Domestic Politics and International Expertise in the History of American Disability Policy EDWARD D. BERKOWITZ George Washington University C OMPARATIVE LITERATURE ON THE WELFARE STATE looks for reasons why America has “lagged” behind western Europe in the development of national social insurance pro- grams, such as national health insurance. By prejudging what should have happened instead of trying to understand what did, in fact, happen, some analysts allow themselves to become “dispensers of moral judgments,” in Herbert Butterfield’s phrase, “dividing the world into the friends and enemies of progress” (Ashford 1989). Although this approach makes for spirited history, it also obscures the unique ways in which different countries have attempted to solve common social problems (Fox 1986). This essay uses rehabilitation and disability policy— relatively un- familiar areas of social welfare policy— to compare the United States with the earliest German social insurance programs and with Great Britain, the Netherlands, and Sweden. It seeks historically informed answers to two questions. What is distinctive about the American approach? Do nations learn from one another, or do cultural differences overwhelm efforts to transplant social policy from one nation to another? Guiding Assumptions and Initial Cautions The answers must of necessity be tentative. In part, this condition reflects my ability to read the sources. I use the relatively abundant The Milbank Quarterly, Vol. 67, Suppl. 2, Pt. 1, 1989 © 1989 Milbank Memorial Fund 195