Why Doesn’t the United States Have National Health Insurance? The Political Role of the American Medical Association
中文摘要
本文考察了第二次世界大战后的关键时期，美国医学会（AMA）如何推动塑造了美国医疗保险体系的发展。美国医学会与政治公关公司Campaigns, Inc.合作，在全国发起了一场运动，将全民医疗保险框定为“社会化医疗”以削弱公众对其的支持，同时推动人们加入私人医疗保险计划，使需求从公共替代方案转向私人保险。利用新整理的档案数据，我们发现，更多接触该运动可以解释私人医疗保险参保率上升幅度的约20%，以及公众对全国性医疗保险计划支持度相近幅度的下降。该运动似乎还通过协调一致的信息传播、公民组织通过的决议、国会言辞和政治捐款影响了政策制定。这些发现表明，美国私人医疗保险的兴起并非仅仅源于宏观经济力量或集体谈判；相反，一项由利益集团出资、旨在塑造公民观点并影响政策的策略性行动也为其提供了助力。
Abstract
Abstract This article examines how the American Medical Association (AMA) helped shape the development of the U.S. health insurance system in the critical period after World War II. Working with the political public relations firm Campaigns, Inc., the AMA launched a nationwide campaign to weaken support for national health insurance by framing it as “socialized medicine,” while simultaneously enrolling people in private health insurance plans to shift demand away from a public alternative. Drawing on newly assembled archival data, we find that greater exposure to the campaign explains about 20% of the rise in private health insurance enrollment and a comparable decline in public support for a national program. The campaign also appears to have influenced policy making through coordinated messaging, resolutions passed by civic organizations, congressional rhetoric, and political donations. These findings suggest that the rise of private health insurance in the United States was not solely due to macroeconomic forces or collective bargaining; rather, it was also enabled by a strategic, interest group–financed effort to shape citizen views and influence policy.