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    "ocrText": "PPF 1031\nMILBANK, JEREMIAH\nKINGSBURY, John A.\nMilbank Memorial Fund,\nNew York City.\nSee 944 for President's letter dated November 2,\n1933, to -- regarding Mrs. Harrison Eustis\nwho has used trained dogs in connection\nwith infantile paralysis cases.\n1031\nMILBANK, JEREMIAH\nTOMI\na quarterly, which 1 am sending under sepa-\nrate cover in the hope that you will have an opportunity to glance at\nit, I have outlined briefly a plan which I have formulated as a result\nFDR-MD\nDecember 4, 1935.\n1031\nDoor John:\nI on dolighted to have your 1n-\ntoresting lottor. I wish much you would\nhave n talk with the Socretary of Labor,\nthe Secretary of the Interior and the\nli\nHoad of the Public Health Service. I\nan inclined to think that by noxt wintor\nit will be time for us to tako up the\nGeneral hoalth problem from the national\npoint of view.\nX103 Gen\nt PPF 528\nAlways sincerely,\nJohn A. Dingsbury, Enq.,\nMilbank Monorial Fund,\n#\n40 Wall Street,\nNew York City.\nMILBANK, JEREMIAH\nin the Milloank Quarterly, which 1 am sending under sepa-\nrate cover in the hope that you will have an opportunity to glance at\nit, I have outlined briefly a plan which I have formulated as a result\nMILBANK MEMORIAL FUND\n40 WALL STREET NEW YORK\nOFFICE OF THE SECRETARY\nNovember 24, 1933\nDear Mr. President:\nI wonder if by any chance you saw the outline of a\nnational health plan which I presented in the last Milbank Quarterly.\nIt was so widely and on the whole favorably reviewed, with editorial\ncomments in papers throughout the country, that I thought it might\nhave come to your attention in spite of the multitude of matters\nwhich are pressing through the fringe into the focus of your con-\nsciousness.\nBefore you went to Washington you were good enough to\nindicate that you would like to talk to me about national health, and\nI have sought several opportunities to do so; but I recognize that\nmore pressing matters were occupying your time and attention. In the\nopinion of most recognized experts, there is a health emergency facing\nthis country, the initial effects of which are just beginning to mani-\nfest themselves as a result of serious malnutrition. As Dr. Welch,\nof Johns Hopkins, said at our Advisory Council meeting more than a\nyear ago: \"Any undue retrenchment in health work is bound to be paid\nfor in dollars and cents as well as in the impairment of the people's\nhealth generally. .Undernourishment of children, for example, is\nnot likely to show itself immediately, but is bound to show its effects\nlater, when it is probably too late to remedy. The ground lost by\nundernourishment in childhood may never be regained.\"\nAt a recent meeting of the Administrative Committee of\nthe American Public Health Association, the existing emergency in\nstate, city, and local public health organizations was reviewed, and\nthe serious implications were recognized. Action was taken expressing\nenthusiastic support of the statement in your introduction to the\nNew York State Health Commission report, that nothing is more important\nto the State than the health of its people. And hope was expressed\nthat you would exert the great influence of your office to arouse the\npeople of the nation, as you aroused the people of your State, to the\nend that a national health plan might emerge.\nIn the Milbank Quarterly, which I am sending under sepa-\nrate cover in the hope that you will have an opportunity to glance at\nit, I have outlined briefly a plan which I have formulated as a result\n-2-\nof and conferences with Commissioner Parran, Homer Folks, Dr. Linsly Williams,\nwould be glad to have an opportunity to present a more detailed plan for your\nother recognized experts in this field. This is an outline only. I\nconsideration and to discuss the subject with at convenience. You\nwill find in this same number of our Quarterly you several your very important articles\non the results of the depression on the health of the people, which have grown\nwith the United States Public Health Service and the Health Service of the\nout of studies which we have been carrying on for the past year in cooperation\nLeague of Nations. Dr. C.-E. A. Winslow, Professor of Public Health, Yale\nUniversity, recently wrote me as follows concerning this report:\nThis is a most remarkable document not only on\naccount of your far-reaching and inspiring \"Health\nPlan for the Nation\" and the fascinating preview of\n\"Red Medicine\" but also for the very remarkable series\nof papers on the depression and its effects on health.\nI have seldom seen more of interest packed between\ntwo covers.\nI have, of course, been following with enthusiasm the develop-\nment of your great program step by step. Naturally, I have been hoping that\nyour program would soon embrace a health plan for the nation as comprehensive\nas the one which you developed for the State of New York. I want you to know\nthat all those who worked with you then are ready to respond to your call at\nany time, Indeed, I wish I might go to Warm Springs to discuss this important\nmatter with you.\nThe Litvinov dinner last night was indeed an historical occasion.\nI wish you could have heard the round of continuous applause when Colonel\nCooper stated that this would go down in history as one of the great achievements\nof your administration. I most heartily congratulate you upon the outcome of\nthese important negotiations.\nCordially yours,\nJohnasKing\nSecretary\nThe Honorable Franklin D. Roosevelt\nWarm Springs\nGeorgia\nJAK: EB\n1031\nPERSONAL\nWaxm Springs, Ga.,\nDecember 4, 1934.\nMy dear Mr. Milbank:-\nPerhaps you have read of the plan\ninitiated by Colonel Henry L. Doherty and approved\nby the Trustees of the Georgia Warm Springs Foundation,\nfor holding on January 30, 1935, throughout the Nation,\nin every town and community, a Birthday Ball in honor\nof my fifty-third birthday.\nI am enclosing copies of the letters\nwhich fully describe the purpose of this birthday\ncelebration and how the funds so raised will be used.\nAs a part of this plan, thirty per cent of the money\nis to be presented to me by the National Committee\nfor the Birthday Ball for the President, which money\nI will in turn give to a special commission for the\nexpress purpose of advancing through financial ase\nsistance, the research work now being carried on in\nthe fields of Infantile Paralysis immunization and\nprevention.\nI have designated this special com-\nmission \"The President's Birthday Ball Commission for\nInfantile Paralysis Research\" and I am asking that\nyou serve as a member and Vice Chairman of this\nCommission.\nThe Commission itself will consist\nof eleven people, the Chairman of which will be\nColonel Henry L. Doherty and you, of course, as Vice\nChairman.\nSee P.P.F. 310\"The President's Birthday Ball Commission for\nMILBANK, JEREMIAH\nInfantile Paralysis Research\" for correspondence\nIt is my thought that if you and the other\nmembers of this Commission will meet shortly and plan\nthe necessary machinery for the functioning of your\nCommission, and also the appointment of an Advisory\nMedical Committee, should you deem it wise, that your\nplans can be so comprehensively laid that only a second\nmeeting will be necessary after the nation-wide cele-\nbration is over and the amount of money is ascertained.\nPerhaps at this meeting you could appoint a small\nexecutive committee to disburse, if possible, the funds,\nbe\nwithin a period of twelve months, BO that early financial\nassistance may be given to bring about this vital and\nfar-reaching objective.\nI have followed with interest the splendid\nwork which you have done toward the welfare of your\nfellow citizens, and I can assure you that it has given\nme great personal pleasure to have you accept this\nappointment.\nAlways sincerely,\nJeremiah Milbank, Esq.,\n40 Wall Street,\nNew York, N. Y.\nMILBANK, JEREMIAH\n(Enclosures)\nMORGAN, Hon. Keith\nNew York, N.Y.\n1031\nJune 17, 1937\nWrites Miss LeHand, submitting suggested letters which the\nPresident may want to use in writing the members of the President's Birth-\nday Ball Commission for Infantile Paralysis Research and Advisory Medical\nCommittee to the President's Birthday Ball Commission for Infantile Paralysis\nResearch. - Chairman Jeremiah Milbank wrote the President on May 17 send-\ning copies of two reports, one by Dr. Paul deKruif, Sec. of the Commission\nand second, a letter from Dr. George W. McCoy, Chairman of the Advisory\nMedical Committee, giving their views and results or this work so far. -\nOn May 17, Henry L. Doherty also sent the President his report re this work.\nOn June 29, the President wrote to the following, thanking them for their\nservices and fine work: These are similar letters but not identical -\nChairman Milbank, NYC; Dr. Donald B. Armstrong, NYC; John S. Burke, NYC,\nMrs. James Couzens, Birmingham, Mich. (widow of Senator Couzens, who was on\nthis Commission); Dr. DeKruif, Holland, Mich.; Edsel B. Ford, Fordson,\nMich.; Rev. Dr. Raymond B. Fosdick, NYC; Edward S. Harkness, NYC, Dr. Geo.\nW. McCoy, Wash., D.C.; Mrs. Wm. J. B. Macaulay (formerly Mrs. Nicholas\nBrady), Rome, Italy; Dr. Max M. Peet, Ann Arbor, Mich.; Dr. Thomas M.\nRivers, NYC; Lessing J. Rosenwald, Abington, Pa.; Felix Warburg, NYC; --\nOn June 30, Mr. Morgan wrote Miss LeHand asking re these letters and also\nsuggesting a press release on this subject. - Mr. Early wrote Mr. Morgan\non July 12, saying he has condensed this 8--page report to a 4-page digest\nfor a press release. Asks for comments. - Mr. Morgan wrote Miss LeHand on\nJuly 13 further re this subject. - Mr. Morgan wrote Mr. Early on July 14,\nsaying press release has the approval of Basil O'Connor and himself. --\nOn July 16, Mr. Early replied suggesting this be released on or about\nJuly 25th. Asks advice. - Mr. Morgan replied July 21st leaving release date\nup to Mr. Early. - Attached is press release dated Wednesday, July 28th.\nSEE - P.P.F. 310 - The President's Birthday Ball Commission For\nInfantile Paralysis\nResearch.\nvmb\nP.P.E.\nP.P.\n1031\nApril 6, 1938.\nPersonal\nMy dear John:-\nI am greatly appreciative of your\nletter -- it is the kind I need -- and I am\ndelighted with your pamphlet.\nThe same old crowd that has fought\nus so often 1s still at it -- and only death\nwill mend their ways. Nevertheless, you are\nright about the plain people of this country.\nxpp782\nEven if it is almost impossible for them to get\nxpp74962\nto\nhonest news, they sense that fact and still be-\nlieve in people who are working for them.\nI do hope to see you one of these\ndays.\ne\nAlways sincerely,\nJohn A. Kingsbury, Esq., #\n3 Fairfield Place,\nYonkers,\nNew York.\nMarch 29, 1938\nDear Mr. President:\nPermit me to congratulate you on your admirable Gainsville\nSpeech. It ought to convince economic royalists and fascists that,\nin your fight on behalf of the submerged third, you will never beat\nretreat, despite their barrage of echo lett rs and telegrams.\nAs I have wired you on similar occasions: I am confident that\n\"the world steps aside for the man who knows where he is going\".\nUnhappily this is true momentarily, oven when he is going in the\nwrong direction, but surely is an eternal truth when the man is going\nin the right direction, as you certainly are.\nI said this to Aubrey Williams a few days ago and he suggested\nthat it would be encouraging to have an old friend say it directly\nto you. From what I hear in my travels, I am confident that the\nplain people of America believe in you as they always have. They\nare still strongly back of you. They are not deceived by the cry\nof voices in the subsidized press, any more than they were in 1936.\nYou may be interested to know that, although I was fired from\nthe Milbank Fund, largely because I loaned its expert staff to your\nCommittee on Economic Security, I am still working, through all\nchannels open to my voice and pen, to make medical care available\nto all the people.\nI wish you might find time to read my \"Pugsley Award\" Address\nentitl a \"Health Insurance in a National Health Program\", inclosed\nherewith. I venture to think it may be worthy of your attention,\nX121-A\nsince it has been so highly commended by Dr. Parran, Sir Arthur\nx103\nNewsholme and other distinguished health authorities. If it does\ninterest you I would be glad to have the privilege of a talk with\nyou about the plan therein outlined.\nWith highest esteem and admiration for your Lincolnion fight\nto free the people from economic slavery, I am, as ever\nSincerely your friend\nJAK:AB\nHon. Franklin D. Roosevelt\nJohn a Kingshing\nWarm Springs, Georgia\nMarch 29, 1938\nDear Miss Lehand:\nAubrey Williams suggested that if I sent you the inclosed\nletter to the Presid nt it would reach him. I recall that\nin the old days this was always true, but I have felt that, under\npresent circumstances, it was hardly fair to bother you.\nHowever, since I have rarely had a reply to anything I have\nsent \"through regular channels\", I am venturing to ask you if you\nwill be good enough to bring the inclosed to the President's\nattention. At least once in four or five years, I would like him\nto know that I am one of many old friends who are still standing\nby; and that, in this disjointed world, I glory in the fight ne\nis making for the plain people. Indeed, his fidelity to their\ncause, his courageous spirit, is one of the few bright spots on\nthe dark horizon.\nI know the President is deeply interested in the ubject of\nR\nthe inclosed paper, and I venture to believe the plan outlined\nwill appeal to him.\nAssuring you that I will a preciate your kindness in bring-\ning my letter and inclosure to the President's attention, with\nkindest personal regards and admiration for the great service\nyou continue to render to the President and to the country, I\nam\nSincerely yours\nJAK:AB\njohnashiphing\nMiss Margaret Lehand\nWarm Springs, Georgia\nXPP7200 Ginsville speech\nPP7. - 1031\nMORGAN, Keith\nCOMMITTEE FOR THE CELEBRATION OF THE\nPRESIDENT'S BIRTHDAY\nNew York City, N. Y.\nJune 12, 1942\nLetter to Miss Tullyy saying that he has a letter from\nJeremiah Milbank advising that he has in his files three years correspondence relating\nto the President's Birthday Ball Commission for Infantile Paralysis Research. Mr. Milbank\nwas the Vice Chairman, but actually the Acting Chairman of this group, and he wants to\nknow what to do with these files. Mr. Morgan thought possibly the President might like\nto have them for the Franklin D. Roosevelt Library as they evidently have some interesting\ninformation in them. Ackd. June 16, 1942, by Miss Tully saying that the President would\nlike very much to have this file for the Library and asks Mr. Morgan to make the arrangements\nfor them to be sent direct to Mr. Shipman at the Library.\nSEE - PPF 4885 - Committee folder\nVSI\"\nmcg\nP.P.F\nKINGSBURY, John A.\n1031\nLavorika, Shady, N. Y.\nApril 17, 1944.\nWrote the President concerning a report which Governor Thomas E.\nDewey made and was published in The New York Times on April 15th, entitled \"Report\non the First Year of His Governorship,\" wherein he virtually charges the President and\nhis other immediate predessors with failure to recognize the vital importance of\nPublic Health to the people of the state. Mr. Kingsbury felt that the public's at-\ntention should be called to the Governor's gross misrepresentations and therefore he\nhas written a letter to the Editor of The New York Times which it is hoped will be\npublished. Encloses a copy for the President's information. In closing Mr. Kingsbury\nsays he hopes the President is feeling fit again and that Mr. Harry Hopkins will re-\ngain his health in order to relieve the President of some of his heavy burden. - -\nPresidential Memorandum for the Surgeon General of the Navy dated April 21, 1944, the\nPresident forwarded the above letter from Mr. Kingsbury and said \"Admiral McIntire to\nread with great care and prepare a le tter to Dr. John Kingsbury. Be rougher than you\nhave been before.\" The President wrote Mr. Kingsbury on May 3, 1944, thanking\nhim for bringing to his attention the inaccuracies in Governor Dewey's statement on\nhealth conditions in his report on his first year in his governorship. The President\nagrees with Mr. Kingsbury in calling to the attention of the people of the State his\ninaccuracy in stating that the health department of the State of New York has grown\nlike Topsy. Says that Mr. Kingsbury is correct in his statement that the organization\nof a special commission to make recommendation to the governor resulted in making the\n1913 law operate efficiently. The President looks with great pride on the fine work that\nhas been done in the care of tuberculous citizens of New York. Another outstanding con-\ntribution made by the Health Department during those years while the President was\nGovernor was the improvement in the care of mental patients, and New York today stands\nas a fine example of what can be done for those unfortunates. In closing the President\nsays that Mr. Kingsbury or he has no reason to apologize for anything at all that was\ndone through the years in which they were responsible for conducting the affairs of the\nPublic Health Service of the State of New York.\nPenciled\nnotation\n-\nCopy\nof\nthis\nreply sent to DE. McIntire's Office - 5-4-44.\n-\n-Telegram to the President from Mr.\nSee - 3850\nKingsbury dated May 8, 1944, requesting permission\nto publish the President's letter to him of May 3,\n1944, Further states that N.Y. Times has refused\nto publish his letter but is hopeful of getting\nPM and Chicago Sun to publish it. - Memo to\nMr. Early May 9, 1944, from Mr. Blake stating that\nhe talked it over with Judge Rosenman, who felt\nthat the President should not be drawn into the\nsituation but that Dr. Parran, mentioned in Mr.\nKingsbury's letter to N.Y. Times should reply. - -\nMr. Early in a letter to Dr. John A. Kingsbury on\nMay 9, 1944, re request to quote from the Presi-\ndent's letter of May 3rd. Says that the letter\nwas a personal letter and not written with the\nthought of its publication and does not think it\nshould be released to the Press.\n\"I heartily concur in the decision of the Conference\nto give you the award for the outstanding contribution to\nthe meeting. What an enormous amount of time and thought\nmust have gone into the preparation of this article! It\nis the most complete statement of all of the health needs\nof the country that I have seen. \"\nQuoted from letter from Hon. Thomas Parran, Jr , M.D.\nSurgeon General of the United States Public Health Service.\nSOCIAL work 01 an those presented NY\nnual meeting. The Pugsley Award is the gift of Chester D. Pugsley and\nhas been granted after each annual meeting for the past several years.\nReprinted for private circulation from\nTHE PROCEEDINGS OF THE NATIONAL CONFERENCE OF SOCIAL WORK\n64TH ANNUAL SESSION (Indianapolis, Indiana, 1937)\nPRINTED IN THE U.S.A.\nHEALTH INSURANCE IN A NATIONAL\nHEALTH PROGRAM\nJOHN A. KINGSBURY\nTHE 1937 PUGSLEY AWARD\nThe Conference Editorial Committee voted unanimously that Mr. Kings-\nbury's paper made the outstanding contribution to the subject matter of\nsocial work of all those presented by professional social workers at the an-\nnual meeting. The Pugsley Award is the gift of Chester D. Pugsley and\nhas been granted after each annual meeting for the past several years.\nReprinted for private circulation from\nTHE PROCEEDINGS OF THE NATIONAL CONFERENCE OF SOCIAL WORK\n64TH ANNUAL SESSION (Indianapolis, Indiana, 1937)\nPRINTED IN THE U.S.A.\nNATIONAL HEALTH INSURANCE\n475\nof America had been organized to serve their cause with half the\nzeal with which the American Medical Association served its\nvested interest in sickness, wage-earners and others of small\nHEALTH INSURANCE IN A NATIONAL\nmeans would not have been left unprotected against the serious\nHEALTH PROGRAM\neconomic consequences of illness. A small, selfish group so con-\ntrived that America's program for social security was brought\n(PUGSLEY AWARD)\ninto being without health insurance. Accordingly, our system\nJohn A. Kingsbury, Associate Fellow\nof social security lacks completely that unit which long ex-\nNew York Academy of Medicine\nperience abroad has shown is the first essential in social insur-\nYonkers, New York\nance. We are still without protection in this country against\nthe costs of sickness, despite the fact that in ordinary times\nsickness is the principal cause of poverty and dependency.\nI\nA comprehensive national health program should be designed\nT\nfare HERE of is no greater need today, in promoting the wel-\nnot only to protect all the people from contagious disease, to\nour nation, than a comprehensive national health\npromote their health and vitality, to give special protection to\nprogram. Within the framework of economic\nmothers and children, but also to furnish protection against\nprogram. insurance must have an important place in compulsory any such\nhealth and under existing conditions of social insecurity, our system\nwage loss and to make good medical service available to all the\npeople. Our health services have grown up without plan or\ndesign. It is time that this was reduced to order and the glaring\nThe more Social Security Act of 1935 provided for the\ndeficiencies were made good.\nthan of adequate federal, state, and local development\nThere are five broad elements in a national health program:\nSuch through have preventive we elapsed appropriations have encouraging hitherto services possessed. made as progress under In Titles has the been year public V and and made, health VI a of half especially the services which Act.1\n(1) public health; (2) protection for maternity, infancy, and\nchildhood; (3) public medical services; (4) medical-care insur-\nance; (5) disability and invalidity insurance.\nfare the public health and the wel-\nNo one of these is a substitute for any other. If we would\nauthorities can furnish to communities as whole public have been\nhave real protection of the nation's health, if we are to see the\ngreatly next strengthened, and more may be expected a in the\nmass of our people safeguarded against sickness, we must have\nloss of of small and moderate incomes to budget the\nfamilies ahead; but no provision was made to enable self-supporting years\nall five.\nThe five elements are not sharply separable, one from the\nwages suffered on account of disabling illness against among\nother. Each overlaps one or more of the others in scope, in con-\nto wage-earners and salaried workers, and no provision made\ntent, and in administrative method. I will not undertake to\nwhile give people protection against the costs of medical was If,\nelaborate the details of a comprehensive health program, but I\n1 Title that important act was before Congress, the social care. workers\nwill briefly characterize each of the main elements:\nservices V authorizes appropriations for grants to states for health\n1. A strong, co-ordinated public health program-co-ordinated among the\nhabilitation; studies, Title for crippled children, child welfare services, maternal and child re-\nfederal, state, and local agencies. The Surgeon General of the Public Health\nservices and VI authorizes appropriations for grants to states and for for vocational public health\nService is our recognized leader in this cause. He has mapped out his cam-\nfor investigations by the Public Health Service.\npaign and the nation is following him enthusiastically.\n474\n476\nNATIONAL HEALTH INSURANCE\n477\nJOHN A. KINGSBURY\n2. A comparable public service for maternity, infancy, and childhood. The\nII\nChildren's the Bureau, under the leadership of Miss Lenroot, has the vision and\n3. courage A to fight this cause. We are giving her our earnest support.\nI do not propose at this time to present in detail any particu-\ntax-supported development of those medical services which only\nlar plan of health insurance. I laid such a plan before this Con-\ngovernment and can furnish. This means principally state action, aided financially\nference at its Kansas City meeting in 1934, and my proposals\ntuberculosis, medical care of the handicapped, provision of specialized and expensive\ntechnically by the federal government. It deals with mental disease,\nmay be found in the Proceedings for that year. I do not advo-\ncenters, etc.\ncate any hard-and-fast plan. Nor do I favor compulsory health\n4. Medical-care insurance, state-wide in scope, with federal financial and\ninsurance as an alternative to public medicine or as an alterna-\nquality technical aid, and broad enough to guarantee comprehensive service of high\ntive to an extension of federal, state, and local public health\nmade to people of small and modest means and-through contributions\nfacilities. We now have public medicine, notably in the care of\n5. on their behalf from tax funds—to cover people without income.\nthe insane, the mental defectives, and the tuberculous. It is\nCompensation for wage loss from temporary and disability.\nnot a question of whether we shall have public medicine, but\nand The of machinery the of the federal-state system of unemployment permanent compensation\nwhether we shall have more of it-and I favor more of it.\nfederal system of old age benefits can deal with this program.\nPublic medicine is meeting a great need, and, in the main, it is\nThere are other elements to be considered in national health\nefficiently administered.\nprogram. the The special health aspects of education a and nutrition,\nI am in hearty accord with the plan for extension of public\nvocational provision of decent and healthful housing, the means for\nhealth facilities favored by the Surgeon General, by most of\nhalt, rehabilitation of the handicapped, the care of the\nthe leading state and local health authorities, and by many\nthe lame, and the blind-these and many others all have\nvoluntary health agencies. Of course, we need more and better-\nfive appropriate places within the broad framework outlined in the\nequipped health centers; more clinics for specific preventive\ncategories which I have enumerated.\nfunctions; more centers for the diagnosis and treatment of\nNo sensible group in our national life would object to four of\ntuberculosis and of the venereal diseases; and more maternity\nmy five cardinal points. A particular group objects to the\ncenters and baby and child welfare stations.\nfourth-medical-care to insurance. They have fought every move\nWe are making progress both in the direction of public\nmodernize our health program. Latterly, these have\nmedicine and public health service. But our progress is too\nattempted to hide their real purpose by pretending persons to take a\nslow. We are reaching hundreds of thousands through these\npositive instead of a negative and obstructive position. They\nfacilities and by voluntary health and hospital insurance, group\nare now shouting for public health and for medical care of the\nindigent. is But this, if I may be permitted to mix metaphors,\nmedicine, and contact practice; but we must meet the needs of\ntens of millions of our fellow-citizens. While we are cogitating\nprogram-because they know that an aroused public has al-\nonly a red herring. They now say they want a my public health\nwisely, while we are debating cleverly, while we are splitting\nready decided we shall have it; they say they want a system of\nhairs, tens of thousands are dying from preventable causes and\nmedical care for the indigent-because they are asking for their\nmillions are suffering from remediable sickness. I am convinced\nsystem and they know there is little likelihood of getting it.\nthat we can meet the needs which confront us, and do this\nWhat they really want is to divert public attention from the\nwithin the near future, only through a comprehensive national\ngreatest need of all-a social insurance system which will give\nhealth program which includes compulsory health insurance,\nmedical care to all who need it.\nsupervised and subsidized by the federal government.\n478\nNATIONAL HEALTH INSURANCE\n479\nJOHN A. KINGSBURY\nA national health plan should be flexible enough to permit\nis not to be found along this road. Something more than taxa-\nthe several states to decide whether their local conditions re-\ntion must be invoked to meet this need.\nquire greater or lesser emphasis on public medicine, on the exten-\nIt is my judgment that the most promising and productive\nsion of public health facilities, or on compulsory health insur-\nchannel into which we can direct customary expenditures for\nance. But federal aid-financial and technical-should be avail-\nhealth and medical services is a nationally subsidized system of\nable to the states equally for all three procedures. Within broad\ncontributory, compulsory health insurance. The combination\nlimitations laid down in federal statute, the choice of each pro-\nof public health tax funds, public medical service tax funds, and\ncedure and the extent to which it is applied should depend upon\nhealth insurance contributions is the only answer to America's\nconditions in each state and should fall within the sphere of\nneed for health security. Add provision for contributory insur-\nstate action.\nance to give workers protection against disabling sickness and\ninvalidity, and the broad framework will be fashioned to furnish\nIII\nsubstantial security against sickness and its dreaded conse-\nWe now spend in any normal year nearly four billion dollars\n(or thirty dollars per person) for health and medical services;\nquences.\nIV\nand this is nearly enough to buy adequate medical care for\nIt seems to me there can hardly be disagreement, at least\neveryone. The basic problem is not to find more money than is\nnow spent for these services, but to find new and better ways of\namong social workers, as to the need for a comprehensive na-\nnels directing customary expenditures into more productive chan-\ntional health program. Nor should there be disagreement among\nothers not blind to the facts SO convincingly presented in the\nand of reducing the burdens caused by unequal costs. It\nscientific studies which have made their appearance within the\nfuture, any considerable portion of this four-billion-dollar sum\nseems to me obvious that we are not going to obtain, in the near\npast decade. Surely everyone, even the most politically minded\nfrom tax funds.\nmember of organized medicine, who has read these studies must\nbe aware that the time is ripe for a change from the present\nBefore the Social Security Act was adopted, the Public Health\nnegligible sums for subsidies to state and local health services.\nService had from time to time received appropriations of only\nchaotic system of medical organization to an integrated health\nprogram for the nation.\n\"Here is one-third of a nation ill-nourished, ill-clad, ill-housed\nThe Act authorized annual appropriations of $8,000,000 for al-\nlotments to states. I understand that there are now pending\n-now,\" said the President of the United States in a recent\naddress. Social workers of the nation know this is not an over-\nbefore Congress requests for similar purposes amounting to ap-\nstatement of the deplorable condition in which over forty\nproximately $60,000,000. It would be optimistic to assume that\nmillion of our fellow-citizens find themselves today.\none-half or even one-third of this sum will be appropriated this\nIn that striking speech of his at the \"Victory Dinner,\" the\nyear. that Furthermore, it would be absurdly optimistic to assume\nPresident, pleading for a higher standard of life for the Ameri-\nwithin the next five or ten years Congress would add to\nthe funds available to the Public Health Service SO much as\ncan people, must have had in mind that the principal cause of\n$500,000,000 or $200,000,000 or even $100,000,000. Yet almost\nthe poverty he uncovered is due to sickness and ill-health which\nhe himself has referred to as one of the major hazards and\n$4,000,000,000 are required to bring adequate medical care to\nviscissitudes of life. Surely this must have been in the Presi-\nall the people. Expand the tax-supported public health pro-\ndent's mind. And surely, in order to guard against this largely\ngram as we will, the complete answer to a great national need\n480\nJOHN A. KINGSBURY\nNATIONAL HEALTH INSURANCE\n481\npreventable cause of undernourishment, inadequate clothing,\nV\nand bad housing, he will take appropriate steps to secure a\nIt is very significant that when the President's Committee\nsuitable amendment to the Social Security Act as soon as the\non Economic Security set up its professional advisory com-\ntime is propitious to move forward in carrying out the mandate\nmittees this was the first time in the history of social insurance\nthe people gave him last November.\nthat the professions concerned with health insurance were\nOne may find reassurance in the President's message of Janu-\nbrought in at the beginning by the government to help formu-\nary 17, 1935, transmitting to Congress the report of his Com-\nlate an official program. In Germany, more than half a century\nmittee on Economic Security. He said, \"I am not at this time\nago, health insurance was virtually established by the edict of\nrecommending the adoption of so-called health insurance, al-\nBismarck as a measure not only of economic, but also of po-\nthough groups representing the medical profession are co-\nlitical, security. In Great Britain, a quarter of a century ago,\noperating with the federal government in the further study of\nhardly consulting the medical profession, Lloyd George put the\nthe subject and definite progress is being made.\" These words\nNational Health Insurance Act through Parliament while the\nwere reassuring, but I think the President will pardon some of\ndoctors remained aloof or in opposition until the eleventh hour.\nus for becoming impatient for action now.\nToday it is very difficult to find a physician in Great Britain\nIn that report, the Committee on Economic Security said:\nwho is not making at least a decent living or one who would\n\"As a first measure for meeting the very serious problem of sick-\nconsider for a moment abandoning health insurance, the Journal\nness in families with low income we recommend a nation-wide\nof the American Medical Association and other American medical\npreventive public-health program,\" to be \"financed by state\njournals to the contrary notwithstanding. Indeed, the British\nand local governments and administered by state and local\nMedical Association and the local panel committees of doctors\nhealth departments, the federal government to contribute\nall over Great Britain have gone on record over and over again\nfinancial and technical aid.\" The Committee then went on to\nfor extension of the benefits of National Health Insurance to\nsay \"The second major step we believe to be the application of\nembrace not only the workingman but all members of his\nthe principles of insurance to this problem.\" The Committee in-\nfamily as well, and also to extend the medical benefits to include\nformed the President that it had enlisted the co-operation of\nhospitalization and the services of various specialists.\nadvisory groups representing the medical and dental professions\nListen to the following quotations from a statement by Dr.\nand hospitals management in developing \"a plan for health\nG. C. Anderson, Medical Secretary of the British Medical As-\ninsurance which,\" it said, \"will be beneficial alike to the public\nsociation:2\nand the professions concerned.\" These advisory groups had, the\nSoon or late, I predict, every modern civilized community must acknowl-\nCommittee stated, requested an extension of time \"for the\nedge its duty to make provision for the health of its members if they cannot\nfurther consideration of these tentative proposals, and such an\nsecure it for themselves. In America and elsewhere, there are large numbers\nextension has been granted to March 1, 1935.\" The President\nwho suffer from this disability.\nI think that, after twenty-two years, we may be said to have passed the\nwas further informed that the Committee has effected arrange-\nexperimental stage in Great Britain and are able to evaluate the merits and\nments for a close co-operative study between its technical staff\ndefects of our health insurance plan. That it has some defects may be freely\nand the technical experts of the American Medical Association.\nadmitted, but they are emphatically not those which the American Medical\nAre we being inconsiderately hasty if we now call for action on\nAssociation has thrust into the foreground.\nhealth insurance?\n2 Detroit News, September 29, 1934.\n482\nJOHN A. KINGSBURY\nNATIONAL HEALTH INSURANCE\n483\nChiefly, the American Medical Association and its members who oppose\nnational health insurance allege that it has proved to be a failure and detri-\nAdvisory Board, be it said to their credit, who were independ-\nmental to the interests of both profession and public. It is said that the so-\nent of this action and were not party to this political trickery.\ncalled \"panel system\" has tended to stifle initiative and reduce all professional\nLike certain other big business organizations, still endeavor-\nservice to the same level of mediocrity.\ning to defeat other aspects of the New Deal program, the Ameri-\nNothing could be farther from the truth.\nAs a matter of fact most\ncan Medical Association is exerting all its power to prevent\nof our physicians are eager for panel service.\nWithout such steady in-\ncome many would have found it difficult to earn a living by the exercise of\ncompulsory health insurance from taking its proper place in the\ntheir profession alone.\nSocial Security Act. So-called \"organized medicine\" is using\nevery device known to pressure groups and politicians to\nContinuing, Dr. Anderson says:\nprejudice the country against a comprehensive national health\nFrom the viewpoint of the public, the insurance act has been equally suc-\nprogram, and particularly against compulsory health insurance.\ncessful and any attempt to represent it as being otherwise proceeds from a mis-\napprehension of the facts.\nThe American Medical Association and its satellite societies\nThe benefits of the scheme are evident to\nthe public and the public pays its share cheerfully.\nhave printed in their medical journals false and misleading\nstatements concerning the operation of health insurance in\nI have already remarked that, in the formulation of a na-\nEngland and other European countries. And this campaign of\ntional health insurance plan, the United States is the only coun-\nmisinformation still continues. They have passed resolutions\ntry where the professions were let in on the ground floor. Here\nbased strictly on selfishness and their vested interests. Like\nthey were invited and urged to participate in the formulation\nordinary lobby groups, while the Social Security Bill was pend-\nof the plans. The President's Committee on Economic Security\ning, they saw to it that thousands of telegrams were sent to\ndelayed its final report-until now it is long overdue-to give\nthe President and to the Congress, seeking to exert pressure\nthe doctors, the dentists, the hospital administrators, the\nwithout reference to the merits of the proposals under considera-\nnurses, and the public health authorities not only every oppor-\ntion; they used personal influence on those in high places; they\ntunity to be heard but every facility for criticism and suggestion\nspent tens of thousands of dollars in publicity campaigns of mis-\nconcerning the program under consideration. How did they\ninformation; they spread false rumors and resorted to scurvy\nutilize their opportunity? The dentists helped; the hospital\nattacks on individuals. They even pulled the purse strings of\npeople helped; the nurses helped; and the public health people\nreputable research agencies in an effort to curb the freedom of\nhelped. Each gave intelligent and critical advice and counsel.\nspeech of their opponents on the staffs of such organizations.\nBut the doctors \"co-operated\" with the President's Committee\nwith a technique which has its own unique effrontery. While\nVI\ncertain of their leaders and officers were in the full confidence\nOne has wondered how long the real leaders of the medical\nof the official studies which were still in progress, and while the\nprofession, and the rank and file of the various auxiliary pro-\nPresident's Committee and its staff were still deliberating, the\nfessions-dentists, nurses, hospitals, and others-will permit the\nAmerican Medical Association held a special session of its\nmedical politicians, who too often control medical societies and\nHouses of Delegates-the first since the World War-and\nthe editorial columns of the journals, to continue to obstruct\npassed resolutions condemning compulsory health insurance\nprogress and to delay and forestall sound legislation. A ray of\nand important health and welfare sections of the then pending\nhope has just begun to shine over the horizon of organized\nSocial Security Bill! There were members of the Medical\nmedicine, shining from a massive report recently issued by the\nAmerican Foundation, entitled American Medicine: Expert\n484\nJOHN A. KINGSBURY\nNATIONAL HEALTH INSURANCE\n485\nTestimony Out of Court. Most strikingly it presents the doctor's\nwill take an aggressive position in the ranks of organized medi-\ndilemma in the testimony of 2,200 representative leaders in\ncine, or whether they will continue to permit themselves to be\nevery branch of American medicine from every state in the\nrepresented (and misrepresented) by officers and editors who\nUnion, most of them in practice over twenty years.\nobviously do not speak for them and who are today the chief,\nThe concensus of opinion of the American men of medicine\nif not the only, real obstacle in the way of realization of a com-\nwho are credited with the authorship of these volumes is clearly\nprehensive national health program.\nthat the doctor \"is no longer concerned exclusively with the\nIt remains also to be seen whether the social workers of\ncare of the sick, but also with a guardianship of the health of\nAmerica will continue to be intimidated and to remain almost\nthe nominally well\"; that \"the present costs of medical care are\ninactive in the face of selfish opposition to a measure which\ntragically out of reach of a large part of the population\"-that\npromises as much as any other single proposal now before the\nthe State has a stake in the health of its people. This is progress,\ncountry to deal with an underlying cause of poverty and de-\nand much of it is quite obviously contrary to the official views\npendency. How can social workers expect the President and\nof the American Medical Association. Keep in mind that the\nthe Congress to act on a controversial issue, in the face of such\nauthors of this report, with apparently few exceptions, are\nvociferous and politically powerful opposition to health insur-\nmembers in good standing of the Association.\nance, if there is no organized expression of public opinion in\nThe New York Times, commenting editorially on this report\nfavor of it?\nof the American Foundation, says:\nI venture to say that, in this great fight of 1935 and 1936 for\nNot social workers despised by the American Medical Association but\ndoctors themselves, a veritable \"Who's Who in Medicine,\" wrote the Founda-\none of the principal measures of social security, the social work-\ntion's report.\nIt is now doubtful if the entrenched officers of the As-\ners of America were asleep at the switch. They fell down on\nsociation truly speak for organized medicine. The 2,200 representative\ntheir job. This was partly because they were not organized for\nphysicians demand far-reaching, socially-conceived reforms in medical educa-\na conflict with such powerful and unscrupulous opposition, but\ntion and practice because \"the best is not yet good enough.\" But the Associa-\nalso partly because such organizations as the American Associa-\ntion through its journal advocates a policy of letting medicine evolve naturally\ntion for Labor Legislation and the American Association for\n(while millions lie ill without adequate care or die because it costs too much\nto have a doctor) and regards the practice of medicine as a vested interest akin\nSocial Security were too busy with other aspects of the social-\nto that of a plumbers' union in the installation of bathtubs or kitchen fixtures.\nsecurity program. Furthermore, it was because the organiza-\nOn many a page the Foundation's report refutes a Bourbonism which holds\ntion which had been the spearhead of the movement to include\nthat all's well with the general practitioner, that medical care is adequate on\nhealth insurance in the Social Security Act was blackjacked\nthe whole\nIf, as the Foundation makes it clear, the practice of medicine\nand was unable to offset the mischievous misrepresentations of\nneeds continual revision in the light of new community needs it is evident that\nthe clique which controls the machinery of organized medicine.\nsocial and economic changes cannot be ignored. Yet the American Medical\nEven the American Federation of Labor, whose members had SO\nAssociation would have us believe that the old laissez faire evolution is good\nenough today because it was supposedly good enough yesterday.\nmuch to gain from sound measures of social insurance, were too\nmuch absorbed in the problems of unemployment and old age.\nThe report of the American Foundation was eminently worth-\nHowever, the Federation is to be congratulated upon the resolu-\nwhile if for no other reason than to elicit from one of America's\ntion adopted at its annual meeting in November, 1936, indors-\nleading newspapers this editorial comment.\ning health insurance and disability compensation and calling for\nIt now remains to be seen whether these medical leaders,\na federal commission to further advise on sound legislative\nmembers in good standing of the American Medical Association,\nmeasures.\n486\nJOHN A. KINGSBURY\nVII\nOne of the greatest needs of the nation today is a comprehen-\nsive national health program. There is today no long-range\nplan before the social workers of America more important than\nconcerted action for a health program. They know better than\nany other group the devastating effects of illness and the inabil-\nity of the people of low income to budget against sickness except\nas large groups. The social workers must line up against the in-\ntrenched officers of organized medicine; they must align them-\nselves beside the leaders of organized labor and beside the real\nleaders of the medical professions. Together with these groups,\nthe social workers of America can bring to pass a real national\nhealth program. They can bring into being a program broad\nenought in its scope to enable the industrial states and areas to\nprotect themselves through compulsory insurance, and the\nrural and the sparsely populated states and areas to protect\nthemselves through public medicine. They can bring into being\na program to authorize the federal government, which must\nsubsidize any comprehensive plan, to set up standards and to\nprovide effective leadership and guidance.\nLet us put our shoulders to the wheel. We can have, as we\nshould have, a comprehensive health program to meet a crying\nneed of the people. It can be sufficiently flexible to meet the\ndifferent needs of the several states: public health services for\nall, adapted through different techniques to urban and rural\nneeds; public medical services where these are most appropri-\nate; medical-care contributory insurance for the wage-earners\nand salaried workers, and, for those who cannot themselves pay\ncontributions, public provision of contributions instead of\nhumiliating hand-out medicine; contributory insurance against\ntemporary or permanent loss of earnings from disabling illness;\nand federal aid and guidance over all.\nMarching behind the banners of such a program, the social\nworkers of America can sound a clarion call for action in a cause\nworthy of their highest traditions."
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