Toward National Health Insurance in the United States: An historical outline, 1910–1979

Abstract

The paper analyzes the legislative history of the movement toward national health insurance over the last 70 years and analyzes key periods in this history in terms of the value basis upon which legislation was proposed and also in terms of the decision making theory utilized throughout this period in the provision of health care for American citizens. This analysis resulted in the following conclusions: (1) The bulk of the legislation which has come before Congress over the last 70 years has been polarized around two disparate value bases (total comprehensive and compulsory versus limited, categorical and voluntary, and two distinct decision theories—rationale versus incremental). (2) Congress and the administration have demonstrated receptivity on a limited basis to a total comprehensive and compulsory/rational approach in times of great socio-economic upheaval. (3) In times of relative stability, Congress and the administration have tended to adopt a limited, categorical and voluntary stance toward national health care and have utilized an incremental approach in deliberating health policy. (4) In that the nation has experienced more periods of stability than instability over the last 70 years, the present health care system can be understood as being the product of a limited, categorical and voluntary philosophy toward health care coupled with an incremental approach to policy formulation. (5) In that the percentage of Federal dollars spent on health care has risen from 4.3% in 1963 to 12.7% in 1978, the effectiveness of a limited, categorical and a voluntary approach to health care planning is questionable. (6) In that the Federal government has only exhibited receptivity to a total comprehensive and compulsory approach to health care planning during times of great economic and social upheaval, it seemed unlikely that the 96th Congress would respond favorably to the health care legislation proposed by Senator Edward Kennedy and the Committee for National Health Insurance.