restricted access 7. An Integrated Approach
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chapter seven an integrated approach After the enactment of the Social Security Act in 1935, President Roosevelt created an Interdepartmental Committee to Coordinate Health and Welfare Activities. The inelegantly named committee was headed by Josephine Roche of the Treasury Department. It was given the important role of facilitating communication among the various federal departments and agencies dealing with issues of health and welfare. Under the auspices of the Interdepartmental Committee, the PHS, the Social Security Board, and the Children’s Bureau worked together to develop a plan for future federal efforts in the realm of health. During 1938, the Interdepartmental Committee introduced and pushed for the adoption of a new National Health Program. Presented at a presidentially sponsored National Health Conference, the National Health Program embodied the goal of linking public health and individual medical services now being articulated by the PHS under Thomas Parran’s leadership. It also embraced the goals of the Social Security Board, which administered much of the social security program. Though interested in the broader program, the Social Security Board was particularly committed to the creation of a federally backed health insurance system. Many of the participants in the 1938 National Health Conference believed the comprehensive plan introduced at it might soon lead to a new set of additions to the Social Security program. This chapter deals with the politics of the 1938 National Health Program and the 1939 Wagner Health bill that followed on its heels. For scholars focused on national health insurance, the National Health Program and the Wagner bill have largely been of interest because of their insurance components , which received strong opposition from the AMA. Although the insurance provisions were the most important aspects of these proposals from the perspective of the Social Security Board, they were the least important aspects from the perspective of the PHS. For the PHS, the National Health Program represented a framework for bringing together public health and individual medical services. Rather than insurance, Thomas Parran and other PHS leaders continued to hope that economic insecurity arising out AN INTEGRATED APPROACH : 141 of ill health could be confronted through a comprehensive system. This system , they hoped, would include government payment for medical services, funding for biomedical research, and funding for facilities construction. Despite hopes that the conference had created the momentum for a major policy breakthrough, a set of interlocking factors ensured that the plan would not become law. Primary among them were the pushback against the New Deal manifested in the emergence of the conservative coalition and in the 1938 midterm elections, the response of the AMA, divisions within the Interdepartmental Committee, and the gathering likelihood of war in Europe. Nonetheless, there was room for compromise. As in 1934 and 1935, the AMA’s leaders worried that the president and his allies in Congress might successfully push for health insurance. Meeting with members of the Interdepartmental Committee after the National Health Conference, representatives from the AMA offered a deal: they would support the health program if the committee would agree to drop the provisions that allowed for federally backed insurance plans at the state level. Interdepartmental Committee chair Josephine Roche, pushed by the Social Security Board’s Isidore Falk and Arthur Altmeyer, rejected this compromise . The reasons for this decision were both substantive and political. Both Roche and the Social Security Board strongly supported health insurance, which they viewed as a critical next step in American social policy. Abandoning it in order to pursue compromise with the obstructionist AMA did not appear an appealing option. The AMA, they believed, was offering to endorse aspects of the health program that it would have accepted regardless . Isidore Falk and Arthur Altmeyer recognized that insurance was the aspect of the National Health Program with the least support. For the board, it appeared that the prospects for an insurance program would be much improved if it was part of a broader plan that included more popular and less controversial proposals for expanded maternal and child health programs , public health, and hospital construction.1 The decision not to compromise with the AMA in the aftermath of the National Health Conference was a critical one. Already during the development of the Social Security Act, President Roosevelt had indicated his commitment to avoiding a clash with the organization over insurance. With the political context now far less favorable, AMA support was a necessary condition for legislative progress. Even had the Interdepartmental Committee and the AMA reached a compromise, however, Roosevelt might not...