Idiosyncrasies of the 2010 Affordable Care Act from a Comparative Perspective

Abstract

Although there were advocates of universal health coverage prior to World War I, strong opposition developed as well. Because of the medical progress made during the 1920s, opposition to compulsory insurance emerged. Opponents such as the American Medical Association feared that the government would set limits and issue regulations that would hamper their opportunity of making greater profits from health services, especially from middle-class patients who were attracted by medical progress. At the same time, France debated the expansion of social protection. Small business notably opposed those ideas because they feared cost increases (Elbaum 30). During the New Deal, President Roosevelt showed great interest in establishing health insurance but "political realities", namely opposition from Republicans and Southern Democrats with the support of lobbies like the American Medical Association (AMA), prevented it (Katz 258). During the same period, and partly fuelled by Roosevelt's New Deal, Canada attempted to introduce comprehensive, national health care, but the government's proposal was defeated (Boychuck 34-5, 37-8). Truman introduced health care reform twice, in 1945 and 1949, and was defeated both times. Although the New Deal had been under attack from the beginning, Truman remained openly very supportive of the Welfare State principle and the New Deal. Just like Roosevelt's plan, Truman's attempts to establish national health care were attacked as socialism (Morone and Blumenthal). This seems particularly ironic from a comparative perspective, since one of German Chancellor Otto von Bismarck's motives in enacting health care was to weaken the appeal of German socialists (Blackbourn 346). 3 Similar motives were at work in France, but they only found hesitant expression in the 1880s and 1890s (Elbaum 30). 4 The Truman health program planned for national health coverage run and funded by government (Truman 2015). But out of respect for American love of freedom, the program would have been optional. Political scientist Gerard Boychuck argues that Truman's health reforms were opposed and defeated because they were openly linked to the administration's desegregation efforts (Boychuck 41). While Truman's health care bills were defeated in the US, France started developing a comprehensive health care system in 1945 (Valtriani 11). Contracting health care insurance became mandatory, but the system was mixed: only part of the coverage is run by government (Elbaum 7). 5 As mentioned earlier, opposition rhetoric equating universal and national health care with socialism was among the forces preventing the creation of legislation in the US. Hence, as early as the 1950s, health care advocates started shifting their discourse, focusing more on health care for the elderly because it had greater political appeal (Katz-Olson 22