Rosalea Barker: Missouri

“I have never known a question so menacing to the tranquility and even the continuance of our Union as the present one. All other subjects have given way to it and appear to be almost forgotten. As however there is a vast proportion of intelligence and virtue in the body of the people, and the bond of the Union has heretofore proved sufficiently strong to triumph over all attempts against it, I have great confidence that this effort will not be less unavailing.”

So wrote President James Monroe to Thomas Jefferson on February 19, 1820. He was writing, of course, about the Missouri Compromise—which admitted Maine as a free state and Missouri as a slave state, but also established that no western territory or new state north of Missouri’s southern border (Lat. 36. 30) would allow slavery. Monroe’s optimistic belief in the “intelligence and virtue in the body of the people” turned out to be misplaced, as the War Between the States, aka the Civil War, was to prove.

But it’s not Monroe and the question of slavery that I want to address in this post about the 24th state. It’s the issue that TODAY “all other subjects have given way to… and appear to be almost forgotten”: health care. For it was a President from Missouri who, in his November 1945 message to Congress urged that they create a federal health insurance plan.

On September 6, 1945, President Truman had sent a message to Congress stating that: “Millions of our citizens do not now have a full measure of opportunity to achieve and enjoy good health. Millions do not now have the protection or security against the economic effects of sickness. The time has arrived for action to help them attain that opportunity and protection.”

In his November message he proposed five ways of dealing with those issues by using federal money to fund: the construction or expansion of hospitals and medical facilities; the expansion of public health, maternal and child health services; medical education and research; prepayment of medical costs; and a comprehensive health program.

The fourth item relates to establishing a federal health insurance system. Even back then, Truman was quick to stress: “I repeat—what I am recommending is not socialized medicine. Socialized medicine means that all doctors work as employees of government. The American people want no such system. No such system is here proposed.” Under Truman’s plan, people would still have the freedom to choose the doctors and hospitals they went to, and medical professionals would continue to have the same freedom to work as they pleased.

“There would, however, be this important difference: Whether or not patients get the services they need would not depend on how much they can afford to pay at the time.” Truman’s plan would have consisted of premiums paid by wage and salary earners as well as by those in business for themselves, professional persons, farmers, etc. The needy would have their insurance premiums paid by public agencies, and if those agencies were run by states, the states would be partly reimbursed with federal funds.

The fifth item relates to benefits payable in times of sickness and long-term disability to make up for the sick person’s loss of earnings.

The text of Truman’s message to Congress is available many places online, but the source I used was the December 1945 issue of California and Western Medicine, which is archived on the National Institutes of Health website. Pages 270-274 contain the AP report of the message, quoting it at length, but the editorials in the same issue of that journal are of even more interest.

“On Motivating Influences and Personalities in Back of President Truman's Health (Sickness) Insurance Message, and Its Immediate Legislative Expression, Senator Wagner's New Bill—S. 1606” refers to a November article in another journal, Medical Economics, which asserts that the proposed legislation is part of a master plan of the International Labor Organization, which is “already responsible for the establishment of state medicine in Chile and New Zealand!” (Yes, there’s an exclamation point as if to say, Shock! Horror! Poor benighted Kiwi that I am, I suffered from free medical care for four decades and never knew I was suffering.)

The other two editorials dismember and discredit the statistics that Truman uses of five million people being turned down for war service for health reasons, and rubbish his idea of establishing hospitals in every county in the U.S. You can read those editorials here and here.

The origins of Truman’s prepaid health care actually lie in the private sector in the 1930s, at a large construction project in the Mojave Desert. With disarming candor, the history page of the Kaiser Permanente website states: “When Sidney Garfield, MD, looked at the thousands of men involved in building the Los Angeles Aqueduct, he saw an opportunity.”

Ah, yes! The American way—praise be to anyone who sees their fellow man as an “opportunity” to get rich.

But perhaps I’ve got my wires crossed. FDR—whose death in April 1945 catapulted Truman from the Vice Presidency to the White House—actually exempted Dr. Garfield from military service when the US joined WWII specifically so he could organize and run a prepaid health plan at the Kaiser shipyards in Richmond, CA, which built war vessels around the clock. And both the International Longshoremen’s and Warehousemen’s Union and the Retail Clerks Union were big supporters of Permanente’s health plans.

As for Truman’s federal health insurance plans—they went nowhere during his presidency, but in 1965 a version for people 65 years of age and older, and some disabled people, was enacted as Medicare. States can expand the range of those who are covered under a similar federal plan called Medicaid.

--PEACE—

rosalea.barker@gmail.com

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