Health Care Policy in the United States: A Historical Perspective

This semester, I am taking my Government senior seminar in 20th Century American Social Policy.  We have just begun covering developments in U.S. health policy from 1900-1950.  While doing reading for the class, I was shocked by how similar much of the discourse surrounding national health insurance in this time period was to accusations and criticisms used during the debate over the Affordable Care Act (ACA).  Events from as early as the 1900s have had a profound impact on the way opponents of national health insurance characterize federal programs.  The historical context of the first debates over government regulation of health care created a set of frames that are still used when discussion of health care arise.

For example, when California and New York began debating comprehensive health care bills in the early 20th century, opponents of the state involvement in health care decried these programs “socialized medicine” (“The Lie Factory,” Lepore).  The “Red Scare,” or fears of latent communist or socialist elements among the American population, provided a ready-made set of criticism for proponents of national or state health insurance programs.  The most fervent opponents of national health insurance, physicians and private insurance companies, capitalized on these widespread fears and labeled any form of government involvement “creeping socialism” (Hamovitch 281). Public opinion on government regulation of health services was generally positive, however the public was unsure as to what form they wanted this involvement to take. Organizations such as the American Medical Association (AMA) and congressional Republicans manipulated public opinion and frightened significant portions of the populace.

The rise of political consulting firms also helped opponents of national health care mount effective public relations campaigns.  Early health care battles represented one of the earliest instances of special interest campaigning.  The AMA assessed a $25 dollar fee on all of its members to pay “Campaign Inc.,” one of the first political consulting firms (Quadagno ).  Campaign Inc. had no qualms about quote misattribution, out-of-context “facts,” and outright falsified statistics.  Their efforts successfully derailed at least five attempts at either state or national health insurance plans.   Physicians who dared publicly support reform efforts were expelled from the AMA and lost their admitting privileges at local hospitals.

As seen through the ongoing debate over the Affordable Care Act (ACA), rhetoric surrounding government intervention in health care has remained remarkably similar.  The coinciding of the “Red Scare” and nascent efforts to reform health care allowed opponents of reform to permanently link communism and socialism to questions surrounding government healthcare provisions.


Works Cited

Hamovitch, Maurice B.  “History of the Movement for Compulsory Health Insurance in the United States,” Social Service Review 27, 3 (Sept. 1953): 281-99, available from JSTOR

Quadagno, Jill.  One Nation Uninsured: Why the U.S. Has No National Health Insurance (New York: Oxford University Press, 2005), ch. 1 (Blackboard).

Lepore, Jill. “The Lie Factory,” The New Yorker (Sept. 24, 2012), available at