The Wages of Sickness: The Politics of Health Insurance in Progressive America (review)

Beatrix Hoffman. The Wages of Sickness: The Politics of Health Insurance in Progressive America. Studies in Social Medicine. Chapel Hill: University of North Carolina Press, 2001. xiii + 261 pp. Ill. $39.95 (cloth, 0-8078-2588-3), $17.95 (paperbound, 0-8078-4902-2).

Chapter 1 of the American health insurance saga is the American Association for Labor Legislation's campaign during the second decade of the twentieth century. Charity societies, fraternal orders, dispensaries, company physicians, workmen's compensation laws, commercial "industrial insurance" (individual burial policies sold door-to-door), and the earlier social insurance schemes of certain European nations are the contextual antecedents, if not actual precedents, of this initial American venture toward compulsory health insurance. Since the story of the AALL campaign has been so well told by Ronald Numbers (Almost Persuaded: American Physicians and Compulsory Health Insurance, 1912-1920, 1978), the first question one must ask of any retelling is, What does it add?

Beatrix Hoffman's new account, it turns out, adds quite a lot. She has given the entire experience a close, fresh reading, culling material from an impressive list of archival sources and distilling it all into a highly readable story. Numbers's book, as the subtitle announced, dealt mainly with the American medical profession, particularly the organized profession. With the AALL episode in the foreground, Numbers showed how American physicians discovered their group economic and political interests and formed a corporate attitude that determined their public position on health insurance for a half-century. But while the AALL campaign was formative for the politics of American medicine, and physicians played important roles in the campaign, Hoffman's account places them in the second rank of performers, behind (or beside) labor leaders, manufacturers and other business leaders, insurance executives, statehouse politicians, immigrants, social welfare theorists, public health workers, socialists, nurses, settlement house workers and other middle-class "uplifters," and, especially, women's groups.

The author limits her study to New York, since the state legislature in Albany was the only one to actually debate the AALL's health insurance bill. New York was also home to the AALL's headquarters office, as well as to important opposition groups. Further, the battle was hardest fought in New York. Finally, if the nation's most populous state had enacted the bill (it came close), it would have established a highly visible American demonstration that other states might have replicated. Of course, the campaign failed. The opponents' rhetoric—loud, emotional, and fiercely defensive—overwhelmed the calm, evidence-based reasoning of the AALL leaders, who professed the Progressive Era faith in cooperation, efficiency, and politically neutral science but were generally disinterested in calls for social justice.

One of the book's main contributions is the detail with which the author sets forth the rhetorical arguments and counterarguments on every side of this multifarious debate. Another is her description of an unlikely alliance between high-profile opponents of health insurance, particularly that between Frederick Ludwig Hoffman and Samuel Gompers. Hoffman—the anti-German, German-American actuary, "racial scientist," and Prudential Insurance executive—was also for a time a member of the AALL Committee on Social Insurance. Gompers, who kept his connivance with anti-health insurance (and antiunion) business associations quiet, made no secret of his opposition to social insurance: it ran counter to his vision of a labor movement built on craft guilds in which the union would be the "all-in-all" of the workers. The author explains how the business opponents of health insurance exploited Gompers's position, promoting his as the "one true voice" for all of American labor, when in fact many other influential labor leaders supported the AALL bill.

The author emphasizes especially the political climate in the aftermath of women's suffrage in New York State. By packaging the health insurance bill together with other women's...