Slavery, the original sin of America, is a twofold shame on our society today. The first is the institution itself, and the second is our collective refusal to grapple with the reality of being a nation founded on the bondage of our fellow brothers and sisters. Part of confronting this legacy of subjugation and violence is our atonement for the widescale theft of property, wages, and life by White people and by the government — reparations. While it can and should take many forms, the first step towards a national reparations program should be the fundamental security of health and wellbeing: the implementation of universal healthcare insurance. 

The system of slavery in the United States was particularly horrific in how it handled the health of enslaved people. Because slaves were seen as little more than property, their health was disregarded up until the point where their owner’s investment was threatened. If a slave was close to death, a doctor would be called to heal them enough to return to work. These physicians subjected countless individuals to medical experimentation, forced sterilization, and severely invasive procedures without anesthetic, particularly gynecological experiments against women. Many died directly at the hands of these doctors, and many more through neglect, overwork, and abuse by their masters.

The legacy of racism and exploitation in American medicine ripples out through our history to today. The transgenerational effect of slavery and racism manifests through minority stress and lower life expectancy. The Public Health Service’s Tuskegee syphilis study allowed poor men of color to slowly die of a treatable disease in what was effectively state-sanctioned torture. Even now we see the effects of this history of oppression, where Black women are more than 3 times as likely to die in childbirth than White women regardless of income or education, as Serena Williams can attest.

It is clear that this immense debt has yet to be paid. However, the form of such potential reparations is hotly contested where it is even discussed at all. Given the enduring legacy and modern expression of racism in this country, cash reparations are extremely unlikely to pass in our current government or indeed in any administration in the near future, which is partly why some have looked to programs such as community investment, education grants, and others. However, the best starting point for a multifaceted approach to reparations should be universal healthcare insurance.

Black Americans have the second-highest uninsured rate in the country, with 10.6% having no health insurance in 2017, compared to 8.8% for all Americans. The costs of not having health insurance can be severe. According to the Kaiser Family Foundation, one in five uninsured adults went without needed medical care in 2017 due to cost, and adults without insurance were twice as likely to struggle to pay medical bills than their insured counterparts. This hits low income individuals significantly harder, as they tend to have minimal savings and may be forced to go into debt to cover necessary procedures.

Universal health insurance would alleviate these concerns by guaranteeing coverage for all Americans, regardless of income or employment status. An improved and expanded Medicare for All that abolishes private insurance and ensures coverage for every American is the best path forward. Over 50% of uninsured individuals in 2017 were below 400% of the federal poverty line in states who did not expand Medicaid. Nine of the fourteen states who refused expansion are former Confederate states. A national health program prevents that denial of coverage from continuing.

And while it is true that universal health insurance will benefit all Americans, it is still a form of reparations. Universal health insurance will disproportionately benefit Black people as compared to their White counterparts, due to existing disparities in insurance rates. Descendants of enslaved people are disproportionately poorer and have worse health outcomes, as a result of sustained and systematic discrimination by the medical field and the United States government. Universal health insurance is one way to repay the great debt owed as a result of the institution of slavery and the unique harm caused by the healthcare field on this population, the artifacts of which we still see today. 

We should not consider single payer the end of racism in America. Universal health insurance represents a piece of the puzzle to repay those who suffered most at the hands of slavery, segregation, and Jim Crow. Equal access to healthcare does not mean equal receipt of it, and having insurance neither erases racism nor excuses it. The conversation about reparations and how as a society we expiate our founding failure is ongoing, and other plans should follow. But this is where we should start.

Slavery was brought to our shores 400 years ago. The time has long come for reparations for that history. The time has come for universal health insurance.

Photo by Hush Naidoo on Unsplash