“One Simply Doesn’t Arbitrate Authorship of Thoughts”: Socialized Medicine, Medical McCarthyism, and the Publishing of Rural Health and Medical Care (1948)

Health policy and the practice of medicine in the New Deal era have been skillfully analyzed by Michael Grey, while studies by Alan Derickson and Daniel Hirshfield round out our understanding of the fight for health security in the 1930s and 1940s. They inform us that the Roosevelt administration under the adverse social and economic conditions of The Great Depression recognized the pressing need for health care reform and set an ultimate goal of a compulsory national health care plan; and despite the opposition of the American Medical Association (AMA), they resolved that—in Derickson’s words—there would be “health security for all.” Yet despite the reformers’ steady pursuit of this ideal, as Hirshfield makes clear, their efforts were doomed to become the “lost reform.” What this historical scholarship also makes clear is just how important was the role played in the health reform debates of the 1930s by rural America – which seems, in retrospect, unusual.¹ At this time, although many federal services, agencies, and departments held jurisdiction over the vast and overlapping complexities of health policy, they traditionally directed their gaze toward urban centers. It was the city, with its crowded neighborhoods, transient populations, and epidemic outbreaks, that was thought to be the source and root of so many health problems.²

The formation in 1937 of the Farm Security Administration (FSA) helped redirect attention to America’s rural hinterland; the appointment at that time of Public Health Services officers Ralph C. Williams and Frederick D. Mott as chief and assistant, respectively, of the Health Services Branch of the FSA resulted in a unit that, as Grey argues, became a “highly creative experiment in twentieth-century federal health care policy.”³ Over the next decade from his Washington, DC office, Mott became thoroughly immersed in and conversant on rural health and medical care in the United States. Mott flourished professionally as a member of the Public Health Service (PHS) during the consecutive presidential terms of Roosevelt and his New Deal programs; he assumed variously the roles of Chief Medical Officer of the FSA as well as Chief Medical Officer of the War Food Administration.⁴ Mott was also joined in this highly creative health policy experiment by Milton I. Roemer. Together Mott and Roemer produced the book, Rural Health and Medical Care, published in 1948; they quite literally wrote the book on the subject. Essentially, it posited that because rural America was numerically underserved by physicians and poorly cared for by those who were in practice, instituting a system of compulsory health insurance, along with expanded health care facilities, in rural areas would be more pragmatic and less problematic than proposing such reforms for urban areas. Demonstrated success across such communities would convince other less rural areas to sign on to federal health insurance programs. Incrementally, but inevitably, the United States would develop a program of national health insurance. In time, social and technological inequalities in health care and its delivery might gradually diminish or be eliminated.⁵ Despite its mundane title, Rural Health and Medical Care was a lightning rod for debate as it was arguably a blueprint for major health policy reform in the United States through so-called socialized medicine. As such, its message was polarizing for individuals and institutions. As this discussion demonstrates, both authors of this book, and its actual text, were subject to concerted opposition by medical organizations such as the increasingly conservative New York Academy of Medicine (NYAM), which originally arranged to publish Rural Health and Medical Care, but then attempted to censor and suppress it.

The primary author of Rural Health and Medical Care, Frederick Dodge Mott (1904-1981), was educated at Princeton University before graduating in 1932 in medicine from Canada’s McGill University. Although Mott was a highly regarded health policy advisor and reform-minded physician, his role as a government bureaucrat in the United States and later in Canada, as...