Echoes Of 1930s In Health Care Debate

The current health care debate had precedents in a series that ran on the radio more than 50 years ago. NBC's Town Meeting of the Air offered a lively discussion of new health care options, many of which sound familiar today.

Copyright © 2009 NPR. For personal, noncommercial use only. See Terms of Use. For other uses, prior permission required.

ROBERT SIEGEL, host:

President Obama recently pointed out that presidents have called for health care reform for nearly a century. He mentioned Richard Nixon, Harry Truman, all the way back to Teddy Roosevelt. While the debate has changed over the years, some things remain the same.

And John McDonough has the tapes of the town meetings to prove it.

JOHN McDONOUGH (Writer): In 1912, a startling phrase gained prominence in our national dialogue: single national health service. Its most strident booster was Teddy Roosevelt, a life-long Republican until 1912, at least. But if you think he was an unlikely advocate, wait until you hear who lined up against it. The American Federation of Labor opposed it. Worker welfare was the union's job, not the government's. And the American Medical Association opposed it. It wanted nothing to get between its doctors, their patients and their fees. So national health policy went into remission for a generation. The cause began to stir in the 1930s again. There was some thought of folding national health insurance into Social Security, but Roosevelt - Franklin Roosevelt now - didn't want to take on the powerful AMA. Social Security moved forward, government health care died on the operating table. But the argument went on.

(Soundbite of radio show, "Town Meeting of the Air")

Unidentified Man #1: Town meeting tonight. Town meeting tonight.

McDONOUGH: For 20 years, NBC's weekly "Town Meeting of the Air" debated the great controversies of American life and politics. December 1937, town hall, New York.

(Soundbite of radio show, "Town Meeting of the Air")

(Soundbite of applause)

Unidentified Man #1: Good evening, neighbors. Now, tonight, we're going to discuss what system of medical care should we have. This question has been the subject of controversy within the medical profession for some time and was recently the cause of a division of opinion in the American Medical Association.

McDONOUGH: What divided the AMA in the 1930s was how to defend the traditional doctor-patient relationship against the politics of reform. Relief money was paying doctor bills, and some physicians were actively supporting compulsory health insurance. It all looked like a slippery slope to Dr. Arthur Christie, who spoke for the AMA.

(Soundbite of radio show, "Town Meeting of the Air")

Dr. ARTHUR C. CHRISTIE (Radiologist): It is our conviction that the present system is the one best adapted to the liberal philosophy of democracy without the evils of health insurance or state medicine.

(Soundbite of applause)

McDONOUGH: When the American health care debate was in its infancy in the '30s, so was private health insurance. The AMA wanted to keep it that way because it feared insurers might try to limit their losses by controlling care. In 1937, there were three basic health insurance models. Indemnity insurance simply reimbursed the patient. Another, paid doctors directly but only those in the plan network. The newest model was the prepaid nonprofit clinic, in which the insurer also provided the care. The AMA hated that one because prepayment challenged fee for service. Hospitals could do it if they wanted to but not physicians.

Dr. Christie.

(Soundbite of radio show, "Town Meeting of the Air")

Dr. CHRISTIE: Why does the medical profession approve group hospitalization and disapprove the voluntary insurance plans called Group Health Associations? The important element in this arrangement is the very definite and specified limitation upon the benefits to be received.

McDONOUGH: Group hospital plans would soon become the basis of the Blue Cross system. But the debate over doctor bills was another matter. Some saw a big role for government.

(Soundbite of radio show, "Town Meeting of the Air")

Unidentified Man #1: Now, we're going to hear a slightly different view from Dr. Gilbert W. Hague of Worcester, Massachusetts, who'll give us his version of socialized medicine.

(Soundbite of applause)

McDONOUGH: You might note there were no boos or hisses at that point. In 1937, the word socialism was not yet the poisonous buzzword it would become in the Cold War. Hague's version of socialized medicine was rooted in public health but modeled on the military. Some questioners had their doubts.

(Soundbite of radio show, "Town Meeting of the Air")

Unidentified Man #2: What assurance have I that I would receive the same attention under socialized medicine that I would receive from my own personal physician?

Dr. GILBERT W. HAGUE (Physician): If you are competent to pick out a capable, honest physician, perhaps you could find no better source of treatment. But the average man is not so competent.

McDONOUGH: By 1940, debate on health care went into a political vacuum, but the problem festered and the arguments continued. Town hall, January 1940.

(Soundbite of radio show, "Town Meeting of the Air")

Unidentified Man #1: Various proposals have been made for a compulsory health insurance. Tonight, we meet this question head on…

McDONOUGH: Temperatures were rising along with ideological zeal. For the AMA, Dr. Terry Townsend.

Dr. TERRY TOWNSEND (Urologist): Does America need compulsory health insurance? No. Compulsory health insurance is the mark of decadent medicine everywhere it exists.

McDONOUGH: Not so to Dr. Charles Edward Winslow, professor of public health at Yale.

(Soundbite of radio show, "Town Meeting of the Air")

Professor CHARLES EDWARD WINSLOW (Public Health, Yale University): We stand still and quarrel about details and about hypothetical damage to our vested interest, while men and women and children suffer and die for the lack of the resources of modern medical science.

(Soundbite of applause)

Prof. WINSLOW: Let us forget slogans, which arouse the secretion of endocrine glands instead of stimulating the higher nerve centers. We need, in other words, a broad national health program.

(Soundbite of applause)

McDONOUGH: With Washington wasn't listening much, private innovation was afoot. The nonprofit hospital networks of Blue Cross were paralleled by prepaid physician groups. Even Hollywood jumped into the debate with unusual boldness.

(Soundbite of TV program, "Dr. Kildare")

Unidentified Man #3 (Actor): (As character) How about the theory that the community can afford what the individual can't?

Unidentified Man #4 (Actor): (As character) Oh, so you've been bitten by that bug, have you?

McDONOUGH: It was the bug the AMA had been trying to swat for several years. But at MGM, America's too most beloved screen physicians were making the case: Doctors Kildaire and Gillespie.

Unidentified Man #3: (As character) There are many people in pocket, (unintelligible) could pay 10 cents a week, but who couldn't and wouldn't afford a regular fee. Now, do we all believe that we can give them a medical service for that figure?

Unidentified Man #4: (As character) Oh, I think so. I'm familiar with the theory and I believe in it, of course. But only because of its basic principle: preventative medicine.

Unidentified Man #3: (As character) Right. We must keep most of our people well.

Unidentified Man #4: (As character) Sure, it's cheaper keeping them well than curing them afterward.

MCDONOUGH: If you hear in that argument the early outlines of the modern HMOs, you wouldn't be far wrong. But to Lionel Barrymore's Dr. Gillespie in 1940, it still seemed terribly futuristic.

(Soundbite of movie, "Dark Delusion")

Mr. LIONEL BARRYMORE (Actor): (As Dr. Leonard Gillespie) That's a very beautiful idea, and maybe in 1960, a practical one.

McDONOUGH: 1960 was 20 years in the future to old Dr. Gillespie, but it's 50 years ago to us. And insurance companies have replaced the AMA as the whipping boy. The health care debate of the '30s never came near a universal health program, but it helped produce experiments in finance, organization and health management that led to Blue Cross and Blue Shield, Kaiser Permanente, HMOs and countless prepaid plans. It helped extend care to millions and to provide a revenue flow to doctors. Perhaps, the question now is: What will history be saying about the outcome of the present health care debate 70 years from now?

For NPR News, this is John McDonough.

Copyright © 2009 NPR. All rights reserved. No quotes from the materials contained herein may be used in any media without attribution to NPR. This transcript is provided for personal, noncommercial use only, pursuant to our Terms of Use. Any other use requires NPR's prior permission. Visit our permissions page for further information.

NPR transcripts are created on a rush deadline by a contractor for NPR, and accuracy and availability may vary. This text may not be in its final form and may be updated or revised in the future. Please be aware that the authoritative record of NPR's programming is the audio.

Comments

 

Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.