The Debate on National Health Insurance … 80 Years Ago

Abstract

After much debate, national health insurance was excluded from the Economic Security Bill of 1935, which passed during the first administration of President Roosevelt. As Dr. Thomas B. Gore points out in an adjacent article, my paternal grandfather, Stewart R. Roberts, MD (1) (Figure ​(Figure11), was involved in this debate and took a rather contrary position as a physician. Figure 1 Stewart R. Roberts, MD, 1878–1941. Roberts was a member of two pertinent groups in this national debate, the Committee on the Cost of Medical Care (CCMC), organized in 1925, and the Medical Advisory Board, organized in 1934. He appears to have been strongly supportive of national health insurance and found himself in direct opposition to the American Medical Association (AMA) under the leadership of Dr. Morris Fishbein, who viewed such a plan as socialist, if not communist. The CCMC final report in 1932 highlighted the disconnect between lay reformers, who generally wanted national health insurance, and physicians, who generally opposed that level of governmental involvement. Some physicians, however, including Roberts, went against the majority view within the medical profession. In his 1999 book, …And the Pursuit of National Health, Jaap Kooijman described the circumstance: The polarization within the medical profession reappeared, however, with a statement by Dr. Stewart Roberts, who bitterly criticized the obstinate position of the AMA. When in 1932 he had signed the CCMC majority report [written by lay members and physicians, advocating national health insurance], Roberts had been, as he claimed, condemned by the editorials in the Journal of the American Medical Association. The medical profession's obstruction had to stop, Roberts argued: “Now this American Medical Association, we doctors of America, are on trial in this room this afternoon. If we obstruct and reason and dally, we are going to receive the contempt of the American people, and will rightly deserve it” (2). The Medical Advisory Board, organized in 1934 and composed of 11 physicians, appeared to favor the expansion of existing public health services, as an alternative to a national health insurance plan. The “round robin” letter generated by the board (Figure ​(Figure22) recommended that “experiments in voluntary insurance” be done first, before establishing compulsory health insurance. Roberts was the only board member who did not evidently support this cautious position. Figure 2 Round robin letter from the Medical Advisory Board in 1935 with recommendations concerning national health. My paternal grandfather disliked Roosevelt, but I thought it was because the USA was being drawn into a Second World War in Europe (through the lend-lease program, etc.), an inevitability which my grandfather, an isolationist, like Charles Lindbergh, opposed. The attack on Pearl Harbor, which occurred after my grandfather's death in 1941, would certainly have changed this view. What did not occur to me until Dr. Gore shared his research was that my grandfather probably disliked Roosevelt more for excluding a national health insurance plan in his Economic Security Bill of 1935. I am grateful to Dr. Gore for reminding us of these national deliberations, which occurred some 80 years before the Affordable Care Act of 2010. It proves again that there is nothing new under the sun (Ecclesiastes 1:9).