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The Struggle over Employee Benefits: The Role of Labor in Influencing Modern Health Policy
Author(s) -
Rosner David,
Markowitz Gerald
Publication year - 2003
Publication title -
the milbank quarterly
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.563
H-Index - 101
eISSN - 1468-0009
pISSN - 0887-378X
DOI - 10.1111/1468-0009.00038
Subject(s) - health care , welfare , politics , health policy , social insurance , political science , social policy , meaning (existential) , social capital , economic growth , economics , psychology , law , psychotherapist
Health care policy has often been described as the work of political actors seeking to benefit the larger community or a particular group of individuals. In 20th‐century America, those actors worked in a historical context shaped by demographic and political pressures created during a period of rapid industrial change. Whereas scholars have placed the emergence of European social welfare in such a larger frame, their analysis of movements for health insurance in the United States has largely ignored the need for a frame. If anything, their studies have focused on the lack of a radical political working‐class movement in this country as an explanation for the absence of national or compulsory health insurance. Indeed, this absence has dominated analyses of the failure of health policy reform in this country, which generally ignore even these passing historical allusions to the role of class in shaping health policy. Explanations of why health care reform failed during the Clinton administration cited the lack of coverage for millions of Americans but rarely alluded to the active role of labor or other working‐class groups in shaping the existing health care system. After organized labor failed to institute national health insurance in the mid‐twentieth century, its influence on health care policy diminished even further. This article proposes an alternative interpretation of the development of health care policy in the United States, by examining the association of health policy with the relationships between employers and employees. The social welfare and health insurance systems that resulted were a direct outcome of the pressures brought by organized and unorganized labor movements. The greater dependency created by industrial and demographic changes, conflicts between labor and capital over the political meaning of disease and accidents, and attempts by the political system to mitigate the impending social crisis all helped determine new health policy options.