Deja Vu? FDR and the health care battle

Soaring health care costs, insipid politics and accusations of socialism dominate the health care conversation today — just as they did during FDR’s time.  David Woolner takes a look at how national health care got cut out off the New Deal.

Seventy-five years ago, President Franklin D. Roosevelt opened a national conversation on the need for some form of comprehensive health insurance. On November 14, 1934, taking note of the problem of “economic loss due to sickness,” which he characterized as “a very serious problem for many families with and without incomes” (and which today remains the number one cause of bankruptcy in the United States), FDR observed, “Whether we come to this form of insurance sooner or later on, I am confident that we can devise a system which will enhance and not hinder the remarkable progress which has been and is being made in the practice of the professions of medicine and surgery in the United States.”

The President then went on to charge his Committee on Economic Security (CES) to go to work on this issue in preparation for the passage of the Social Security Act in 1935. Interestingly, the CES noted in the cover letter of its report to the president that although it realized there were “differences of opinion” as to “the advisability of establishing compulsory health insurance,” the committee became convinced “that the compulsory feature” was “essential.” But resistance from the American Medical Association and other professional bodies—who characterized health insurance as being linked to socialism and communism—led the president, on the advice of Francis Perkins and others, to hold off incorporating a health insurance program as part of the Social Security legislation.

The issue was revisited again, however, when FDR convened a new body—the Interdepartmental Committee on Health—to look into the question of national health insurance. In July, 1938, the Committee convened a “National Health Conference” to, as FDR put it, come up with “a long-range comprehensive program providing for the most efficient cooperation of federal, state, and local government with voluntary agencies, professional groups, media of public information, and individual citizens.” Such a program, he said, “must take into account that millions of citizens lack the individual means to pay for adequate medical care.”

Inspired by the findings of the conference, FDR flirted with the possibility of sending a comprehensive health-reform bill to Congress. In a message to the legislative branch dated January 23, 1939, he reiterated his view that the “health of the people is a public concern; ill health is a major cause of suffering, economic loss, and dependency; good health is essential to the security and progress of the Nation.” But strong opposition from the medical community led him to back away from the idea and instead the administration opted for a much more modest piece of legislation that sought to encourage state governments to take the initiative on health care reform.

It would seem that the New Deal—not unlike the many subsequent attempts to instigate serious health care reform in this country since the 1930s—suffered from a certain temerity in the face of vested interests. Let’s hope that this time courage and common sense—especially economic common sense—will prevail.

David Woolner is a Senior Fellow and Hyde Park Resident Historian for the Roosevelt Institute.