In order to understand American health care and social security politics, this chapter looks at political economy—the relationships between business, labor, and the state—from the formative years in the 1930s. The United States developed a private, job-based health insurance system in the political struggle of a particular historical moment. It emerged from the political offensive of American business after the Second World War and the attempt to appropriate the meaning of security and shift its emphasis away from the state to private, individual economic relationships. Once outflanked, liberals and unions accommodated the new system of employer-provided benefits, even adopting management’s slogan of “free collective bargaining.” Where private issues were merged into public ones in Europe’s social democracies, public issues were blurred into the private realm in the US, turning questions of social distribution into private managerial issues, insulated from public oversight, public discussion, and political challenge.
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