Why does the US Lack National Health Insurance?
· Windows of opportunity for healthcare reform, and opportunities and why/how they were squandered
o Healthcare Reform
§ Obamacare/ACA
§ Social Security Act
§ Affordable Care Act (ACA)
§ Medicare/Medicaid
o Why/how they were squandered
· Cooptation of the middle class (Rothman)
o Role of the Blues
§ 1st private health insurance
§ 1. Protected income of doctors/hospitals
§ 2. Could deliver affordable coverage to middle class to not undermine individual autonomy
· Rich had private, poor had public
· Ethos of voluntarism (e.g., physicians’ sliding scales for payment) (Rothman)
o People could pay as much as they wanted to
o More respect for doctors
§ Bakesaled way out of cancer treatment
§ ex) GoFundMe
o Public responsibility linked to welfare system (serving poor!!)
· Consequences of Medicare and Medicaid legislation for the chances of national health care reform (partial solutions); for the subsequent rise in costs in the 1970s
o Medicare – national healthcare didn’t align w/ the fact that older Americans considered unique (more health issues, “deserving” since they worked their whole lives)
o Medicaid – only targeted low income
o Subsequent Rise in costs in 1970s
§ Private insurance industries took over as most powerful stakeholder
· Previous explanations for why national health reform hasn’t passed (American exceptionalism!) and Quadagno’s counterargument
o American Exceptionalism – values & political culture that resumes responsibility of citizens beyond social
§ Weak labor movements that consistently support market-based solutions
§ Political institutions in the way of policy creation
o Quadagno’s Counterargument
§ Why did we pass Social Security & Medicare if we are so unfriendly to people in need?
§ Political institutions doesn’t explain uniqueness of private + public
§ Stakeholder Mobilization Theory – Healthcare financing constructed through struggles between reformers & powerful stakeholder groups mobilizing against national health insurance
· Stakeholder mobilization (Quadagno)
o Stakeholders in the past, stakeholders today
§ Past
· AMA – opposed 3rd party
· Labor Unions – opposed national health insurance
· Private Insurance industry – most powerful
§ Today
· AMA – aligned w/ private insurance after GD
· Labor Unions – shifted opinions after Medicare due to costs of insuring elderly
· Private Insurance industry
o What strategies do stakeholders employ?
§ Lobbying, grassroots strategies, advertising, developing private solutions
· Lobbying – person or organization attempts to influence decisions by government official or policy makers
· Grassroots Strategies – ground-level protests, petition drives, letter writing campaigns
· Advertising – shape public opinion
· Private Solutions
o The role of the AMA (American Medical Association)
§ Opposed 3rd party payers
· Americans should pay out of pocket
· Didn’t want doctors to lose autonomy from private services
§ After GD, against national health insurance
· Didn’t want governmental control
o The role of labor unions
§ Wanted to preserve benefits of their members
§ Goals aligned w/ AMA
§ Against national healthcare
§ Shifted to support Medicare because their private plans for elderly not profitable
o The role of the private health insurance industry
§ Took over as most powerful stakeholder in 1970s
· Limited medical professional autonomy + labor union position changed
§ The Blues
o Attempts at healthcare legislation in the US in the 20th century and their outcomes (e.g., Medicare/Medicaid, Health Care Security Acts of 1993)
§ Medicare/Medicaid – state and/or federally funded; improved health care access + outcomes
§ Health Care Security Acts of 1993 – would manage competition between private insurers (multiplayer); failed because organized campaign by private health insurance industry
o Fear of socialism as a factor in the 1940s -1950s and beyond
§ Push for national health care sunk through anti-communist fears
o Fear of government involvement in healthcare (compare the AMA late 1940s campaign against socialized medicine and the more recent conservative attack on the ACA)
§ AMA campaign – campaigned against national health care due to anti-communist fears from government intervention
§ Conservative Attack – Republican attack of ACA due to less trusting of federal government
o Belief in private solutions to the societal problems (e.g. employer-based private insurance)
§ Institutionalization of employer-based plans after AMA pushed against national health insurance
