as you. Okay, but in order to understand how employers got involved in the health-insurance game, we have to dive into two of history's most exciting subjects, World War II and tax breaks. Now, while Hollywood mainly makes movies about the battles, running a war is actually very difficult and logistically complex. And during World War II, the federal government was fighting Nazis and their own fears of post-war inflation. And rightfully so-- the administration saw what happened when hyperinflation wreaked havoc on the German economy after World War I. So they were determined to hold it at bay through wage and price controls. This, of course, did not make workers very happy. In reaction to the wage controls, many labor groups threatened to strike, which could have been devastating to, you know, winning the war. So, in a concession to the unions, the War Labor Board exempted employer-based health benefits from wage controls and income tax. Plus, the government offered big tax breaks for providing coverage. As a result, employers started offering health plans to attract new employees. Unions didn't strike, and by the end of the war, health coverage had tripled. So, because history loves irony and unintended consequences, it was FDR and labor unions who played a big part in generating the modern employer-based healthcare system. But what does communism have to do with any of this? Well, post World War II, employer-based health insurance wasn't guaranteed. President Truman pushed hard for a nationalized healthcare system, but was defeated by Republicans with a big assist from communism. But first, a quick post-war recap. In Great Britain, devastations from bombings during World War II led to a post-war political consensus and the formation of the National Health Service. The fact that average citizens were hurt during the bombings in the U.K. played a big role in pushing this agenda forward. In the U.S., this wasn't the case. Other than the attack on Pearl Harbor, American soil remained almost entirely unscathed, and most non-veterans were physically okay. So rather than dealing with a devastated populace, American politicians were trying to bring wartime taxes under control and size up its next enemy, communist Russia. In 1945, when Truman proposed his five points for better national health, including national health insurance, the threat of communism was used to defeat it. Remember the American Medical Association? Yeah, still wasn't too keen on universal healthcare. The AMA used the red scare to convince the public and Congress that Truman's plan was "socialized medicine." They called the administration "followers of the Moscow party line," which despite sounding like a line dance, was actually a pretty strong condemnation of Truman. Of course, Truman didn't appreciate being called a communist and used the Christian-values argument against the AMA, saying, "I put it to you-- is it un-American "to visit the sick, aid the afflicted, or comfort the dying? I thought that was simple Christianity." But ultimately, Truman's efforts for universal healthcare failed. After that defeat, the Korean War took hold, and the 1950s boom economy led to greater employer-based health insurance, and America got more and more set in its healthcare system. So what do we get when we add all this up? Well, things that we rationalize as normal often need a lot of historical turns to arrive at that same point. Without a combination of creative marketing, the complex economic regulations of World War II and a post-war boom economy mixed with the threat of communism, American health insurance could have ended up in a very different place. And remember that thing about displaying premature babies in incubators at Coney Island Freak Shows? Yeah, that one actually worked and paved the way for neonatal healthcare. History is a weird place.

(Describer) Titles: PBS Digital Studios.

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