and have continued to do so since.
TWENTIETH-CENTURY CAMPAIGNS FOR HEALTH CARE REFORM
In the 1940s, new potential for grassroots mobilization arose when organized labor became a major backer of national health insurance. As the cost of medical care began eating up more of the average worker’s budget, both the AFL and the Congress of Industrial Organizations (CIO) took leadership roles in the struggle for health reform. In 1943, labor unions joined the reformerexperts of the Committee for the Nation’s Health and liberal administration officials in drafting the Wagner–Murray–Dingell bill (named for its congressional sponsors), the major health insurance legislation of the Truman era. This bill proposed a national medical insurance program financed through social security payroll taxes, and it enjoyed the strong support of Harry S. Truman.
During the struggle over Wagner–Murray–Dingell, the opportunity to mobilize a broad-based movement was once again lost. Labor leaders and policy intellectuals believed they could make change from within the system and so did not need the organized activity of union members to back up their efforts. The “failure of union leaders to enlist union members in the battle,” historian Alan Derickson argues, was “a crucial flaw in the campaign for health security.” Both AFL and CIO leaders, aiming for a place in the postwar power structure, “discouraged rank-and-file initiatives” and “never considered grassroots mass mobilization.” The lack of rank-and-file participation greatly weakened the cause of union-led health reform as it became associated with “union bosses” rather than ordinary workers. The other major reform backer, the Committee for the Nation’s Health, a successor to the CCMC with many of the same members, also decided not to solicit grassroots participation on behalf of the Wagner–Murray–Dingell bill, arguing that it lacked the funds to organize local branches.9
Reformers needed all the help they could get to fight an unprecedented onslaught by the AMA. After Truman’s electoral victory in 1948, the doctors’ organization spent over $1 million on an anti–health reform public relations blitz that included advertising, television and radio spots, telegram and letter-writing campaigns, and the lobbying of legislators by their own personal physicians. Unlike reformers, AMA members successfully reached out to the grassroots with “doctor-to-patient” letters denouncing the Wagner–Murray– Dingell bill.10 And in the midst of the Cold War, health reformers’ insider status made them vulnerable to opponents who saw a Soviet-inspired conspiracy for “socialized medicine” at the very heart of the federal government. Prospects for the passage of the health bill vanished when most of its congressional supporters were unseated in 1950 with the help of the AMA’s campaign.11
By then, organized labor’s attention had turned elsewhere. Unions were increasingly winning health benefits for their members through collective bargaining agreements with employers, so the need for national reform seemed less urgent. The failure of national health legislation further encouraged labor to pursue private solutions, while these solutions themselves, by meeting the needs of at least some of America’s workers, made it more difficult to argue for systemic change. Organized labor would continue to be a major supporter of universal health care proposals, particularly through Walter Reuther’s Committee for National Health Insurance in the 1970s. But, “because most of the working-class constituency for social insurance had been accommodated , the potential for building a mass movement . . . dwindled.”12
9.Alan Derickson, “Health Security for All? Social Unionism and Universal Health Insurance, 1935–1958,” Journal of American History 80: (1994): 1333–1356 (quotes from pp. 1342–1343); Gordon, Dead on Arrival, 413.
10.Gordon, Dead on Arrival, 339. See also Monte M. Poen, Harry S. Truman vs the Medical Lobby: The Genesis of Medicare (Columbia: University of Missouri Press, 1979).
11.Alan Derickson, “The House of Falk: The Paranoid Style in American Health Politics,” American Journal of Public Health 87: (1997): 1836–1844; Marmor, Politics of Medicare, 12–14.
12.Derickson, “Health Security for All?” 1355. On the postwar rise of employer health benefits, see Marie Gottschalk, “The Elusive Goal of Universal Health Care in the US: Organized Labor and the Institutional Straightjacket of the Private Welfare State,” Journal of Policy History II, No. 4: (1999): 367–398; Jennifer Klein, “Managing Security: The Business of American Social Policy, 1910s–1960” (PhD diss, University of Virginia, 1999); Raymond Munts, Bargaining for Health: Labor Unions, Health Insurance, and Medical Care (Madison: University of Wisconsin Press, 1967). On the Committee for National Health Insurance, see Starr, Social Transformation of American Medicine, 382, 404.
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