Before WWI Began, Universal Health Care Seemed a Sure Thing
Deja Vu column by Cynthia Crossen, Wall St. Journal, April 30, 2007

Health insurance "is a dead issue in the United States," reported a committee of the New York State Medical Society almost a century ago.

It seems ludicrous today that anyone believed the debate over government-mandated health insurance had been settled forever. But in 1925, that's how things looked.

In 1912, Theodore Roosevelt, campaigning for president on the Progressive Party ticket, endorsed compulsory health insurance as part of his platform. The same year, an organization of progressive economists -- the American Association for Labor Legislation, or AALL -- started a crusade to make health insurance mandatory for workers who earned less than $1,200 a year (about $25,000 today). The cost of the premiums would be shared by employer and employee (two-fifths each) and the state. Compulsory health insurance, proponents argued, would eliminate sickness as a cause of poverty.

There wasn't a lot you could do for a sick person in 1912; the greatest cost of illness or injury was loss of wages. Keeping their workers -- and their armies -- on the job was one reason most European countries, starting with Germany in 1883, had instituted mandatory health insurance for many workers. "You cannot maintain an A-1 empire with a C-3 population," said Lloyd George, the British wartime prime minister, whose Parliament passed the National Insurance Act in 1911.

For a few years, it looked as though health-insurance legislation in the U.S. was inevitable, and advantageous for workers and doctors. With access to prompt medical care, laborers would be able to return to their jobs more quickly, keeping their families fed. And doctors would prosper if a growing number of patients could pay their fees. More than a dozen state legislatures began considering compulsory health insurance based on a model bill drafted by the labor group.

But the "professional philanthropists, busybody social workers, misguided clergymen and hysterical women," as an opponent described them, hadn't reckoned on a mighty resistance movement of some the unlikeliest political bedfellows in history. They included commercial insurance companies; fraternal organizations; pharmacists; manufacturers; Samuel Gompers, then president of the American Federation of Labor, and some other labor unions; Christian Scientists; assorted xenophobes and anti-Communists; and -- the coup de grâce -- doctors.

Although united in their goal to defeat mandatory insurance, the challengers had wildly different motives. Commercial insurance companies and fraternal organizations sold sickness and burial policies and feared losing business. Pharmacists suspected the government would start telling patients what medicines to take and how much they should cost. Samuel Gompers argued that the solution to the problem of illness was not compulsory insurance but higher wages. Management didn't want to pay for another benefit, especially if, as a representative of an industry trade group argued, "the sickness had been contracted either through intemperate or licentious living."

Emotional arguments also worked against the effort. Christian Scientists, then a potent political force, complained compulsory insurance meant "exclusively a material method of healing in preference to a spiritual method." Labor groups said it would lead to the determination of who was a good insurance risk. "When found defective, they will, of course, be thrown on the scrap heap," one argued.

America's entry into World War I in 1917 provided another knock against health insurance: It was un-American. As California prepared for a referendum on the issue, commercial insurers published pamphlets picturing Kaiser Wilhelm II with the caption, "Made in Germany. Do you want it in California?" (Voters rejected the measure.) In Albany, an insurance bill under consideration by the state Legislature came "straight from Germany" and was "devilish in principle and foreign to American ideals," argued Henry W. Berg, a New York doctor. It never got out of committee.

The AALL also neglected to woo physicians, often ignoring their opinions when negotiating the legislation. Most doctors became convinced that health insurance would insert the dubious judgment of the government between patient and doctor, and cut their pay. Charles H. Mayo, president of the American Medical Association, urged physicians to be wary of "anything which reduced the income of the physician" because that would "limit his training, equipment and efficiency."

One unintended consequence of this campaign was the organization of the medical profession "into an effective and articulate political force," wrote Ronald L. Numbers in "Almost Persuaded," a 1978 study of physicians' responses to compulsory health insurance.

In the end, not a single state passed a health-insurance law. Henry Seager, one-time head of the AALL and a Columbia University professor, said, "We are still so far from considering illness as anything beyond a private misfortune against which each individual and each family should protect itself, as best it may, that Germany's heroic method of attacking it as a national evil through government machinery seems to us to belong almost to another planet."