Without a doubt, Bill Clinton has had a hard time getting the medical establishment to support his plan for health care reform. But the resistance he has met in 1993 is timid compared with the firestorm the American Medical Association unleashed on Harry Truman almost fifty years ago.
On November 19, 1945, three months after taking office, Truman became the first American president to support national health insurance. Truman’s plan was the “single-payer system,” in which health care would be financed and administered like Social Security through a 3 percent payroll tax paid half by the employer and half by the employee. It would cover medical, hospital and nursing care for everyone. Citizens would be free to choose their doctors from a competitive marketplace, while a federal health insurance agency would reimburse doctors on fee schedules set through negotiations in various localities. As Truman put it: “The best hospitals, the finest research laboratories and the most skillful physicians are of no value to those who cannot obtain their services.”
According to Monte M. Poen, author of Harry S Truman Versus the Medical Lobby, Truman’s support for a radical reformation of health care evolved from his dismay that one-third of the men reporting for the draft during World War II were physically unfit to serve. What’s more, Truman’s populist foundation was shaken by the economic inequities of medical care. James Ewing, a retired publisher whose father, Oscar Ewing, advised Truman on the issue, recalls, “Truman felt the little guy was getting shafted by the health care system.” The little guy agreed. A November 1945 poll found that 58 percent of Americans who had heard of
Truman’s proposal approved of it. So did Eleanor Roosevelt, Fiorello La Guardia and RCA chief David Sarnoff. Truman’s plan defied one of the nation’s most powerful lobbies: the AMA. The organization fought the proposal, insisting that it would transform doctors “into dock watchers” and “slaves.” It balked at a 1947 federal study that found that 325,000 Americans died each year for lack of health care: “the true measure of medical progress,” the AMA countered, “is not how many die, but how long they live before they die.”
The AMA’s hand was strengthened by the 1946 election, which brought a Republican majority to Congress. Truman was unable to muster the support needed to pull his legislation out of committee. His opponents in Congress used Red Scare rhetoric honed by- the AMA: in 1947 a House subcommittee investigating national health insurance reached a “firm conclusion” that “American communism holds this program as a cardinal point in its objectives,” and that “known Communists and fellow travelers within federal agencies are at work diligently with federal funds in furtherance of the Moscow party line.”
The war against Truman’s plan became so dirty that in July 1947 Raymond Rich Associates, a public relations firm hired by the AMA to improve its image, resigned in protest, citing the lobby’s unwillingness “to put the public first, and to become adequate in its responsibilities.” The AMA responded by hiring a less squeamish P.R. firm.
Truman, however, didn’t back down. During his 1948 campaign, he blasted the “do-nothing” Republican congressional majority for capitulating to health industry lobbies. ‘The medical lobby says [national health insurance is] un-American,” Truman said. “I put it to you. Is it un-American to visit the sick, aid the afflicted or comfort the dying? I thought that was simple Christianity.”
The battle became even hotter after Truman’s surprising re-election in 1948. In response to his campaign promise to pass national health insurance, the AMA, for the first time in its 102-year history, demanded mandatory dues (of $25) from its 142,000 members. The money was used to finance a $4 million anti-reform campaign through 1949 and 1950. At the time, it was the largest legislative lobbying campaign in American history,
Truman’s opponents were keen to keep fighting health care reform with scary cold war rhetoric. In December 1949, the AMA sent every member of Congress a Christmas gift: The Road Ahead by John Flynn. The book’s cover portrayed a doctor and a nurse leading a group of citizens toward a signpost labeled, “To Socialism.” The work argued that Truman had been duped by “hooded Socialists.” Don’t be fooled, Flynn warned, by the fact that government planners “wrap themselves in a mantle called anticommunism.…they are Socialist planners—and unless they are… stopped, they wilt destroy the country.”
Even without such pressure, Truman faced serious obstacles in Congress. By the late 1940s, southern Democrats, angered at the administration’s pro-union and anti-segregationist slant, were siding with the Republicans to defeat many of Truman’s legislative proposals. The AMA worked to ensure that health reform would go down in defeat as well.
In one two-week period right before the 1950 congressional elections, the AMA spent more than $1 million on advertising, and persuaded large health-related companies to cosponsor $2 million worth of similar ads. This paid for full-page anti-reform ads in each of the nation’s 10,000 newspapers and on 16,000 radio stations. The Committee for the Nation’s Health, the one private lobbying group established to support reform, countered all the publicity they could afford with an annual budget, in 1950, of just $36,000.
Anti-reform propaganda also reached Americans in their doctors’ offices. The AMA distributed 55 million pamphlets warning, “Guard your health, guard your pocketbook, socialized medicine would rob both.” The pamphlet reported Lenin’s declaration that, “Socialized medicine is the keystone to the arch of the Socialist state.”
Lenin, in reality, never said this. What’s more, Truman repeatedly emphasized that his plan was not socialized medicine. The president never proposed making doctors and hospitals part of the federal bureaucracy. He simply argued for a federal insurance program that would finance and reimburse patients—all of whom would be free to choose their health care in an open marketplace. Such facts were conveniently lost in the growing hysteria of the McCarthy era.
The 1950 election saw the defeat of a few liberal senators who had campaigned for national health insurance. Truman’s proposal was dead. “I have had some bitter disappointments as president,” he later wrote, “but the one that has troubled me most, in a personal way, has been the failure to defeat organized opposition to a national compulsory health insurance.”