- Doctors and Reformers: Discussion and Debate over Health Policy: 1925-1950 (review)
- Journal of the History of Medicine and Allied Sciences
- Oxford University Press
- Volume 58, Number 3, July 2003
- pp. 385-386
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Journal of the History of Medicine and Allied Sciences 58.3 (2003) 385-386
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Jonathan Engel. Doctors and Reformers: Discussion and Debate over Health Policy: 1925–1950. Columbia, South Carolina, 2002. xvii, 407 pp., illus. $24.95.
Morris Fishbein, M.D., was once a household name in the United States for his blustering crusade against “socialized medicine.” As the editor of the Journal of the American Medical Association from 1924 to 1949, Fishbein wielded such influence that he was known as “Mr. AMA.” Jonathan Engel’s new book covers the volatile debates over health care reform that took place during the “era of Fishbein.”
Most of Engel’s narrative will be familiar to U.S. historians, from the voluntary insurance proposals in the 1920s by the Committee on the Cost of Medical Care, to the activities of various New Deal agencies that attempted to add health insurance to the Social Security Act, to the failure of Truman’s national health care program in 1948. Engel’s contribution is to add extensive material from little-used archives, including the papers of reformers Isidore Falk, John Peters, and Michael M. Davis, as well as their notorious opponent Fishbein. From his thorough reading of these sources, the author presents an impressively detailed, yet highly readable, description of internal committee debates, the reform proposals they engendered, and the sometimes thoughtful, sometimes hysterical responses of politicians, physicians, and journalists.
Engel does a particularly good job of portraying diversity and dissent among doctors and reformers. He demonstrates that, despite Fishbein’s hegemony, “a significant portion of the physician community actively opposed the stated policies of the AMA” during its well-financed and ferocious campaign against health reform (p. 171); the book discusses their organizations and writings in detail. Reformers too experienced internecine struggles over power and ideology. The experts of New Deal and Truman-era committees fought, sometimes bitterly, over issues such as means-tested versus universal coverage and federal versus state control in their proposed health care systems. Engel finds fault with the overheated rhetoric and overblown claims of both the AMA and reform leaders, and argues that both failed to reflect the more temperate views of most physicians and the public.
In contrast to his complex and thoughtful narrative, Engel’s explanation for the failure of health reform is simple, indeed dismayingly so: “Americans simply did not want national health insurance” (p. 201). This sweeping perspective is no more demonstrable or useful than one that portrays greedy special interests defying a monolithically pro-reform American populace. [End Page 385] Even if opinion polls supported it (which they arguably do not), Engel’s assertion posits an automatic and direct relationship between public opinion and policy that has long been discredited by scholars. The author provides no evidence for his repeated statements about the beliefs and desires of the public; and his argument is further weakened because he never engages or refers directly to any of the secondary literature on the history of health reform.
Again unlike Engel’s carefully documented and detailed treatment of health reform debates, his discussion of voluntary health insurance is riddled with inaccuracies and overgeneralizations. Once Americans were offered the option of private, voluntary health coverage, he argues, they became “quite happy with their new lot” and rejected national insurance (p. 221). Engel assumes that for this reason labor unions always preferred their own benefit schemes to a government alternative. But the International Ladies’ Garment Workers’ Union (ILGWU), the Typographical Union, and the Western Federation of Miners, among others, provided health care for their members and advocated a more universal system. (The book lists the ILGWU as an opponent of compulsory health insurance in the 1910s, when in fact they were the legislation’s most active union supporter.) “Private insurance,” Engel writes, “would be a permanent fixture of any solution, not because it was politically potent, but because it worked and people liked it” (p. 257). But Engel offers no evidence for this or other assertions about voluntary health insurance, which...