If Harry S. Truman and Robert Alfonso Taft are the presidential nominees of their two parties this year, the state of the nation's health may be a hot campaign issue. On this one point at least, their views differ as widely as did those of Herbert Hoover and Franklin Roosevelt.
Both Truman and Taft have been active in the matter. Opposing bills they are sponsoring have deadlocked Congress on health legislation, and Taft's supporters have come out in opposition to the National Health Assembly, called by the Truman Administration to draft a ten-year program to raise the national health level.
On health, President Truman can match his record proudly with that of Roosevelt, at least as far as verbal expressions are concerned. He is the first President to address a special message to Congress on the subject, and to repeat his demand for an adequate medical-care program in budget and other messages to follow. In November, 1945, Truman asked Congress to approve:
1. More hospitals and more doctors—in all areas of the country where they are needed.
2. Adequate public-health services, including an expanded maternal and child-health program.
3. Additional medical research and medical education.
4. Insurance against the costs of medical care.
5. Protection against the loss of earnings during illness.
The Wagner-Murray-Dingell bill, embodying the President's proposals, was promptly introduced. Now, almost two and a half years later, the Senate Committee on Education and Labor has just completed hearings on the measure and has not yet decided what action it will take on it.
Taft promptly accepted Truman's challenge to make health a political issue for 1948. After he and Chairman James E. Murray (D, Mont.) of the Senate Committee on Education and Labor had quarreled a few times in the opening hearings on the Administration bill, Taft came up with a bill of his own which he did not deny that the American Medical Association had helped him to prepare.
While the political struggle over these two measures has gone on, the health of the nation has continued to suffer. Seven million people in the US fall victim to sickness or disability during every 24-hour period. Most or all of the 97 million Americans who could not afford all the medical care they required in 1945 had to forgo needed treatment during 1946 and 1947 (AMA Medical Economics Bureau figures). And the 82 percent of Americans who, when questioned in 1944, indicated in a national public-opinion poll that they believed something must be done to make it easier for people to get medical care, are still waiting in 1948—and going into debt for doctor bills.
The Wagner-Murray-Dingell bill is a moderate approach to the national health problem. For years the federal government has engaged in steadily expanding programs for health and medical research, largely as assistance to state health programs. Health care for the individual citizen, which was the greatest need, was also the greatest gap.
The National Health Insurance Act (W-M-D bill) would meet this need by a national program of insurance through which most workers would contribute a small part of their earnings and in return would be entitled to the medical care needed, with no questions asked. The program would be administered by representatives of the taxpayers—the consumers—rather than by any proprietary group from the medical profession.
About 85 percent of our entire population would be covered under the present bill. Under this insurance, they would receive needed preventive, diagnostic or curative services—by their family physician, or by specialists when required. Hospital care, laboratory and X-ray service, medicines, special appliances and eyeglasses, would all be available, plus dental and home- nursing care as soon as funds permitted.
All qualified doctors, dentists, nurses, and hospitals would be eligible to participate in the national program, but only if they wished. If they joined, they would have the right to reject patients and to decide whether they preferred to be paid by salary, fee, or some other method.
Senator Taft and some physicians who put their own profit and convenience above the general welfare do not like this proposal. The American Medical Association is against any federally subsidized health-insurance plan, and along with its protégé, the National Physicians’ Committee, helped draft and support the Taft bill (S.545) only when it became apparent that the country was going to insist on some action from Congress. The Taft bill would do no more than provide handouts of federal money to the states to cover what are now “bad risks" in the medical business. It is a charity program, in line with the general Taft philosophy, providing free medical care only to "indigent" families who can prove by a means test that they are too poor to pay.
The Taft plan would be run by the states according to the dictates of the American Medical Association. Under the administrative provisions of the bill, the new “health agency" would have to be headed by a physician who would oversee operating divisions which in turn must be headed by a physician who would oversee operating divisions which in turn must be headed by a physician
There is a clause in Taft's bill that reads: "It is the policy of the US… to make available medical, hospital, dental and public-health services to every individual regardless of race or economic status." But nowhere in the bill are there provisions for enforcing these beautiful promises. The federal money appropriated would be allocated among those states which chose to match these funds with their own to carry out a program of medical assistance for “low-income” families—but with the jokes that each state would be allowed to count the money it now spends for “similar purposes” as a part of its contribution. Thus, wealthier states would not have to put up any additional money, while the poorer states, least able to afford a matching program, would be discouraged from participating.
In actual effect, the Taft bill would require people who could not pay for the medical care they were seeking to take a pauper’s oath or pass a means test in order to get help. Only children who were duly certified as coming from low-income families would be given medical and dental attention. The Taft program is a medical dole for those who are willing to beg for it. Even this kind of charity would be provided for probably not more than 10 percent of our population, since pitifully small funds are requested and experts estimate that the cost of administering a means test might be far higher than the cost of the benefits.
At one of the earliest hearings on the Wagner-Murray-Dingell bill, Senator Taft roared out at Chairman Murray, "It is to my mind the most socialistic measure that this Congress has ever had before it." Ironically, Taft's own bill is much closer to "socialized medicine" than is Murray's. With a large enough appropriation to extend its benefits to everyone, and with the means test deleted, the Taft bill would became a truly "radical" program.
Both the American Medical Association and the National Physicians' Committee (NPC), two of the smartest and best-heeled lobbies on Capitol Hill, might be at a loss to know how to defend themselves against such long-range possibilities. But few groups have done a more effective job of protecting their immediate interests. AMA “consultants" are always available to assist members of the Senate and House committees. Joe Lawrence, chief full-time AMA representative in Washington, was one of the highest-paid registered lobbyists last year. The NPC, propaganda arm of the AMA, officially reported having spent $345,000 in 1947 lobbying against national health insurance. About 80 percent of this money, the report showed, came from doctors and medical societies, about 20 percent from drug companies. The NPC protected the names of its individual donors by advising them to make their checks for $499.99 to escape the requirement that contributors of $500 or more to lobbying activities be officially listed with Congress. For 1948, the organization is asking double its 1947 budget.
But Doctor Marjorie Shearon, a former government employee and a personal crusader against "socialized" health-insurance plans, is rated by some as even more effective than these well- organized pressure boys. Early in the history of the national-insurance bill, witnesses observed that Senator Forrest C. Donnell (R, Mo.), who had quickly assumed the role of prosecuting attorney against witnesses for the Truman Administration's proposal, asked his sharpest questions from bits of paper passed him by a little woman who sat at his elbow. Dr. Shearon, it turned out, was paid by the Republican National Committee to help Donnell and Taft block an adequate medical-care program. When the Republican National Committee became embarrassed by Dr. Shearon's lobbying, Taft established her as a consultant for the Senate Labor Committee.
Dozens of large and influential labor and citizens' groups are lined up against Senator Taft and Doctor Shearon and the AMA bloc. But they have not matched the enthusiasm of those zealots. The Committee for the Nation’s Health, the clearing-house organization for groups supporting the President's health program, was supplied with only one-tenth as much to spend last year as the NPC had alone. The organizations favoring the Wagner-Murray-Dingell bill are concentrating now on preventing Senate committee members from voting to report out the Taft bill favorably. They think they may have enough influence to block it. But thus far, they have not mobilized their memberships in anything like the strength that will be necessary to force a favorable vote on the W-M-D bill.
Meanwhile the AMA and the NPC are busy at the other end of Washington, doing their best, first to wreck, and now to keep under control, the National Health Assembly which will meet May 1-4. When Oscar R. Ewing, President Truman's political adviser and Federal Security Administrator, refused to be intimidated by the AMA's early blast against holding such a conference at all, the medical monopolists changed their tactics. Officially, the AMA expressed its intention of cooperating, although it still insisted it was outlandish of Ewing to have given the organized medical profession less than a majority position on the steering committee for the meeting. Soon, however, the NPC announced a cartoon contest, in a full-page ad in Editor and Publisher, offering $3,000 in prizes for the best published cartoons against health insurance. The scheme backfired when Editor and Publisher editorially branded the "contest" a "bribe" and called upon professional journalism societies to "take a firm stand against such contests." Cartoonists and editors all over the country joined in denouncing the trick. But no one doubts that the AMA party liners will continue to harass the government conference in yet other ways.
Taft has had nothing to say about the plans for the National Health Assembly. He probably figures that even if the Assembly produces constructive results, he will be able to trump this Truman ace by forcing his bill through the Senate before the time for the national party conventions. Taft action versus Truman talk would be his boast. The Taft health bill is one of the trinity of “humanitarian" measures which the Senator from Ohio has carefully prepared over the last several years for quick passage during May and early June of 1948. The Taft bills for federal aid to the states on education, housing and health are a special treat their author has been saving up for the needy voters.
In the case of the health bill, at least, there is reason to believe that Taft intended to let it die after passing the Senate. Chances now are that this shabby trick will fail, that the Taft bill will remain tied up in the Senate Labor Committee, where it is at the moment. If the National Health Assembly stirs the people's concern for theft own health, the Senate committee will hear about it and vote against the Taft bill accordingly.
Widespread enthusiasm for the Assembly's program may also speed passage of several other less important health bills now pending. One, a stop-gap measure designed to deal with one major problem until such time as a general health bill can be passed, is the national school-health-services bill, which would authorize federal grants to help states provide specific aids in the school-health field. Another, to set up a National Institute of Dental Research, already passed by the Senate, could be forced through the House this year by strong public pressure. A sizable sum for cancer research will almost certainly be voted even without additional public lobbying. The Assembly might well mobilize the extra sentiment for more funds for further Public Health Service research in other degenerative diseases.
But clearly it will take more years and much more energy, on the part of the Administration as well as of public-minded lobbies, to force the passage of the Wagner-Murray-Dingell bill, the first step in an adequate program of protection.