A COLOSSAL MISTAKE
CHARLES C. SMITH JR., M.D.
APRIL 4, 1975
Facing the prospect of an Innominate paper and my own entry into the hierarchy of organized medicine, I have chosen to look into an oft-quoted “stand” by organized medicine which seems incomprehensible to those of us who graduated since World War II. This “stand” is epitomized by Walter Ruether’s statement at a Congressional hearing in 1961 on Medicare: “It is a sad fact that through the 1930s and the early 40’s the American Medical Association did not believe in voluntary sickness insurance and did almost everything possible to prevent its development.”
Motivated by George Santayana’s familiar statement, “Those who cannot remember the past are condemned to repeat it,” I decided to see what I could find out about the events of this era.
I first turned to this book by Professor Rayack “PROFESSIONAL POWER AND AMERICAN MEDICINE—the economics of the American Medical Association which contains many interesting chapters such as:
1. The AMA and Medical Education: A study in
Professional Birth Control
2. The Shortage of Physicians
3. Medical Imperialism: Conflict among Health Professionals
4. Medical Insurance and the AMA.
After consulting Professor Rayack I decided that the next place to go was the archives of the AMA itself. And, six weeks ago Rosemary and I went to Chicago and spent a day and a half in the dusty stacks on the 9th floor of the AMA Headquarters building where a human dynamo, Miss Margaret Fallucio came up with every bulletin, book, or journal written on the subject in Dr. Fishbein’s finest hours.
This was an illuminating and entertaining experience since other authors on the same subject had spent time there and Miss Fallucio had observations on these folk aw well as the swashbuckling Dr. Fishbein himself.
To set the stage for our analysis, we remember that Bismarck had established government administered sickness insurance in 1883 in Germany and England had adopted its compulsory health insurance law in 1911. The idea had spread to this country and the Progressive Party, under Theodore Roosevelt, in 1912 had a plank calling for “Protection of homelife against the hazards of sickness through the adoption of a system of social insurance.” A committee on Social Insurance in 1915 proposed a “standard bill” which was a compulsory health and disability law to be enacted by the states.
At this point the leaders of the AMA responded favorably and the Judicial Council under Dr. Alexander Lambert issued a report supporting the concept. The AMA Board of Trustees confirmed this in 1916 and appointed a Committee on Social Insurance to further education of the profession and appear before legislative bodies.
The Committee presented a 35-page report at the 1917 meeting in New York the auspices of Dr. Alexander Lambert, Chairman. The biography of Dr. Lambert notes that he was the personal physician to Theodore Roosevelt, his brothers were Dean of Physicians and Surgery, and Professor of Surgery, respectively.
The reported stated that “blind opposition, indignant repudiation...of these laws is worse than useless, it leads nowhere and it leaves the profession in a position of helplessness if the rising tide of social development sweeps over them. The profession can, through its influence in the community, prevent for a time these laws passed and it can, by a refusal to cooperate, still further retard them, but in the end the social forces that demand these laws and demand an improvement in the social existence of the great mass of the people will indignantly force a recalcitrant profession to accept that which is unjust to it and that which is to its detriment.
“The profession today in certain states, is acting the part that our school boy history showed of old King Canute sitting by the seashore bidding the rising tide to stop, and King Canute only got wet for his trouble.”
The report ended with a resolution the House of Delegates cooperate in the molding of these laws and that it instruct the Council in Health to insist that such legislation shall provide for freedom of choice of physician by the injured.
After adoption of the report a further tribute was extended to Dr. Lambert in a resolution prepared by Dr. Arthur T. McCormack of Kentucky in recognition of his outstanding work. Later, in 1919, Dr. Lambert was President of the AMA at the Atlantic City session.
In the official history of the AMA one may obtain a “clue” to later thinking in the manner which Dr. Fishbein reports this segment of action and I quote, “most of the extensive report dealt with conditions in Germany. It considered not only health insurance but old age protection and unemployment insurance. The pattern in foreign countries had been a beginning, with voluntary insurance, which proved inadequate, then voluntary insurance subsidized by the state which, although more successful, was still inadequate, and finally full compulsory sickness insurance. Poorly concealed throughout this report is a plea for early adoption of compulsory sickness insurance in the United States.
Parenthetically I might add that the Committee did condemn the Boston Medical and Surgical Journal for suggesting that medicine be eliminated from social insurance.
At about this same time (1917) some identifiable opposition began to appear. The Journal repeatedly published the “London Correspondents” discouraging descriptions of the operation of the British system, although carrying articles favorable to a government sponsored system of medical care.