|This Week in American History
July 1117, 1938
President Franklin Roosevelt Fights for a National Health Plan
On July 15, 1938, President Franklin Roosevelt wrote a letter of greeting to the representatives of the public and of the medical professions who would be attending the National Health Conference in Washington, D.C. Roosevelt told them that there was a pressing need for a coordinated national action program on health. "Such a program," wrote the President, "necessarily must take account of the fact that millions of citizens lack the individual means to pay for adequate medical care."
Franklin Roosevelt's campaign for better health care for Americans had begun at Warm Springs, Georgia, where he focussed not only on his own rehabilitation from polio, but became an expert on physical therapy for the disabled. Literally summoned from Warm Springs by his nomination for Governor of New York, Roosevelt won the office, and then embarked on a campaign to provide better health for all New Yorkers. He began his famous radio "fireside chats" were while he was New York's Governor, and used them to report to his constituents on future plans, and to what extent the legislature had or had not acted upon them.
On February 18, 1931, Roosevelt devoted the whole of a radio message to the problems of the crippled, appealing to people to stop hiding their crippled children in back rooms or the attic and to bring them to doctors or public health officers so that their problems could be diagnosed and they could then be treated with modern medicine. In that address, Roosevelt stated, "People know well that restoring one of us cripplesbecause as some of you know, I walk around with a cane and with the aid of somebody's arm myselfto useful occupations costs money." But he stated that the cost was justified, even if merely from a monetary standpoint, because crippled people could then become part of society and earn a living.
Governor Roosevelt appointed a Special Health Commission and then sent its report to the Legislature in February of 1931. The outstanding feature of the report was its proposal to institute county boards of health, rather than relying on the smaller town and city boards which did not have the population or wealth to support vital medical infrastructure. The legislature, which was controlled by Republicans allied to President Herbert Hoover, ignored the proposal on county boards of health, but it did vote to fund a smaller proposal for building three state tuberculosis sanitariums.
In June of 1931, Roosevelt attended the annual Governors' Conference at French Lick, Indiana. There, he outlined a program for dealing with the deepening Depression, including measures instituting a progressive, rather than regressive, tax system; dealing with unemployment by providing jobs; and working out a system of health insurance for people who could not afford medical care.
By the summer of 1932, Roosevelt was the Democratic candidate for President, and he was furious when the Hoover Administration made attempts to cut appropriations for child-welfare work. A member of Hoover's Cabinet had suggested that the Depression wasn't altogether a bad thing for the nation's children, and Roosevelt responded that unemployment of parents led to malnutrition for the children, something which would affect them for the rest of their lives.
Governor Roosevelt stated that the Federal Government had no continuing policy for dealing with the problems of public health and social welfare. "I propose," he said, "to inaugurate a definite long-range plan for dealing with all phases of public health and welfare, which are a proper concern of the Federal government. May I add that, in the State of New York, during the past four years, we have accomplished definite and practical results by coordinating and planning the work of the state? I cite as a simple example the public-health program, which is a part of my administration. It has been referred to in other states as the most important contribution to practical public-health work during this generation."
In the notes to his public papers, Roosevelt reviewed his actions as President to develop a comprehensive health plan for all Americans, as he had promised during his campaign. "In 1934," wrote Roosevelt, "I appointed the Committee on Economic Security whose research and recommendations formed the basis of the Social Security Act. In an address to the Advisory Council of the Committee on Economic Security a few months after its appointment, I called attention to the need for study of plans which would minimize the economic loss due to sickness.
"The Social Security Act of 1935 authorized an annual appropriation of $8,000,000 to enable the Public Health Service to assist states and their local subdivisions in training personnel and maintaining public health services. Under the 1939 amendments to the Act, this authorization was increased to $11,000,000.
"With the passage of the Social Security Act, it was important that the health activities of the various federal agencies be coordinated, and that the problem of adequate protection of health receive additional study. Therefore, on August 15, 1935, I appointed the Interdepartmental Committee to Coordinate Health and Welfare Activities. I instructed this Committee to appoint special subcommittees of physicians and other technical experts to study and make recommendations on health problems."
One of these subcommittees was called the Technical Committee on Medical Care, which "concluded that there were many deficiencies in the present facilities available, and that without federal assistance the states and local communities could not meet the demands of adequate protection against sickness.
"The recommendations of the Technical Committee," wrote President Roosevelt, "were embodied in a five-point program which was designed to expand gradually until full-scale operation was reached within ten years. The immediate necessity for increased public health, maternal and child health, and hospital facilities was emphasized. The Committee recommended, for example, that the federal government should undertake additional annual expenditures of $100,000,000 to be matched by a like amount in states and localities, for the eradication of tuberculosis, venereal diseases and malaria, the control of pneumonia and cancer, and for mental and industrial hygiene.
"Up to $165,000,000 was recommended for maternity care and care of newborn infants, medical care and services for crippled childrenalso to be divided equally between the federal government and the states and their subdivisions. The Committee further suggested that an average annual expenditure of $147,400,000 be divided between the federal government and states and localities on a 50-50 basis, for the construction and maintenance of additional hospitals and diagnostic centers.
"The balance of the Committee report dealt with the need for medical care for the underprivileged and for a system of health insurance. It was advised that the federal government meet half the costs of an expenditure which would in ten years reach $400,000,000 annually for the medical care of lower income groups. Insurance plans to distribute the costs of sickness and disability among wage earners and the general population were also recommended.
"It should be emphasized that this plan contemplated no centralized and bureaucratic control or form of 'socialized medicine,' as frequently charged by some critics. Rather, it was simply a proposal to work out the problem of giving some assurance to wage earners of continuity of income through periods of disability due to sickness, and accomplishing this within the federal system, with the responsibility of administration being placed upon the various states and localities."
After he received its report, Roosevelt wrote to the chairman of the interdepartmental committee and suggested that "your Committee give consideration to the desirability of inviting, at some appropriate time, representatives of the interested public and of the medical and other professions, to examine the health problems in all their major aspects and to discuss ways and means of dealing with these problems." The result was a call for a National Health Conference, which began on July 18, 1938 in Washington, D.C. The President addressed it through the letter sent on July 15, which called for a coordinated national program of action.
The following year, President Roosevelt wrote about the results of the conference: "Subsequent to the National Health Conference, representatives of professional groups, farm and labor organizations, and other interested individuals conferred with the Interdepartmental Committee to Coordinate Health and Welfare Activities in preparing the final report transmitted to the Congress.
"Senator Robert F. Wagner introduced the proposed 'National Health Act of 1939' shortly after my message. This bill, S. 1620, embodied the chief recommendations of the Interdepartmental Committee.
"Although in general, farm, labor, and welfare groups heartily endorsed the objectives of the bill and the bill itself, opposition developed among the professional groups, particularly the American Medical Association. This opposition assumed the familiar tone of agreeing with the 'objectives' of the bill, but disagreeing with the 'methods' contemplated. The critics expressed fear that the increased federal grants-in-aid would expand federal control too far; and they were particularly worried that the health insurance proposals for the families of wage-earners would mean a trend toward what they called 'socialized medicine.'
"I have definitely expressed the view that 'there can be no substitute for the personal relationship between doctor and patient which is a characteristic and a source of strength of medical practice in our land.' I have also made the definite statement that: 'Neither the American people nor their government intends to socialize medical practice any more than they plan to socialize industry.' There is no basis for the charge of the opponents of the national health program that it was designed to socialize medicine.
"The Congress held committee hearings upon these recommendations; but when it failed to take action, I felt that some beginning should be made in the direction of a health program at least in the poorer sections of the nation. Therefore, I asked the Congress to consider legislation to construct small hospitals in needy areas of the country."
This was submitted on January 30, 1940, as "A Recommendation for the Construction by the Federal Government of Small Hospitals in Needy Areas of the Country Presently Without Such Facilities." As President Roosevelt wrote later, "This was not designed as a substitute for the national health program recommended by the Interdepartmental Committee to Coordinate Health and Welfare Activities. This was contemplated as the first immediate forward step toward the enactment of a more comprehensive scheme of federal aid for health and medical care."
Just as the New York State Legislature had at first refused to set up county boards of health, but did provide funding for three tuberculosis sanitariums, Roosevelt hoped that the U.S. Congress would at least build the small hospitals in underserved areas of the country. But, by the outbreak of World War II, Congress had still not passed the bill, and it was only after Roosevelt's death that some of his health plans became reality, such as the Hill-Burton Legislation for hospitals and Medicare for the elderly. A comprehensive health plan for the general American population, especially those who cannot afford health insurance, still awaits future action.