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Health Care Reform and History

Class 1: Sickness as a Social Problem


This class analyzes debates on sickness, poverty, workers’ rights, and the costs of medical care during the Progressive Era, World War I, and the 1920s. Students will analyze the defeat of Progressive-era movement for compulsory health insurance and how it set the United States on a different course from European health systems and welfare states.

Class Resources
Primary Sources
  • Russell, Martha M. “What Social Insurance Will Mean to Nurses.” The American Journal of Nursing Vol. 17, No. 5 (Feb., 1917): 388–393.
  • “Some Objections to Compulsory Health Insurance,” Monthly Review of the U.S. Bureau of Labor Statistics, Vol. 4, No. 4 (April, 1917): 512–518
  • Cartoons on compulsory health insurance in American Labor Legislation Review, Vol. 9 No. 1 (Mar 1918): 3, 49, 64.
  • “The Committee on the Costs of Medical Care Presents Its Final Report.” The Milbank Memorial Fund Quarterly Bulletin Vol. 11, No. 1 (Jan., 1933): 21–30.
Secondary Sources
  • Derickson, Alan. “A Fertile and Lively Cause of Poverty” and “One of the Most Radical Moves Ever Made.” In Health Security for All: Dreams of Universal Health Care in America. Baltimore: Johns Hopkins University Press, 2005, pp. 1–48.
Discussion Questions:
  1. What were the major health and medical problems that concerned Progressive reformers? How did Progressives see health as an element of industrial or labor reform?
  2. According to Alan Derickson, what made Progressive health legislation proposals particularistic, rather than universal? Why did Progressives adopt this strategy?
  3. What groups opposed compulsory health insurance, and why?
  4. Compare the definition of “health insurance” (or sickness insurance) in the early 20th century with our definition today.
  5. Why did health politics shift from concern about workers’ wages in 1920 to concern about doctors’ bills in 1930? What accounts for the rise in the cost of medical care between 1920 and 1930?
  6. Explain the disagreements among the authors of the Final Report of the Committee on the Costs of Medical Care.
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