Fitting an elephant through a keyhole: America's struggle with national health insurance in the twentieth century

National health insurance has been a top political issue in the United States for the better part of the twentieth century. This dissertation is a synthetic analysis of the seven times health insurance for the American people topped the national agenda. During the Progressive era, the American Association for Labor Legislation spearheaded a state by state campaign to provide wage relief and medical coverage for the working poor. During the Great Depression reformers struggled to include health insurance in the New Deal. Failing that, President Harry S. Truman backed a cradle-to-grave insurance package. His unsuccessful approach led reformers to an incremental approach that focused first on medical care for the elderly. Medicare and Medicaid finally passed during Lyndon B. Johnson's first term. Many national health insurance advocates viewed this legislation as a step toward universal coverage. President Richard M. Nixon took up the issue in response to agitation by Senator Edward M. Kennedy and a compromise effort between the two was nearly successful. President Jimmy Carter added the issue to his agenda to placate organized labor and liberal Democrats, but his effort was half-hearted and plagued by the flagging U.S. economy. President Bill Clinton revived the issue as a national priority but met the most serious resistance to date. The continual failure of universal health care defies one simple explanation. Reformers met with vigorous opposition from varying special interests, particularly organized medicine and insurance companies. Presidential leadership often started out strong but then lagged as leaders became embroiled in other pressing issues. At times compromise seemed possible, but then the interested parties refused to move far enough from their original plans. The key to these incidents lies in public opinion polls that show Americans favor government action to reform health care, but disagree on what action to take. Even more importantly, the polls also show that most Americans are personally satisfied with their health care options, and so change is not a pressing concern.