We Didn’t Build a Healthcare System—We Built a Workaround

Apr 25

When Social Security was created, healthcare was part of the conversation.

It just didn’t make it in.

So there wasn’t a national system for covering medical costs.

But that didn’t mean the need went away.

In the 1940s, during World War II, the government introduced wage controls to stabilize the economy.

Employers couldn’t simply offer higher pay to attract workers.

But they still needed to compete.

So they found another way.

Instead of raising wages, employers began offering things like health insurance.

It was valuable to workers.
And it wasn’t restricted in the same way wages were.

Over time, this became more than a workaround.

It became a system.

After the war ended, wage controls went away.

But employer-sponsored health insurance didn’t.

It had already taken hold.

Employers were offering it.
Workers had come to expect it.
And it was financially advantageous to keep it that way.

Healthcare didn’t become part of Social Security—or any broader national system.

It became tied to employment.

Which meant access to coverage depended on where you worked, whether you were working, and what your employer offered.

Because not everyone was working all the time.

And some people weren’t working at all.

So over time, new programs were created to fill those gaps.

Not as part of one unified system.

But as separate pieces.

We didn’t build a healthcare system all at once.

We built it in pieces.

Often in response to what wasn’t working.

And that’s part of why it can feel so difficult to navigate today.

By the Time Social Security Started Working, It Was Already Complicated