Americans have been debating national health insurance throughout the twentieth century. The content of this elusive reform has evolved far more than the tone of the debate. When Theodore Roosevelt championed health care reform (during the 1912 presidential campaign) he wanted to build a hardy stock of Anglo Saxons—health insurance would help deliver white America from race suicide (Dyer 1980; Ross 1913, 299–304). More than thirty years later, President Truman made health insurance the major domestic issue of his presidential campaign; his goal was an extension of the New Deal social welfare state (Starr 1982). Today, the reform that was once condemned as too costly is widely prescribed as cost control.

While the reform itself has changed, the debate that surrounds it remains entirely predictable. Theda Skocpol describes the contestants: On one side, self-confident, neo-Progressive experts touting rationalizing schemes. On the other, conservative critics deploying “ideological, emotionally charged arguments” (Skocpol 1994). The shrill rhetoric of opposition has alternately bemused and baffled observers. Compulsory insurance was “a dangerous device … announced by the German emperor” (in 1918), a force representing “social theory … socialism, even communism” (in 1932), “the keystone to the arch of socialism” and “a threat to every area of freedom as we have known it (by the 1960s).