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National Health Insurance and the Politics of Race in the United States, 1945-52
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Boychuk
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A number of recent and influential interpretations of the development of public health
insurance in the United States adopt a historical institutional approach emphasizing the concept of path dependence. These interpretations argue that the development of public health insurance in the US has been, to some significant degree, shaped by the outcomes of earlier struggles over health insurance. (Hacker, 1998; Maioni, 1998; Tuohy, 1999; Gottschalk, 2000; Hacker, 2002; Hacker and Béland, 2004) In such accounts, the failure of national public health insurance in the immediate postwar period is widely considered to have marked a critical juncture in the development of public health insurance in the United States.
Over the seven year period from 1945 to 1952, a number of bills with presidential support
providing for national health public health insurance would be presented to Congress. None, however, would pass and the only significant health legislation adopted during Truman’s tenure provided federal cost-sharing for hospital construction. Following this failure, national compulsory public health insurance providing broadly comprehensive coverage of the American population would never again be a serious possibility in the United States. Future efforts at developing universal national health insurance would be stymied by political barriers created by the expansion of voluntary health insurance coverage, the political dynamics generated by public programs for those most in need including the elderly and the poor, and deeply-institutionalized resistance created as a result of the expansion of the medical industry prior to the development of universal public insurance. (Hacker, 1998: 128; see also Gottschalk, 2000) Thus, a central question of enduring historical significance is why this push for national health insurance in the immediate postwar period ended in failure.
Examinations of public health insurance reform in this period make reference to various
explanatory factors including, most notably, the power of opposition interest groups such as the American Medical Association (AMA) and the role of voluntary insurance in limiting the political prospects for public health insurance. Each interpretation makes an important contribution to understanding the fate of national health insurance proposals in this period. However, the dynamics generated by the politics of race were a crucial element contributing to the demise of national public health insurance in the immediate postwar period. Consideration of these dynamics is a necessary element in fully understanding the failure of national health insurance at this critical juncture in the development of public health insurance in the United States. THE ROLE OF RACE IN EXPLAINING THE FAILURE OF NATIONAL COMPULSORY HEALTH INSURANCE, 1945-52
The politics of public health insurance in this period were shot through with dynamics
generated by the politics of race. To the degree that race enters into conventional understandings of the development of public health insurance, health reform is typically portrayed as being linked to racial politics only as a result of its chronological coincidence with Truman’s civil rights program. However, the direct linkage between health insurance and the politics of race have not been adequately considered. The two were inextricably interwoven: the administration explicitly linked its policies on health service provision and its anti-segregation program; support and opposition to national compulsory health insurance was drawn along racial as well as segregationist/integrationist lines; and opposition to national compulsory health insurance was framed in ways that both explicitly and inadvertently raised issues central to racial segregation.
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| | Authors: Boychuk, Gerard. |
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Boychuk
1
A number of recent and influential interpretations of the development of public health
insurance in the United States adopt a historical institutional approach emphasizing the concept
of path dependence. These interpretations argue that the development of public health insurance
in the US has been, to some significant degree, shaped by the outcomes of earlier struggles over
health insurance. (Hacker, 1998; Maioni, 1998; Tuohy, 1999; Gottschalk, 2000; Hacker, 2002;
Hacker and Béland, 2004) In such accounts, the failure of national public health insurance in the
immediate postwar period is widely considered to have marked a critical juncture in the
development of public health insurance in the United States.
Over the seven year period from 1945 to 1952, a number of bills with presidential support
providing for national health public health insurance would be presented to Congress. None,
however, would pass and the only significant health legislation adopted during Truman’s tenure
provided federal cost-sharing for hospital construction. Following this failure, national
compulsory public health insurance providing broadly comprehensive coverage of the American
population would never again be a serious possibility in the United States. Future efforts at
developing universal national health insurance would be stymied by political barriers created by
the expansion of voluntary health insurance coverage, the political dynamics generated by public
programs for those most in need including the elderly and the poor, and deeply-institutionalized
resistance created as a result of the expansion of the medical industry prior to the development of
universal public insurance. (Hacker, 1998: 128; see also Gottschalk, 2000) Thus, a central
question of enduring historical significance is why this push for national health insurance in the
immediate postwar period ended in failure.
Examinations of public health insurance reform in this period make reference to various
explanatory factors including, most notably, the power of opposition interest groups such as the
American Medical Association (AMA) and the role of voluntary insurance in limiting the
political prospects for public health insurance. Each interpretation makes an important
contribution to understanding the fate of national health insurance proposals in this period.
However, the dynamics generated by the politics of race were a crucial element contributing to
the demise of national public health insurance in the immediate postwar period. Consideration
of these dynamics is a necessary element in fully understanding the failure of national health
insurance at this critical juncture in the development of public health insurance in the United
States.
THE ROLE OF RACE IN EXPLAINING THE FAILURE OF NATIONAL
COMPULSORY HEALTH INSURANCE, 1945-52
The politics of public health insurance in this period were shot through with dynamics
generated by the politics of race. To the degree that race enters into conventional understandings
of the development of public health insurance, health reform is typically portrayed as being
linked to racial politics only as a result of its chronological coincidence with Truman’s civil
rights program. However, the direct linkage between health insurance and the politics of race
have not been adequately considered. The two were inextricably interwoven: the administration
explicitly linked its policies on health service provision and its anti-segregation program; support
and opposition to national compulsory health insurance was drawn along racial as well as
segregationist/integrationist lines; and opposition to national compulsory health insurance was
framed in ways that both explicitly and inadvertently raised issues central to racial segregation.
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