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For better or worse, I have avoided the temptation to paint the last hundred years of workers’ compensation in broad brush strokes, opting instead for a series of detailed portraits revolving around a common theme: how workers’ compensation came to be established as the exclusive responsibility of state governments and stayed that way, even as the national government expanded its role in many other social programs. All but a handful of readers have by now experienced a quantum leap in their factual knowledge of workers’ compensation in the United States, more than enough to sustain a cocktail or dinner table conversation on the topic. On the remote chance that some readers may not place a high value on such knowledge, I will conclude by indicating how this history helps to reinforce or refine a number of generalizations about social policy and policy making.

Start first with some descriptive generalizations about the America welfare state. One major thread of this paper has been federalism, and in particular the ways in which state-level control of workers’ compensation has periodically been challenged at the national level and allowed to persist. The large role of subnational governments has long been viewed as one of the defining features of the American welfare state, and the example of workers’ compensation only strengthens that view.31 States have greater control of workers’ compensation than any other major social program. A second thread has been the importance of private insurance companies, self-insured employers, and medical professionals, both in delivering cash benefits and medical care to injured workers and in creating an important set of stakeholders. The American welfare state is known for its mix of publicly financed but privately delivered goods and services, and workers’ compensation is a good illustration of that pattern as well.

This case helps to remind us that shared understandings of social policy can vary over time. During the first half of the 20th century, workers’ compensation was viewed primarily as social insurance, and therefore part of social policy. Comprehensive studies of social policy (e.g., Haber and Cohen 1948) analyzed workers’ compensation as well as social security, unemployment insurance, health insurance, and various forms of public assistance. That no longer happens. At some point between the mid-1950s and mid-1960s, workers’ compensation became more closely linked in policy debates to workplace safety and in academic research to industrial relations. This shift was made possible by the dual objectives of workers’ compensation, income support and accident prevention, which had been present since the first state laws were enacted. In the process of expanding the responsibilities of the national government, U.S. policy makers focused on income support before workplace safety; they created old age and unemployment and disability insurance before OSHA. The sequence of state-building at the national level helped influence the ways in which policy makers and researchers defined workers’ compensation as a public problem.

At another level, this study shines light on the policy process. Most journalistic and academic treatments of the policy process focus on the stage when authoritative decisions


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