By David Hoskins
On Nov. 19, 1945—just three months after the brutal atomic bombings of Hiroshima and Nagasaki, Japan—President Harry Truman became the first sitting U.S. president to propose a national health insurance program.
Truman unveiled his five-point plan for universal health care in a special message to Congress. He emphasized that “everyone should have ready access to all necessary medical, hospital and related services.”
The plan’s centerpiece was expanding compulsory insurance under the Social Security system to cover medical, hospital, nursing, laboratory and dental care. Other key points included federal funding for hospital construction, expanding public-health services, increasing investment in medical education and research, and a cash benefit in the event of sickness and long-term disability.
The Truman plan was introduced to Congress in the form of a revised Wagner-Murray-Dingell Bill. The original bill had been introduced in 1943 by Democratic Sens. Robert Wagner of New York and James Murray of Montana, along with Rep. John Dingell Sr. of Michigan—and it never came to a vote in Congress.
The revised bill was doomed to a similar fate.
The plan was supported by a coalition of workers and farmers led in part by the American Federation of Labor and the National Farmers Union.
Conservative mobilization defeated reform
The program envisioned by Truman had its own set of flaws, including an exception that allowed physicians to reject patients covered by the plan in favor of those patients who could afford to purchase private coverage or pay for services outside of the universal insurance system.
Truman went to great lengths to assure potential opponents that his plan was not a form of “socialized” medicine. It certainly was not like the totally free, non-profit state health systems being set up in East European countries where capitalism had been uprooted. Nor did it go as far in building government-owned health facilities as Britain’s national health system, which was set up by the Labor Party after the war under great pressure from the working class.
However, Truman’s attempt to inoculate himself from criticism did not prevent opponents from red-baiting the plan. The American Medical Association took the lead in mobilizing opposition.
The Journal of the American Medical Association described the plan as “the discredited system of decadent nations which are now living off the bounty of the American people—and if adopted here it would not only jeopardize the health of our people but would gravely endanger our freedom. It is one of the final, irrevocable steps toward state socialism and every American should be alerted to the danger.”
Reaction was riding so high that in 1947 a key House subcommittee investigating national health insurance charged that Truman’s plan was a communist plot supported by known communist sympathizers working within federal agencies.
The AMA spent millions of dollars and hired the public relations firm Whitaker and Baxter in 1948 to help wage its aggressive anti-reform campaign. The Chamber of Commerce, the American Bar Association and the American Legion were among the organizations backing the AMA drive to block universal coverage. The campaign was the most expensive in U.S. history at the time.
The accusations leveled by the conservative opposition were emblematic of the emerging McCarthy period of anti-communist repression. The legislation effectively died in committee before Truman’s term ended.
Cold war influenced Truman plan
Truman did not launch the struggle for health reform. The American Association of Labor Legislation had pushed for a form of national health insurance back in 1906. The American Federation of Labor actually opposed this effort, acting in its narrow bureaucratic interests out of fear that universal coverage would undermine the importance of union membership.
In 1912 Theodore Roosevelt’s Bull Moose Party platform called for “a system of social insurance adapted to American use.” The 1906 and 1912 efforts were unable to gain significant momentum, and President Franklin Roosevelt later failed to throw his support behind calls to include national health insurance as part of the New Deal legislation.
Truman did not have a reputation as a committed progressive reformer. In fact, FDR’s selection of Truman as his running mate in the 1944 election was part of a shift to the right.
Vince Copeland, a founding leader of Workers World Party, described Truman’s selection in his book “Market Elections: How Democracy Serves the Rich.” Copeland wrote: “In 1940, the ‘left’ New Dealer and Secretary of Agriculture Henry Wallace was chosen for the second spot. … In 1944 Roosevelt maneuvered Wallace out of consideration and gave the vice president slot on the ticket to Harry Truman, who was in the right wing of the New Deal. … A great number of commentators, including some radicals, have observed that U.S. history was changed by this decision, since Truman became an architect of the Cold War, whereas Wallace was a fierce opponent of it.”
Truman took office following Roosevelt’s death early in 1945. By the time he proposed his national health insurance plan, World War II had come to a close.
The war had brought about the defeat of German, Italian and Japanese imperialism; severely diminished the capacity of Britain and France; and positioned the U.S. as the dominant imperialist power. The war also ended with the Soviet Union’s historic victory over fascism and the defeat of the German Nazi armies. A new dynamic thus emerged which lent itself to the intense competition between the systems of capitalism and socialism known as the Cold War.
Truman’s health reform plan was tied to the U.S. ruling class’s attempt to prevent the rise of widespread revolutionary sentiment at home and abroad. The Bolshevik Revolution of 1917 had brought with it a form of socialist medicine and the promise of health care as a right to workers across the globe. Truman’s plan was an attempted appeal to convince workers at home that capitalism could provide for their health. This appeal died in committee alongside the plan.
Truman also explicitly linked his health plan to the needs of the U.S. military, which he saw as a necessary force to smash the emerging tide of revolutions and national liberation struggles.
In his 1945 message to Congress, Truman spoke of the connection between inadequate health care and military service: “As of April 1, 1945, nearly 5,000,000 male registrants between the ages of 18 and 37 had been examined and classified as unfit for military service. … After actual induction, about a million and a half men had to be discharged from the Army and Navy for physical or mental disability, exclusive of wounds. … Among the young women who applied for admission to the Women’s Army corps there was similar disability.”
Then he added, “These men and women who were rejected for military service are not necessarily incapable of civilian work.”
Truman’s statement makes it clear that, for a sizable wing of the U.S. ruling class, health-care reform was not an issue of justice but rather a matter of “national”—that is, class—security.
Next: Soviet medicine—a workers’ health plan