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theses

ETD doctoral

This dissertation recasts the history of the late twentieth-century United States welfare state by examining the battles over Chicago’s only public hospital, Cook County Hospital (CCH), from the 1950s to the 1990s. By focusing on the history of insurance, historians of health care politics in this time period have overlooked debates over the delivery of health care for the poor and, most markedly, the critical role local welfare state institutions played in providing care for those left out of the means-tested and discriminatory health care system. Public hospitals were the safety nets below the federal safety net, I argue, and many fought to defend them as such and as models for an alternative health care system across the second half of the twentieth century. This perspective invites reinterpretation of late-twentieth century health care and welfare state politics. Where scholars of political economy, labor, and intellectual history have argued that a consensus about the public-private welfare state emerged in this period, “Poor Health” recovers competing visions for the public sector and the continuous struggles over health care starting in the 1960s and lasting for decades after. One group—a diverse set of power brokers including government officials, fiscal conservatives, and even some well-intentioned reformers—argued that privatization would lead to greater efficiency and equity as justification for reducing spending on public infrastructure. They drew on rhetoric made available by Great Society health care legislation, which reified the public-private health care system and suggested the public hospital was obsolete. A second group—hospital employees and community members—defended a different vision of an accountable, accessible, and well-funded public sector that provided dignified care to all. In the early 1960s, activists in this group pushed to build a South Side public hospital to increase health care access for Black Chicagoans. By the late 1960s, a patient-centric labor activism engaged in protracted struggles for decent treatment of workers and patients. Activists fought to defend the hospital in the late 1970s, and in the 1980s and 1990s struggles focused on quality reproductive and HIV/AIDS care and on rebuilding the public hospital. These activists’ sustained efforts to maintain, improve, and even expand the local health care system found surprising success, including during moments of federal retrenchment such as the 1980s. Though the rhetoric used to support these two visions sometimes overlapped, I propose that analyzing differences in rhetoric and, especially, chronicling struggles on the ground is key to understanding the politics of this time period. In particular, the dissertation restores a robust vision for the public sector in the late twentieth century.

ETD_11076

Ph.D.

Includes bibliographical references

doi:10.7282/t3-szft-6c41

The author owns the copyright to this work.