Econ Papers Daily / 期刊论文
美国为何没有全民医保？美国医学会的政治角色
Why Doesn’t the United States Have National Health Insurance? The Political Role of the American Medical Association
摘要
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.
中文摘要
本文考察了美国医学会（AMA）在二战后关键时期如何影响美国医疗保险体系的发展。通过与政治公关公司Campaigns, Inc.合作，AMA发起了一场全国性运动，将国家医疗保险框架定义为“社会化医疗”以削弱其支持度，同时引导民众加入私人医疗保险计划，从而将需求从公共替代方案转移。基于新整理的档案数据，我们发现，该运动对私人医疗保险参保率上升的贡献约为20%，并对国家医保计划公众支持率的下降产生了同等程度的影响。该运动还通过协调信息传递、民间组织通过的决议、国会言论以及政治捐款，对政策制定产生了影响。这些发现表明，美国私人医疗保险的兴起并非仅由宏观经济力量或集体谈判驱动，而是由利益集团资助的战略性努力所推动，旨在塑造公民观点并影响政策。