restricted access 9. Health Divided
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chapter nine health divided Long a central player in debates over federal policy dealing with individual medical services, the PHS was largely sidelined after 1948, when Thomas Parran was ousted from the position of surgeon general after a dispute with Truman’s federal security administrator, Oscar Ewing. The already dim prospects for national health insurance, meanwhile , faded further. Although Harry Truman advocated a national health insurance program during the 1948 election and clashed with the AMA over the issue during 1949, the barriers to such a program were high: the Democratic Party was increasingly divided along regional lines, a growing number of Americans received insurance through their employers, and the AMA remained implacably opposed. After Truman’s failed 1949 push for insurance , the Social Security Board and other insurance proponents embraced an incremental approach that focused on securing hospital insurance for the elderly. Ultimately, this approach would result in the enactment of Medicare and Medicaid. The PHS, for its part, concentrated on shoring up what were now its core areas of strength: the CDC and the NIH. The Truman Administration and Thomas Parran Despite his strong advocacy for President Truman’s health program, Thomas Parran had no real relationship with the nation’s new chief executive . In August 1947, Truman appointed Indiana Democrat Oscar Ewing to head the Federal Security Agency, which had overseen the PHS since it left the Treasury Department in 1939. An important player in the Democratic Party, Ewing helped persuade President Roosevelt to choose Truman as his running mate in 1944. As FSA chief, Ewing quickly became embroiled in a personal dispute with Parran over a grant application to the NIH. Dr. Walter Kempner, a German refugee who worked at Duke, had treated Ewing’s wife.1 When Kempner’s request for NIH funding was rejected, Ewing decided to appeal directly to Parran. Parran looked into the matter and agreed with the NIH’s conclusion that Kempner’s work should not be funded. At this point, Ewing turned decisively against the surgeon general. 180 : CHAPTER NINE He began refusing to approve Parran’s appointments for various advisory committee positions at the NIH, making it difficult for the organization to function and infuriating Parran. “The situation,” Ewing later admitted, “got rather critical. Some of the institutes couldn’t function because their advisory committees could not muster quorums.” Enraged, Parran confronted Ewing and told him that the appointments had to be approved. Ewing asked, dismissively, “Who is going to make me?” Parran ultimately relented, but the episode led directly to the end of his tenure as surgeon general. “The whole experience,” Ewing explained, “annoyed me so much that when Dr. Parran’s term as Surgeon General expired the following May [1948], I did not recommend him for reappointment .”2 In Parran’s place, Truman appointed Leonard Scheele, a younger physician who had joined the PHS in the midst of the Great Depression.3 Dr. Scheele, Ewing recalled, “was just as cooperative as anyone could be.”4 Parran’s ouster marked a crucial turning point for the PHS, causing its leaders to focus on consolidating existing programs such as the CDC and NIH and making clear the limitations on its authority. North Carolina state health officer Carl Reynolds, writing to Parran, expressed dismay. “To my mind,” he told Parran, “it proves that [Harry Truman] is a small town, pinhead politician, whose interests lie in what he thinks to be expedient to his political needs,—self-aggrandizement—rather than to the interest and welfare of the people of these United States. The President slipped a cog this time and it is now my fervent hope he will fall in his political quagmire, and I am a Democrat.”5 Truman and Insurance Parran’s demise meant the end of the PHS’s commitment to a comprehensive national health program linking public health and individual medicine . President Truman, however, began to speak out more and more on the issue of health insurance. Facing an election in 1948, Truman campaigned against the “do-nothing” Republican Congress. Among the policies Truman promised to enact if elected to his own term with a Democratic majority was a health insurance program modeled along the lines of that still being pushed by Isidore Falk, Arthur Altmeyer, and the Social Security Administration (formerly the Social Security Board, but renamed and reorganized in 1946). The Democrats, however, were deeply divided. After Roosevelt’s death and the end of World War II, Truman emerged as a restrained but...