User:Doc Tropics/United States health reform under Truman

Introduction
On November 19, 1945, only 7 months into his presidency, Harry S. Truman sent a Presidential message to the United States Congress proposing a new national health care program. In his message, Truman argued that the federal government should play a role in health care, saying "The health of American children, like their education, should be recognized as a definite public responsibility." One of the chief aims of President Truman's plan was to insure that all communities, regardless of their size or income level, had access to doctors and hospitals. President Truman emphasized the urgent need for such measures, asserting that "About 1,200 counties, 40 percent of the total in the country, with some 15,000,000 people, have either no local hospital, or none that meets even the minimum standards of national professional associations. "

President Truman's plan was to improve the state of health care in the United States by addressing five separate issues. The first issue was the lack of doctors, dentists, nurses, and other health professionals in many rural or otherwise lower-income areas of the United States. He saw that "the earning capacity of the people in some communities makes it difficult if not impossible for doctors who practice there to make a living." He proposed to attract doctors to the areas that needed them with federal funding. The second problem that Mr. Truman aimed to correct was the lack of quality hospitals in rural and lower-income counties. He proposed to provide government funds for the construction of new hospitals across the country. To insure only quality hospitals were built, the plan also called for the creation of national standards for hospitals and other health centers. Mr. Truman's third initiative was closely tied to the first two. It called for a board of doctors and public officials to be created. This board would create standards for hospitals and ensure that new hospitals met these standards. The board would also be responsible for directing federal funds into medical research.

The most controversial aspect of the plan was the proposed national health insurance plan. In his November 19, 1945 address, President Truman called for the creation of a national health insurance fund to be run by the federal government. This fund would be open to all Americans, but would remain optional. Participants would pay monthly fees into the plan, which would cover the cost of any and all medical expenses that arose in a time of need. The government would pay for the cost of services rendered by any doctor who chose to join the program. In addition, the insurance plan would give a cash balance to the policy holder to replace wages lost due to illness or injury.

President Truman's health proposals finally came to Congress in the form of a Social Security expansion bill, co-sponsored in Congress by Senators Robert Wagner (D-NY) and James Murray (D-MT), along with Representative John Dingell (D-MI). For this reason, the bill was known popularly as the W-M-D bill. The American Medical Association (AMA) launched a spirited attack against the bill, capitalizing on fears of Communism in the public mind. The AMA characterized the bill as "socialized medicine", and in a forerunner to the rhetoric of the McCarthy era, called Truman White House staffers "followers of the Moscow party line".* Organized labor, the main public advocate of the bill, had lost much of its goodwill from the American people in a series of unpopular strikes. Following the outbreak of the Korean War, President Truman was finally forced to abandon the W-M-D Bill. Although Mr. Truman was not able to create the health program he desired, he was successful in publicizing the issue of health care in America. During his Presidency, the not-for-profit health insurance fund Blue Shield-Blue Cross grew from 28 million policies to over 61 million.** When on July 30, 1965, President Lyndon B. Johnson signed the Medicare bill into law at the Harry S. Truman library & Museum, he said that it "all started really with the man from Independence".**

Background
Truman's attempts to adopt a form of a single-payer system were met with opposition, both from the public and from special interest groups. Although polls confirmed that over 58% of Americans approved of Truman's propsal, his programs seemed too liberal and radical for the American public(Greenberg 20). Because of external forces like the "Red Scare" and the commencement of the Cold War, Truman's health reform plan never had a chance (Hamby 659). Domestic policy like health care reform was not the priority at the time. Moreover, the American Medical Association (AMA) vehemently attacked Truman's ideals.

The American Medical Association was a very powerful force and dominated "interest-group activity in the health policy arena" (Mayes 37). With endless funds, the AMA attacked Truman's proposals as Communistic and ultimately destroyed any chance of success for Truman. The AMA felt that any creation of a health care plan under Social Security would be a stepping-stone for the government to take over the entire health care system. In their opinion, this would result in inefficiency and an overall decrease in the quality of health care in the United States (Mayes 37).

How the issue got noticed
There were rumblings of universal health coverage plans in California, beginning with the election of Culbert Olson in 1938 as governor (Mitchell 11). Olson's platform contained a focus on state health insurance, but his inabilities as a leader served as its doom (Mitchell 11). When Earl Warren won the governor's seat in 1943, he too put a premium on enacting state-wide health insurance. Warren entered the office in a positive place: with a swollen state tax revenue and support from both Democrats and Republicans for his programs (Mitchell 13). Thus, Warren began initiating his own health proposal in 1943, for presentation in 1945. Warren made himself a national figure in 1944 by turning down Dewey's invitation to run for vice-president, and thus his proposals were well-recognized (Mitchell 16). Warren's hard push for universal coverage in California likely stirred the interest of Truman, and had Warren been successful, Truman may have favored more of a state run health system (Mitchell 30). Additionally, California was seen as an innovator, and high-profile state which many states would likely have followed had they been successful in enacting state-wide health coverage (Mitchell 3).

How the issue was framed
Opposition to Truman's healthcare reform framed this negatively. They felt that increased government control on American health care would result in socialized medicine. They therefore portrayed Truman's reform as an increase in big government, which would result in lowered competition. This leads to increased medical fees, inefficiency, and a result of "damaging the high quality of American health care" (Mayes 37). Their efforts of framing Truman's reform negatively largely resulted in the failure of Truman to be able to make any progress.

The framing of health reform by opposition effectively targeted the vulnerability of America to the expansion of big government and the increasing fear of the spread of communism.

Policy communities
The strength of physician interest groups, and their opposition to proposed forms of universal health insurance was evident during the Warren administration in California in 1943. Warren felt that he had a good relationship with the California Medical Association (CMA) (Mitchell 17), but because he proposed the plan before the CMA had time to meet and discuss it, they immediately rose up against Warren (Mitchell 18). The CMA then hired the powerful political consulting firm, Whitaker and Baxter, to campaign against Warren (Mitchell 18). This shows that the physicians interests were in fact quite powerful and would use any means necessary to oppose plans that could "socialize" medicine.

The origin of the idea of National Health Insurance
The idea of National Health Insurance was considered after the enactment of the New Deal. Although excluded from the initial legislation, the idea of publicly funded medical care seemed an eventual addition. These forms of government-run were observed in other countries and being proposed in Great Britain (Starr 280).

The national mood
The sentiment of the nation was influenced by the conflicts of the United States on the international level. The start of the Cold War resulted in the growing fear of the spread of communism. Therefore, an expansion of government to create universal healthcare coverage created national concern. Public opinion felt that nationalizing medicine would open opportunities for socialized government in other realms of public life (Starr 280).

The close of World War II and the emergence of the Cold War brought about a heightened fear of communism. On March 11, 1945, federal agents raided the offices of a left-wing scholarly journal, Amerasia, and found thousands of State Department classified materials (Quadagno 2005: 28). The ensuing federal investigation found that federal employees had been giving secret documents to the Communist Party. Truman formed a loyalty board to inspect federal employee ties to communism. Increasing the public fear was the renewed activities of the House Un-American Activities Committee, or HUAC, which began a highly public investigation of communist penetration of Hollywood. Even though the search produced very little in the way of uncovering any suspicious activity, the fears of the public were nonetheless fueled. HUAC also managed to convince the nation that they had found a communist spy in Alger Hiss, high-ranking State Department official, though he was only found guilty of perjury. A young Republican by the name of Richard Nixon was thus credited with nabbing the biggest spy in State Department history (Quadagno 2005: 29).

Government
Bills were introduced in the Senate and the House, but no action was taken that year. In 1946, the bipartisan Hill-Burton Act was passed, which allocated federal funding for hospital construction to states.

Competition within the government was fierce. (Greenberg 20).

Why the window of opportunity for health reform opened
Some of Truman's ideas for health reform came on the heel's of FDR's New Deal. Post World War II, Truman showed much support for health care reform. This could have been due to presence of domestic health problems related to the war efforts. After resolve of foreign conflicts, the country and President Truman saw necessity of stabilization of health care in America.

President Truman was one of first presidents to support a healthcare insurance program throughout his term. In fact, on November 19, 1945, he was the very first president to deliver a presidential message which pertained solely to healthcare (Mayes 36). He therefore brought this issue to the public eye and framed it as a large public concern, therefore creating demand and opportunity for healthcare to be reformed.

Why the window of opportunity for health reform closed
Although Truman's health policies did not pass, that is not to imply that no gains were made during his presidency. In fact, "the 1950 social security amendments which helped the states provide medical care for the elderly, the blind, dependent children and the disabled were a significant achievement" (Morgan 130).