Milton I. Roemer Advocate of Social Medicine, International Health, and National Health Insurance

Abstract

MILTON ROEMER WAS BORN in 1916 in Paterson, New Jersey, where his father practiced medicine. At the age of 16, he entered Cornell University in Ithaca, New York, as a premedical student. At Cornell, he met Ruth Rosenbaum, who was soon to become Ruth Roemer, his lifelong partner in public health and health activism. Henry Sigerist, then professor of the history of medicine at Johns Hopkins, was an important influence on Roemer during his medical school years. Even before entering medical school, Roemer had begun work on an MA in sociology. He finished the degree in 1940, a few months before obtaining his MD. He later recalled that his master’s thesis, “Sociological Factors Influencing American Medical Practice,” was influenced by Sigerest and drew him into a career in public health. Roemer’s first job after medical school was as a medical officer of the New Jersey State Health Department, supervising 92 venereal disease clinics. During World War II, he became a member of the commissioned corps of the US Public Health Service and worked under officials whose names read like a roll call of progressive public health leaders. He served first in the Farm Security Administration under Fred Mott, then in the office of Assistant Surgeon General Joseph Mountin, and then at the Social Security Administration under I. S. Falk. Roemer’s primary goal in these positions was to plan for the implementation of national health insurance should the Wagner-Murray-Dingell bill be enacted. In 1948, Roemer left the federal government to become a county health officer in West Virginia. One of his lifelong ambitions was to integrate medical care with public health, and as a local health officer, he established the county’s first cancer detection clinic. The local doctors attacked him for interfering with their practice and were hardly appeased when he pointed out that he had helped to increase their business by identifying more sick patients. Like the historian Eric Hobsbawm, who explained his own unwavering commitment in a recent autobiography, Roemer viewed the Soviet Union as embodying a vision of the future, with a health system more oriented to preventive than curative medicine built on principles of equity. At Roemer’s memorial service in 2001, his son John stunned the audience by saying that his father had believed in the Soviet Union to the end. Roemer was often silent about his involvement in left-wing politics because of the fear engendered by McCarthyism. He was in West Virginia when he received a notice from the Board of Inquiry on Employee Loyalty of the Federal Security Agency stating that “reasonable grounds may exist for belief that you are disloyal to the Government of the United States.” The six charges against him included membership in the American-Soviet Medical Society and an appearance as a speaker at the International Workers Order Social Security Conference in Washington, DC. (He had given a speech on national health insurance that the US Public Health Service had approved in advance.) He was able to clear himself of the charges, but his troubles had just begun. Roemer became an assistant professor at Yale University in New Haven, Connecticut. He had not been there long when a request by the World Health Organization (WHO) to design health demonstration areas in El Salvador and Ceylon inaugurated his distinguished career in international health. In 1951, he was appointed as a medical officer of WHO and left for Geneva, Switzerland, with his family. Nine months after their arrival, the US Consulate seized their passports and agreed to return them only for reentry into the United States. The Roemers soon fled to Canada, where Milton helped build the Canadian health care system by working on the development of a hospital insurance program in Saskatchewan. Throughout his life he remained committed to emulating the Saskatchewan model. When frustrated with national efforts in the United States, he urged health care advocates to work toward health insurance at the state level, thereby laying the groundwork for a future national health insurance system. While in Canada, Roemer also began the study of hospital utilization that culminated in the finding we now know as Roemer’s law: the number of available beds creates the demand for their use. When the decline of McCarthyism enabled the Roemers to return to the United States, Roemer resumed his academic career, first at Cornell, then at Yale, and finally at the University of California at Los Angeles (UCLA), where he remained until his death in 2001. He chaired the Department of Health Services at UCLA for 8 years and taught courses in public health, medical care, hospital administration, and comparative health systems. Roemer was a consistent advocate for an international perspective and became a leading authority on the national health systems of the world. Roemer’s major works include Medical Care in Latin America,1 with Ruth Roemer; Health Care Systems and Comparative Manpower Policies2; National Strategies for Health Care Organization: A World Overview3; and his magnum opus, National Health Systems of the World. Vol I: The Countries and Vol II: Issues.4,5 These titles represent just a fraction of his remarkable bibliography, which totals 32 books and some 430 articles.