Why Doesn’t the United States Have National Health Insurance? The Political Role of the American Medical Association
This study examines a critical juncture in the development of health insurance in the United States. We examine how the American Medical Association (AMA) reduced support for National Health Insurance (NHI) in the immediate post-World War II period and contributed to the entrenchment of private insurance coverage. The AMA’s national campaign against NHI—directed by the country’s first political public relations firm, Whitaker & Baxter’s Campaigns, Inc—implemented a two-pronged strategy: (1) persuade the American voter that supporting NHI was equivalent to supporting socialism; and, (2) enroll working-age adults (and eventually their dependents) in private health insurance plans to reduce demand for a public scheme. We bring together archival data from several novel sources documenting Campaign operations, which involved leveraging mass communications and the professional network of physicians. We find a one standard deviation increase in Campaign exposure explains approximately 20% of the increase in private medical insurance enrollment and a similar decline in public opinion support for legislation enacting NHI. We further show that Republican legislators from jurisdictions with greater Campaign exposure were more likely to oppose the Truman plan, and adopted rhetoric closely aligned with the Campaign’s messaging.
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