These aid societies did more than provide relief from doctors’ bills, lost wages or funeral expenses. They also divided the “deserving” poor from miscreants who suffered through their own fault. Their bylaws stressed “thrift, leadership skills, self-government, self-control and good moral character,” the historian David Beito has written. Lodges required members to hold an “honorable” job, banned women of “immoral or questionable behavior,” and limited the use of alcohol and drugs.

Today, Medi-Share requires members to “live by biblical standards:” no tobacco or illegal drugs and no sex “outside of traditional Christian marriage.” Samaritan Ministries, with headquarters in Peoria, Ill., requires a pastor’s approval of medical expenses (and refuses to cover treatment for S.T.D.s unless “contracted innocently”). Liberty HealthShare, based in Independence, Ohio, is the only Affordable Care Act-exempt ministry open to people of many faiths. It asks them to affirm that “it is my spiritual duty to God and my ethical duty to others to maintain a healthy lifestyle.”

Members say these rules are marks of the kind of community that government programs undermine. “This is a solution for those of us who see the A.C.A. as a problem,” said Daniel Alders, 28, a Samaritan member who lives in Nacogdoches, Tex., and has turned to the ministry to pay for the births of his two children. Samaritan members send their monthly share directly to another member with medical expenses. “When we receive money, nine times out of 10 there’s a note attached saying they’re praying for us and the health of the baby,” he told me.

“A community is an organically grown organism, so it can’t succeed if it’s pushed and enforced from the top level down,” he said. “You have to have a moral foundation, a reason to trust those whose needs you’re sharing.”

In a recent interview with NPR, President Obama acknowledged that many white working-class voters felt no such trust in the government. “They think: ‘I’m being left out. Nobody seems to be thinking about how tough it is for me right now,’ ” he said.

He’s not the first liberal to hope that publicly funded health insurance could win that trust. More than a century ago, the Progressive reformer Jane Addams admired the parades of mutual aid societies in Chicago’s Italian quarter, where members marched “with a brave showing of banners, celebrating their achievement in having surrounded themselves by at least a thin wall of protection against disaster.” She longed “to pour into the government of their adopted country all this affection and zeal, this real patriotism. A system of State insurance would be a very simple device and secure a large return.”

In fact, mutual aid societies fought compulsory insurance legislation that Progressive activists proposed in the World War I era, fearing that such laws would endanger Americans’ “spirit of self-reliance.” The legislation failed, but the societies’ days were numbered, too. The financial burdens of their aging membership sometimes became crushing. And they were no match for the growing political power of commercial insurance companies and organized medicine, or the I.R.S.’s ruling in 1943 to grant tax breaks to employers who paid for workers’ insurance.