History and Health Policy in the United States: The Making of a Health Care Industry, 1948–2008

The UK's National Health Service is approaching its sixtieth anniversary, an oppportune time perhaps to consider the case of the United States, where there is no national health service. Federal law requires hospitals to treat those who enter their emergency rooms, but not for free; military veterans are offered care in health facilities supported by federal tax dollars and the national Medicare programme provides government-sponsored health insurance for specified services to those over 65 years of age and to individuals certified as disabled. However, Medicare does not provide health services, which are predominantly purchased in the private sector. This article considers the history of American health care over the past 60 years, reflecting the diverse ways in which health care is embedded in the economy, politics, power structures and culture of the United States and discussing what it is like to have a health care industry without having a national health service or universal health insurance. The article concludes that, since the Second World War, the United States has been successful in achieving highly specialized, valued, life-improving health care for most—not for all—members of the population, but at a huge and rising cost. Notable achievements have been produced by the public–private mix of the American health enterprise. However, broad questions of social class, illness, insurance and the burden of payment for health care remain in a society with widening divisions of the population by socio-economic class, education, health literacy and computer skills.