CES Report - Edwin Witte Memo on Health Insurance
In this memorandum (presumably from December 1934) Edwin Witte, Executive Director of the CES, is trying to document the "official story" regarding the controversy surrounding the issue of health insurance during the Committee's deliberations. Because of comments made by President Roosevelt at the National Conference in November, and because of public outcry from the medical profession, the CES' commitment to health insurance had been called into question, and there was all sorts of extreme speculation about what the CES might propose. This was Witte's attempt to put the records straight. This memo comes three months before the President, in March 1935, would ultimately decide that the CES report on health insurance would be withheld.
THE HEALTH INSURANCE STUDY OF THE COMMITTEE ON ECONOMIC SECURITY
By Edwin E. Witte, Executive Director, Committee on Economic Security
President Roosevelt, in his address to the National Conference on Economic Security, November 14, 1934, referring to health insurance said:
"Whether we come to this form of insurance soon or later on, I am confident that we can devise a system which will enhance and not hinder the remarkable progress which has been made and is being made in the practice of the professions of medicine and surgery in the United States."
In her address on the same occasion Hon. Frances Perkins, the Secretary of Labor, said:
"I want very much to say that I am deeply grateful to the physicians who, doubtful in some respects of the implications of some of the things that they have heard discussed, have nevertheless come to take part, as citizens, in the consideration of what is best, not fro their group alone, but what is best for all of the people of the United States."
These statements by the President and the Chairman of the Committee on Economic Security reflect accurately the spirit in which the subject of health insurance has been approached by this Committee.
This is a Committee of four members of the Cabinet and the Federal Emergency Relief Administrator, organized subsequent to the President's message of June 8, in which he indicated that he would probably make recommendations to the next Congress looking for social insurance to protect individuals against the many hazards which involve them in destitution and dependency. In organizing the Committee, the President specifically instructed it to survey this entire field, with a view toward making recommendations to him both on a long time and an immediate legislative program.
In accordance with this instruction, the Committee on Economic Security has, since August, been engaged in an intensive study of possible methods of meeting the major hazards which lead to destitution and dependency, among them unemployment, accidents, sickness and invalidity, premature death of the family breadwinner, and old age.
In its study of possible measures for preventing dependency resulting from sickness of the wage earner or of members of his family, the Committee has proceeded much in the same manner as in other fields. It put in charge of this study the man who has given more attention to the problem of economic consequences of ill health, than any one else in the entire country, Mr. Edgar Sydenstricker, who, for nearly 20 years, has been the Chief Statistician of the United States Public Health Service and in recent years has also been Director of Research of the Milbank Foundation. It instructed Mr. Sydenstricker and his staff to bring together the world experience on methods of meeting this problem and to prepare a preliminary plan for improving the existing situation in this county.
Mr. Sydenstricker and his staff began their work in August and at that time, at Mr. Sydenstricker's suggestion, the Committee decided and announced that it would appoint an advisory committee from the medical profession to give it technical and other advice in its study of this problem. When late in October Mr. Sydenstricker advised the Committee that he had about completed his preliminary studies, the Committee appointed a Medical Advisory Board composed of eleven eminent physicians and surgeons from all parts of the country. These leaders of the profession were selected with great care to get men believed to be open-minded on controversial issues and, at the same time, representative of all points of view. Plus the Medical Advisory Board, the Committee decided to create three other advisory groups, the Dental Advisory Committee, the Hospital Advisory Committee, and the Public Health Advisory Committee, this decision being reached because the preliminary recommendations prepared by the staff affected these special groups, as well as the medical profession. In each instance the presidents of the national organizations were included in the committee membership (in the case of the College of Physicians, the vice-president was named because the president was a Canadian). In accord with the usual practice in the designation of advisory committees by federal departments, however, these presidents were appointed as individuals rather than as representatives of their organizations and all other members were selected on the basis of their peculiar fitness.
The four advisory groups held their first meetings during the second half of November. At these meetings the staff presented its preliminary recommendations and the Committee advised each group that it wanted its advice on all matters dealt with in the preliminary recommendations, with a view toward working out a plan which would be in the best interests both of the public and the profession. It further advised these groups that it had no intention of making any hurried recommendations and did not want them to merely act as a rubber stamp.
All four advisory committees joined in recommendations for the extension of public health activities for the prevention of illness. On the subject of health insurance the Medical, Dental and Hospital Advisory Committees asked for further time for consideration. This has been granted by the Committee on Economic Security with the request that the advisory groups complete their work, if possible, by March 1, 1935.
At the request of the Committee on Economic Security, Dr. Leland and Mr. Simons of the Bureau of Medical Economics of the American Medical Association attended the meetings of the Medical Advisory Board along with the members of the Committee's staff. At this meeting, the staff was asked to work out its recommendations more in detail and Dr. Leland and Mr. Simons have been associated with it for this purpose. Since then, the staff and these representative of the American Medical Association have been engaged in work on a detailed preliminary program plan for health insurance, which is now near completion. This will be presented to the Medical Advisory Board and the dental and hospital groups early in January and will presumably be the basis for their further consideration.
The Committee on Economic Security and its advisory committees have approach the entire problem in the spirit suggested by the President. Whether we are to come to a system of insurance for the better distribution of the economic cost of illness in low income groups cannot be decided by the profession alone. "Soon or later" health insurance may come, and it is clearly in the interests of the profession that it should cooperate in developing a form of insurance which will take account of its point of view. Through the advisory groups which have been organized, the profession has an opportunity to participate in the development of a sound program, avoiding the error made in England, where the profession was not consulted until the health insurance legislation was put through Parliament.
The Committee on Economic Security is not considering socialized medicine and is taking the attitude that whether there shall be health insurance or not will have to be decided by the President, the Congress and the several states. What it is trying to do is to work out a plan which, if we should come to health insurance, will be beneficial alike to the public and the professions concerned.
In this endeavor we are fortunate in having the cooperation of so many able leaders in the professions. While unjust attacks were made upon the Committee in the early stages of its work which had the effect of compelling it to give much more attention to these problems than they might otherwise have received-there is now, fortunately, much better understanding of the aims and purposes of the President and the Committee. What will come out of it no one can now say, but for the first time, there is a real prospect for the development of a program which will meet the crying need for the better distribution of the economic costs of illness in a way which will be fair and just to the men and women who devote their lives to the care of the sick.
A complete list of the membership of the four groups advisory to the Committee on Economic Security in the health field is as follows:
List of Advisory Group Members (in Adobe PDF format)