US sets up national health insurance in the early 20th century

Inside the Outbreaks, Pendergrast, 2010, pages 292-93.

https://books.google.com/books?id=p...auled the pasteurized premix to the "&f=false

'In October 1994 . . . . . a major epidemic of Salmonella enteritidis. . . . . Hennessy thought that ice cream, with eggs as an ingredient, seemed a logical culprit. But Schwan's ice cream contained no eggs. Tanker-trailer trucks hauled the pasteurized premix to the Marshall, Minnesota, plant, which Hennessy found pristine. He discovered, however, that truck drivers were "back-hauling" liquid raw eggs on their return trip, and they were not cleaning their tankers sufficiently to prevent cross-contamination. An estimated 224,000 people throughout the continental United States had gotten diarrhea from eating Schwan's ice cream. This was the largest common-source outbreak of salmonellosis ever recognized in the United States.

'Dragnets of Microbes

'Despite the huge number of Schwan's victims, fewer than three hundred cases were actually reported to the CDC. The epidemiologists arrived at the larger estimate by extrapolating attack ratios to the number of total customers. In fact, most diarrhea is never reported. . . . . '
A lot of important stories like this. And I find myself wondering, why did I not hear about this before?
 
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@Shevek23 this is true. The problem is, the way social legislation in America is typically done is that one state experimebts, then other states think it's a good idea and try it, then the feds step in to ensure somewhat consistent service.

Also, what seems to have been proposed in this POD isn't NHS-style medical bureaucracy, but a requirement that everyone be insured - National Insurance, essentially, or basically Obamacare. I mean, OTL, while the GOP has been trying (and largely failing) to dismantle the system, I think before the 1960s you can achieve a longer lasting consensus that Obamacare OTL did not have (which in large part was due to the White House pissing off certain religious stakeholders, and even then it was less about the actual mechanics or principle of the plan as to what exactly the insurance requirements would cover, which due to Sebelius and Pelosi's pressure ended up wading into needlessly sectarian issues.) Since the decade before and after WWII don't have those particular issues, National Insurance after several states adopting it (CA was close before the anti-German hysteria killed it), the debate will be rather less charged, especially if it's done before WWI.
 


Microbiology is growing things in petri dishes, and . .




such techniques as "pulsed-field gel electrophoresis." The smaller DNA fragments go faster and thus further, with the end result producing a kind of fingerprint. This is an analogue technique to identify particular strains of bacteria.

Yeah for earlier, more successful, and more widely available microbiology!!!
 
A 2005 post of mine in soc.history.what-if:

***
It may seem odd today to imagine the American Medical Association supporting compulsory health insurance and organized labor opposing it--but that was exactly what the situation was for a brief period:

"In 1906, the American Association of Labor Legislation (AALL) finally led the campaign for health insurance. They were a typical progressive group whose mandate was not to abolish capitalism but rather to reform it. In 1912, they created a committee on social welfare which held its first national conference in 1913. Despite its broad mandate, the committee decided to concentrate on health insurance, drafting a model bill in 1915. In a nutshell, the bill limited coverage to the working class and all others that earned less than $1200 a year, including dependents. The services of physicians, nurses, and hospitals were included, as was sick pay, maternity benefits, and a death benefit of fifty dollars to pay for funeral expenses. This death benefit becomes significant later on. Costs were to be shared between workers, employers, and the state.

"AMA supported AALL Proposal
In 1914, reformers sought to involve physicians in formulating this bill and the American Medical Association (AMA) actually supported the AALL proposal. They found prominent physicians who were not only sympathetic, but who also wanted to support and actively help in securing legislation. In fact, some physicians who were leaders in the AMA wrote to the AALL secretary: “Your plans are so entirely in line with our own that we want to be of every possible assistance.” By 1916, the AMA board approved a committee to work with AALL, and at this point the AMA and AALL formed a united front on behalf of health insurance. Times have definitely changed along the way.
In 1917, the AMA House of Delegates favored compulsory health insurance as proposed by the AALL, but many state medical societies opposed it. There was disagreement on the method of paying physicians and it was not long before the AMA leadership denied it had ever favored the measure.

"AFL opposed AALL Proposal
Meanwhile the president of the American Federation of Labor repeatedly denounced compulsory health insurance as an unnecessary paternalistic reform that would create a system of state supervision over people’s health. They apparently worried that a government-based insurance system would weaken unions by usurping their role in providing social benefits. Their central concern was maintaining union strength, which was understandable in a period before collective bargaining was legally sanctioned.

http://www.pnhp.org/facts/a_brief_history_universal_health_care_efforts_in_the_us.php?page=1

Added to the opposition of organized labor was that of the insurance industry. Here the advocates of universal health insurance may have made a serious tactical error in including funeral expenses:

"The commercial insurance industry also opposed the reformers’ efforts in the early 20th century. There was great fear among the working class of what they called a “pauper’s burial,” so the backbone of insurance business was policies for working class families that paid death benefits and covered funeral expenses. But because the reformer health insurance plans also covered funeral expenses, there was a big conflict. Reformers felt that by covering death benefits, they could finance much of the health insurance costs from the money wasted by commercial insurance policies who had to have an army of insurance agents to market and collect on these policies. But since this would have pulled the rug out from under the multi-million dollar commercial life insurance industry, they opposed the national health insurance proposal."

And yet with all this opposition, some states seriously considered universal health insurance. The crucial development in killing it may have been World War I and the ensuing Bolshevik Revolution:

"WWI and anti-German fever
In 1917, the US entered WWI and anti-German fever rose. The government-commissioned articles denouncing “German socialist insurance” and opponents of health insurance assailed it as a “Prussian menace” inconsistent with American values. Other efforts during this time in California, namely the California Social Insurance Commission, recommended health insurance, proposed enabling legislation in 1917, and then held a referendum. New York, Ohio, Pennsylvania, and Illinois also had some efforts aimed at health insurance. But in the Red Scare, immediately after the war, when the government attempted to root out the last vestiges of radicalism, opponents of compulsory health insurance associated it with Bolshevism and buried it in an avalanche of anti-Communist rhetoric. This marked the end of the compulsory national health debate until the 1930’s.

http://www.pnhp.org/facts/a_brief_history_universal_health_care_efforts_in_the_us.php?page=2

So had there been no World War I and no US backlash against "Prussianism" and "Bolshevism" we might have seen universal health insurance enacted at the state level, and this could have provided the foundation for an eventual federal program. Of course other things could also have made a difference As noted at http://eh.net/book_reviews/the-wage...s-of-health-insurance-in-progressive-america/ for example "Gompers' opinion was not shared by all labor groups" so perhaps if he had died earlier, organized labor would have taken a different stand. And as the same article notes, advocates of universal health insurance were inept not only in dealing with doctors (at least on a statewide level, despite the national AMA endorsement) and the commercial insurance industry but with employers: "In chapter 5, Hoffman similarly discusses how the needs and/or anxieties of employers and commercial insurance companies were barely considered and their opposition seriously underestimated. Both groups were liable to bear considerable costs associated with the legislation. Employers would be required to contribute to the cost of the insurance program, yet AALL reformers erroneously believed that employers would come to support the bill (as they had workers' compensation laws)."

Any thoughts?

As a footnote to this post, here is the great economist Irving Fisher in December 1916, predicting the speedy enactment of health insurance legislation:

"In the last six months, through the efforts of the American Association for Labor Legislation, a consciousness of the imperative need in this country for health insurance has dawned upon thinking Americans. Within another six months it will be a burning question in many states. As Dr. Blue, surgeon general of the United States Public Health Service, has said, it is the next great step in social legislation in this country.

"At present the United States has the unenviable distinction of being the only great industrial nation without compulsory health insurance. For a generation the enlightened nations of Europe have one after another discussed the idea and followed discussion by adoption. It has constituted an important part of the policy and career of some of Europe's greatest statesmen, including Bismarck and Lloyd George. Germany showed the way in 1883 under the leadership of Bismarck. This act was the first step in her program of social legislation. Her wonderful industrial progress since that time, her comparative freedom from poverty, reduction in the death rate, advancement in hygiene, and the physical preparedness of her soldiery, are presumably due, in considerable measure, to health insurance.

"Following the example of Germany, health insurance was adopted successively by Austria, Hungary, Luxemburg, Norway, Serbia, Great Britain, Russia, Rumania, and Holland. Other countries have adopted a subsidized voluntary system, namely, France, Belgium, Switzerland, Denmark, Sweden, and Iceland. Thus the only European countries which, like the United States, are without any general system are Italy, Spain, Portugal, Greece, Bulgaria, Albania, Montenegro, and Turkey.

"Because we have a democratic form of government we have peacefully assumed that our civilization is more advanced than others, but while we have rested complacently on our oars, other nations have forged ahead of us. The war has at last startled us out of our Rip Van Winkle slumber, and we are now passing through a period of national self-examination.

"There are special reasons to hope that health insurance may win favor rapidly. The war has made labor scarce and therefore dear. This fact will make not only for high wages, but also for the conservation of labor. Students of the history of slavery find that when slaves were abundant and cheap, masters worked them to death and replaced them when worn out. Consequently, cruelty was condoned and fashionable. On the other hand, when slaves were scarce and dear, the masters took good care of them and a humanitarian sentiment developed to correspond. I believe it to be a correct economic portent that the world is about to enter upon a period of life conservation. The war has for a time withdrawn much of the world's labor supply and destroyed and maimed a large part of that which it has withdrawn. The world will seek the greatest possible salvage out of the wreck.

"This impulse to conserve has at first been felt in terms not of industry, but of military preparedness. The strong impetus toward preparedness of all kinds has been the result. Witness the recent laws in New York for compulsory physical training in the public schools. Health insurance and other measures for health conservation will in turn be furthered by the same impulse toward conservation.

"Fortunately we have already taken one step in a social insurance program. After a long and uphill fight, workmen's compensation has had a belated recognition in America. The American Association for Labor Legislation was foremost in this fight, and now at last it is ready for a similar fight to secure workmen's health insurance. For four years an able committee of this Association has been studying American conditions and foreign health insurance acts, and constructing a standard bill. This bill, with some variations, has been introduced into the state legislatures of Massachusetts, New York, and New Jersey, and commissions to consider the subject have been appointed in Massachusetts and California and are expected to report in January. It is significant that so large were the throngs which attended the public hearing of the Massachusetts commission on October 3 that the meeting place had to be twice changed during the hearing to larger quarters. During the ensuing year it is expected that the bill will be introduced in about twenty state legislatures.

"The United States Public Health Service has issued a special study on Health Insurance by Dr. B. S. Warren and Edgar Sydenstricker. The American Medical Association has a working committee on health insurance of which Alexander Lambert is chairman and I. M. Rubinow secretary. This association has published a report on social insurance. Several medical societies, including the Pennsylvania State Medical Society and the State Medical Society of Wisconsin, and several public health associations, have endorsed the principle of health insurance. The American Association for the Study and Prevention of Tuberculosis and many of its affiliated organizations have, through public meetings and otherwise, helped the movement. A number of charitable organizations have also favored the idea and forty-five organizations of various natures, including the American Academy of Medicine, the International Association of Industrial Accident Boards, the National Conference of Charities and Correction, the New York Chamber of Commerce, and the American Public Health Association have appointed committees to study and report upon health insurance.

"The federal Commission on Industrial Relations recommended health insurance. In accepting favorably the report on health insurance of its industrial betterment committee the National Association of Manufacturers at its annual meeting last May put itself on record as favoring the project. The chairman of the same committee stated in July, 1914: "I give it as my opinion that sickness insurance of some kind, with compulsory contribution on the part of employers, will be enacted into law by many states of the union within the next five years." The Associated Manufacturers and Merchants of New York State have expressed their approval.

"Many trade unions have taken up the subject. Some have strongly favored the idea; a few leaders have vigorously opposed it, apparently because of a groundless fear that in some way the power of the labor unions would be lessened. Thus some oppose health insurance as they at one time opposed compulsory workmen's compensation. On the other hand several international unions, including the International Typographical Union, have definitely gone on record as favorable. State federations of labor in Ohio, New Jersey, Massachusetts, Missouri, Nebraska, and Wisconsin are favorable. A number of local trade unions have taken favorable action. Many individual labor leaders of prominence have definitely approved it...

"The cordial and almost unprecedented welcome which this movement has received in spite of the opposition of strong vested interests and their industrious and insidious efforts to misrepresent and injure the movement would seem to indicate that the time for health insurance in the United States is ripe...

"Workmen's health insurance is like elementary education. In order that it shall function properly it needs must be universal, and in order to be universal, it must be obligatory. In regard to obligatory military training it has been said that what America most needs to-day is a higher appreciation of obligation and that without it we shall ever be a drifting, weak, and inefficient nation. The case for compulsory health insurance is, however, far clearer than that for compulsory military training. In health insurance, as in education, we are dealing not with obligatory burdens, but with obligatory benefits.

"Certain interests which would be, or think they would be, adversely affected by health insurance have made the specious plea that it is an un-American interference with liberty. They forget that compulsory education, though at first opposed on these very grounds, is highly American and highly liberative, that prohibitory laws on various subjects such as habit-forming drugs and even alcohol have introduced liberative compulsions in many states in America, and that workmen's compensation acts have introduced liberative compulsion in this very field of workingmen's insurance. The truth is that the opponents of compulsory health insurance are in every case, as far as I can discover, subject to some special bias. They grasp at the slogan of liberty as a subterfuge only. ..According to the logic of those now shedding crocodile tears over health insurance we ought, in order to remain truly American and truly free, to retain the precious liberties of our people to be illiterate, to be drunk, and to suffer accidents without indemnification, as well as to be sick without indemnification. In fact, if compulsory health insurance is tyranny, all labor laws, all tenement laws, all health laws, all pure food laws, even all laws, are tyranny. In fact, all laws are an interference with some one's liberty, even laws against vice and crime. It is the nature of the Law to restrict. But it is by the compelling hand of the law that society secures liberation from the evils of crime, vice, ignorance, accidents, unemployment, invalidity, and disease.

"We have already seen that most of the enlightened and progressive nations of the world have, one after another, adopted compulsory health insurance. This would not have happened if it were a real interference with liberty. England, the most liberty loving of nations, the home of laissez-faire, adopted the compulsory system after careful and deliberate study of the German and other systems.

"It is also noteworthy that where, as in Switzerland, France, and Belgium, the half-way stage has been reached of a subsidized voluntary system, the tendency has been to convert this into a compulsory system. Such a change was about to be put on the statute books in Belgium when the present war broke out.

"In addition to the primary advantage of universality, there are incidental advantages in the compulsory system. There are important economies in administration owing to the elimination of the cost of collection, the cost of advertising, and the other costs of securing business as well as in the elimination of lapses, and of the necessity for accumulating a large actuarial reserve in invested funds. The advantages are similar to those recently realized by insurance companies in some degree and on a small scale in 'group insurance.'..."


http://books.google.com/books?pg=PA9&id=oGJJAAAAMAAJ
 
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