“This is a valuable book. It is a translation from the Dutch of a 2001 work
on a topic that has seen little written in English: the history of how
Continental health insurance systems began and developed. Combined with
Paul Dutton’s short history of French health care finance [1], we now have
a solid overview in English of the origins of Continental state-led health
insurance systems.
Companje et al. describe their subject in minute detail. They begin with
high medieval guilds, and pay particular attention to the prehistory of
health insurance in Flanders and among German miners. The end of the guild
system after the French Revolution left sickness insurance funds free to
develop as workers and employers saw fit. The era of what might be called
free insurance, analogous to free banking, did not begin to dissolve until
the German state required insurance coverage in the late nineteenth
century. While the German story of pioneering state intervention in health
care financing markets is well known, previous histories have not covered its
development at this level of detail. Elsewhere, the early twentieth century
history of health insurance in the Low Countries is considerably less
familiar, but not because it was dull. In Belgium health insurance
provision was a political football knocked around by Catholic and Socialist
parties. The Dutch network, a “motley collection” (p. 98) of insurance
funds, grew rather more horizontally across the economy than vertically
through the government.
In /The Divided Welfare State/ [2], Jacob Hacker wrote that among the
obstacles to government insurance in the United States were certain
democratic institutions that national governments in Europe need not have
trifled with. Exhibit A of this model is surely the Dutch experience from
1914 to midcentury. From the Great War onwards every effort to enlarge the
government’s presence in health insurance markets halted due to unwanted
amendments, parliamentary deadlock, dissolved governments, and other flotsam
of a democratic polity. The authors concede in the midst of describing one
of many such cycles (p. 165), “This is beginning to sound monotonous.”
But all was not lost. The arrival of Nazi occupation forces spelled
springtime for health insurance. To bring the Netherlands in conformity
with the example of Das Vaterland, the occupiers promulgated a compulsory
sickness fund decree, thoughtfully issued in Dutch as well as German, that
broke through the parliamentary clutter and established government health
insurance once and for all. As for Belgium, the Allied breakout from Normandy caused the Germans to put Nazifying health insurance on hold. But
soon after liberation the Belgians too enacted compulsory insurance. Thus,
among both destroyers and defenders of the West, government health insurance
was an idea whose time had come by the mid-twentieth century.
This book’s virtues are many. Much writing on the subject can take on a
polemic aspect which either thrills or dismays, depending on the reader’s
perspective. Perhaps because they are writing for a readership for whom the
state has provided health insurance for generations, the present authors take
the government’s role for granted, and so their narrative proceeds
self-assuredly rather than aggressively. The authors are also attentive to
the critical economic problems in insurance contracts that plagued all the
programs discussed, some more than others. For example, since monitoring
and administrative costs increase less than proportionally as membership,
such scale economies tended to favor larger funds in late nineteenth century
Netherlands (p. 100). Throughout the authors rely on sources in Dutch and
German, many of which are difficult to obtain in the United States. The
bibliography alone is worth asking your library to buy a copy. They also
note opportunities for further research, such as the lack of studies on
factory funds in late nineteenth century Belgium, so the book can serve as
both instructor and guide to field work for interested readers. And, a
nontrivial feature is the excellent translation into smooth English.
Of course any reviewer will find points that he would like to have seen
developed in further detail. In this case, the discussion of the Hartmann
Bund (p. 77), a league of physicians in Germany, notes the near strike that
was avoided in 1913, but does not note the actual strikes that occurred in
1903-04. The difference between avoiding and enduring a physician strike
would have made for an interesting analysis. I would also have liked
reading more about the role of honorary members in Belgian funds. That
attractive assurance of tone also leads to some question begging, as in the
proclamation that health insurance is a government responsibility (p. 63).
Still, the authors do acknowledge that, for example, the growing generosity
of the Belgian government’s subsidies in the 1920s came with all manner of
compulsory conditions attached (p. 150). In addition, a final chapter that
did not appear in the Dutch edition covers political developments since 2001,
perhaps at a level of resolution too fine for most historians. And the lack
of an index is regrettable; the inclusion of one would have increased the
book’s value to scholars markedly. These are small points that are
outweighed by far by this volume’s clarity and usefulness.
Two Centuries of Solidarity deserves a wide readership among English-speaking
historians of social insurance and the welfare state.
Notes:
1. Paul V. Dutton, /Differential Diagnoses: A Comparative History of Health
Care Problems and Solutions in the United States and France/, Ithaca: Cornell
University Press, 2007.
2. Jacob Hacker, /The Divided Welfare State: The Battle over Public and
Private Social Benefits in the United States/, New York: Cambridge University
Press, 2002, pp. 191-196.
John E. Murray is the author of /Origins of American Health Insurance: A
History of Industrial Sickness Funds/, New Haven: Yale University Press,
2007.
