Remedy and Reaction: The Peculiar American Struggle over Health Care Reform

In this book, Paul Starr, formerly a senior White House health-policy advisor for President Bill Clinton, examines the failure of the United States to adopt national health insurance in the past century. He begins by reviewing major developments in the history of national health insurance. In 1915–19, efforts to adopt European-style national health insurance systems failed to gather support. In the 1930s and 1940s, efforts to include national health insurance in New Deal programs foundered because of higher priority for Social Security and unemployment insurance and the opposition of organized medicine and other interest groups. The 1940s and the 1950s saw the widespread adoption of commercial group health insurance by employers and labor unions. These programs excluded the elderly, a growing proportion of the population, and the poor. In 1965, Congress enacted a two-tier system with Medicare as a national health insurance program for the elderly and Medicaid as a joint federal-state program for welfare recipients. The uninsured in 1970, mostly the working poor and their families, comprised less than 12 percent of the population.