Framing choice: The origins and impact of consumer rhetoric in US health care debates.

This paper examines the origins of consumerist discourse in health care from a communication perspective via a historical textual analysis of health writing in popular magazines from 1930 to 1949. The focus is on Consumers Union's Consumer Reports and the American Medical Association's lay health magazine, Hygeia. Findings from Consumer Reports show that the consumer movement of the 1930s-40s staunchly advocated for universal health insurance. Whereas consumer rights language nowadays tends towards individual choice and personal responsibility, consumerism in health care during that era articulated ideas about consumer citizenship, framing choice and responsibility in collectivist terms and health care as a social good. This paper also illuminates the limits and weaknesses of a central tenet in consumerism-freedom of choice-by analyzing stories in Hygeia about the doctor-patient relationship. A textual analysis finds that the AMA's justification in the 1930s-40s against socialized medicine, i.e., the freedom to choose a doctor, was in practice highly controlled by the medical profession. Findings show that long before the rhetoric of the "empowered consumer" became popular, some patients exercised some choice even in an era when physicians achieved total professional dominance. But these patients were few and tend to occupy the upper socioeconomic strata of US society. In reality choice was an illusion in a fee-for-service era when most American families could not afford the costs of medical care.

Historical and comparative reflections on the U.S. national health insurance reforms.

The 2010 US reforms addressed forms of public and private insurance designed to reinforce a delivery system that developed to maximize the autonomy of physicians and hospitals. That autonomy emphasizes fees and specialization, which led to for-profit incorporation and overtreatment. Powerful corporate lobbies have defeated previous reforms and diluted the impact of the Obama reform. It barely passed and does little to manage costs or rationalize medicine. US health care does not fit established models of welfare states and contains five different models of health care delivery. Most interesting are forms of democratically run community health centres. Selected features of the reforms are highlighted.

Presidents and health reform: from Franklin D. Roosevelt to Barack Obama.

The health care reforms that President Barack Obama signed into law in March 2010 were seventy-five years in the making. Since Franklin D. Roosevelt, U.S. presidents have struggled to enact national health care reform; most failed. This article explores the highly charged political landscape in which Obama maneuvered and the skills he brought to bear. It contrasts his accomplishments with the experiences of his Oval Office predecessors. Going forward, implementation poses formidable challenges for Democrats, Republicans, and the political process itself.

A short history of health care reform: Minnesota Medicine's perspective, 1934-1967.

From 1934 through 1967, Minnesota Medicine published a section called Medical Economics. The editors used the section to address the politics and economics of health care and health insurance by excerpting news items, reprinting opinion pieces, and contributing original material to inform and influence the readership. This article reviews the history of health care reform and organized medicine's response to it as reflected in this section of the journal.

Frederick L. Hoffman, LLD (Hon), 1865-1946.

This biographical sketch on Frederick L. Hoffman corresponds to the historic text, The Classic: A Plan for a More Effective Federal and State Health Administration, available at DOI 10.1007/s11999-009-1000-x. The article can also be accessed on the American Journal of Public Health web site at (http://www.ajph.org/cgi/reprint/9/3/161-a).

A plan for a more effective federal and state health administration. 1919.

This Classic article is a reprint of the original work by Frederick L. Hoffman, LLD, A Plan for a More Effective Federal and State Health Administration. An accompanying biographical sketch on Frederick L. Hoffman, LLD, is available at DOI 10.1007/s11999-009-1001-9. The Classic Article is (c)1919 by the American Public Health Association and is reprinted with permission from Hoffman FL. A plan for a more effective federal and state health administration. Am J Public Health. 1919;9:161-169. The article can also be accessed on the American Journal of Public Health web site at (http://www.ajph.org/cgi/reprint/9/3/161-a).

Medicare and Medicaid: the past as prologue.

On July 30, 1965, President Lyndon B. Johnson signed the Social Security Amendments of 1965 into law. With his signature he created Medicare and Medicaid, which became two of America's most enduring social programs. The signing ceremony took place in Independence, Missouri, in the presence of former President Harry S. Truman, as if to indicate that what President Truman and other Presidents before him had tried to get done had now been accomplished. Yet, for all of the appearance of continuity, the law that President Johnson approved differed in significant ways from the law that President Franklin D. Roosevelt would have passed in the thirties or President Truman would have signed in the forties. The very idea of national health insurance underwent a major transformation between the beginning of the century and 1965. Even as the passage of Medicare became assured late in 1964 and in 1965, the legislation remained fluid, with important matters related to consumer choice and the basic design of the program in constant flux.

The Medicare approach: political choice and American institutions.

The most significant health reform in American history was the passage of Medicare in 1965, but this was an accomplishment born of defeat. Medicare was designed and understood by its early promoters as an approach to health reform, not simply as a discrete program for a distinct target population. Although Medicare incrementalism has tended to be shunted aside when the opportunities for health reform are most promising, the final years of the Johnson administration reveal previously underappreciated efforts to expand Medicare eligibility to large new population groups and offer insights into the continuing potential of Medicare incrementalism in our own time.