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JAMA Dermatology a Century Ago
January 2014

Far Echoes From the XVII International Congress of Medicine in London

JAMA Dermatol. 2014;150(1):8. doi:10.1001/jamadermatol.2013.8011

The party in power had promised health care reform, and now it was time to deliver. Besides the expected resistance from the political opposition, many other groups also objected to change. Labor unions were afraid that the new system might provide fewer benefits than they had achieved through collective bargaining. Poorer people opposed the plan’s mandate that they had to purchase insurance. Organized medicine offered tepid support, hoping that by endorsing the administration’s plan it could have more say-so in the mechanisms by which it was implemented. The cost of the reforms could not even be hazarded: Each side of the debate threw out whatever numbers supported their own position. The administration claimed that the current system was riddled with waste and overpaid insurance agents; it insisted that a centralized governmental bureaucracy would be cheaper and more efficient. Rumors circulated that the real reason for reform was to nationalize health care. As the legislative deadline loomed, it became obvious that the administration was willing to support any bill as long as it could be passed. At the eleventh hour, and following heated closed door negotiations, Britain’s Chancellor of the Exchequer, David Lloyd George, forced Parliament to pass the National Insurance Act of 1911. The act left 1 out of 6 working people without insurance coverage. It did not even address paupers who had never been employed. Despite these and many other shortcomings, this piece of legislation would become the cornerstone of the British welfare state. The National Insurance Act of 1911 did produce one clear and undisputed winner: The giant insurance companies whose back-room bargaining had insured its passage.

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