National Health Insurance and American Exceptionalism: A Comparative Historical Analysis

Award Year: 1999	Investigator: Jill Quadagno	Budget: $244,735	Categories: Comparative Healthcare Systems, Health Insurance
Abstract: The lack of national health insurance is the most distinctive feature of America's welfare state, the prime example of a larger historic issue known as American Exceptionalism. Three presidents (Truman, Nixon, and Clinton) championed universal access to health care but failed to win congressional approval of their proposals. Yet, Medicare and Medicaid, which provide benefits for limited constituencies, were enacted. Using the comparative method, Dr. Quadagno analyzes historical forces that led to the defeat of national health insurance proposals and compares these failed plans with the successful enactment of Medicare and Medicaid. She develops a case study of national health insurance to illustrate fundamental features of American political development. Her work contributes to the understanding of one of the most perplexing health policy issues why the U.S. remains the only western, democratic nation without guaranteed access to care. Findings should help policymakers develop more realistic proposals for health reform, taking into account historical trends.