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


End of the Year Reflection

After spending most of the Fall Semester engaged in what the Obamacare team has come to affectionately term “data-hazing,” I was looking forward to starting my independent data project and moving on to move engaging elements of the research process.   Then I met R.  R is a free software program that allows researchers a great deal of data analysis freedom.  So much freedom, I might add, that learning the program adequately reflects the well-known saying, “give em’ enough rope and they’ll hang themselves.” The beauty of R is that you can tell it to do anything, as long as you know the command.  However, therein lies the greatest challenge as well.  The first few sessions were a haze of parentheses, brackets, and red error messages.  With the patient help of Professor Settle, Meg, and Taylor, the lab gradually became more acclimated to R.  Although the learning process could be tedious, successfully entering commands felt like a huge victory.

One of the major lessons I have learned about the research process is that is often, long, disappointing, and painfully slow.  However, this characteristics also make the small pay-offs along the way incredibly satisfying.  Over the course of the past year, I’ve had to grow used to scaling back my expectations, then scaling them back a little more, and then adjusting them perhaps one more time.  There are tangible things I’ve learning working in the lab, such as how to create a bar graph in R, but there are also so many intangibles that I may not be able to neatly fit on a line in a resume.  Growing used to slow and obstacle-riddled research process has been one of those invaluable intangibles.  As I prepare to begin my senior year of college,  I will need to remember the importance of remaining flexible and keeping an open-mind about the future. While I am excited to start putting my new-found R skills to use for my independent research project this summer, I am even happier about undertaking an independent project (and senior year!) with a better, continually evolving attitude about the process of research itself.