The compulsory medical benefit scheme for white public servants in South Africa grew out of a friendly society founded in 1905. This development diverged from the experience of other members of the British Commonwealth, where universal health insurance schemes developed following the British example. The Civil Servants’ Medical Benefit Association (CSMBA) addressed the needs of white public servants, leaving the non-white communities without any form of government-sponsored medical support, apart from health care provided at government hospitals. The CSMBA was a well-managed medical benefit association, but when it was appointed the compulsory medical benefit association for white public servants, government intervention affected the financial viability of the organization, despite the payment of a state subsidy.

The powerful personalities of Thomas Jefferson and Napoléon dominate Louisiana Purchase narratives. Such a focus obscures the important institutional, electoral, and partisan dynamics that help explain the transfer of Louisiana to the United States. This article offers new insight into relationships between the Federalists and the Republicans as well as the institutional relationship between Congress and the president. During the purchase, both political parties at times sacrificed the consistency of their issue positions on the altar of electoral politics. The politicians’ actions were based not only on their personalities and partisan affiliations but also on their institutional contexts. By additionally considering the partisan and institutional dynamics of the early 1800s, this article provides a more complete understanding of the Louisiana Purchase.

In this article, we examine participation in floor debates by U.S. House Speakers in the First through Twenty-sixth Congresses (1789-1841). Consistent with the often-stated view that Speaker Henry Clay of Kentucky transformed the office of Speaker by using the prerogatives of the office more expansively than other early Speakers, Clay stands out among the Speakers of this period for the frequency and length in which he engaged in House debates. However, we also find that Speakers were regularly participating in floor debates over a decade before Clay held the office and that the five Speakers who succeeded Clay did not regularly participate in debate. Although Clay was not the first Speaker to participate regularly in floor debate, we propose that he transformed the office by effectively using all of the leadership tools available to the Speaker, demonstrating to his House colleagues the benefits of having the Speakership function as the central leadership institution for the chamber.

Contemporary events illustrate both the opportunities and the obstacles to democratic nation-building through military occupation. In addition to international influences or prewar legacies, domestic political forces within the occupying nation also set limits on the capacity for social and political change. We illustrate this dynamic by examining the effects of U.S. interest group politics on Japanese health policy during the American occupation after World War II. These struggles over health policy in postwar Japan illustrate that military occupations do not operate in a political vacuum but are shaped by the push and pull of domestic interest group politics back home.

Under the burden of Jim Crow, how did African Americans obtain health care? For nearly 40 years the Afro-American Hospital of Yazoo City, Mississippi, was a leading health care supplier for blacks in the Mississippi Delta. It was founded in 1928 by the Afro-American Sons and Daughters, a black fraternal society, and provided a wide range of medical services. The society, which eventually had 35,000 members, was led by Thomas J. Huddleston, a prosperous black entrepreneur and advocate of Booker T. Washington’s self-help philosophy. The hospital had a low death rate compared to other hospitals that served blacks in the South during the period. It ceased operation in 1966 as a fraternal entity after years of increasingly burdensome regulation, competitive pressure from government and third-party health care alternatives, and the migration of younger dues-paying blacks to the North.

We examine the relationship between age, sickness, and longevity among men who were members of the Hampshire Friendly Society (HFS) in southern England during the late nineteenth and the early twentieth centuries. The HFS insured its members against sickness, death, and old age, keeping detailed records of the claims for sick pay submitted by its members from 1868 onward. From 1892 onward these records included information about the cause of the sickness for which compensation was paid. We can therefore use this information to construct individual “sickness biographies” for men who joined the society during this period. This article uses these sickness histories to address two questions. The first concerns the relationship between the age of the society’s members and the nature of the claims they submitted. We find that both the incidence and the duration of periods of sickness increased with age. Older men experienced longer periods of sickness both because they experienced different types of sickness and because it took them longer to recover from the same illnesses as those suffered by younger men. The second question is whether sickness in early adulthood was associated with increased mortality. We find that repeated bouts of sickness, as revealed by the number of claims made for sick pay, at ages under 50 years were associated with an increased risk of death at ages over 50 years.

Some studies that address the decline of fraternal sickness insurance conclude that fraternal insurers were crowded out of the market by increasing government and commercial competition. This line of reasoning reinforces beliefs that government and commercial insurers were superior to fraternal providers and that voluntary insurance arrangements were deficient for addressing household income risks before the rise of the welfare state. This article shows that this interpretation is problematic. The largest sickness insurer in the United States, the Independent Order of Odd Fellows, dismantled its sick benefit arrangements between the 1860s and the 1920s not because of an inability to compete with the government and commercial insurers that were not in the market until well after 1920 but rather because of declining demand for the insurance within the membership.