When you ask most Americans why we’re the only developed nation on Earth without a national healthcare system that covers everybody at low cost, saves trillions, and saves hundreds of thousands of people from unnecessary death and disability every year, most will tell you about the AMA, the insurance lobby, or Reagan.
And, indeed, they’re all part of the story. But the deeper answer, one I discovered — to my shock — when I was writing this book, is that it’s almost all because of a guy nobody in modern America has every heard of.
Frederick Ludwig Hoffman stepped off a boat in New York in 1884 with $4.76 in his pocket and not a word of English. By 1920 he was a vice president of Prudential, one of the most powerful and respected statisticians in the country, and America’s leading authority on the pseudoscience used to justify Jim Crow that was then called “scientific racism.” He was also, as you’ll read next Sunday, the single most effective opponent of universal health insurance this nation has ever produced.
What makes Hoffman so unsettling is that he wasn’t a crank. He published the first work anywhere in the world linking tobacco to lung cancer, documented the connection between asbestos and the mesothelioma that killed my father, and helped create what became both the American Cancer Society and the American Lung Association.
He was brilliant when it came to numbers, and could read a mortality table better than almost anyone alive. And in 1896 he put that skill to work on a 300-page book that I tracked down in an antiquarian book store titled: Race Traits and Tendencies of the American Negro. In that book, he purported to “prove” that Black Americans were headed for extinction because of their racial inferiority, and that any attempt by white society or government to help them — healthcare above all — would only speed up the process while dragging white people down with it.
This chapter follows Hoffman from the Georgia obstetrician’s pamphlet that gave him the idea, through the statistical case he built for it, to the arguments he left behind. “Easy conditions of life and a liberal charity are among the most destructive influences affecting the lower races,” he wrote. When David Koch ran for vice president in 1980 on the proposition that government help hurts the people it’s meant to help, he was simply reciting Hoffman with the racial vocabulary filed off.
A warning before you begin reading: I quote Hoffman at length, and his language is the language of white supremacy. I left it intact because I want you to see exactly what the founding intellectual of American healthcare opposition believed, in his own words. That thread runs straight from his book to your Republican congressman’s talking points.
America, the Land of the Sick
America is the only developed country in the world that doesn’t recognize healthcare as a human right, the only country with more than two-thirds of its population lacking access to affordable healthcare, and the only country in the developed world that has, since its founding, continuously enslaved and legally oppressed and disenfranchised a large minority of its population because of their race.
Prior to the “Trump Depression,” roughly 60 percent of Americans would have to take out a loan or otherwise borrow or beg for money to deal with a single, unexpected $1000 expense59; the number now is probably closer to 80% of Americans who can’t handle such a hit and is higher still for minority communities. Yet copays and deductibles when a person gets sick averaged $1318.00 in 2015 when the Kaiser Family Foundation did a comprehensive survey of Americans, up from $548 just ten years earlier.60 This strikes minorities particularly hard , which, it turns out, is not an accident.
The simple fact is that were it not for slavery, white supremacy, and the legacy of “scientific racism” America would have had a national, single-payer healthcare system in 1915, just 30 years after Germany put into place the modern world’s first such program.
At the center of the effort to prevent a national healthcare system – or any form of government assistance that may even incidentally offer benefit to African Americans – was Frederick Ludwig Hoffman and the Prudential Insurance Company that promoted his “science based” racial theories to successfully fight single-payer health insurance.
Frederick Ludwig Hoffman Makes a Discovery
Racism is the main reason America doesn’t consider healthcare a human right and provide it to all citizens, as does every other developed country in the world. Racist whites, particularly in the South, have worked for over a century to make sure healthcare is hard for Black people and other minorities to get. And their biggest ally, their founding spokesperson in the post-Civil War era, their biggest champion right up to the 1940s, was a man most Americans have never heard of.
In 1884 nineteen-year-old Frederick Ludwig Hoffmann left Germany for America after failing at a number of job attempts and being rejected for the German Army because he was “physically deficient” and frail, standing 5’ 7” and weighing a mere 110 pounds. He arrived in New York with $4.76 in his pocket, speaking “not a word of English,” but determined to prove wrong his mother’s assessment that he was a “good-for-nothing.”61
From this humble beginning, Hoffman would become one of America’s most influential statisticians and analysts of public health, making numerous consequential discoveries about how industrialization was killing American workers.
He dropped the last n in his last name, became so fluent in English that his accent was nearly indistinguishable, and married into an upscale Georgia family. By 1920, he was an American citizen, Vice President of America’s largest insurance company, and a national authority on the now-discredited pseudoscience called scientific racism.
In 1908 his article The Mortality from Consumption [tuberculosis] in the Dusty Trades, published by the US Department of Labor, produced the first national efforts to reduce lung damage in the workplace. He also published the first work (1915) linking tobacco to lung cancer.
From this, he became Vice President of the National Tuberculosis Association (today known as the American Lung Association) and later demonstrated the association between exposure to asbestos and the disease that killed my father, mesothelioma (a bit of data asbestos companies worked to keep hidden for the next 80 years).
In 1913 Hoffman wrote a seminal paper on the relationship between workplace pollution and cancer, which led him to cofound The American Society for the Control of Cancer (known today as the American Cancer Society). In 1937, he extended his research beyond the workplace and published Cancer and Diet, a book correctly pointing out the correlation between poor nutrition and cancer that is still in print at a dense 767 pages, mostly of statistical analysis between dietary habits and rates of disease.
His cancer research was so extensive and detailed (he concluded that diets heavy in processed foods and animal products produced higher cancer rates) that Adelle Davis – whose books became my mother’s nutrition guru in the 1950s and ‘60s – became an early “convert” and “a devotee of Frederick Hoffman.”62 But Hoffman’s most controversial lifelong obsession was with the relationship between disease, race, and society.
On one of his first trips to Georgia, he wrote, he came across a pamphlet by Dr. Eugene R Corson, a Georgia obstetrician, titled Vital Equation of the Negro. It was apparently an updated or shortened version of Corson’s widely read “The Future of the Colored Race in the United States From an Ethnic and Medical Standpoint,” published in 1887 in the New York Medical Times.63
This was just after the failure of Reconstruction, and a widespread topic of speculation, particularly in the South, was whether blacks would soon outnumber whites in that part of the country. The Klan and others calling for wholesale slaughter and suppression of black people claimed that blacks were more likely to have larger families because they were “more prolific,” code for “excessively sexual,” a charge that had persisted from the earliest days of slavery and led to the murder of Emmet Till (among others).
However, the “scientific” racists of the day, like Corson, thought differently. Corson led a movement suggesting that people of African ancestry, now lacking the protective womb of slavery, would die out for the simple reason that the black race was inferior to whites.
Corson acknowledged the Klan’s argument that, “The simpler the organism, the simpler the genesis and the greater the prolificness.” But, he said, whites would prevail because they were less likely to die of disease, citing Herbert Spencer’s “Theory of Population Deduced from the General Law of Animal Fertility.”64 While blacks may have more children, Corson wrote, whites would still outnumber them because black fecundity “is more than compensated for by the ability [of white people] to maintain individual life.” Enslaved people from Africa had found themselves in a civilization “of which he is not a product” and thus were less likely to be successful in “the struggle for existence.” Therefore, Corson wrote, the Negro “must suffer physically, a result which forbids any undue increase in the race…”
The discovery of this theory, called the “racial extinction thesis,” electrified Hoffman, and he spent the rest of his life promoting it, while campaigning to stop any sort of movement toward a national health insurance program that may prevent or slow down the extinction of black people in America.
Race Traits and Tendencies of the American Negro
In August of 1896, the American Economic Association published a book that represented a turning point in Frederick Hoffman’s life and sealed the fate of single-payer health insurance in America. It was Hoffman’s opus magnum, summarizing decades of compiled statistics on black versus white mortality, proving, according to Hoffman, once and for all, that for black people “gradual extinction is only a question of time.”65
In Race Traits and Tendencies of the American Negro, Hoffman set out not only to repeatedly make and statistically prove the above claim, but to prove that any time white people tried to help black people, particularly by offering them healthcare services, the result was disaster for both.
Noting that “the Negro has failed to gain a foothold in any of the northern states,” Hoffman writes, “he is in the South as a permanent factor…with a tendency to drift into the cities, there to concentrate in the most undesirable and unsanitary sections…and the evil effect will be more felt by the cities which are thus augmented in population of an undesirable character.”66
In great detail, Hoffman spends about 300 pages documenting, with exhaustive tables and statistics, that blacks were more likely to die as a result of everything from malaria to tuberculosis to childbirth.
And it was all because of their race.
“The decrease in the rate of increase of the colored population has been traced first to the excessive mortality, which in turn has been traced to an inferior vital capacity. … This racial inferiority has, in turn, brought about a moral deterioration…sexual immorality…diminished social and economic efficiency…” And that represented a danger to white people, Hoffman wrote.
The participation of freed blacks in the contemporary labor pool and in society overall, he wrote, “in the course of years must prove not only a most destructive factor in the progress of the colored race, but also in the progress, social as well as economic, of the white race brought under its influence.”
Slavery had actually been good for black people, Hoffman believed, and the abolition of slavery at the end of the Civil War was only going to speed up the demise of that race.
“Nothing is more clearly shown from this investigation,” he wrote,” than that the southern black man at the time of emancipation was healthy in body and cheerful in mind. He neither suffered inordinately from disease nor from impaired bodily vigor.”
But with abolition, former slaves were “tending toward a condition in which matters will be worse than they are now, when diseases will be more destructive, vital resistance still lower, when the number of births will fall below the deaths, and gradual extinction of the race will take place.”
While Hoffman pioneered linking causal conditions such as asbestos or carcinogen exposure to sickness, he was so blinded by racism that a modern reader of his book constantly finds himself shouting, “But these things are also true of poor whites! These are caused by discrimination and poverty!!”
But at the time, the vast majority of white Americans agreed with him. He was echoing the white cultural and scientific consensus of the late 19th and early 20th centuries when he wrote:
“Given the same conditions of life for two races, the one of Aryan descent will prove the superior, solely on account of its ancient inheritance of virtue and transmitted qualities which are determining factors in the struggle for race supremacy. The lower races, even under the same conditions of life, must necessarily fail because the vast number of incapables which a hard struggle for life has eliminated from the ranks of the white races, are still forming the large body of the lower races.”
And, according to Hoffman and the other white “scientific racists,” the problem wasn’t just physical inferiority. The deepest “problem of the Negro,” Hoffman wrote, was moral.
“All the facts prove that a low standard of sexual morality is the main and underlying cause of the low and anti-social condition of the race at the present time. … The conclusion is warranted that it is merely a question of time when the actual downward course, that is, a decrease in the population will take place. In the meantime, however, the presence of the colored population is a serious hindrance to the economic progress of the white race.”
To those well-intentioned white people who wanted to help out the people who were a mere generation or two away from slavery, Hoffman (and his colleagues, including the Prudential Insurance Company) had one simple bit of advice: Don’t even try.
From Scientific Racism to Libertarianism
In 1980, David Koch famously ran for Vice President of the United States on the banner of the
Libertarian Party, an organization founded a few decades earlier by big business to give an economic rationale and political patina to their simple theory that economics were more important than democracy, and the quality of life of working people should be decided in the “free marketplace” instead by unions or through democratic processes via government regulation.
In this, Koch and his libertarian friends were echoing Frederick Hoffman.
In his 1896 Race Traits book, Hoffman laid out his “scientific” assertion that when government steps in to help people, it invariably ends up hurting them instead. Not only should there be no government assistance given to help African Americans recover from three centuries of property theft, forced labor and legal violence, but it was scientifically wrong to even consider the idea.
White people and government programs to better the lives of black people, Hoffman wrote, deserve “the most severe condemnation of modern attempts of superior races to lift inferior races to their own elevated position…” The damage done to black people by offering them any sort of help, government assistance, or even a minimum wage, he wrote, is “criminal” behavior for a “civilized people.”
Hoffman points to Native Americans to prove his point. “Few races have made such a brave struggle for their own preservation; few races can boast of so high a degree of aboriginal civilization. … An iron will can be traced upon the countenance of nearly every Indian of note.”
But it was government help, Hoffman wrote, that had destroyed the American Indian.
It wasn’t “adulterated whiskey nor the frightful consequences of sexual immorality, spread around the forts and settlements of the whites” that was “sufficient” to destroy Native Americans. It was charity. “The most subtle agency of all,” he wrote, sounding like Ronald Reagan or David Koch, “governmental pauperism, the highest development of the theory of easy conditions of life, did what neither drink nor the poisons of venereal disease could do, and today the large majority of the tribes are following the Maories and Hawaiians towards the goal of final extinction.”
White Americans rationalized their brutality toward Native Americans and African Americans by saying that it was simple evolutionary biology: Only the strong survive, and when the weak are allowed to propagate it weakens the overall human race.
“Easy conditions of life and a liberal charity are among the most destructive influences affecting the lower races,” Hoffman concludes, “since by such methods the weak and incapable are permitted to increase and multiply, while the struggle of the more able is increased in severity [by the increase in taxes and regulation].”
And it’s not just charity. “All the facts prove,” Hoffman wrote, “that education, philanthropy and religion have failed to develop [among blacks] a higher appreciation of the stern and uncompromising virtues of the Aryan race.
“Instead of making the race more independent, modern educational and philanthropic efforts have succeeded in making it even more dependent on the white race at the present time than it was previous to emancipation.”
Free education – as any Libertarian can tell you – is more dangerous to the souls of people than slavery. And free healthcare is even worse.
Sounding like a modern-day acolyte of Ayn Rand, Hoffman wrote, “Instead of clamoring for aid and assistance from the white race, the negro himself should sternly refuse every offer of direct interference in his own evolution. The more difficult his upward struggle, the more enduring will be the qualities developed.” And, like Ayn Rand, David Koch and Ronald Reagan, Hoffman believed these were eternal truths independent of race.
“No missionary or educator or philanthropist extended aid or comfort to the English peasant class during its darkest days, to the earliest settlers on the coast of New England, or the pioneer in the forests of the far West. …[I]t is extremely rare to find a case where easy conditions of life or liberal charity have assisted man in his upward struggle. Self reliance … must be developed, and thus far have not been developed by the aid of charity or liberal philanthropy.”
This libertarian ideal is still pervasive in our modern fragmented healthcare system, and in the midst of the COVID-19 crisis in 2020, resulted in thousands of daily American deaths, disproportionately hitting racial minorities.
Notice how Hoffman handled his numbers here, using real Black mortality data. The fact is that Black Americans in 1896 did die younger and more often of tuberculosis, malaria, and childbirth.
What Hoffman pulled off here, though, blinded by his own racism, was to strip out the obvious cause for all that suffering — three centuries of slavery followed by thirty years of poverty, Jim Crow, and hospitals that turned Black patients away — and attribute it instead to a simplistic argument for “race inferiority.”
That one widely-believed-in-his-day move of blaming the struggles and pain of the victims of American racism on themselves is also at the core of the libertarian/GOP case against healthcare. When you hear Republican politicians and on-the-take Democrats argue that uninsured people have “chosen” not to have coverage, that Medicaid recipients need “skin in the game,” or that expanding healthcare coverage “creates dependency,” you’re hearing echoes of the words of the long-dead Frederick Hoffman.
Next Sunday I’ll move from healthcare (and race) theory to the literally trillions of dollars involved. Prudential Insurance Company made Hoffman a VP and put him on the road, speaking to legislatures, physicians groups, and Congress between 1916 and 1920. Through those well-paid efforts he personally helped kill — repeatedly — what would have been America’s first healthcare-for-all program. And, ironically, all this was going down just three decades after Germany built the world’s first successful single-payer system in 1886.
If you know a young person who’s heard the Republican mantra that “welfare makes people dependent,” send them this chapter.
And join us for a discussion of the book and the situation with American healthcare on the last Sunday of October at 9 am PT, noon ET.
Thank you Mr. Hartmann, this article is amazing and I would guess this information is unknown to most americans. I appreciate your research and all of your work as always.
Thom's interesting biography of Her Hoffmann is the American Dream. He not only went from poverty to wealth, but he also was a model citizen who contributed to national health promotion societies very much alive and influential today.
Was Hoffman a racist? Well, the statistics are in his favor if you ignore what behavioral scientists refer to as intervening variables. Hoffman's equation ignored low access to quality (if any) education, low access to jobs with middle-class wages, and low access to decent food, clothing, and housing with decent plumbing and low exposure to disease. Those factors would shorten the life expectancy of a member of any race.
So, was Hoffman a racist or just somebody who misconstrued the data because they ignored causal variables in American society, and/or mistakenly accepted a eugenic explanation rather than accept a social one due to society's history of abusing racial minorities? In either case, it manifested socially as racial discrimination.