2. Public Health and Health Insurance
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chapter two public health and health insurance After the Rockefeller hookworm announcement, Oklahoma senator Robert Owen introduced legislation that would have created a national department of public health, modeled on the powerful USDA.1 Owen’s bill soon gained the support of the Committee of One Hundred on National Health, an organization created by progressive academics and committed to consolidating and expanding the public health powers of the federal government. It also gained the support of the life insurance industry and the AMA, both of which would later emerge as highly influential opponents of government-backed health insurance. The push for a national department of public health failed, but it clari fied the challenges that any effort to expand the role of the federal government in domestic health matters would face. The Public Health and Marine Hospital Service was among the staunchest opponents of the plan, which Surgeon General Walter Wyman viewed as a threat to the service’s relative independence. Ultimately, the service was able to capitalize on the debate over Senator Owen’s proposed department, using it to help secure an expanded research mandate and reorganization as simply the US Public Health Service. With a broader mandate and a new set of appropriations, the PHS entered into an expansionary stage. Much of its new research was focused on the problems of rural America, and the PHS’s Hygienic Laboratory began to make a name for itself through research into pellagra, a disturbing disease recently identified in the South. The PHS also initiated research into issues such as stream pollution and industrial hygiene. In addition, it began an important study of the relationship between health insurance and public health. Published in 1916, the study staked out a strong position in favor of compulsory health insurance. It was coauthored by Edgar Sydenstricker, who would head the development of the Social Security Act’s health provisions nearly twenty years later. Citing the service’s marine hospital system , Sydenstricker and leading PHS thinker Benjamin S. Warren argued that a clear precedent existed for a national system of compulsory health PUBLIC HEALTH AND HEALTH INSURANCE : 35 insurance. Such a system, they maintained, should be integrated with public health efforts. Indeed, health insurance would help to strengthen public health efforts: with workers, business, and government collectively footing the bill for individual medical services, each would become more interested in pursuing less expensive public health efforts. A National Department of Public Health On February 10, 1910, only a few short months after the announcement of the Rockefeller donation, Senator Owen introduced a bill to create a national department of public health. Owen’s bill was short and to the point. It listed the organizational shifts necessary to bring a Department of Health into being, and it declared its purpose to be the consolidation of “all matters within the control of the Federal Government relating to the public health and to diseases of animal life.”2 In consolidating federal health efforts, the bill proposed changes for a number of federal agencies, including the Public Health and Marine Hospital Service, the revenue cutter service, Indian affairs, and even the Government Printing Office.3 After the Public Health and Marine Hospital Service, the two most prominent affected agencies were the Census Bureau and the USDA. In 1880, the US Census Bureau created a Death Registration Area, initially comprising Massachusetts, New Jersey, Washington, DC, and a number of other cities. States were admitted to the Death Registration Area as the bureau confirmed that they were capable of accurately collecting mortality statistics. Beginning in 1900, the bureau reported death rates annually. As of 1910, a number of states remained outside the Death Registration Area (Figure 2.1). Under Owen’s plan, the effort to collect nationwide vital statistics would be moved into the new health department, as would the USDA’s work in regulating nonbiologic drugs and inspecting meat entering interstate commerce under the 1906 Pure Food and Drug Act.4 Bringing together functions housed in a variety of agencies, Senator Owen’s proposed Department of Public Health would collect health-related data, develop and implement quarantine measures, and enact standards for the safe production of chemical , biological, and other materials.5 It would, Owen hoped, lay the groundwork for both the coordination of existing national-level health efforts and for a significant increase in the national government’s role in ensuring the public’s health. At first, there appeared to be strong momentum in...