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

The United States is alone among industrial democracies in having no national health insurance system, even as polls show large majorities of Americans favoring one. This comprehensive and convincing academic study illuminates this great American political conundrum. Gordon, a historian and author of New Deals: Business, Labor and Politics in America, 1920-35, examines reform efforts from the First World War to the Clinton health plan fiasco, and critiques scholarly explanations of the failure of more ambitious national healthcare initiatives. He explores America's idiosyncratic conception of healthcare as quasi-contractual social insurance and consumer commodity, not a right of citizenship, and its legacy in our ungainly system of private employment-based insurance. He traces the abandonment of national health insurance by its natural allies in the labor movement, which concentrated on protecting its private benefits, and among reformers, who settled for piecemeal programs that serve a portion of the population but undermine the rationale for universal coverage. Most of all, he points to the subservience of the American political system to economic interests. Time and again, he finds, the private healthcare industry has used its financial clout to""throttle"" popular reforms through bare-knuckled lobbying, political donations, and PR campaigns associating national health insurance with Communism and vilifying successful Canadian and European systems. The result is a muddled system driven by the contradictory demands of doctors, hospitals, insurers and employers, one that generates the world's highest medical bills while leaving millions uninsured. Gordon synthesizes an enormous amount of scholarly research into a readable and compelling account of the debate over healthcare policy, one that poses larger questions about the failings of American democracy.