Abstract: This study examines the rise of private health insurance (PHI) in the United States in the post-World War II era (1946-1954). We examine the role of the American Medical Association (AMA) who financed a campaign against national health insurance (NHI) directed by the country's first political public relations firm, Whitaker and Baxter (WB). The AMA-WB Campaign had two key components: (1) physicians who would endorse private health insurance (PHI) to patients; and (2) newspaper advertising that described PHI as “freedom” and “the American way." We bring together archival data from several novel sources to assess whether the Campaign was effective. We find that areas more exposed to the Campaign experienced sharp declines in support for NHI and increased enrollment in PHI. We also find effects of the Campaign on House elections and on physician financial contributions to the Republican presidential candidate in 1952.  Lastly, we find language used by the Campaign is observed more  frequently in the Congressional Record. These findings suggest the rise of PHI in the U.S. was not solely due to collective bargaining, favorable tax treatment, or price controls. Rather, it was enabled by an interest group financed Campaign that used ideology to indirectly lobby policymakers via persuading ordinary citizens.

Bio: Marcella Alsan is a physician-economist studying the economics of health inequality domestically and internationally. Alsan received a BA from Harvard University, a master’s in public health from Harvard School of Public Health, a MD from Loyola and a PhD in Economics from Harvard. She trained at Brigham and Women’s Hospital Howard Hiatt Global Health Equity Residency Fellowship – then combined the PhD with an Infectious Disease Fellowship at Massachusetts General Hospital. Prior to returning to Harvard she was tenured at Stanford. She is Associate Editor at the Journal of Economic Literature and Co-Chair of the Health Care Delivery Initiative of Abdul Latif Jameel Poverty Action Lab at MIT. She is co-recipient of the 2019 Arrow Award for Best Paper in Health Economics, the 2021 William G. Manning Memorial Award for the Best Research in Health Econometrics, recipient of a MacArthur Fellowship and was elected into the National Academy of Medicine in 2022. She co-directs the Health Inequality Lab at Harvard Kennedy School of Government.