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- 1. 1940s and 1950s Health Care
- 2. Roosevelt: Pre-1940 New Deal: 1933 Ended Great Depression in 1941 Social Security Act: 1935 The Technical Committee on Medical Care: 1937 Wagner National Health Bill: 1939 Increased aid and services Germany starts WWII: 1939 Soviet Union drawn into WWII
- 3. Roosevelt: 1940-1945 Democratic Congress Emergency Maternity and Infant Care Program: early 1940s Provided maternity care of wives of army and navy enlisted men U.S. enters WWII: 1941 Emergency Stabilization Act: 1942 Encouraged employers to offer benefits, such as health insurance IRS Employer Tax Incentive: 1942 War Labor Board: 1943 Ruled health insurance exclusion from period’s wage and price controls Wagner-Murray-Dingell Bill: 1943 National health insurance funded through employee taxes Public Health Service Act: 1944 Increase in grant money for medical services and care Grounds for public health insurance
- 4. Truman: 1945-1946Fair Deal Health Reform in the Fair Deal Proposed single insurance system to cover all Americans McCarran-Ferguson Act: 1945 National Health Insurance Proposal: 1945 Re-proposed: 1947 & 1949 Cover all citizens Hill-Burton Act: 1946 Enacted The Hospital Survey and Construction Act Recognized those not able to pay for medical services
- 5. Truman: 1946-1953 Full Employment Act: 1946 Use government resources to promote maximum employment, production, and purchasing power Termination of Fair Employment Practices Committee: 1946 Terminated despite Truman’s support Marshall Plan: 1948 Berlin Blockade: 1948-1949 Inland Steel Co. vs. United Steelworkers Union: 1949 Post-war Economic Boom!!!!!! Social Security Act Amendment: 1950 Permanently disabled eligible Korean War: 1950-1953
- 6. Eisenhower: 1953-1959 Department of Health, Education, & Welfare: 1953 Medical Facilities Survey and Construction Act: 1954 Amendment to Hill-Burton Act Transfer Act: 1954 Indian health care responsibility from BIA to PHS Health Amendments Act: 1956 Amends Public Health Service Act: 1944 Dependents Medical Care Act: 1956 Health care for the family members of military personnel Civil Rights Act: 1957 Federal Employees Health Benefit Act: 1959 Vietnam/Cuba Continued expansion of Communism
- 7. Social Leaders and Organizations Unions AMA Opposed national health insurance Blue Cross and Blue Shield Southern Democrats Wanted to maintain segregation in health care Majority in Congress 1946: Republicans in control 1948: Democrats in control
- 8. Racism and “Health Care” The Tuskegee Syphilis Experiment: 1932-1972 400 African-American males purposely banned from treatment over the course of 40 years to enable study of pathology via autopsy Made possible by leaders and staff of United States Public Health Service, incl. African-American nurse Eunice Rivers University of Virginia medical school eugenics curriculum consistent with beliefs of the time which still influence health care policy today! One lasting ramification: Modern lack of trust in gov‘t public health programs by minorities
- 9. Public vs. Private Health Insurance What’s the difference? Administration Bill and AMA Plan Proposals Private: AMA; Taft Bills Public: Roosevelt’s plan; Wagner-Murray-Dingell Bills; Truman’s plan Key Players: Nationalized Health Care For: Committee for the Nation’s Health, Organized Labor, Liberal Farmers, Liberal Physicians, Henry Sigerist, Rep. Nixon(CA) Against: AMA, American Hospital Association, American Bar Association , southern Democrats, Chamber of Commerce Debates
- 10. Implications of our Findings:Relating Then to Now Attitudes Towards Nationalized Health Care AMA, Union, Southern Democrat: no longer opposition Socialism Socialized medicine Private vs. Public Health Insurance Now know the outcomes of private health care Internationally demonstrated outcomes of Nationalized Health Care
- 11. References Béland, D. (2006). The history of public and private social policy in the United States. Canadian Review of American Studies, 36(2), 237-241. Black, E. (2003). The horrifying American roots of Nazi Eugenics. Retrieved from http://hnn.us/articles/1796.html Black History Month: A Medical Perspective. (1999, 2006). Duke University Medical Center Library Online. Retrieved from http://www.mclibrary.duke.edu/hom/ exhibits/blkhist/ Cornelius, L. (2003). Fixing that great hodgepodge: Health care for the poor in the U.S. Journal of Poverty, 7(1/2), 7-21. Derickson, A. (2000). Take health from the list of luxuries: Labor and the right to health care, 1915-1949. Labor History, 41(2), pp. 171- 186. Division of Public Health Methods in the Office of the Surgeon General. (1944, July 14). Public health service act, 1944. Public Health Reports, 109(4),468. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1403520/?log%24=activity Dowbiggin, I. (2009). Book Review. Journal of the History of Medicine and Allied Sciences. doi:10.1093/jhmas/jrp027 Expensive Operation. (1949, December 19). TIME. Retrieved from http://www.time.com /time/printout/0,8816,855091,00.html Faber, R. B., & Bedford, E. A. (2008). Domestic programs of the American presidents: A critical evaluation. Jefferson, NC: McFarland & Co.
- 12. References Furman, B. (1948, September 3). Truman gets report urging big 10-year health program. The New York Times. Retrieved from http://0- proquest.umi.com.bianca.penlib.du.edu/pqdweb?did=96694861&sid=1&Fmt=10&cli entId=48347&RQT=309&VName=HNP Goldberg, J. (2009, July 14). Ruth Bader Ginsburg and a question of eugenics. The Los Angeles Times. Retrieved from http://latimes.com/2009/jul/opinion/oe-goldberg14 Greenberg, J. ( 1993). Give’em health, Harry. New Republic, 209 (15), 20. Hamovitch, M. B. (Mar-Dec. 1953). History of the movement for compulsory health insurance in the United States, Social Service Review. pp.281-299 Hill-Burton Act. (2004). In C. Rose (Ed.) American Decades Primary Sources, 5, pp. 433-435 Detroit: Gale Hoffer, C. R., Schuler, E. A. (December 1948). Measurement of health needs and health care. American Sociological Review, Vol. 13 No. 6, pp. 719-724 Retrieved from http://www.jstor.org/stable/2086824 Hoffman, C. (2009). National Health Insurance-A Brief History of Reform Efforts in the U.S. The Henry J. Kaiser Family Foundation, 1-8. Igel, L.H. (2008). When did health care become a campaign issue? Society (45), 512-514. doi: 10.1007/s12115-008-9151-z Jannsson, B. S. (2006). The reluctant welfare state: Engaging historyto advance social work practice in contemporary society (6th ed.). Belmont, CA: Brooks/Cole, Cengage Learning.
- 13. References Jimenez, M. A. (1997). Concepts of health and national health care policy: A view from American history. Social Service Review, 71(1), 34-50. Jones, J. H. (2006). Tuskegee Syphilis Experiment. In C. A. Palmer (Ed.) Encyclopedia of African- American Culture and History, 5 (2nd ed., pp. 2215-2217) Detroit: Macmillan. Kane, R. (1985). Health policy and social workers in health: Past, present, and future. Health and Social Work, (10(4)), 258. King Jr., J.A. & Vile, J.R. (2006). Presidents from Eisenhower through Johnson, 1953-1969. Westport, CT: Greenwood Press. Klein, J. (2004). The politics of economic security: Employee benefits and the privatization of New Deal liberalism. Journal of Policy History, 16(1), 34-65. Komlos, J., & Lauderdale, B. E. (2007). Underperformance in affluence: The remarkable relative decline in U.S. heights in the second half of the 20th century. Social Science Quarterly (Blackwell Publishing Limited), 88(2), 283-305. Kronenfeld, J. J. (1997). The changing federal role in U.S. health care policy. Westport, CT: Praeger. Kronenfeld, M. R. (2004). Healthcare reform in America. Abc-clio. Kronenfeld, J.J. (2009). Social policy and health care. In J. Midgley & M. Livermore (Eds.), The handbook of social policy (pp. 381-401). Thousand Oaks, CA: Sage Publications Inc.
- 14. References Kusmer, K.L. (2002). Hot war, cold war, and civil rights. Journal of Political History, 14(4), 431-438. Livermore, M., Tracy, M., & Migdley, J. (2000). The Handbook of social policy. Sage Publications, Inc., 383-384. Lombardo, P., A., & Dorr, G., M. (2006). Eugenics, medical education and the Public Health Service: Another perspective on the Tuskegee Syphilis experiment. Bulletin of the History of Medicine, 8(2), pp. 291-316. Mechanic, D. (2006). Truth about health care : Why reform is not working in America. New Brunswick, NJ: Rutgers University Press. Medicine: A bargaining position. (1949, August 22). TIME. Retrieved from http://www.time.com/time.magazine/article/0,9171,800613,00.html Mitchell, D. J. B. (2002). Impeding Earl Warren: California's health insurance plan that wasn't and what might have been. Journal of Health Politics, Policy and Law, 27(6), 947-976. Money (2003). History, 32 (11). 74-75. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=11056919&site=ehost-live Morris, K.S. (2007). The founding of the National Medical Association (Doctoral dissertation). Retrieved from http://ymtdl.med.yale.edu National affairs: The moon & sixpence. (1949, May 2). TIME. Retrieved from http://www.time.com/time.magazine/article/0,9171,800134,00.html Newman, R. (2004). Hill-Burton Act (1946). In B. K. Landsberg (Ed.) Major Acts of Congress, 2, pp. 166-167. New York: Macmillan.
- 15. References Palmer, K., S. (1999). A brief history: Universal health care efforts in the US. In Physicians for a National Health Program. Retrieved October 20, 2009, from http://www.pnhp.org/facts/a_brief_history_universal_health_care_efforts_in_the_us.php. Parran, T. (October 1961). Group health objectives. Journal of Public Health, Vol. 51 No. 10, pp. 1485-1490 Paul, D.B. (2009). Book Review. The American Historical Review, 114, 1103–1104, doi:10.1086/ahr.114.4.1103 Pearson, R.L. (2004). Crucible of change : Black health care in the urban South, 1910-1954 (Doctoral dissertation). Retrieved from Dissertation Abstracts International 2004 (65)4: 1497-A. (DA3129786) Phillips, C. (1949, February 27). Bitter debate over health program: Congress will be arena for clash between Truman and AMA plans. The New York Times. Retrieved from http://www.nytimes.com/packages/flash/health/HEALTHCARE_TIMELINE/1948_tr uman.pdf. President’s Commission on the Health Needs of the Nation. (1953). Building America’s health : A report to the President. Raleigh, NC: Health Publications Institute, Inc. Public Health Service Act, 1944 (PHS). (1944). In Public Health Reports (Vol. 59, p.468). Quadrano, J. S. (2005). One nation, uninsured : Why the U.S. has no national health insurance. New York: Oxford University Press. Riggs, C.K. (1999). The irony of American Indian health care: The Pueblos, the five tribes, and self- determination, 1954-1968. American Indian Culture and Research Journal, 23 (4), 1-22. Robin, F. E. (September 1950). The case for national health insurance. The American Journal of Nursing, Vol. 50 No. 9, pp. 540-542 Retrieved from http://www.jstor.org/stable/3459300
- 16. References Schick, T.W. (1982). Race, class, and medicine : ‘bad blood’ in twentieth-century America. Journal of Ethnic Studies, 10(2), 97-105 (009132192). Schultz, K.M. (2008). The FEPC and the legacy of the labor-based Civil Rights Movement of the 1940s. Labor History, 49(1), 71-92. Shafter, G. H. (September 1950). Compulsory health insurance for America? No!, The American Journal of Nursing, Vol. 50 No. 9, pp.542-543 Retrieved from http://www.jstor.org/stable/3459300 Shelton, B.L. (2004). Legal and historical roots of health care for American Indians and Alaska natives in the United States. Issue brief for the Henry J. Kaiser Family Foundation. Retrieved from http://kff.org/minorityhealth/upload/Legal-and-Historical-Roots-of-Health-Care- for-American-Indians-and-Alaska-Natives-in-the-United-States.pdf Smith, S.L. (1996). Neither victim nor villain : nurse Eunice Rivers, the Tuskegee syphilis experiment, and public health work. Journal of Women’s History, 8(1), 95- 113. Snyder, L. P. (1994). Passage and significance of the 1944 Public Health Service Act. Public Health Reports, 109 (6), pp.721- 724. Somers, A., Somers, H. (January 1961). Coverage, cost, and controls in voluntary health insurance. Public Health Reports, Vol. 76 No. 1, pp. 1-10 Stevens, R. A. (2008). History and health policy in the United States: The making of a health care industry, 1948-2008. Social History of Medicine, 21(3), 461-483. Thomasson, M. (2003). Health Insurance in the United States. EH.Net Encyclopedia. Retrieved from: http://eh.net/encyclopedia/article/thomasson.insurance.health.us Thomasson, M. A. (2006). Racial differences in health insurance coverage and medical expenditures in the United States: A historical perspective. Social Science History, 30(4), 529-550. Tompkins, V. (Ed.) (1994-2001). American decades. Detroit, MI: Gale Research.
Editor's Notes
- New Dealo The central focus on unemployment and not National Health Care.o Social Security Acto Health care initially left out of original bill.o 1937 Technical Committee on Medical Care advanced health care reform.o Health care was private or state based.o Employers and insurance companies developed new welfare measures in response to the New Deal to make more money. o Roosevelt did not make NHI an issue during elections and could not make it apart of Social Security –he wanted to press health insurance after the war as a part of the economic bill of rights, but never could. Social Security Act: 1935Social Security Act prompted labor unions and community groups to build upon their foundations and request more social services. The act was followed by a 10 year period of creating health-care projects, as trade unionists, leftists, African Americans, rural residents, women’s auxiliaries, and physicians tried out economic security programs that did not rely on employers. The New Deal’s promotion of security encouraged labor to seek health benefits for its members. The New Deal with the passage of the Social Security Act, the Wagner Act, and the Fair Labor Standards Act, granted American workers rights and gave employers the responsibility to promote workers’ security. Technical Committee on Medical Care (1937)States could choose whether to participate-Didn’t get passed after elections of 1938, led to Wagner Bill that never passed eitherWagner National Health Bill of 1939 increased aid and services for maternal health, child health, crippled or physically handicapped, Tb, and venereal disease, diagnosis and tx of cancer-general support for national health funded by grants to states and administered by states.
- Emergency Maternity and Infant Care Program:Early 1940sTemporary Program instituted during WWII Provided maternity care of wives of army and navy enlisted menAs a result there was a significant improvement in the health of infants as well as maternal health during the war.However, the program was discontinued after war. Was reconsidered in later debates about health care.Emergency Stabilization Act, 1942 wage and price controls encouraged employers to offer fringe benefits, which included health insuranceIRS Tax IncentivesCorporations’ participation in welfare capitalism from 1920-1950 sparked their desire to offer health insurance as part of their employee benefits. With this, the role of employers changed from protector of appreciated workers to financial manager who negotiated health insurance packages that were becoming increasingly expensive. To alleviate employers from some expenses and to encourage employers to offer health insurance to their employees, the federal government began offering tax incentives to employers in the 1940s; this continues today.War Labor Board: 1943 (during WWII) The War Labor Board ruled that certain work benefits like health insurance coverage be excluded from the period’s wage and pricecontrols.Employers used generous health benefits to attract workers.Began to bolster group health insurance plans. Economy doing well as a result of American capitalism improving businesses who offered health benefits. Large businesses were so profitable that unions started negotiating for greater fringe benefits such as health insurance.Wagner-Murray-Dingell Bills: 1943 Proposed a national health insurance coverage plan that would be funded through taxes on employment based income(Palmer, 1999). Although the bill was eventually vetoed, the debate over enactment was carried out for roughly 14 years (Palrmer). Public Health Service Act: 1944 Initiated into action by President Roosevelt in 1944. Included in the act is the increase in grant money for the purposes expanding medical research, especially for TB (initially). Specific trainings for medical professionals, the building of new medical care facilities, and affordable means of providing care to the public. Thought of as the grounds for the issue of public health insurance.Today the Surgeon General, The National Institute of Health, The Bureau of Medical Services, the Bureau of Health Services, and the Bureau of State Services are all responsible in running the Public Health Act (Snyder, 1994). The act was put into effect after WWII when the demand for trained medical professionals was high, as well as the need for research on treatment of diseases acquired during the war, such as malaria (Snyder). Another large piece of this act included the distribution of grant money for such research operations and trainings (“Public Heath Service Act”, 1944). The total sum designated to states for such programs was raised from $11,000,000 to $22,000,000 (PHS). Questions over whether to include matters of national medical insurance coverage in the program brought about a lot of debate. It was decided that the act would deal more with the promotion of medical research and advancement rather than getting into funding matters of personal care (Snyder). Became the groundwork for most public health legislation after World War II, which included a large growth for the building of public hospitals, where funding came from the Hill-Burton amendment. Expands the capacity of previously est. Public Health Service Functions. It provides power to create grants-in-aid to research institutions for the study of any disease. It sanctions expansion of the Federal-State cooperative public health programs, and calls for the creation of a national tuberculosis control program. By administering grants-in-aid to state health departments, the responsibility of carrying out research that leads toward the elimination of tuberculosis falls upon the Public Health Service.In addition, the grants-in-aid appropriated to the States for general public health services are raised from 11 million annually to 20 million. This allows the Service to spend a limited amount of these funds to train public health employees and for special demonstrators in the response of specific community health problems. Stipulations have also been made for support of the commissioned corps of the U.S. Public Health Service and to contract specialists in fields that relate to public health (entomology, chemistry, zoology). Furthermore, nurses will now be appointed in the service. Previous responsibilities will continue to include medical and hospital care of American Merchant Marine Seamen, U.S. Coast Guard, and other Federal recipients; the National Quarantine Service; scientific research; biologic product control; “and care of lepers and narcotic drug addicts (paragraph 4). As well as assistance to health departments of the State and Territories will continue. Now includes 4 Critical administrative units: (1) the Office of the Surgeon General, (2) the National Institute of Health, (3) the the Bureau of State Services, and (4) the Bureau of Medical Supplies
- Health Reform in the Fair DealProposal was built into the Wagner-Murray-Dingell bill: 1943The major NHI legislation of Truman eraThree months after war, Truman asked Congress to pass a national program to ensure the right to medical care.Reformers moved away from a state-administered system to health insurance being national, universal, comprehensive and part of Social Security.Truman proposed single insurance system to cover all Americans which included:Public subsidies to pay for the poorUncharged medical services.Doctors and hospitals being allowed to choose their payment method.Hospital construction and expansion (1946)Truman’s Fair DealNamed for economic prosperity and equality for AmericansCoined in his State of the Union Address to Congress January 5, 1949 Shortly assuming the presidency, Truman began to propose a vast plan to promote equality, prosperity, and civil rights, as well as national health careIncluded:Public housing initiativesStrengthening and broadening the social security programRaising the minimum wage and provide for full employment of the American workforceLegislation to ensure fair employment practices, in an effort to end racial and ethnic discrimination in the workplaceCreating national health insuranceTax cuts for the poorExpanded civil rights lawsNearly all of Truman’s legislation proposals were greatly ignored. He had some progressive ideas, but Truman had to tackle a Congress in which both houses were firmly Republican majority.Eventually, Truman moved away from his Fair Deal proposals and began to focus on the emerging Cold War and concerns over perceived threats posed by the rise of Communism. However at the end of his term he had succeeded in ending segregation in the U.S. Armed Forces and in the federal hiring programs, achieved a higher minimum wage, and passed legislation for expanded social security programs and the initiation of public housing. National Health Insurance Proposal In 1945 President Truman becomes the first sitting U.S. President to advise a comprehensive national medical insurance program to cover all citizens * Response to large disparities in health care * Based almost entirely on policy developed by Roosevelt’s administration * Revised and separate development of the original proposed Wagner, Murray,Dingell, Bill. “Our health is far behind the progress of medical science. Proper medical care is so expensive that it is out of the reach of the great majority of our citizens” (Truman, 1945, January 5).Would allow Americans to participate voluntarily and be delivered through the Social Security System through a 3% tax deduction paid half by the employer and half by the employee. Would cover medical, hospital, and nurse care and doctors and would be reimbursed by the federal health agency. Defied the AMA, one of the most powerful lobbies in the nation, who adamantly fought the proposal, claiming it would ruin the doctor-patient relationship. Truman calls for the obligation of a national health insurance again in 1947 and in his 1949 Fair Deal Plan. Government should be held responsible for the health of the nation, which would transform medical care from the classification of luxury to national resource. Continuously blasted by the American Medical Association (AMA) for being a communist policy an un-American. The AMA used scary cold war rhetoric as a lobbying tactic to protect the interest of private insurance companies and ensure that Truman’s health reform would be defeated. In the end conservative powers reigned and no new national health care system was created.Hill-Burton Act: 1946 Granted a spending budget of $75 million per year for the production of hospitals, over the course of five years: a.k.a. the Hospital Survey and Construction Act. Distributed based on need: population of an area in comparison to the areas average income. First time those not able to pay for medical services were taken into account.The Hill- Burton act was created by senators Lister Hill and Harold Burton of Alabama and Ohio respectively (Newman, 2004). In 1946 the American Hospital Association revised the bill putting it into action (Hill- Burton Act, 2004). Not only did the doctrine work towards expanding the creation of hospitals and medical services, but it also provided aid to those who could not afford the cost of medical care at free of charge or lowered prices (Hill-Burton Act). Funding came from both state and local levels (Newman). Various amendments to the act have been made throughout history keeping the act in effect (Newman).