Many were aware of the public schemes evolving in Europe and the arguments behind these developments.

The Progressive Party under President Theodore Roosevelt included national health insurance in its platform for the 1912 election (Harris, 1969), and some key officials of the U.S. Public Health Service supported compulsory insurance in the belief that it would encourage more backing for public health measures (Starr, 1982; Mullan, 1989). Legislation to study and plan for national unemployment, old age, and sickness insurance was introduced in Congress in 1916 and 1917 by its only Socialist member. Hearings were held, but the legislation never passed, in part because of the pressures and distractions presented by World War I and in part because of interest group opposition (Anderson, 1968; Starr, 1982).

Reflecting the federalism of the times, most initial efforts to secure government action focused on state rather than national initiatives. The following discussion first traces early attempts to secure state health insurance legislation and then examines subsequent efforts to achieve national health insurance. It turns last to initiatives in the private sector and the stimulus provided to employment-based health coverage by federal decisions affecting employee benefits and employer-employee relationships generally.

Unsuccessful Early State Initiatives

After workers' compensation or disability insurance for work-related injury, medical care insurance was one of the earliest targets for groups in the United States advocating social insurance against the hazards of modern industrial society (Anderson, 1968, 1972; Starr, 1982). Particularly prominent in behalf of both was the Committee on Social Insurance of the American Association for Labor Legislation (AALL), the organizing of which began in 1905 at the annual meeting of the American Economic Association.7 The AALL, whose prestigious administrative council included Jane Addams, Louis Brandeis, and Woodrow Wilson, drafted a model state medical care insurance bill in 1915, and some 16 such bills were introduced at the state level by 1920.

The standards for these proposals, which were set forth by AALL in 1914 (Anderson, 1968), are summarized in Table 2.2. The actual benefits provided by the model bill included sick pay (at two-thirds of wages for up to 26 weeks); medical coverage for physician, hospital, and nursing care; maternity benefits for working women and workers' wives; and a $50 ben-


The social activism of social scientists in this period is suggested by the program of the 1916 annual meeting of the AALL, which included joint sessions with the American Economic Association, the American Political Science Association, the American Sociological Association, and the American Statistical Association (Anderson, 1968).

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