Physicians Against the State

Almost Persuaded: American Physicians and Compulsory Health Insurance, 1912–1920, by Ronald L. Numbers, Baltimore: John Hopkins University Press, 1978, 158 pp., $10.

While Senator Kennedy and President Carter argue about the exact timetable for nationalizing medicine, Prof. Ronald L. Numbers's account of an earlier battle on the same subject makes good reading.

Shortly before World War I, after compulsory health insurance had been enacted in much of Western Europe, it seemed headed for the lawbooks in the United States as well. High officials of the American Medical Association praised it, and an editorial in the Journal of the AMA called it "pregnant with benefit to the public." Even many who doubted the legitimacy of the pregnancy agreed with the New York Medical Record: "Whether one likes it or not, social health insurance is bound to come."

In an America that still had a functioning federal system, proponents concentrated on state governments. The progressivist American Association for Labor Legislation (AALL) drew up a model bill, and the New York State legislature seemed ready to pass it, with Massachusetts and Illinois quickly to follow.

Under the scheme proposed by the AALL, and seconded by the AMA, the state government would have paid 20 percent of the costs of the program, with employers and employees sharing the remainder. Depending on their income, employees would have paid from zero to 20 percent, leaving an employer's share that ranged from 40 to 80 percent. All surgical, medical, hospital, and nursing costs and all drugs and medical supplies were to be covered; disabled workers would get pensions during the period of their disability. Physician compensation was to be capitation—so much for each patient seen. Private insurance companies were barred from participating in any part of the plan.

A few years later, compulsory medical insurance was dead. What killed it? Professor Numbers, head of the University of Wisconsin-Madison's medical history department, is sorry the persuasion wasn't successful, but his scholarly presentation gives all the facts. The answer: the awakening of the average practicing physician to the danger he and his patients faced. Working through their county medical societies and special organizations formed to fight socialized medicine, doctors turned first their state societies and then the AMA into vigorous opponents of government medicine.

Studies of the pauperization of physicians and the lowered quality of care for patients in European systems helped, as did the results of socialism in the young Soviet Union. Accurate cost estimates were also a factor. But aroused physicians, influencing patients and politicians, were the key.

The house of delegates of the New York State Medical society, after a fiery speech by John J.A. O'Reilly, M.D., of Brooklyn's Professional Guild, voted to oppose all forms of government medicine. One of the sponsors of socialized medicine in the New York State legislature, Republican Sen. Frederick Davenport, lamented that his bill was dead because "public opinion had been poisoned against it." The American people had come to agree with Dr. O'Reilly that "compulsory health insurance is…unamerican, unsafe, uneconomic, unscientific, unfair, and unscrupulous."

Ignoring the advice of their president, the house of delegates of the AMA voted nine-to-one for a resolution that stated: "Resolved, That the American Medical Association declares its opposition to…any…plan of compulsory [health] insurance…provided, controlled, or regulated by any state or the Federal Government."

The landslide election of Republican Warren Harding in 1920, an opponent of socialized medicine, over a Democratic nominee who favored it, was almost overkill. Compulsory health insurance was dead in the United States for two generations.

Note: Alluded to, but unanalyzed, is the role that government licensing of physicians, and restriction of the supply of doctors, may have played. In 1912, many physicians may have favored State medicine for reasons of economic self-interest. Many of the same doctors may have opposed it by 1920, for the same reason. This area needs more study. But whatever the reasons, American patients and taxpayers were spared the high prices and low quality of State medicine for many years. Almost Persuaded can be a valuable resource in the fight against that control today.

Llewellyn Rockwell is the former editor of Private Practice and is currently administrative assistant to Rep. Ron Paul.