Chronic Politics

Health Care Security from FDR to George W. Bush

Philip J. Funigiello

Few domestic issues dominate todays headlines as much as the high cost of health care. Despite this media attention and a litany of election-year debates over health care funding, some 45 million Americans remain without adequate health insurance. Philip Funigiello chronicles the contentious political history behind this state of affairs, from the New Deal to the present.

Funigiello unlocks the puzzle of why the United States has never guaranteed its citizens health security comparable to that enjoyed by people of other first-world nations—and he tells what needs to happen for policy reform to take place. Examining specific episodes in the history of health care financing, he highlights the importance of key individuals in the legislative process, the political haggling involved in shaping a bill, the clash of personalities and agendas that determine its fate, and the extent to which American ideas about fairness are reflected in the result. Beginning with the National Health Survey of the 1930s, Funigiello traces the long struggle to enact Medicare and explains how medical inflation adversely affected both public and private employment-based insurance systems. He then recounts how Medicare became a target in the Republicans war on spending, assesses the ill-fated Clinton health plan, and brings everything up to date with the Bush administrations expansion of Medicare to include prescription drug coverage.

“A well-crafted, detailed chronological account. . . . The combination of a solid grounding in scholarly research and a compelling writing style make Funigiello’s book accessible and rewarding for academics, students, and interested members of the public.

—The Historian

“A solid, exhaustively researched synthesis of primary sources and the massive literature on health-care reform in America. Anyone new to the subject would, by reading this book, learn about the events that make up the story, both major and minor, and become acquainted with the enormous array of characters who joined the elusive quest for national health insurance. . . . A very useful book that expands our understanding of the uniqueness and peculiarity of U.S. health care.

—Business History Review
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Throughout this history, Funigiello shows that both liberals and conservatives, Democrats and Republicans, share the blame for not providing every American with health security as a right of citizenship. He argues that ideological values such as rugged individualism and laissez-faire capitalism have continually overshadowed the spirit of pragmatism, cooperation, and community ethos that health security requires.

As the swelling ranks of the uninsured threaten to destabilize the entire health care system for those who can still afford it, this country is faced with growing health insecurity unless we learn to rise above political differences. Chronic Politics is an incisive look at how history has affected current policy and is required reading for all concerned with the politics of financing health care in America.