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Starting National Health Insurance Thread

Subject: Query: Starting national health insurance

Date: Sat, 03 Feb 1996 10:35:17 -0500 (EST) From: John C. Campbell <jccamp@umich.edu>

In a book about health policy in Japan, my co-author Naoki Ikegami and I have a short section on the history of health insurance. We have discovered that back in the 1920s, when the government started compulsory health insurance for employees (then a minority of the labor force of course), it was disliked and resisted by virtually everyone.

That is, employers didn't want to pay their share of the premium and thought workers would malinger. Workers didn't want to pay any premiums, and resented that occupational injuries would not be paid from the workman's comp fund (all paid by the employer) and instead would come from health insurance. Doctors didn't like it because the fees were below their normal and customary fees. None of these three groups saw the longer range payoffs--worker attachment to the firm for businesmen, getting gneral health insurance for workers, increased demand for docs. It was forced down their throat by bureaucrats in the Home Ministry, "industrial statesmen" types, and Kitazato Shibasaburou, the highly connected doctor that led the Medical Association of the day.

My question is simply whether this pattern occurred elsewhere as well, or whether health insurance was demanded or at least welcomed by someone out in society, early on?

Date: Sat, 03 Feb 1996 14:46:02 -0500
From: Peretz Hirshbein <peretz@umich.edu>

On 3 Feb 1996 John C. Campbell <jccamp@umich.edu> wrote:

> My question is simply whether this pattern occurred elsewhere as well, > or whether health insurance was demanded or at least welcomed by someone > out in society, early on?

The situation you describe in Japan, that of the origins of _compulsory_ health insurance sounds similar in many ways similar to the abortive movement for compulsory health insurance in New York State in the 1910s.

In 1912 the American Association for Labor Legislation began work on a model compulsory health insurance bill to be presented to New York's state legislature and other Northeastern state legislatures. The AMA lent the AALL support initially, appointing a Committee on Social Insurance to work with the AALL planners. By the time the US became involved in WWI, the medical profession was turning away from compulsory health insurance, (mostly because of concerns re: remuneration) and by the end of the War, the perceived German nature of health insurance killed the bill's progress. There were, of course, other factors that helped stall this movement. For a more complete narration of this story, see Ronald Numbers, _Almost Persuaded: American Physicians and Compulsory Health Insurance, 1912-1920_, Johns Hopkins, 1978.

--

Peretz Hirshbein                            peretz@umich.edu
Lecturer, Inteflex                    University of Michigan

http://www.welch.jhu.edu/homepages/peretz/html/homepage.html

Date: Sat, 03 Feb 1996 18:33:40 -0500 (EST) From: Theodore Liazos (GD 1996) <tliazos@minerva.cis.yale.edu>

Peretz Hirschbein posted a message recently on efforts to win universal health care legislation (or compulsory health care legislation, as he prefers to call it) in the 1910s in New York. I want to offer a somewhat different read of that campaign.

It's probably not a bad idea to refer to the American Association for Labor Legislation's plan as a compulsory plan. They wanted a plan in which employers would pay the lion's share of the costs for insurance, and no doubt many employers saw this as a very unwelcome imposition of costs. Commons and the other institutional economists had two motives: first they traced a good deal of the illness occuring in the uninsured population to industrial causes -- silicosis, maimings, lacerations -- and hoped to force firms to assume the costs for these problems. Internalizing the cost for injuries, they thought, would create strong inducements for sound industrial hygiene and safety programs. Second, though they were impressed by the productivity of the rising industrial system, they were equally impressed by the insecurity of the industrial workforce and the inability of most workers to save adequately or afford insurance. A universal plan paid for mostly by employers seemed to solve both problems at once.

Where I would differ more from Hirschbein is in the reception afforded the plan. American Federation of Labor unions, so often described as logy or backward in the period before the New Deal, worked aggressively for the bill's passage. They were led in this by building trades unionists

But universal health care did have powerful enemies, and they were able narrowly to defeat the AALL bill in the Assembly. The AMA had come to oppose the AALL bill, but more important and more determined in their opposition were the Associated Manufacturers and the state's insurance industry. Ultimately it was a close friend of the AM's president, an upstate paper manufacturer and Speaker of the Assembly, who engineered the bill's defeat on the last day of the session.

All of which is a long way of saying it was a close thing, and the idea of compulsory health insurance got support from a number of places. It also had support in a number of other states, where many of the same groups lined up in support -- 18 state federations of labor, for example, supported such legislation in defiance of Sam Gompers. One place to go for more detail would be David Moss' fine Yale dissertation on the AALL.

Ted Liazos

Date: Sat, 03 Feb 1996 23:38:05 -0500
From: Peretz Hirshbein <peretz@umich.edu>

Mr. Liazos,

I am not quite sure where you see great differences in our opinions on the late-Progressive Era health insurance issue, but I did wish to clarify some points:

> It's probably not a bad idea to refer to the American Association for > Labor Legislation's plan as a compulsory plan.

By using the word "compulsory" as opposed to "universal", I am following the lead of Ronald Numbers' 1978 book on the subject, in which he describes the AALL's plan as compulsory in order to contrast their plan with volutary health insurance plans.

> costs. Commons and the other institutional economists had two motives: > first they traced a good deal of the illness occuring in the uninsured > population to industrial causes -- silicosis, maimings, lacerations -- > and hoped to force firms to assume the costs for these problems. > Internalizing the cost for injuries, they thought, would create strong > inducements for sound industrial hygiene and safety programs. Second, > though they were impressed by the productivity of the rising industrial > system, they were equally impressed by the insecurity of the industrial > workforce and the inability of most workers to save adequately or afford > insurance. A universal plan paid for mostly by employers seemed to solve > both problems at once.

The early teens saw the passage of workmen's compensation laws in many states - however, the second motive you describe was indeed a poweful one. This motive did lead many reformers to support health insurance legislation. However, there were other ways to respond to the motivation to protect the stability of the workforce, such as the corporate welfare programs established by a number of Progressive Era industries.

> Where I would differ more from Hirschbein is in the reception afforded > the plan.

I did not argue that the plan was not well-received. On the contrary, I stated that even the AMA supported the plan prior to 1917. What I find interesting is the shift of support away from the plan, especially on the part of physicians, after the US entry into WWI. For many of the parties involved, motivations and positions for and against the plan did not change between 1915 and 1919; I simply called attention to one group whose position did change rather dramatically over time.

--

Peretz Hirshbein                            peretz@umich.edu
Lecturer, Inteflex                    University of Michigan

http://www.welch.jhu.edu/homepages/peretz/html/homepage.html

Date: Sun, 04 Feb 1996 16:39:03 -0500 (EST) From: Daniel Levine <dlevine@bruin.bowdoin.edu>

For the situation in several countries, my *Poverty and Society* might prove useful. In considering the position of organized labor, one should keep in mind the weakness of organized labor in the US in the pre WWI years when compared to Germany's SPD amd UKs Labour Party, Lib-Lab alliance and TUC. The AFofL was simply fighting for its right to strike. And of course the AALL was not a labor organization at all.

                        Dan Levine
                        dlevine@polar.Bowdoin.edu

Subject:      Re: Starting National Health Insurance

Perhaps Dan Levine can correct me if I am wrong, but it was my understanding that British unions were not solidly behind national health insurance until they became included as potential administrators of the system established before World War I.

Larry Gerber

Date: Mon, 05 Feb 1996 14:12:42 -0500 (EST) From: Robert H. Zieger <RHAGZ@nervm.nerdc.ufl.edu>

There is an excellent piece in International Labor and Working-Class History, no. 48 (F95) by James Hinton, "Vountarism vs. Jacobinism: Labor, Nation, and Ci tizenship in Britain, 1850-1950," on the several powerful traditions of British labor with regard to social provision. It is esp. strong on the gender implications of British voluntarism.

Date: Tue, 6 Feb 1996 10:52:50 -0500 (EST) From: Daniel Levine <dlevine@bruin.bowdoin.edu>

Larry,

In 1910 the Labour Party sent a delegation to Germany to examine many things, including health insurance. They came back in favor, in general, of health insurance. They were divided, however, about many details of Lloyd George's 1911 proposal, particularly whether the system should be contributory or non-contributory, but most elements in the leadership backed the bill. The Friendly Societies, with important labour union elements, were also in favor.

In Germany, the SPD voted against the original bill in 1883, but they then made use of the system, including politically, when it was in place.

Dan Levine

Date: Tue, 6 Feb 1996 10:52:50 -0500 (EST) From: Daniel Levine <dlevine@bruin.bowdoin.edu> Larry,

In 1910 the Labour Party sent a delegation to Germany to examine many things, including health insurance. They came back in favor, in general, of health insurance. They were divided, however, about many details of Lloyd George's 1911 proposal, particularly whether they system should be contributory or non-contributory, but most elements in the leadership backed the bill. The Friendly Societies, with important labour union elements, were also in favor.

In Germany, the SPD voted against the original bill in 1883, but they then made use of the system, including politically, when it was in place.

Dan Levine



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