The US is the only rich democracy that lacks a system of universal health care provision. This weak public health infrastructure has severely constrained the country’s pandemic response: since May, it has suffered the highest mortality rates of all countries reporting adequate data. Even before the outbreak of the global pandemic, the United States was experiencing a health care crisis, with 87 million people uninsured or underinsured, more than 137 million people struggling to pay off medical debt, and among the weakest population health outcomes in the Organization for Economic Co-operation and Development (OECD).

The absence of public health care provision in the United States is commonly traced to 1948, when Harry S. Truman’s national health care proposal was soundly defeated through extensive lobbying efforts by the American Medical Association (AMA). But the battle for universal provision reached an earlier peak during World War I, when a coalition led by the American Association for Labor Legislation (AALL) put forward a bill for mandatory health insurance in fourteen states.

In this early campaign, women trade unionists in the International Ladies’ Garment Workers’ Union (ILGWU) and the Women’s Trade Union League (WTUL) powerfully broke with the strategy of the American Federation of Labor (AFL), advancing a political vision that unified skilled and unskilled workers, and integrated feminist demands with the interests of the working class as a whole.