Understanding American Health Care Reform, 1910-1932 : Toward and Interpretive History of Health Policy

Abstract

The purpose of this article is to analyze the two early health care reform groups: the American Association for Labor Legislation(AALL), the first organization to try to initiate compulsory health insurance in the U.S., and the Committee on the Costs of Medical Care(CCMC), a self-formed committee to study the economics of medical care. By viewing health policy from a historical perspective, we can find a variety of possible alternatives that would have been implemented in different place and time. Unlike positivistic studies on health policy whose only concern is with successful programs, the history of health policy is interested not only in success but also in failure of policy. Reformers from the late 1910s through early 1930s recognized health insurance as a medical issue not as a welfare issue. As long as health insurance belonged to medical domain, policy on health insurance remained separate from public policy. If so, who analyzed and decided the policy? This article argues that social reformers in this period should have tried to launch health insurance not from the front of medical care but in the field of public welfare. This shift in the direction of health care reform would inevitably have caused changes in the strategies accepted.