This page is a portfolio adaptation of the work described below. A link to the original appears where it is publicly available.

Overview

This senior capstone examines the American health-care system through a combined constitutional, historical, and policy lens. Rather than treating single-payer health care only as a contemporary policy proposal, the paper places the debate within a longer American argument over federal power, state authority, fiscal capacity, collective welfare, and the practical responsibilities of government.

The analysis connects modern health-policy design to competing traditions in American political thought, including differing interpretations of the General Welfare Clause and the balance between national coordination and state autonomy.

Research question

How has the American health-insurance system evolved in structure, scope, and purpose, and what constitutional and functional challenges would a transition to a single-payer model present for federal and state governments?

Analytical approach

The project combines several levels of analysis:

  • Constitutional interpretation, particularly competing readings of federal taxing and spending power and the General Welfare Clause.
  • Founding-era political thought, including Hamiltonian arguments for national fiscal capacity and Madisonian concerns about enumerated powers and federalism.
  • Federalism, using the division of responsibility between national and state governments to examine the structure of contemporary health programs.
  • Historical policy development, tracing the growth of public and private health-insurance arrangements in the United States.
  • Modern policy design, considering how financing, administration, access, cost, and political feasibility interact in proposals for broader national coverage.

Key themes

One recurring theme is the tension between national capacity and decentralized authority. The paper uses programs such as Medicaid to illustrate cooperative federalism: federal financing and regulation combined with state administration can preserve local discretion, but that same decentralization can contribute to variation and fragmentation.

The capstone also uses the competing views of Hamilton and Madison to frame a broader question about governance. Hamiltonian fiscal capacity provides one intellectual foundation for coordinated national action, while Madisonian federalism emphasizes limits, divided authority, and the continuing role of states.

The result is not a claim that one historical framework mechanically resolves modern health policy. Instead, the paper uses those traditions to explain why American health reform repeatedly encounters constitutional, institutional, political, and administrative tensions.

Why this work matters

The capstone demonstrates long-form research across political theory, constitutional government, federalism, and contemporary policy. It shows how a present-day policy problem can be situated within the institutional and historical structures that constrain available choices.

For the portfolio, it serves a different purpose from shorter policy-analysis pieces: it demonstrates sustained research, synthesis across disciplines, and the ability to carry one research question through a substantially longer argument.

SSRN working paper

An expanded working-paper version of this research is publicly available through the Social Science Research Network (SSRN).

Single-Payer and the American Dream: The Role of Modern American Health Care (Working Paper)
23 pages

As of September 26, 2026, SSRN reports 189 downloads and 324 abstract views.

View the working paper on SSRN →

DOI: 10.2139/ssrn.5930155

Portfolio context

Completed as the senior capstone for POLS 497 – Senior Seminar in Political Science at American Military University.