Through the 1980s and early 1990s, the course of American health research was increasingly shaped by politically-aggressive activism for two particular diseases, breast cancer and AIDS (Acquired Immunodeficiency Syndrome). Even as national stakes rose, both in dollars spent and growing demands on the medical system, breast cancer and AIDS advocates made government policy-making for research ever more public and controversial. Through skillful cultivation of political strength, interest groups transformed individual health problems into collective demands, winning notable policy influence in federal agencies such as the National Institutes of Health (NIH) and Food and Drug Administration (FDA). Activists directly challenged fundamental principles of both government and medical systems, fighting to affect distribution of research funds and questioning well-established scientific methods and professional values. In the contest for decision-making power, those players achieved remarkable success in influencing and infiltrating (some critics said, undermining) both the politics and science of medical research. Between 1990 and 1995, federal appropriations for breast cancer study rose from $90 million to $465 million, while in that same period, NIH AIDS research rose from $743.53 million to $1,338 billion.

Social Security has achieved a privileged status in American politics. As a result of the Social Security tax, supporters claim, recipients have not received unearned benefits, nor has Congress felt as if it were building a massive welfare state. Indeed, the Social Security tax system has legitimated the program in the minds of policy experts, politicians, and recipients. Through Social Security, the American state has forged a strong alliance with the elderly and their descendants, both with retirees who received cash payments and with working families who did not have to finance their parents' retirement years.

During the early months of 1919, the term “Reconstruction,” of concern to few but historians and the friends and foes of D.W. Griffith in the years immediately preceding the Great War, was again on the lips of Americans. Alabama State Federation of Labor President, William L. Harrison, noted that “Since the signing of the Armistice, and the cessation of hostilities, the questions of reconstruction and re-adjustment are being diligently studied by the people generally.” Out of the war, he argued, came “new and progressive ideas on reconstruction.” He was right. As the war ended, dozens of books and articles bearing titles like Reconstructing America, Democracy and Reconstruction, and Social Reconstruction joined a new journal called Reconstruction: A Herald of the New Time. This literature celebrated the role that a strong federal government had played in helping workers secure the right to join unions during the war, and it laid out hopeful plans for what the government might do to solve the “labor question” after the war. Such ideas helped convince Harrison's counterpart, Florida State Federation of Labor President John H. Mackey, that the postwar era would bring “a silver ray which carries with it wondrous tidings for the uplift of the masses.”

Why, alone among its democratic capitalist peers, does the U.S. not have national health insurance? This question has invited a range of replies; some focusing on specific historical episodes, some invoking grand political or cultural or economic explanations for the peculiar trajectory American social policy. For the most part, the historical accounts have trouble climbing from narrative to explanation; little of the scholarship on the failure of health reform in 1920 or 1935 or 1948 or 1970 or 1994 makes any substantial contribution to our larger understanding of the American welfare state and its limits. And the theoretical accounts often stumble on the descent to historical context; the largely artificial debate between “state-centered” and economic explanations, for example, rests largely on abstractions which are either not unique to the American setting (capitalism, industrialism, liberalism) or which are offered in such broad strokes that they make little sense in specific historical contexts. In explaining this “hole” in the American welfare state, it is necessary to pursue two lines of inquiry; to consider both the relative success of other American social programs during the years in which health insurance was beating at the door, and the relative success of public health insurance in other national settings. Our understanding of the American health debate of the 1940s, in other words, must in part explain both the distinct trajectory of health policy during the formative years of Social Security, and the “exceptional” character of the American welfare state.

In 1977, the United States Congress forbade the Food and Drug Administration to outlaw use of the food additive saccharin as an artificial sweetener for a period of three years. Subsequent legislation extended the congressional ban. It remains in effect today. Congress's saccharin action neatly represented late twentieth-century federal regulatory policy. The process had become decidedly antibureaucratic and ultimately democratic. Forces both for saccharin's prohibition and for its continued use outlined and debated their positions in public, letting their arguments contend in the marketplace of ideas. Following the conduct of this de facto national plebiscite, duly elected representatives weighed the respective cases and selected the course that their constituents seemed to favor.

During the mid-1960s, the governments of the United States and Canada each declared “war” on poverty. The former venture has received far greater scholarly attention, and for obvious reasons: its high-profile inception, the broader spirit of Great Society liberalism that it embodied, the profound crisis of American society and politics within which it soon became embroiled, the rapidity with which its prescriptions and hopes were extinguished. By comparison, the Canadian War on Poverty seems an unimportant venture, and one that lacks the stuff of which drama is made. It has, accordingly, been neglected by scholars on both sides of the 49th parallel.

In his 1922 novel Babbitt, Sinclair Lewis introduced his main character, George Follansbee Babbitt, a realtor and member of the local planning board, by describing Babbitt's suburban residence. Paraphrasing contemporary house-plan publications, Lewis characterized the Dutch Colonial dwelling as at once “competent and glossy.” Babbitt's yard, “was perfection … his bathroom … porcelain and glazed tile and metal sleek as silver … and his bedroom … right out of Cheerful Modern Homes for Medium Incomes.” Indeed, his house “had the best of taste, the best of inexpensive rugs, a simple and laudable architecture, and the latest conveniences.”

In the years since the Supreme Court handed down its ruling in Roe v. Wade (1973), the abortion controversy has raged across America with increasing vigor. Since Ruth Bader Ginsburg's appointment solidified the Rehnquist Court's moderate bloc, holding the line on Roe's basic principle but inviting more state regulation, the conflict over abortion is likely to expand and intensify in most of the fifty states. The increased and bitter activity since the Supreme Court decided Webster v. Reproductive Health Services (1989), which gave state legislatures more latitude to respond to pro-life pressures, provides only a small indication of what the future may hold. Almost twenty years after Roe legalized abortion in the United States, an end to the “clash of absolutes,” as Laurence Tribe has recently called the American abortion conflict, seems nowhere in sight.

The Great Depression of the 1930s transformed municipal political life in Montreal, as it did that in other major cities in North America. For one thing, the debate between populists and reformers was revived as the electoral scene underwent fundamental changes. In many cities, political machines running on patronage became more influential as the middle class began to desert the city for the suburbs. At the same time, the margin of budgetary maneuvering available to cities was shrinking, and local public finances were reduced. Municipalities that had been obliged to borrow to meet social needs resulting from the depression were faced with a prolonged fiscal crisis, which for many of them resulted in bankruptcy and trusteeship. This was Montreal's fate in 1940.

In his 1974 testimony before the U.S. Senate Subcommittee on Antitrust and Monopoly, Bradford Snell lay partial blame for the decline of mass transit in the United States on a targeted program, spearheaded by General Motors (GM), with the goal of “substitution of buses for passenger trains, streetcars and trolley buses; monopolization of bus production; and diversion of riders to automobiles.” Snell argued that General Motors and its subsidiary company National City Lines were responsible for “the destruction of more than 100 electric surface rail systems in 45 cities including New York, Philadelphia, Baltimore, St. Louis, Oakland, Salt Lake City and Los Angeles.”

In mid-nineteenth century America the asylum became the foundation of public policy. This ubiquitous institution was regarded as a symbol of an enlightened and progressive nation that no longer ignored or mistreated its severely and chronically mentally ill citizens. The faith in an institutional policy was embodied in a vast and costly system of state mental hospitals that by 1940 had an inpatient population of about 450,000. Despite the presence of serious problems, there was little disposition to call into doubt the wisdom of institutional care and treatment. Even though mental health policy was formulated within a decentralized and divided political system, there was no doubt that a holistic and clear consensus prevailed.

During the past two decades, sociologists, political scientists, and historians have been increasingly interested in the development of modern states and their administrative structures. By focusing on specific policies and government agencies, these scholars have provided various frameworks for understanding the growth of the American state in the twentieth century, especially during the New Deal and the 1940s. One issue that has received scant attention, though, is housing policies. Public housing, federally insured home mortgages, and tax policies that privileged home owners were significant state interventions that profoundly affected economic relationships and the formation of social policy. Housing policies therefore need to be seen as part of larger economic and political developments.