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 practice of the professions of medicine and surgery in the United States.
--Franklin D. Roosevelt
With these words, spoken at the Conference on Economic Security in Washington DC on November 14, 1934, President Franklin D. Roosevelt promised reformers that national health insurance would someday be enacted but at the same time reassured opponents by suggesting that no drastic action would be taken. He added that he did not know "whether this is the time" for extensive federal legislation, either for national health insurance or for old-age insurance.(1) "ROOSEVELT BARS PLANS NOW FOR BROAD SOCIAL PROGRAM; SEEKS JOB INSURANCE ONLY" ran the New York Times on its front page. Ambiguity dominated Roosevelt's message, prompting one Washington columnist to question "The Mystery of the President's Speech, or Does the English Language Mean Anything?"(2)
This strategy of promising social change through cautious action may seem ambiguous but is, in fact, characteristic of Roosevelt's pragmatic politics. He never intended drastic reform of the existing economic order. The New Deal relief programs were temporary and could, therefore, be experimental. The Social Security Act, on the contrary, would establish a permanent system that needed broad political and popular support. Through incremental reform, as Roosevelt hoped, social insurance would eventually replace the need for relief. "We cannot work miracles or solve all our problems at once," he concluded, "What we can do is to lay a sound foundation on which we can build a structure to give a greater measure of safety and happiness to the individual than any we have ever known."(3)
Historians have assumed that Roosevelt's cautious approach to national health insurance was a direct result of the medical profession's opposition as represented by the American Medical Association (AMA)? This was also the view of several of the original participants. For example, Secretary of Labor Frances Perkins stated that because of the opposition of the AMA, national health insurance "would have killed the whole Social Security Act if it had been pressed at that time."(5) Even though the opposition of the AMA was real, the overestimation of its influence reduces the history of national health insurance to a battle between idealistic reformers and medical obstructionists. In this way, one tends to forget that national health insurance was not so much a "lost reform" as an option that was not chosen.
Little is known about Roosevelt's personal views on the issue of national health insurance. What is known is based either on his public statements (mostly written by others but revised by himself) or on hearsay. Roosevelt hardly discussed the topic directly with the policy makers involved but used mediators such as his personal physician Ross McIntire, Surgeon General Thomas Parran, and Federal Relief Administrator Harry Hopkins.(6) Also, rumor had it that the president's actions were strongly influenced by his friend Harvey Cushing, a highly respected brain surgeon whose daughter Betsey was married to Roosevelt's son James, and by his wife, Eleanor Roosevelt. Other sources have suggested that Roosevelt was either "cold about health insurance" or favored such a program but recognized the political obstacles.(7) In any case, his cautious actions and ambiguous rhetoric left Roosevelt's position unclear.
The Committee on Economic Security
In his message to Congress of June 8, 1934, Roosevelt announced that the social insurance system he envisioned would be "national in scope" to provide all Americans with a "safeguard against misfortunes which cannot be wholly eliminated in this man-made world of ours."(8) Three weeks later, Roosevelt appointed the Committee on Economic Security (CES). …