Why Some Countries Have National Health Insurance,others Have National Health Services,and the United States Has Neither

Abstract

This article presents a discussion of why some capitalist developed countries have national health insurance schemes, others have national health services, and the United States has neither. The first section provides a critical analysis of some of the major answers given to these questions by authors belonging to the schools of thought defined as “public choice,” “power group pluralism,” and “postindustrial convergence.” The second section puts forward an alternative explanation rooted in a historical analysis of the correlation of class forces in each country. The different forms of funding and organization of health services, structured according to the corporate model or to the liberal-welfare market capitalism model, have appeared historically in societies with different correlations of class forces. In all these societies the major social force behind the establishment of a national health program has been the labor movement (and its political instruments-the socialist parties) in its pursuit of the welfare state. In the final section the developments in the health sector after World War II are explained. It is postulated that the growth of public expenditures in the health sector and the growth of universalism and coverage of health benefits that have occurred during this period are related to the strength of the labor movement in these countries.

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References

Fuchs

V. R.

The Health Economy, p. 269. Harvard University Press, Cambridge, Mass., 1986.

Ginzberg

The Limits of Health Reform: The Search for Realism, p. 3. Basic Books, New York, 1977.

Evans

R. G.

Illusions of necessity: Evading responsibility for choice in health care. J. Health Polit. Policy, Law, Fall 1985, pp. 439–465.

Fein

Medical Care Medical Costs: The Search for a Health Insurance Policy. Harvard University Press, Cambridge, Mass., 1986.

Parenti

Inventing Reality. The Politics of the Mass Media. St. Martin's Press, New York, 1986.

Bagdikian

B. H.

The Media Monopoly. Beacon Press, Boston, 1983.

Bowles

Girtis

Schooling in Capitalist America. Basic Books, New York, 1976.

Smith

D. N.

Who Rules the Universities. An Essay in Class Analysis. Monthly Review Press, New York, 1971.

Schneider

Public ready for real changes in health care. National J., March 23, 1985, p. 665.

10.

Navarro

Where is the popular mandate?

N. Engl. J. Med. 307: 1516–1518, 1982.

11.

Navarro

The 1984 election and the New Deal: An alternative interpretation. Social Policy, Spring 1985, pp. 3–17.

12.

Ferguson

Rogers

The myth of the American public's turn to the right. In The Decline of the Democrats and the Future of American Politics, pp. 3–39. Hill and Wang, New York, 1986.

13.

Coughlin

Ideology, Public Policy and Welfare Policy. Attitudes Toward Taxes and Spending in Industrialized Societies, p. 77. Research Series No. 42. Institute of International Studies, University of California, Berkeley, Cal., 1980.

14.

Marmor

Political Analysis and American Medical Care Essays. Cambridge University Press, New York, 1983.

15.

Anderson

O. W.

Health Services in the United States. A Growth Enterprise since 1875. Health Administration Press, Michigan, 1985.

16.

Starr

Social Transformation of American Medicine. Basic Books, New York, 1983.

17.

Navarro

Medical history as justification rather than explanation. Int. J. Health Serv. 14(4): 511–527, 1984.

18.

Anderson

Health Care: Can There Be Equity? The United States, Sweden, and England. J. Wiley, New York, 1972.

19.

Navarro

Class Struggle, the State and Medicine. A Historical and Contemporary Analysis of the Medical Sector in Great Britain. Robertson, London, 1978.

20.

Navarro

Medicine under Capitalism. N. Watson, New York, 1976.

21.

Himmelstein

Woolhandler

Socialized medicine: A solution to the cost crisis in health care in the United States. Int. J. Health Serv. 16(3): 339–354, 1986.

22.

Schieber

G. T.

Poullier

T. P.

International health care spending. Health Affairs, Fall 1986, pp. 112–122.

23.

Therborn

When, How, and Why Does a State Become a Welfare State? Paper presented at the ECPR Workshop on Comparative Study of Distribution and Social Policy in Advanced Industrialized Nations, Freiburg, March 20–25, 1983.

24.

Immergut

Between state and worker. Sickness benefits and social control. In Public/Private Interplay in Social Protection: A Comparative Study, edited by Rein

Rainwater

, pp. 57–98. Sharpe, White Plains, N.Y., 1986.

25.

AFL backs national health plan. Mich. CIO News 15: 2, January 1, 1953.

26.

Davis

Prisoners of the American Dream. Verso, London, 1986.

27.

Esping-Andersen

Power and distributional regimes. Politics and Society 14(2): 223–256, 1985.

28.

Esping-Andersen

Korpi

Social policy as class politics in post-war capitalism: Scandinavia, Austria, and Germany. In Order and Conflict in Contemporary Capitalism, edited by Gadthorpe

J. H.

, Oxford University Press, New York, 1984.

29.

Korpi

The Democratic Class Struggle. Routledge and Kegan Paul, Boston, 1983.

30.

Esping-Andersen

Politics against Markets: The Social Democratic Road to Power. Princeton University Press, Princeton, N.J., 1985.

31.

Sigerist

H. E.

From Bismarck to Beveridge: Developments and trends in social security legislation. Buff. Hist. Med. 8: 365–388, 1943.

32.

Navarro

Radicalism, Marxism, and medicine. Int. J. Health Serv. 13(2): 179–202, 1983.

33.

Meyer

J. A.

Levin

M. E.

Poverty and social welfare: An agenda for change. Inquiry 23(2): 122–133, 1986.

34.

Green

A national health program for a stronger America. American Federalist 59: 6, February 1952.

35.

Navarro

Renner

The macro-economic changes in the United States and their implications in health coverage. Int. J. Health Serv., in press.

36.

Taylor

M. G.

Health Insurance and Canadian Public Policy. McGill University Press, Montreal, 1978.

37.

Organization for Economic Cooperation and Development. Measuring Health Care 1960–1983. Expenditures, Costs and Performance. OECD Social Policy Studies No. 2, 1985.

38.

A left majority in the EEC. New Socialist 33: 4, December 1985.

39.

Therborn

The prospects of labour and the transformation of advanced capitalism. New Left Rev. 145, 1984.

40.

Newsnight poll, February 10. Guardian February 11, 1986. Cited in Marxism Today, March 1986.

41.

Edsall

T. B.

The New Politics of Inequality. Norton, New York, 1984.

42.

Panitch

Working Class Politics in Crisis, p. 7. Verso, London, 1986.

43.

Wood

E. M.

The Retreat from Cass, p. 182. Verso, London, 1986.

44.

Pertschuck

Revolt Against Regulation, p. 57. University of California Press, Berkeley, Cal., 1982.

45.

Anderson

European social democracy. Against the Current 1(6): 21–28, 1986.

46.

AFL-CIO. The Changing Situation of Workers and their Unions. A report of the AFL-CIO Committee on the Evolution of Work, February 1983.

47.

Edsall

T. B.

Growing party allegiance by income. N. Y. Rev. Books, April 24, 1986.