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Marie Gottschalk. The Shadow Welfare State: Labor, Business, and the Politics of Health Care in the United States. New York: ILR/Cornell University Press, 2000. x+288 pp. $45.00 cloth, $18.95 paper.
If you are searching for a comprehensive analysis of the dynamic between labor, business, and government, and the resulting historical and institutional impediments to far-reaching health care reform in the United States, then this is the book to read. Drawing on a mixture of primary and secondary material, including three dozen semi-structured interviews with pivotal labor union and business representatives, Gottschalk analyzes the similarities and differences between unions and the tensions within the AFL-CIO over health policy.
Gottschalk argues that the institutions of the private welfare state, that patchwork of employer-linked social benefits sometimes called the "shadow welfare state," became an institutional straitjacket for organized labor's efforts to secure universal and affordable health care in the U.S. In reminding us that the U.S. has "a peculiar employment-based welfare system that is neither wholly private or public," Gottschalk demonstrates the complex interplay, and labor's role therein, between the private- and public-sector safety nets. We owe Gottschalk a debt of thanks for a well-argued, history-packed analysis of why leaders of organized labor have failed to anchor a winning movement for national health insurance.
Gottschalk presents a wide range of scholarly opinions and analysis on the interaction between labor and business as pertains to health policy. In particular, she explores the story of how labor, with its fate unshakably saddled to the Democratic Party's recent rightward drift, and business, big and small, have waffled in the post-war era between alternating positions in support of national health insurance and employer mandates.
She presents a well-developed case, rich in detail and persuasively argued, that the...