Dead on Arrival

Dead on Arrival: The Politics of Health Care in Twentieth-Century America

Colin Gordon
Copyright Date: 2003
Pages: 336
  • Cite this Item
  • Book Info
    Dead on Arrival
    Book Description:

    Why, alone among industrial democracies, does the United States not have national health insurance? While many books have addressed this question,Dead on Arrivalis the first to do so based on original archival research for the full sweep of the twentieth century. Drawing on a wide range of political, reform, business, and labor records, Colin Gordon traces a complex and interwoven story of political failure and private response. He examines, in turn, the emergence of private, work-based benefits; the uniquely American pursuit of "social insurance"; the influence of race and gender on the health care debate; and the ongoing confrontation between reformers and powerful economic and health interests.

    Dead on Arrivalstands alone in accounting for the failure of national or universal health policy from the early twentieth century to the present. As importantly, it also suggests how various interests (doctors, hospitals, patients, workers, employers, labor unions, medical reformers, and political parties) confronted the question of health care--as a private responsibility, as a job-based benefit, as a political obligation, and as a fundamental right.

    Using health care as a window onto the logic of American politics and American social provision, Gordon both deepens and informs the contemporary debate. Fluidly written and deftly argued,Dead on Arrivalis thus not only a compelling history of the health care quandary but a fascinating exploration of the country's political economy and political culture through "the American century," of the role of private interests and private benefits in the shaping of social policy, and, ultimately, of the ways the American welfare state empowers but also imprisons its citizens.

    eISBN: 978-1-4008-2567-7
    Subjects: History, Political Science, Health Sciences

Table of Contents

  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-viii)
  3. Acknowledgments
    (pp. ix-x)
  4. Abbreviations
    (pp. xi-xvi)
  5. Introduction Why No National Health Insurance in the United States?
    (pp. 1-11)

    Why, alone among its democratic capitalist peers, does the United States not have national health insurance? This question, or variations of it, has invited a range of replies, some focusing on specific historical episodes, others invoking broad political or cultural or economic explanations for the peculiar trajectory of American social policy. At the same time, the explanatory laundry list is profoundly unsatisfying. Historical accounts often have trouble climbing from narrative to explanation; little of the episodic scholarship on the failure of health reform contributes to our larger sense of the American welfare state and its limits. And theoretical accounts often...

  6. 1 The Political Economy of American Health Care: An Overview, 1910–2000
    (pp. 12-45)

    The contours of the American health debate emerge most clearly in six historical moments. Between 1915 and 1920, Progressive reformers pressed unsuccessfully for state legislation mandating health insurance for industrial workers. In 1934–35, architects of Social Security toyed with the inclusion of health coverage alongside pension, unemployment, public assistance, and public health programs. In the next decade, New Dealers floated various proposals for adding health coverage, an effort that ultimately failed in 1949. After 1949, reformers retreated to the idea of offering coverage to those already eligible for Social Security, an effort that won the passage of Medicare and...

  7. 2 Bargaining for Health: Private Health Insurance and Public Policy
    (pp. 46-89)

    As a political alternative to national health insurance, private insurance had enormous appeal to a wide range of interests. As a practical alternative, it was a dismal failure—leaving public policy to subsidize private plans, mop up around their edges, and (in the process) stigmatize those they left behind. In turn, private coverage proved inherently fragmentary and discriminatory: it magnified the impact of job segregation by race and gender, perpetuated the ideal of family-wage male employment, and widened disparities in the social wage created by regional wage competition, uneven unionization, and a changing labor market. And private benefits, creating a...

  8. 3 Between Contract and Charity: Health Care and the Dilemmas of Social Insurance
    (pp. 90-135)

    The United States has always had a notoriously weak sense of social citizenship. The confusion of citizenship and property rights, a characteristic of modern liberalism exaggerated in the American setting, has created a two-tracked welfare system in which contractual employment benefits or contributory public programs have always been more important and more legitimate than means-tested charitable assistance. From early in the twentieth century, fascination with contractual benefits imbued social provision with the family-wage premise of the private economy: women were viewed as either maternal conduits for charitable family assistance or dependents of contracted employment benefits, and health care was confined...

  9. 4 Socialized Medicine and Other Afflictions: The Political Culture of the Health Debate
    (pp. 136-171)

    Over the course of the twentieth century, the language and culture of American politics shaped the aspirations of reformers, animated the arguments of their opponents, and set the terms and the boundaries of public discourse. This is not to say, as is often casually concluded, that a popular aversion to statist solutions doomed the prospects for national health insurance. Periodic measures of public support suggest quite the opposite: most Americans did not view a system of national health insurance as at all incompatible with their beliefs about the responsibilities of individuals or the role of government. In any case, it...

  10. 5 Health Care in Black and White: Race, Region, and Health Politics
    (pp. 172-209)

    The American welfare state has always been, at root, a Jim Crow welfare state—disdainful of the citizenship claims of racial minorities, deferential to a southern-controlled Congress, and leery of the racial implications of universal social programs. At the same time, racial distinctions have rarely been explicit, masquerading as anxieties about “Americanization” in the Progressive Era, as administrative distinctions between agricultural and domestic and industrial workers in the New Deal, as deference to private labormarkets and employment-based benefits in the 1950s, as concessions to federated governance through the Great Society and beyond, and as a backlash against dependency and the...

  11. 6 Private Interests and Public Policy: Health Care’s Corporate Compromise
    (pp. 210-260)

    Democratic capitalism sets capitalist boundaries around democratic rule (and vice versa). This logic is exaggerated in its American setting, which invites economic influence and organizes political competition around investments in parties and candidates. The absence of a social democratic tradition and the weakness of state institutions both reflect this pattern of economic influence and contribute to it. The federal system exaggerates the clout of economic interests, which are able to play political jurisdictions off against one another. Over time, the political status of economic interests has yielded considerable cultural clout as well. All of this has had a direct political...

  12. 7 Silenced Majority: American Politics and the Dilemmas of Health Reform
    (pp. 261-296)

    The political and ideological clout of leading health interests stood in stark contrast to the organizational struggles of health reformers. Although reformers always commanded a clear and substantial majority of public support, they only rarely made themselves heard above the cacophony of the corporate compromise and were quickly silenced when they did. In part this reflected a political system characterized by routine deference to economic interests, weak ties between reform interests and party politics, and nonprogrammatic electoral competition. And in part it reflected the peculiar politics of health care, in which private interests were well entrenched, the organization of public...

  13. Conclusion The Past and Future of Health Politics
    (pp. 297-302)

    At the root of our current situation, and of the historic failure of national health insurance in the United States, lies the persistent mismatch between the political resources commanded by health interests and those commanded by reformers. Though increasingly at odds over the costs or implications of political solutions, the parties to health care’s corporate compromise have at least shared the ability and the willingness to deflect reform whenever their stakes in the private health market have been threatened. And these stakes have increased markedly in recent years, as the costs of private health coverage continue to outpace inflation and...

  14. Archival Sources
    (pp. 303-306)
  15. Index
    (pp. 307-316)
  16. Back Matter
    (pp. 317-317)