I just started T.R. Reid's The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care, and it's compelling so far (though here's a critique by a sympathetic academic who nonetheless objects to his arguments): a very readable account of how health care is practiced in other countries, and how the U.S. might learn from them to provide a more efficient system with less waste and confusion. Early on, there's an interesting little nugget about the wall American health care reformers hit early on, and its resonance today:
In U.S. policy debates, the term "socialized medicine" has been a powerful political weapon—even though nobody can quite define what it means. The term was popularized by a public relations firm working for the American Medical Association in 1947 to disparage President Truman's proposal for a national health care system. It was a label, at the dawn of the Cold War, meant to suggest that anybody advocating universal access to health care must be a communist. And the phrase has retained its political power for six decades.
Reid is a longtime Washington Post reporter whose years as a foreign correspondent inspired, in part, his travelogue of overseas health care; at one point he mentions that his American insurer rejected his bills because it couldn't contact his doctor's office—because the insurer had a phone system that didn't allow international calls.
In her fascinating history of Campaigns, Inc., America's first political-advertising firm, Jill Lepore goes a bit farther into the AMA's lengthy and very expensive campaign against national health care:
At the beginning of 1949, Whitaker and Baxter, the directors of the A.M.A.’s National Education Campaign, entered national politics, setting up headquarters in Chicago, with a staff of thirty-seven. “This must be a campaign to arouse and alert the American people in every walk of life, until it generates a great public crusade and a fundamental fight for freedom,” their Plan of Campaign began.
Whitaker and Baxter’s campaign against Harry Truman’s national-health-insurance proposal cost the A.M.A. nearly five million dollars, and it took more than three years. But they turned the President’s sensible, popular, and urgently needed legislative reform into a bogeyman so scary that, even today, millions of Americans are still scared.
Since the AMA is located in Chicago, locals got the full blast of its campaign. And even Lepore's account doesn't quite capture how reactionary the AMA was at the time. It was opposed to any state support of medicine, not just a comprehensive national plan, from the medical examination of school children to subsidized scientific research:
As an example of the "piecemeal" efforts of those advocating socialized medicine, Gen. Lull [George F. Lull, AMA executive secretary, former surgeon general] said there is now pending in congress a bill to provide for medical examination of school children.
"No one wants to oppose health measures for school children," Gen. Lull said, "but this bill also provides that money shall be appropriated for the treatment of every school child. It is actually socialized medicine for a large segment of the population." (Chicago Tribune, 8/25/49)
More extreme than Lull was Dr. Ernest E. Irons (most famous for his work in discovering sickle-cell anemia with James Herrick), the AMA's president from 1949-1950:
"The nationalization of medicine as a part of the attempt to socialize this country has been adopted as a political measure by certain politicians," Dr. Irons said. "Federal aid to education, including medical education, is one of these parts of the welfare program.
"New money is attractive to schools that find themselves in financial difficulties. More prosperous schools are willing to be included. Proffers of easy administration are as dangerous to freedom of thought and action in medical education as are offers of easy living. Every subsidy carries with it the threat of regulation, despite any disclaimer of previous intent.
"We in America are at the point now where prohibition is being replaced by compulsion. The democracy of our republic is threatened by the steady encroachment of socialistic, bureaucratic government. What began as an apparently innocent effort for comfort and happiness is becoming a destructive instrument of dictatorship. (2/6/50)
Irons barely tempered his rhetoric when invited to speak at a UIC graduation ceremony, delivering the most depressing graduation speech I've ever seen. He said that grants-in-aid for research in training "were devised to meet post-war problems and have been carefully and well administered, but warned that 'even here there lies danger to our national thinking,'" and that these fresh-faced young public-college grads were themselves soldiers of creeping socialism: "our young people so exposed do not realize they are part of the government in the democracy of our Republic and that when they depend on government to provide their living they are really enslaving themselves to the wishes of a few selfish leaders" (6/17/50).
But not all government subsidies received quite the stern lecturing of Dr. Irons towards the UIC grads. The AMA did get behind a bipartisan plan that's resonant today:
In Congress, the Murray-Dingell omnibus health bill stalled in committee, even as rival legislation – a Republican bill that would have provided health care only for the poor and required a means test; another Republican bill that would have established a private system, locally administered, with federal funds provided to make up income/cost differences; and a bipartisan bill that would subsidize states for insuring citizens in private health plans like Blue Cross were introduced.
Of the bills being considered, the bipartisan (Hill-Aiken) bill had the best chance for success. Its focus on the propagation of private health insurance earned it AMA and American Hospital Association (AHA) support….
The AMA's opposition not only diverted Truman's support of a national health care system as the Democratic party was splintering—it was defeated by a Republican/Southern Democrat coalition—it also laid the groundwork for Obamacare, which provides subsidies to the poor towards the expansion of private insurance.
Photograph: David Gonázlez Romero (CC by 2.0)