History of American Liberal and Conservative Healthcare Rhetoric and Public Policy

Abstract

This chapter examines the history of liberal and conservative healthcare rhetoric and public policy in the US. It provides an overview of historical efforts to expand access to health insurance and discusses the discourse of those seeking to expand it and the policies they proposed. It considers the specific efforts of Richard Nixon to expand access to health insurance and discusses the discourse of opponents of health insurance coverage expansion. It considers the way in which “socialism” was used as an epithet and signifier of danger and extremism by health insurance expansion opponents. It explores the mixed and sometimes contradictory role of unions in impacting the expansion of health insurance as well as that of corporations. It addresses how the Reagan era initiated a new conservatism that vigorously rejected social and economic rights (positive liberty) in favor of an ideology of limited government and negative liberty and thus made it increasingly difficult to expand health insurance. Finally, it addresses historical healthcare reform policy milestones and proposes some reasons as to why the US has been an unusual outlier amongst industrialized, wealthy liberal democracies in lacking universal health insurance until the most recent expansion of health insurance under the Affordable Care Act.