Boychuk
18
would be covered. Benefits for the elderly (as opposed to children and pregnant women, for
example) were “advocated solely because it seemed to have the best chance politically.” (Ball,
1995: 62-3) The well-established and politically popular Social Security program provided an
attractive basis for providing health insurance benefits.
15
By default, if not design, this approach
replicated the major compromises inherent in the contributory pension component of the New
Deal which was made acceptable to the southern congressional representatives only by explicitly
excluded agricultural workers and domestic servants and, as a result, avoiding any challenge of
the racial status quo in the South. (Quadagno, 1988)
16
Medicare would be initially introduced in Congress in 1957. Eight years later, an
expanded version of the proposal, embodied in the Medicare Act (providing for hospital care for
eligible Social Security beneficiaries, premium-based insurance coverage for physician care, and
federal grants-in-aid to the states for provision of health insurance for people with low-income),
would finally pass. Despite meager efforts at comprehensive health insurance reform in the
1970s, this development would effectively shut the door on national universal public health
insurance at least for the foreseeable future.
CONCLUSION
The recent emphasis on historical institutional analysis and focus on path dependence in
understanding contemporary patterns of public policy has generated renewed interest the
historical development of public policy across a number of policy fields. Ongoing public
debates regarding health care reform in the United States have provided considerable impetus for
scholars to apply this analytical approach to the historical development of public health
insurance.
In such analyses, the immediate postwar period appears to have been a critical juncture in
the development of public health insurance in the United States. An adequate understanding of
developments in this period requires careful consideration of the dynamics generated by the
politics of race. These dynamics were a critical element contributing to forestalling the
development of comprehensive national public health insurance in the immediate postwar period
and, as a result, in shifting the focus of reform to the narrower categorical programs that still
form the central plank of public health insurance in the United States today.
15
As Robert M. Ball, who was deeply involved in developing the alternative program, has noted: “The slogan
became ‘health insurance through Social Security’… Much was meant by these references to Social Security, some
of it explicit and some subliminal.” (Ball, 1995: 65)
16
Social Security coverage would be extended to regularly employed farm workers in 1954 -- only after the
‘Medicare’ approach had come to dominate the strategy of health insurance reformers.
Convention