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Health Care Reform and Social Movements in the United States

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Health Care Reform and Social Movements in the United States PUBLIC HEALTH THEN AND NOW Health Care Reform and Social Movements in the United States | Beatrix Hoffman, PhD Because of the importance of THE UNITED STATES IN THE grassroots social movements, or 20th century witnessed the flow- “change from below,” in the his- ering of social movements de- tory of US reform, the relationship manding access to the American between social movements and Dream. Women, workers, Afri- demands for universal health care can Americans, seniors, and wel- is a critical one. fare recipients, to name just a National health reform cam- few, organized to change a soci- ety that made them second-class paigns in the 20th century were citizens. Although each move- initiated and run by elites more ment had its leaders, each relied concerned with defending against on grassroots participation, or attacks from interest groups than “change from below”: they were with popular mobilization, and made up of ordinary people de- grassroots reformers in the labor, manding reform, often on their civil rights, feminist, and AIDS ac- own behalf.1 tivist movements have concen- Yet no movement of compara- “Toward Better National Health” is a pamphlet from the Technical Committee trated more on immediate and in- ble size or intensity has arisen in on Medical Care of the Interdepartmental Committee to Coordinate Health cremental changes than on the United States to demand uni- and Welfare Activities, published by the Government Printing Office in 1939. versal health care. Labor unions, From the US Health Activism History Collection of the Institute of Social transforming the health care sys- Medicine and Community Health. tem itself. senior citizens, socialists, and other groups have certainly par- such a movement for universal manded changes in the health However, grassroots health care ticipated in campaigns to re- health care, and whether and care system. But their health care demands have also contained the design the health care system, how one may emerge now and demands were for specific seeds of a wider critique of the but the campaigns themselves in the future. changes on behalf of their partic- American health care system, lead- have most often been initiated This article brings together ular group, such as racial deseg- ing some movements to adopt and run by elite organizations some recent historical depictions regation of hospitals, access to calls for universal coverage. and individuals with little con- of struggles for universal health abortion, and the release of ex- nection to a popular base of sup- care in the 20th century, with an perimental AIDS drugs. These port. Public opinion has generally emphasis on the role of popular grassroots demands have not co- run in favor of health care re- mobilization—or lack thereof—in alesced into a movement for uni- form, but popular approval has these struggles. It offers a new versal health care. In fact, some not been matched by the rise of understanding of social move- scholars and reformers have seen a large-scale, activist popular ments and health care reform. such small-scale improvements in movement for change.2 Because Many grassroots movements, in- health care delivery as impedi- of the importance of grassroots cluding the civil rights and ments to, or distractions from, movements to reform in the women’s movements and those more comprehensive reform. United States, it is important to on behalf of people with particu- But grassroots health care de- ask why there has never been lar diseases like AIDS, have de- mands have also contained the January 2003, Vol 93, No. 1 | American Journal of Public Health Hoffman | Public Health Then and Now | 75 PUBLIC HEALTH THEN AND NOW seeds of a wider critique of the pers, president of the American march and rally on the state capi- The Great Depression was a American health care system. Ac- Federation of Labor (AFL), tol, their demands included com- time of extraordinary popular up- tivists who worked for immediate thought workers should win their pulsory health insurance. heaval, as farmers, workers, the and particular changes found that own benefits through union or- A somewhat bewildered AALL unemployed, veterans, elderly their experiences with health care ganizing rather than government gratefully accepted this popular Americans, socialists, and commu- led them to a new and urgent un- action; he denounced the AALL support, which led to their cam- nists organized and marched in derstanding of the need for major for neglecting labor’s opinion paign’s first and only victory: a the streets and on Washington reform, and some eventually in- and directed his membership to majority vote in the New York calling for relief and justice.6 The corporated demands for universal oppose the plan as elite paternal- Senate. But when the powerful demands of these New Deal–era access as part of their social ism. The health reformers chose speaker of the house (antisocialist social movements centered on movement agendas. By combin- a strategy of research and lobby- campaigner Thaddeus Sweet) economic security for workers and ing the history of national reform ing rather than political organiz- killed the bill in committee, the the aged; at the height of the de- campaigns with that of grassroots ing; expertise, not popular pres- first campaign for health insur- pression, the ravages of unemploy- activism for changes in the health sure, would be their tool of ance was over. Cooperation be- ment and national economic col- care system, we can better see persuasion. AALL leaders felt tween elite reformers and popu- lapse commanded more how these 2 types of movements that the most important con- lar movements had been too little immediate attention than did the have been kept apart, and also stituency for their bill was the and come too late to overcome a cost of medical care. For example, how they might come together. medical profession, and they united opposition of physicians, the Lundeen bill, an alternative to spent much of their energy per- businesses, insurance companies, the Social Security Act drafted by TWENTIETH-CENTURY suading doctors to support the and conservative legislators intent Minnesota’s radical Farmer–Labor CAMPAIGNS FOR HEALTH legislation—a cause that turned on branding health insurance Party, outlined a program of social CARE REFORM out to be futile in the face of “Bolshevism.”4 insurance for all workers, includ- practitioners’ fears that compul- The emphasis of health reform ing wage replacement for those Early in the 20th century, in- sory insurance would erode their shifted during the 1920s as med- “unable to work because of sick- dustrial America faced the “prob- incomes and independence.3 ical care became both more effec- ness,” but it made no mention of lem of sickness”: when working When reformers did look to tive and more expensive; soon, medical care or health insurance.7 people missed work owing to ill the popular movements of the medical costs and access to care With unemployment crowding out health, they also lost their wages. Progressive Era, they found sub- replaced wage support as reform- health care as a social movement This loss of income, even more stantial support for health insur- ers’ primary concern. But the priority, health reformers needed than the cost of medical care, ance. The Socialist Party had en- character of reform leadership to make a concerted effort to per- made sickness a major cause of dorsed a compulsory system as changed little, and health reform- suade social activists to join their poverty. In 1915, progressive re- early as 1904, and in 1912 ers continued to share the elite crusade. formers proposed a system of Theodore Roosevelt’s insurgent status of their predecessors. The But New Deal health reformers compulsory health insurance to Progressive Party included a most prominent reform group of remained out of touch with the protect workers against both health insurance plank in its the 1920s, the Committee on the grassroots. In the 1930s, some wage loss and medical costs dur- campaign platform. In New York Costs of Medical Care (CCMC), CCMC leaders became political ing sickness. The American Asso- and California, local labor lead- which was financed by large insiders as they joined the com- ciation for Labor Legislation’s ers defied the AFL’s directive and foundations and made up of mittees charged by President (AALL) proposal, modeled on ex- threw their support behind the physicians, academic economists, Franklin D. Roosevelt with creat- isting programs in Germany and AALL’s plan, arguing that health and representatives of private in- ing proposals for health care to England, was debated through- insurance would protect both terest groups, again relied on re- add to the Social Security Act out the country and introduced workers’ health and their wages. search rather than popular mobi- (the Committee on Economic Se- as legislation in several states. Women trade unionists and suf- lization. The CCMC’s modest curity and the Technical Commit- This early campaign for com- fragists were intensely interested proposals for group medicine and tee on Medical Care). These New pulsory health insurance set a in the proposal because it in- voluntary insurance were de- Deal committees worked mostly precedent for a continuing dis- cluded maternity benefits for nounced by the American Med- in secret, isolated from public tance and lack of cooperation be- women workers. In New York in ical Association (AMA) as “social- input and debate. Their members tween reform leaders and popu- 1919, women reformers adopted ized medicine,” but the battle was were constantly on alert for at- lar movements. The AALL was a the AALL plan as part of a slate fought in the pages of newspa- tacks from the medical profession group of academic reformers of bills to protect working pers and academic journals, with and business, and this caution led who drafted their proposal with- women, and when suffragists no attempt to enlist ordinary peo- to less-than-sweeping proposals out input from the working peo- joined with the New York State ple as advocates for the reform- for health reform; both commit- ple it would cover.
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