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 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.

The idea of policy history arises from an awareness of“something missing.” In the view of some social scientists, politics and public policy too often have been treated ahistorically by their disciplines, with evidence subordinated to theory. For some historians, the apparent waning of disciplinary interest in political history has been similarly distorting. Because of these things, social scientists, political historians, and more than a few social historians increasingly function as “policy historians,”as scholars especially alive to the vagaries and contingency of public policy and its history.