HARRY S TRUMAN AND THE AMA

National Health Insurance and the AMA

In the 1940s, if an American president wanted to stir up a hornet's nest with the American Medical Association (AMA), all he had to do was propose some form of national health insurance. National health insurance already existed in many European nations, including Germany, which had established the first national system of compulsory sickness insurance in 1883. The first attempts to secure some form of national health insurance for the United States began in 1915 with an early proposal from the American Association for Labor Legislation to give medical coverage to workers and their dependents. Since reformers saw health insurance as a way to subordinate medical practice to public health and to change the method of payment from fee-for-service to salary or capitation (a single fee for each patient during each year), tensions arose when physicians saw this potential attack on their income and autonomy. After the 1938 elections President Franklin D. Roosevelt sent a national health-care program to Congress, but the bill was not passed. Toward the end of his life he indicated he would press for health insurance once the war was over. In 1944 he asked Congress to agree to an "economic bill of rights," including a right to adequate medical care. Three months after the end of the war his successor, Harry S Truman, called upon Congress to pass a national program to assure citizens the right to adequate medical care and protection from the "economic fears" of illness. By the time President Truman brought a health-care bill to Congress on 19 November 1945, the AMA saw it as a full-fledged government attempt to regiment medicine and to control the freedom which the association's members had enjoyed for the ninety-eight years of its existence. "No socialized medicine!" buzzed the doctors.

The Truman Plan

Truman's plan was similar to Roosevelt's New Deal health program of 1938, but he emphasized different aspects. He was strongly committed to health insurance, and his five-point plan suggested

1. increased federal aid for constructing needed hospitals and other facilities;
2. expansion of public-health, maternal-health, and child-health services;
3. increased education and research for the medical profession;
4. compulsory health insurance; and
5. disability insurance.

His recommendations reversed the order of the 1938 program. Unlike Roosevelt's earlier program, which proposed a separate system of medical care for the needy, Truman proposed a single health-insurance system that would include all classes of society. It was this point that angered the AMA.

Reaction

Public reaction to Truman's plan was initially favorable, but Congress's reception was mixed. Sen. Robert Taft of Ohio, the senior Republican, called the plan socialist. "It is to my mind the most socialistic measure this Congress has ever had before it," complained Taft. The AMA was furious. Ever since 1933, when its president had warned members to agree with the policy of the association, the AMA had fought against anything that sounded like "socialized medicine." "By this measure," said 170 AMA delegates of the policy-making group of the association, "the medical profession and the sick whom they treat will be directly under political control…and doctors in America will become clock watchers and slaves of a system. Now, if ever, those who believe in the American democracy must make their belief known to their representatives so that the attempt to enslave medicine as first among the professions, industries, or trades to be socialized will meet the ignominious defeat it deserves."

MEDICAL "FADS" OF THE 1940s

Dr. Harry Bakwin, associate professor of pediatrics at New York University College of Medicine, stated his case against medicine's modern "fads" for children in the New England Journal of Medicine in 1945:

• In New York 61 percent of New York eleven-year-olds studied already had their tonsils removed, and doctors advised that one-half of the remaining 39 percent needed theirs out. Bakwin called the craze for tonsil removal "a useless expenditure of time, effort, and money."
• Most doctors advocated separating newborn babies from their mothers and putting them on a clock-ruled feeding schedule. Bakwin maintained that the practice is inhumane and almost bound to produce anxiety in parents and loss of appetite in children.
• Doctors diagnosed flatfeet, large tonsils, malocclusion (crooked teeth), heart murmurs, and poor posture as serious ailments. According to Bakwin, these are only normal childhood variations better left alone.

Source:

"Doctor, Spare the Scalpel!," Time (9 July 1945): 46-47.

Defeat

When the Republicans took control of Congress in 1946, they had no interest in passing national health insurance. The president focused more attention on the issue as the 1948 election approached. After Truman's surprise victory, the AMA thought the end of the world as they knew it had come. It assessed each of its members an additional $25 solely for the purpose of fighting national health insurance. Its battle in 1949 cost $1.5 million, at that time the most expensive lobbying effort in American history. "Would socialized medicine lead to socialization of other phases of American life?" demanded one pamphlet. It answered, "Lenin thought so. He declared: 'Socialized medicine is the keystone to the arch of the Socialist State.'" (The Library of Congress was not able to locate this quotation in Lenin's writings.) Even though the administration insisted that national health insurance was not "socialized medicine," the AMA campaign was so successful that even supporters of the bill identified it as socialization and therefore tantamount to communism. Public support dropped rapidly, and as anti-Communist sentiment rose later in the decade, national health insurance all but disappeared from sight, defeated by the AMA's considerable wealth, prestige, and publicity and by support from businesses that did not want the additional costs of health insurance. From that time public policy on health care fragmented, and each government health agency pursued its own special agenda. A unifying national health-insurance proposal was down, but not out, and would appear again from time to time in the decades to come.

HER TEETH AND HIS

According to the March 1941 issue of the American Dental Association, by the time she graduated from high school in 1941, an American girl had an average of 9.1 cavities, but her brother averaged only 7.7. Dentists were at a loss to explain this difference. Even the tact that a girl's permanent teeth grew in about five months earlier than a boy's could not account for the disparity. Although women took better care of their teeth than men, they still retained their unenviable lead in tooth decay in later life.

Source:

"Biting Odds tor the Male," Newsweek (17 March 1941): 65.

George H. Copeland, "Wanted: More Monkeys," The New York Times Magazine (8 December 1940): 25.

Sources:

"It's Socialized Medicine, All Right, Says AMA of the Truman Proposal," Newsweek (17 December 1945): 84+;

Paul Starr, The Social Transformation of American Medicine (New York: Basic Books, 1982), pp. 237-286.