Interest Groups, Ideology, and Indirect Lobbying: The Rise of Private Health Insurance in the United (with Marcella Alsan and Yousra Neberai).
[NBER WP 32484] [Draft]
This study examines the rise of private health insurance in the United States in the post-World War II era. We investigate the role of the American Medical Association (AMA) which financed a campaign against National Health Insurance that was directed by the country’s first political public relations firm, Whitaker & Baxter’s (WB) Campaigns, Inc. The AMA-WB Campaign had two key components: (1) physician outreach to patients and civic organizations; and (2) mass advertising that tied private insurance to “freedom” and “the American way.” We bring together archival data from several novel sources documenting Campaign intensity. We find a one standard deviation increase in Campaign exposure explains about 20% of the increase in private health insurance enrollment and a similar decline in public opinion support for legislation enacting National Health Insurance. We also find suggestive evidence that the Campaign altered the narrative for how legislators and pollsters described health insurance. These findings suggest the rise of private health insurance in the U.S. was not solely due to war-time wage freezes, collective bargaining, or favorable tax treatment. Rather, it was also enabled by an interest group-financed Campaign that used ideology to influence the behavior and views of ordinary citizens.
Trends in Political Polarization of Civil Liberties in the U.S. vs. Europe (with Minjeong Joyce Kim, David Y. Yang, Marcella Alsan, and Stefanie Stantcheva).
[Draft coming soon]
National crises can aggravate or alleviate political polarization. COVID-19 was an unprecedented “stress test” for liberal democracies, prompting restrictions on civil liberties as part of the public health response. To what extent did the citizens of Western Democracies agree on these restrictions? How did these views change over time across countries and individuals? We examine these questions using nationally representative surveys fielded at the initial (March-April 2020) and later (March-May 2022) phases of the COVID-19 pandemic in France, Germany, Italy, the United Kingdom, and the United States. During the initial phases of the pandemic, citizens across all liberal democracies broadly agreed on the importance of sacrificing rights during a crisis for societal well-being. During the later phase of the pandemic, Europeans continued to enjoy broad agreement regarding the appropriate level of sacrifice. However, a stark partisan divide emerges in the U.S. which is due to more extreme positions among both Republicans and Democrats. Random forest prediction models find political affiliation became the most important factor in explaining views on sacrificing civil liberties in the later pandemic phase in the U.S., whereas in Europe the local level of COVID-19 burden is the most important factor. Although polarization is discussed as an issue across all liberal democracies, these results highlight the extent to which polarization in the US has surpassed that of other liberal democracies in response to the pandemic.