The Political Economy of State Provided Health Insurance in the Progressive Era: Evidence from California

I investigate why the United States did not adopt European style health insurance in the 1910s by examining voting determinants on the 1918 referendum on state-provided health insurance in California. I find that although the persuasiveness of interest groups, especially doctors, was an important determinant of the 1918 vote, interest groups alone could not explain the resounding defeat of state-provided health insurance. Voters, I find, were unwilling to pass a costly measure with an unpredictable outcome.