Why is the United States the only major industrialized nation without universal health insurance coverage? Why have so many efforts to pass a national health insurance plan failed? Many observers argue that this glaring peculiarity of American social policy is due to the superior lobbying efforts of the American Medical Association, a general weakness on the part of the federal government, or, more generally, America's cultural sense of rugged individualism. This book argues that there is actually no one politics of health care or single explanation for the lack of universal coverage; there are, instead, different patterns of politics at different stages of policy development. Throughout these stages, however, a unique and critical relationship has existed between Social Security and the development of health insurance. In Universal Coverage, Rick Mayes analyzes how the fate of Social Security and Medicare became commingled and how myriad elected leaders, interest groups, and organizations invested in the existing arrangements have effectively prohibited comprehensive change to America's medical industrial complex.