The History of Health Care Reform
Judith Randal ( 1993) recounted a rather grim bit of humor regarding demands for comprehensive health care system reform in the United States: "A durable joke has it that the late Wilbur Cohen, an architect of Social Security and later Lyndon Johnson's Secretary of Health, Education, and Welfare, once asked God whether the United States would ever have national health insurance. 'Only if I live long enough,' God replied" (p. 22). Although rather hyperbolic, this odd bit of humor sums up the past several decades of attempts to achieve national, comprehensive reform of the U.S. health care system. Indeed, the history of health care system reform in the United States is marked more by tombstones than milestones. Each and every comprehensive national attempt at reform has met with failure.
Accounts of attempted reform efforts of the health care system in the United States during this century are interesting from a historical perspective, but they are also illuminating in other ways. The history of health care reform during this century helps provide an important context for examination of reform efforts during the 1990s. The failure of comprehensive reform elements points to the substantial obstacles confronting contemporary reformers and policy makers, and to the enduring nature of health issues as major components of national, political, and rhetorical appeal. Further, the incremental responses that have tended to emerge from previous health care debates set the tone for the measure of effectiveness of reform calls.
There are many places to turn for such historical data. Perhaps the most extensive collection of information available on the subject is the work of sociologist Paul Starr ( 1982). Starr has constructed an award-winning account of the rise and fall of health care system reform efforts in the United States from the very early 1900s through the 1970s. The following, though laced with that of others, draws heavily upon Starr's work.
"For decades, presidents and members of Congress have struggled with the question of how to assure health security for all Americans" (Health Care Reform, 1994, p. 225), and that struggle has had several periods of drama, interest, and