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Dynamics of Healthcare Reform: Bitter Pills Old and New

The United States is at a crossroads—albeit one it has visited several times before. Although the Supreme Court has ruled upon the constitutionality of the Patient Protection and Affordable Care Act, the polarizing controversy surrounding national healthcare that began several generations ago is likely to continue into the foreseeable future. In this latest round of national debates, the issue of healthcare has been framed exclusively as a domestic issue. But history shows that the question of national healthcare in the United States has also been an extremely important issue for international law and international politics. To shed light on the overlooked nexus between the Act, U.S. constitutional law, and international human rights law, this Article examines the debates surrounding healthcare and human rights that occupied the nation’s attention over six decades ago.

In the late 1940s, the controversy over President Harry Truman’s national healthcare plan became known as the nation’s “Great Debate.” But because Truman’s plan never actually became law, this episode of U.S. history has largely escaped the attention of legal scholars. This mid-century debate over healthcare reform has had a profound impact on contemporary domestic and international legal institutions. This Article reveals how, beginning in 1948, the debate over healthcare set in motion a series of political precedents, social practices, and legal interpretations that have influenced every subsequent battle over U.S. healthcare. But in particular, this early debate over healthcare was an important factor in the historic decision in 1952 to divide the Covenant on Human Rights into the two treaties we have today—the International Covenant on Civil and Political Rights, and the International Covenant on Economic, Social and Cultural Rights.


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