Colleen M. Grogan's "Grow and Hide: The History of America’s Health Care State"

Session Submission Type: Author meet critics

Session Description

The U.S. health care system is almost always described as predominately private even though it is a predominantly public-funded system and has been that way since 1930—before the passage of The New Deal, Medicare and Medicaid, and the Affordable Care Act. This book explains the persistence of this myth by documenting how the American government—federal, state and local—invested in the health care system, and how policy actors described state actions over time. Grogan shifts from the common historical question concerning why the U.S. lacks national health insurance to consider instead why the U.S. government significantly expanded health care spending and public provision in every historical period since 1900, and yet successfully hide the government’s role in the system. Grogan calls this Grow and Hide and offers three main factors to explain the phenomenon: using the federal structure to expand growth; delegating authority to the voluntary sector; and institutional fragmentation whereby administrative responsibility is dispersed across numerous agencies at all levels of government. In addition to these structural factors, Grogan documents the use of discursive strategies by political actors over time and across ideological divides to hide growth and demonize government. Grogan argues that the Grow and Hide Regime was firmly established by 1965 leading to three main consequences for our health system today: extreme fragmentation and the demise of health care planning; profiteering and the financial industry's takeover; and growing inequality while public discourse intentionally pulls public attention to focus on “the problem” of public expenditures for the poor.

Sub Unit

• Division 48: Health Politics & Health Policy

Chair

• Andrew S. Kelly California State University, East Bay

Presenters

• Andrea Louise Campbell Massachusetts Institute of Technology

• James A. Morone Brown University

• Jamila D. Michener Cornell University

• Scott L. Greer University of Michigan