Employment and Health Benefits: A Connection at Risk

The following HTML text is provided to enhance online readability. Many aspects of typography translate only awkwardly to HTML. Please use the page image as the authoritative form to ensure accuracy.

out regard to income; payments for basic coverage are not explicitly priced to reflect the individual's level of risk; and tax or other revenue-generating policies subsidize coverage, particularly for the poor.

The creation of a comprehensive array of social insurance programs was, however, uneven in its pace across nations and piecemeal in its formulation within nations (Anderson, 1968, 1972; Glaser, 1991). Bismarck is cited as the originator of statutory health insurance, which was one of the social insurance programs he initiated in Germany in the 1880s. A major objective was to defuse worker unrest. Like many later programs, this system was a product of compromises that, in this case, left the national government with far less administrative power than Bismarck had proposed. The existing sickness funds retained administrative responsibilities that persist to this day. As with many other social insurance programs, Germany's became universal in fits and starts. White-collar workers were not covered initially, and farmers were not included until after World War II. In 1907, only 21 percent of the German population was covered by sickness insurance (Starr, 1982). By the end of World War II, however, most European countries had social health insurance or other government health programs in place for major segments of their population.

THE DIVERGENT PATH OF THE UNITED STATES

As noted in the preceding chapter, the United States is almost alone among developed countries in lacking some governmentally mandated form of comprehensive health coverage for all or nearly all its population. Its divergent path became apparent primarily after World War II, when most other countries moved to adopt, restructure, or complete their schemes for protecting most of their population against expenses for medical care.

The seeds for a more typical evolution were not totally absent in the United States. For example, the government established the U.S. Marine Hospital Service in 1798 and deducted 20 cents a month from each seamen's wages to pay for it. Unlike somewhat similar initiatives in Sweden and elsewhere, it did not become the cornerstone for a government medical care delivery or insurance program for the citizenry at large (Anderson, 1972; Mullan, 1989). The marine system eventually did evolve into an important research and public health organization, the U.S. Public Health Service.

Early in this century, the instability and inadequacy of voluntary health benefit programs and the need for broad government action became a subject of public debate and agitation in this country, as it had elsewhere (Anderson, 1968, 1972; Harris, 1969; Starr, 1982). As noted above, many early employer-sponsored programs were not well regarded, and the financial instability of union and mutual aid programs and the conservatism of commercial insurers also contributed to negative opinions of voluntary private insurance.

Free Resources

Related Titles