Why is there no national health insurance in the United States of America? This question became popular again when President Bill Clinton's Health Security Plan of 1993 proved to be a failure. Throughout the twentieth century, every attempt to enact a national health insurance program failed. The majority of the working population is covered by private, employer-based health insurance, the elderly and welfare poor by the government programs Medicare and Medicaid of 1965, while a growing number of Americans remain uninsured.
This study focuses on two important decisions that have shaped American health care policy: the exclusion of national health insurance from the Social Security Act of 1935 and the shift of focus from a health insurance program for the working population to a hospital insurance program for the elderly and the welfare poor. Based on presidential archives and the papers of social security policymakers, this study examines the incremental strategy to achieve health insurance coverage for all Americans. The result is a compelling history of political compromise that will be of interest to both the scholars of the welfare state and the scholars of American ideology and exceptionalism.