Wages of Sickness: The Politics of Health Insurance in Progressive America

Studies in Social Medicine

by Beatrix Hoffman

The Clinton administration's failed health care reform was not the first attempt to establish government-sponsored medical coverage in the United States. From 1915 to 1920, Progressive reformers led a spirited but ultimately unsuccessful crusade for compulsory health insurance in New York State. Beatrix Hoffman argues that this first health insurance campaign was a crucial moment in the creation of the American welfare state and health care system. Its defeat, she says, gave rise to an uneven and inegalitarian system of medical coverage and helped shape the limits of American social policy for the rest of the century.

Hoffman examines each of the major combatants in the battle over compulsory health insurance. While physicians, employers, the insurance industry, and conservative politicians forged a uniquely powerful coalition in opposition to health insurance proposals, she shows, reformers' potential allies within women's organizations and the labor movement were bitterly divided. Against the backdrop of World War I and the Red Scare, opponents of reform denounced government-sponsored health insurance as "un-American" and, in the process, helped fashion a political culture that resists proposals for universal health care and a comprehensive welfare state even today.

Genres: History, Health Care, Medicine, Politics

280 pages, Paperback

First published January 22, 2001

Reviews

[Jonathan · Rating 5 out of 5]

As Beatrix Hoffman states clearly at the end of her introduction, "The story of the Progressive Era heath insurance campaign demonstrates that America's limited welfare state was born not simply of preexisting structural constraints but of political and ideological struggles and turbulent historical changes. American resistance to universal health care, then, has not been predetermined, inevitable, or insurmountable -- and a different future is more than conceivable."

This sharp thesis statement captures both the excellent research work done by Hoffman for the book and its central takeaway. "Wages of Sickness" focuses on the campaign for compulsory health insurance (and maternity leave) in New York in the 1910s. She discusses why this emerged as a key campaign and the tensions that bedeviled the campaign -- between middle-class technocratic reformers and their allies in the left-wing of labor, between factions of labor (who had very different visions of the role of the state), between different women's organizations, and between different factions of the business community (which came together quite forcefully during the campaign).

The business opposition to compulsory health insurance -- employers, physicians, commercial insurance companies -- did not want to come out and admit that economic self-interest was their reason for opposing the proposed reform. As a result, various strategies emerged: back-room lobbying, front groups, reports that challenge the data behind it, claims that health insurance would make the problem worse, and --- above all -- taking advantage of World War I era xenophobia around Germany (the country where such a welfare proposal first appeared). As we have seen in subsequent fights about health care in the US, the fight ends up centering on what "freedom" means and how that connects to a American national identity. When it comes to businesses fighting workplace protections, there's very little new under the sun, and "Wages for Sickness" demonstrates how current fights very clearly echo those of a century ago.

Hoffman also shows pitfalls and potentials, such as how the technocratic reformers underestimated their opposition and also underestimated the importance of robust agitation. Seeing how missteps or divisions stymied a proposal in the past is critical to reflecting on how to keep the fight going. We can see who was excluded, who was listened to too much, and who was taken for granted--and we can't change the future without correcting strategy accordingly.

[Jeffrey Thayer · Rating 5 out of 5]

"Wages" is the second Hoffman book I've read, a good complement to her "Healthcare for Some." I learned of her through C-SPAN and appreciate her comments that the U.S. healthcare system will only be reformed when it becomes non-profit. Until that day, I don't expect any changes. Healthcare reform was at its peak during the Progressive Era, and even then nothing happened. Insurance companies, physicians, and all other vested interests fought against reforms. Myths were created, socialized medicine was not to be trusted, and millions of Americans were deprived. The political spin machine regaled in the belief that universal healthcare was somehow anathema to the United States. I'm always left to wonder just how divided we really are. Profits seem to be the driving force. I thoroughly enjoyed this book.