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Health Care Business and Historiographical Exchange

Published online by Cambridge University Press:  01 May 2019

Peter A. Swenson
Peter A. Swenson*
Affiliation:
Yale University
*
Email: peter.swenson@yale.edu
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Extract

Before addressing the commentators for their thoughtful input on “Misrepresented Interests,” let me first thank the editors of Studies in American Political Development for providing a forum for an enduring debate about the power of capitalists in capitalist democracies like the United States. As a comparativist, I ventured into that complicated territory after extensive research in Sweden, where I discovered to my great surprise that the Social Democrat labor movement was kicking at open doors as it introduced each piece of Sweden's famous system of industrial relations and social insurance. Sweden's undeniably powerful employers stood contentedly aside and had no interest in closing the doors afterward. I was able to come to that conclusion with confidence only because the Swedish Employers’ Confederation had allowed me extraordinary access to their entire archives, confidential minutes, internal and external correspondence, and the diaries of a former chief executive.

Type
Research Article
Information
Studies in American Political Development , Volume 33 , Issue 1 , April 2019 , pp. 36 - 49
Copyright
Copyright © Cambridge University Press 2019 

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Footnotes

Acknowledgments: I thank Lina Daly, Isabela Mares, Frances Rosenbluth, and Ian Shapiro for many useful suggestions. Anthony Chen's superb editorial judgment and sharp eye helped make my contribution to this roundtable much better than it would have been.

References

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11. An excellent study of the assertion of business interests in the implementation phases is Patashnik, Eric M., Reforms at Risk: What Happens after Major Policy Changes Are Enacted (Princeton, NJ: Princeton University Press, 2008)Google Scholar.

12. Excellent introductions to the issues are Weisbrod, Burton A., “The Health Care Quadrilemma: An Essay on Technological Change, Insurance, Quality of Care, and Cost Containment,” Journal of Economic Literature 29, no. 2 (June 1991), 523–52Google Scholar; Anderson, Gerard F., Reinhardt, Uwe E., Hussey, Peter S., and Petrosya, Varduhi, “It's the Prices, Stupid: Why the United States Is So Different from Other Countries,” Health Affairs 22, no. 3 (May/June 2003), 89–105CrossRefGoogle ScholarPubMed; Garber, Alan and Skinner, Jonathan, “Is American Health Care Uniquely Inefficient?” Journal of Economic Perspectives 22, no. 4 (Fall 2008), 27–50CrossRefGoogle ScholarPubMed; Nolte, Ellen and McKee, C. Martin, “Measuring the Health of Nations: Updating an Earlier Analysis,” Health Affairs 27, no. 1 (January/February 2008), 58–71CrossRefGoogle ScholarPubMed; Bradley, Elizabeth H., Elkins, Benjamin R., and Herrin, Jeph, “Health and Social Services Expenditures: Associations with Health Outcomes,” British Medical Journal Quality & Safety 20, no. 10 (October 2011), 826–31CrossRefGoogle ScholarPubMed; Davis, Karen, Stremikis, Kristof, Squires, David, and Schoen, Cathy, Mirror, Mirror on the Wall: How U.S. Health Care Compares Internationally (New York: Commonwealth Fund, 2014)Google Scholar.

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18. Ameringer, Carl F., “Organized Medicine on Trial: The Federal Trade Commission vs. the American Medical Association,” Journal of Policy History 12, no. 4 (October 2000): 445–72CrossRefGoogle Scholar;

19. Laugesen, Miriam J., Fixing Medical Prices: How Physicians Are Paid (Cambridge, MA: Harvard University Press, 2016)CrossRefGoogle Scholar.

20. Peter A. Swenson, The Political Transformation of American Medicine: Doctors, Democracy, and Disease in the Progressive Era (manuscript).

21. Kessel, Reuben A., “Price Discrimination in Medicine,” Journal of Law and Economics 1 (October 1958): 20–53CrossRefGoogle Scholar.

22. Abraham, Kenneth S., The Liability Century: Insurance and Tort Law from the Progressive Era to 9/11 (Cambridge, MA: Harvard University Press, 2008)Google Scholar; McGarity, Thomas O., Freedom to Harm: The Lasting Legacy of the Laissez Faire Revival (New Haven, CT: Yale University Press, 2013)CrossRefGoogle Scholar.

23. In addition to Mizruchi, see Richard I. Kirkland Jr., “Today's GOP: The Party's Over for Big Business in a Political Arena Now Dominated by Small-Business Populists, Anti-Government Conservatives, and the Religious Right,” Fortune, February 6, 1995, http://fortune.com/2011/05/15/todays-gop-the-partys-over-for-big-business-fortune-classics-1995/; Lydia DePillis, “Here's the History of How Big Business Lost Control of the GOP,” Washington Post, October 4, 2013; Tory Newmyer, “The Inside Story of How Big Business Lost Washington,” Fortune, February 20, 2015, http://fortune.com/2015/02/20/the-inside-story-of-how-big-business-lost-washington/; Steven Pearlstein, “How Big Business Lost Washington,” Washington Post, September 2, 2016; Katharine Q. Seelye, “Republicans Get a Pep Talk from Rush Limbaugh,” New York Times, December 12, 1994.

24. “Rush Limbaugh: Crony Capitalism, Big Money behind GOP Amnesty Push,” June 18, 2013, Breitbart website, https://www.breitbart.com/the-media/2013/06/18/rush-limbaugh-crony-capitalism-big-money-behind-gop-amnesty-push/.

25. Vormedal, Irja, “From Foe to Friend? Business, the Tipping Point and U.S. Climate Politics,” Business and Politics 13, no. 3 (October 2011), 1–29CrossRefGoogle Scholar.

26. Martin, Cathie Jo, “Nature or Nurture: Sources of Firm Preference for National Health Reform,” American Political Science Review 89, no. 4 (December 1995), 898–913CrossRefGoogle Scholar.

27. Mishel, Lawrence, Bivens, Josh, Gould, Elise, and Shierholz, Heidi, The State of Working America (Ithaca, NY: ILR Press, 2012), 248–50Google Scholar.

28. Committee for Economic Development (CED), Building a National Health Care System (New York: CED, 1973), 5–6, 23–24, 87–94Google Scholar.

29. Broockman, David A., “‘The Problem of Preferences’: Medicare and Business Support for the Welfare State,” Studies in American Political Development 26, no. 2 (October 2012): 83–106CrossRefGoogle Scholar.

30. Ibid.

31. Ibid.

32. Broockman says that the NAM would have not have said there was strong opposition if 36 percent against it “implied that the remaining 64 percent of respondents supported Medicare.” His point is as obscure as the NAM's report is ambiguous. The NAM did not mention the number in favor. Why not? It may have strategically neglected to report it. In light of the new survey Broockman cites, possibly up to one-third favored Medicare. A disinclination to report such a number would not surprise me at all, given the character of the NAM I describe: a puny, unrepresentative organization with an ultraconservative agenda.

33. The Democratic bill covered only hospitalization, while the Byrnes bill also covered drugs, outpatient medical services, and skilled nursing home care. The Byrnes bill was also more liberal because of its financing out of general revenues. Byrnes vehemently criticized the King-Anderson bill for relying on “the most regressive tax we have” and forcing middling level employees to pay for hospitalization of wealthy patients who had either paid nothing into the system or would pay a smaller share of their income. Many low-paid workers would pay none of the income taxes required for his bill's financing. The Byrnes bill had a semivoluntary element, and only in this sense was it less “liberal.” Like today's Part B of Medicare—inspired by Byrnes—it allowed retirees to opt out of all coverage and therefore skip paying the very modest (because heavily subsidized) premiums. Experts expected around 90 percent enrollment, about where Part B enrollment stands today. Swenson, Peter A., “B Is for Byrnes and Business: An Untold Story about Medicare,” Clio: Newsletter of Politics and History 16, no. 2 (Spring/Summer 2006): 39–40Google Scholar.

34. Broockman misrepresents my claims about the need to examine economic interests by imputing to me the view that they “should be regarded as more reliable” (his italics) than their so-called true preferences. I wrote, not “more reliable,” but “above all, facts about economic interests are needed to help sort out the tricky inferential problems involved in preference attribution.” In the context it is clear that “above all” does not mean “more reliable than.” It means “an indispensable complement to.”

35. Admittedly, my historical approach assumes that important parameters will remain constant in the short run. But politics, as well as business, is mostly about short-term profits, stock prices, and upcoming elections.

36. Pauly, Mark V., Health Benefits at Work (Ann Arbor: University of Michigan Press, 1997)Google Scholar.

37. Michael F. Cannon, “Why Wal-Mart Supports an Employer Mandate,” Cato at Liberty, July 1, 2009, https://www.cato.org/blog/why-wal-mart-supports-employer-mandate.

38. Along with other pettifogging quibbles about this quote, Broockman points out that Byrnes paraphrased his informant as saying, “maybe we might,” not just “might” (p. 30).

39. Swenson, “Misrepresented Interests,” 6.

40. Ibid., 10.

41. Broockman claims, again erroneously, that I regard favorable big business attitudes as a “necessary condition” for Medicare's passage. I wrote, with italics added here, “Evolving interests, not power balances, may often be a decisive factor, given politicians’ realistic worries about a business backlash and electoral losses if they pass reforms that undermine broad capitalist interests” (p. 2 in “Misrepresented Interests”).

42. Swenson, Capitalists against Markets.

43. Paster, Thomas, The Role of Business in the Development of the Welfare State and Labor Markets in Germany: Containing Social Reforms (London: Taylor & Francis, 2012)CrossRefGoogle Scholar; Mares, Isabela, The Politics of Social Risk: Business and Welfare State Development (Cambridge: Cambridge University Press, 2003)Google Scholar.

44. Swenson, Peter A., “Good Distribution, Bad Delivery, and Ugly Politics: The Traumatic Beginnings of Germany's Health Care System,” in Divide and Deal: The Politics of Distribution in Democracies, ed. Shapiro, Ian, Swenson, Peter, and Donno, Daniella (New York: NYU Press, 2010), 245–79Google Scholar.

45. Hertel-Fernandez, Alex, Skocpol, Theda, and Lynch, Daniel, “Business Associations, Conservative Networks, and the Ongoing Republican War against Medicaid Expansion,” Journal of Health Politics, Policy and Law 41, no. 2 (April 2016): 239–86CrossRefGoogle Scholar; Nadja Popovich, “How Does Your State Make Electricity?” New York Times, December 24, 2018.