Shifting Ideologies, New Villains, and Changing Concerns: The Evolution of the U.S. Health Debate

• In Event: U.S. Public Policy

Abstract

This paper explores the long-term evolution of the health reform debate in the U.S. over several decades, from President Richard Nixon’s health proposals in the 1970’s, to the major overhaul proposed by Bill Clinton’s administration in the 1990’s, to the Affordable Care Act (ACA) crafted and ultimately passed by congressional Democrats and President Barack Obama in 2009-2010. I will look at the public statements of prominent political figures in both parties and news coverage of health reform in each of these eras to assess how several key issues common to all three periods of debate were portrayed over time. The analysis will include how leading politicians and the media in each case depicted employer and/or individual mandates; the optimal role of insurance companies and the federal government; and concerns about costs, quality, and efficiency in the health care system. By looking at how the discussion of major health proposals with comparable elements developed and changed across three major periods of debate, we can better understand the trajectory of health reform politics over time, including why the ACA, the major policy change that finally became law, included many traditionally conservative components. This inquiry will also shed light on the state of the health reform debate in the U.S. today, including what the past can tell us about the limits of advocating for repeal of health care programs and what shape future debates about reform might take.

Author

• Jennifer Hopper, Southern Connecticut State University