Part 3 of the AMA... the great communicator

The introduction of the King-Anderson bill in Congress in 1961 began a five year campaign by the AMA and other opponents of the bill to fight its passage. The King-Anderson bill was viewed by many as a necessary compromise for the continuing health care of a growing number of elderly in the United States. As medical procedures increased in efficiency and effectiveness they necessarily increased the life span of Americans. With the increased effectiveness also came increased cost and most American retirees were simply not prepared for the rapid increase in health cost that accompanied these two effects.

Several demographics changed in the early sixties to give impetus to those fighting the AMA and large insurance carriers in their attempt to push a health care initiative for seniors and the indigent. Between 1950 and 1963 the elderly population in the US increased from 12 million to 17.5 million, to about 9.5% of the population. For the first time the AMA and large insurance carriers found some organized opposition pushing for a national health care initiative. Organized labor began to actively push for health care reform because they saw the spiraling health care costs destroying their ability to provide health care for their members that were part of collective bargaining agreements. Ironically, it were these spiraling costs for retired union workers that were later to be one of the main forces that drove Chevrolet and Chrysler into bankruptcy early in the next century. The unions saw it coming as early as 1960 as costs steadily outstripped their ability to provide health care benefits for their members.

While most Americans understood there was a problem, there was no universal agreement as to how to mitigate the problem. Most favored some sort of governmental involvement but the AMA and other private medical groups concerned with profit margins for doctors and hospitals were plainly nervous about what such plans would do to doctor’s standards of living. With the introduction of the King-Anderson bill, the line was drawn in the sand and both sides began an all-out campaign to get their message before the people.

A few days after his inauguration, President Kennedy sent a special message to Congress on health. This was immediately followed by the King/Anderson bill which was later modified to become the Medicare plan. Even though Kennedy had campaigned on National Health Care reform and now had a more organized group of backers pushing for reform, he did not have the votes in Congress to push the bill through. The election of 1960 saw Democrats lose some 20 seats in the house although they increased in the Senate. Kennedy shrewdly saw that it was necessary to postpone pushing for this reform until after the 1962 election when he hoped to gain more seats in the House. Kennedy soon saw his support drop even more after the Bay of Pigs fiasco in Cuba and a crisis with the overbearing Soviet Premier ,Krushchev, over the Berlin wall.

Aside from the normal congressional buttonholing lobbying efforts the AMA utilized by its wealthy members who held some percentage of the all important purse strings that party officials utilized for running campaigns, the AMA immediately instituted several expensive and widespread efforts and convincing the public that the King-Anderson was a bad idea. The AMA bought radio and television ads painting supporters as “socialist” or “communist” agents bent on the destruction of the American system of free enterprise. This was a tried and true methodology that the AMA had already employed several times with great success in the first part of the 20th century and there was no reason to believe it wouldn’t work again. Ads claimed that jack booted federal bureaucrats would violate the sanctity of the operating room and the doctor patient relationship by deciding what doctors could and could not do, whether their patients agreed or not. It has always seemed interesting to me that such arguments can hold up the sanctity of the American free enterprise system by insinuating that our own federal government is somehow bent on making us into socialists or communists. Yet these same proponents of our system insist that all our government’s actions in the way of military involvements in other countries around the world are done in the name of protecting us from these same socialist or communist interests. It seems that our government is the paragon of virtue militarily while at the same time an agent of these same sinister socialist forces it is protecting us from when it attempts to implement domestic policy improvements that might actually help Americans who need help.

The AMA produced and reprinted a vast library of speeches, policy writings, and public information statements that it found ways to get into public media and magazine articles preaching against the “red tactics” that were sure to ruin medical care if the bill passed. The AMA produced high school debate kits that it handed out to local doctors in the hopes that they could use their influence in the community to get this information broadcast as widely as possible. Most of these actions were based upon the idea that any sort of public health care policy would ruin the medical system of free enterprise and necessarily be the first step to a socialist, communist takeover of the country itself.

The AMA organized a large women’s auxiliary effort of doctor’s wives across the country into a grass roots political movement. This organization was the core group that formed WHAM, Women Help American Medicine. The group’s reason for existence was spelled out in a public statement: “This campaign is aimed at the defeat of the King-Anderson bill of the 87th Congress, a bill which would provide a system of socialized medicine for our senior citizens and seriously curtail the quality of medical care in the United States.” It is a little bit of a stretch for me to see how a watered down version of what later became Medicare could seriously curtail the quality of medical care in the country but maybe that is hindsight; or possibly common sense devoid of the hysteria about communism/socialism that existed in early 1960.

The idea of using the wives of doctors as one of the sources for the campaign was an interesting one. As members of the community that we well respected it seemed common sense to use the maternalistic instincts of Americans in general to gain their attention. The idea was that doctor’s wives would organize community get-togethers to discuss the issue. At these get-togethers there were detailed packages supplied by the AMA that included suggestions for how to get the people participating to write letters to their congressmen in opposition to the plan. It was thought that having private citizens instead of doctors write the letters would be more effective and would also necessarily involve a larger number of people and therefore a larger number of letters in congressmen’s inbox. The behind the scenes muscle of campaign contributions was to be enhanced by the public show of disdain for the plan. It was thought that a widespread “motherly” opposition to health care reform would necessarily be a stronger tool than the reality of a bunch of doctor’s wives who were afraid of a loss of income. It must be remembered that the AMA had long been the monopolizing agent of medical care in the United States and had vehemently opposed every attempt at applying free market principles to the medical community since its inception.

The AMA paid for and produced a long play LP record that was to be the convincing argument against the King-Anderson Bill and hopefully would be the nail in the coffin of all future such bills that threatened the autonomy of doctors. The AMA needed a smooth talker; a storyteller and master speaker to encompass its arguments in a homespun narrative that would convince listeners of the danger of a government program that would provide affordable health care for the elderly. It takes quite a salesman to convince people that free health care for the elderly is an evil idea but the AMA found their man in a B-list actor who no longer could find work in the movie industry. In point of fact he had spent the immediately previous years working as a paid shill of General Electric travelling the country making speeches to its employees extolling the virtues of working for low wages while at the same time spelling out the evil dangers of socialist/communist tendencies such as unions. This man’s name was Ronald Reagan and he was to make a career out of saying one thing while simultaneously doing the opposite. As a measure of his ability to preach one thing and do another, he was in fact the president of the actor’s guild while simultaneously working for General Electric in this capacity. How he managed to pull this off without being called on his hypocrisy is remarkable, but he was later to prove even more of a magician in his ability to preach virtue while indulging corruption on a vastly larger scale but that is a subject for a later post.

The LP vinyl record was called “Ronald Reagan Speaks Out Against Socialized Medicine”. It featured an 18 minute speech by the actor and further comments by an unnamed narrator. The idea was that the Women’s Auxiliary members would call informal get-togethers with members of their neighborhood and play the record for the participants. After the record was played they would follow the form letter recommendations as to how to get the participants to mail in letters of dissent to their congressman. The LP came with written instructions and a kit that included the following:

• A cover letter, informing the attendees that “the chips are down, in the next months Americans will decide whether or not this nation wants socialized medicine;”

• A list of members of Congress;

• A ten-point check-list on how to write effective letters to Congress;

• A set of instructions to hosts in what Operation Coffeecup was and how it was to be carried out, including “Provide guests with stationery, pens and stamped envelopes. Don’t accept an ‘I’ll do it tomorrow’ reply—urge each woman to write her letters while she’s in your house—and in the mood!”;

• A report form listing the number of attendees, the number of times the accompanying record was played, and the number of letters written.

The plan was known as “Operation Coffeecup” and was to be used as one tool amongst many the AMA was using to lobby Congress to defeat the bill. There were even detailed plans as to how to carry out the gatherings in an impromptu manner. The organizers were urged to downplay the reason for the get together and simply invite their neighbors for coffee. The kit urged that the letters produced from these gatherings “not have the appearance” of being a part of an organized campaign as this would necessarily reduce their influence with Congressmen who were used to receiving such mail.

Reagan’s remarks on the LP were carefully polished stagecraft, aimed at seeming a neighborly conversation in the beginning but rising to a crescendo of red, white, and blue patriotic duty. The AMA never formally announced the existence of “Operation Coffeecup” or publicized the Reagan LP. As a matter of fact, recipients of the LP were warned that they were not to permit the commercial broadcast of the recording. The LP was to be used only in the controlled informal “Coffeecup” neighborhood meetings.

The LP started as follows:

My name is Ronald Reagan. I have been asked to talk on the several subjects that have to do with the problems of the day. . . .
Now back in 1927 an American socialist, Norman Thomas, six times candidate for president on the Socialist Party ticket, said the American people would never vote for socialism. But he said under the name of liberalism the American people would adopt every fragment of the socialist program. . . .
But at the moment I'd like to talk about another way because this threat is with us and at the moment is more imminent. One of the traditional methods of imposing statism or socialism on a people has been by way of medicine. It's very easy to disguise a medical program as a humanitarian project. . . . Now, the American people, if you put it to them about socialized medicine and gave them a chance to choose, would unhesitatingly vote against it. We have an example of this. Under the Truman administration it was proposed that we have a compulsory health insurance program for all people in the United States, and, of course, the American people unhesitatingly rejected this.

The socialist bogeyman strikes again. Reagan starts out by pointing out that medical services for people who need it is the proverbial foot in the door of socialism/communism that leads to worse things. Never mind that people need health care and cannot afford it; that is a side issue. The truly important thing to remember is that it is the first step to takeover by godless communist if the government starts providing health care for the elderly. The LP then goes on to explain what this “imminent” threat that Reagan wants to warn people against:

Congressman Forand introduced the Forand Bill. This was the idea that all people of Social Security age should be brought under a program of compulsory health insurance. Now, this would not only be our senior citizens, this would be the de¬pendents and those who are disabled, this would be young peo¬ple if they are dependents of someone eligible for Social Security. . . .

There we have it… the Forand Bill which was actually defeated two years earlier is brought to the forefront as being synonymous with the current bill under consideration but the crux of the matter is simply that a health insurance plan for the elderly would be paid for by the government. By necessity that AMA had by this time conceded that there was a problem although they differed considerably with the common perception of the size of the problem. The AMA’s primary interest was at the time and still is today the protection of fees that doctors charged their customers. The formation of a government entity that might tend to set prices was anathema to them and that was the fear that was at the bottom of their campaign against any sort of national health care system and still is today. Reluctantly, the AMA had agreed to passage of the Kerr-Mills bill that implemented a plan for care of the indigent elderly on a voluntary basis. The AMA had no interest in protecting the elderly on fixed incomes who simply couldn’t afford higher health care costs without losing everything they had saved over a lifetime. Reagan goes on to claim that the Kerr-Mills bill takes care of the problem even though by this time it had been effect for some time and obviously did not take care of the issue. The point that Reagan carefully skips over is that the Kerr-Mills bill itself is a socialist bill in that is the government’s attempt to take care of the indigent. While it does nothing to help the problem of seniors on fixed incomes going bankrupt trying to afford needed health care and virtually guarantees that they would either be forced to lose their life savings or do without needed health care, it is at heart a socialist bill which is in reality a continuing part of our system in this country; a blending of pure capitalism with socialism. This has been the case since governments of the people were formed in ancient Greece and it will continue to be the case in the future. A government of the people will always lean towards socialist institutions as long as it is a free government; it is the balance that is important. The idea that the any free government is a purely capitalist or free market society is a willing twisting of the facts. Reagan goes on to greater exaggerations of the facts on the LP as he describes the fictitious slide towards communism:

The doctor begins to lose freedom. . . . First you decide that the doctor can have so many patients. They are equally divided among the various doctors by the government. But then doctors aren’t equally di¬vided geographically. So a doctor decides he wants to practice in one town and the government has to say to him, you can't live in that town. They already have enough doctors. You have to go someplace else. And from here it's only a short step to dictating where he will go. . . . All of us can see what happens once you establish the precedent that the government can determine a man's working place and his working methods, determine his employment. From here it's a short step to all the rest of socialism, to determining his pay. And pretty soon your son won't decide, when he's in school, where he will go or what he will do for a living. He will wait for the government to tell him where he will go to work and what he will do.

One can only wonder where this line of reasoning comes from. There was nothing in the bill under consideration that insinuated that the government would do anything of the kind. The truth of the matter is that doctors work where doctors can have enough customers to pay their bills. Having an insurance provider pay the bills is exactly what was in place at the time and is exactly what is in place today, whether it is a private insurance provider or the government in the form of Medicaid but this is exactly the kind of half baked logic that Reagan would use to prey on fears in a long political career later on. In truth neither the King-Anderson bill nor Medicare, which eventually was the bill that passed, ever intended to regulate the medical industry. It was simply a plan for putting in place the ability of the government to pay for health care for the elderly through private institutions. Medicare does no more to control the industry and in fact does much less than private health carriers. If you should doubt this try to dictate to your health care insurance provider what procedures you want your doctor to perform and see how successful you are in that endeavor. Reagan finished his pitch with a flourish and the kind of look at the future contemplative scare tactics he was to perfect in later years:

What can we do about this? . . . We can write to our congressmen and to our senators. . . . And at the moment the key issue is: We do not want socialized medicine. . . . In Washington today 40,000 letters, less than 100 per congressman, are evi¬dence of a trend in public thinking. . . . Representative Halleck of Indiana has said, “When the American people want something from Congress . . . if they make their wants known, Congress does what the people want.” So write. . . . that you demand the continuation of our traditional free enterprise system.
You and I can do this. The only way we can do it is by writing to our congressman even if we believe he’s on our side to begin with. Write to strengthen his hand. Give him the ability to stand before his colleagues in Congress and say, I heard from my constituents and this is what they want. And if you don't do this and if I don't do it, one of these days you and I are going to spend our sunset years telling our children, and our children's children, what it once was like in America when men were free.

One would suppose that Reagan might consider that other people were spending their sunset years attempting to get health care they couldn't possibly afford or simply dying for the lack of it but perhaps that didn't happen in the imaginary shining city on the hill where he seemed to spend most of his time. In any case, Reagan might have been a good actor and was definitely a good public speaker but his skill at forecasting the future proved to be one that left something to be desired.

Meanwhile, the AMA and a large group of insurance carriers steeled themselves for more confrontation over the issue of allowing the federal government to begin instituting what they saw as price controls. Even though everyone understood that skyrocketing medical costs were the problem, the AMA and insurance carriers were determined to protect profit margins above all else. Just after Kennedy’s election, Dr. Ernest B. Howard, executive vice president of the AMA and chief strategist charged with fighting the passage of a federal health care plan, declared there would be no compromise on the issue. “The surest way to total defeat is to say, we are now going to sit across the negotiating table and see what you will give us. I think no one should underestimate the tremendous strength of medicine; that’s the way we won last time.”

A few weeks later the AMA announced an “all-out effort” against “the most deadly challenge ever faced by the medical profession.” This program included a team of 70 speakers travelling the nation speaking to local chambers of commerce and civic organization against the evils of “socialized” medicine and a whole spate of new radio and TV ads against the bill.

They were joined in their efforts by commercial health care providers and the nonprofit Blue Cross Association. Most of their efforts were aimed at issuing official looking reports suggesting that the cost of such a plan would bankrupt the country. If this sounds familiar now, it is second only to the eternal “socialist bogeyman” in the unending effort by those enriching themselves the most from healthcare for profit in being utilized to fight any and all efforts to bring down costs in this area. While spiraling costs were then and are now the real danger in our system, they continue to suggest that we “can’t afford” a better system while ignoring the fact that every other industrialized nation in the world provides better healthcare at a fraction of the cost of ours.

As time went on, the supporters of reform efforts began to get better organized as well. Efforts of the Democratic National Committee aimed at organizing support in the home districts of the member of the House Ways and Means Committee that continued to hold the bill hostage in the House of Representatives. The head of the Ways and Means committee was a Democrat from Arkansas; Wilbur Mills for sixteen years and was widely known as the most powerful man in Washington to insiders. At the time, the Ways and Means Committee was the originator of fiscal bills in the US Congress. Mills served as the leader of this committee longer than any person in US history. Mills was the son of a school superintendent. His father oversaw the first school district in the state of Arkansas to integrate. Mills studied constitutional law at Harvard under Felix Frankfurter who was later nominated and confirmed as a Supreme Court Justice. Frankfurter was what would be viewed as an odd mix ideologically in today’s world. He was one of the founders of the American Civil Liberties Union yet became the voice for judicial restraint on the Supreme Court for 23 years. He was a life-long supporter of labor rights yet refused to sit in judgments of state courts. Mills, as one of his better students, fit the same mold. He was well respected in Washington yet was hard to predict as far as how he would swing on issues. Previous to his service in Congress, Mills served as a County Judge in White County, Arkansas. There he organized a county-funded program with a public fund to pay medical bills for people who could not afford them. Through this program, prescription drugs were sold at costs and doctor’s fees paid for the indigent. Patients were qualified for the program through the Justice of the Peace while Mills himself made the final approvals.

A grass roots campaign to organize seniors in need of help with rising costs culminated in the million members National Council of Senior Citizens for Health Care. This group became a spokesman for seniors across the nation as well as maintaining strong efforts to stimulate local political action through its various member organizations. The “Physicians’ Committee for Health Care through Social Security” was also formed in opposition to the AMA. The commission included Dr. Caldwell Esselstyn who had been the personal physician to Eleanor Roosevelt. Esselstyn later formed a private clinic for treatment of heart problems that has achieved phenomenal results by controlling diet and eating habits as opposed to invasive surgery. You can read about Esselstyn and his work in “The China Study” or by watching the popular film “Forks Over Knives”. Esselstyn was joined on this committee by several other prominent physicians including two Nobel Prize winners; Dr. Arthur Kornberg and Dr. Dickinson Richards. This group lobbied for what they saw as a desperate need for health care subsidies for a growing population of seniors unable to afford needed health care.

As the 1962 elections approached both sides worked hard to slant the field in their favor. Medicare supporters worked to lobby senior voters away from the Republican party while the AMA and Insurance Companies used the same scare tactics that they had used so effectively in the fifties to defeat government reform of the system. Socialism and communism fears were stoked mightily while business interests beat the drum about runaway costs.

By this time runaway costs were hurting everyone involved. Even insurance carriers, especially the smaller ones, began to feel the pinch as increased costs led them to increase premiums dramatically. Senior on fixed income couldn’t afford the increase and often dropped out of the program completely leading to even more downward spirals for health care providers saddled with more and more non-paying customers unable to afford needed healthcare. These costs were then passed on to other customers in the form of even higher premiums as the pool narrowed. Health care providers’ attempts to pass these costs on to paying customers raised the cost of health care for everyone and the vicious cycle continued. A study that year by a Senate committee determined that only one half of senior had sufficient insurance coverage to cover 75% of their health care bills. Only 25% of seniors had adequate hospital coverage.

What actually swung the election in the Democrats favor was the Cuban Missile Crisis in October of 1962. President Kennedy gained much support for his actions in staring down Krushchev and the Democrats held their own in the House. They gained extra support in the Senate but probably the most important outcome of the election was two Democratic vacancies opened up on the powerful Ways and Means Committee which had been holding the bill hostage.

Even though Kennedy had pledged to push Medicare through the next session it took a back seat after the election to the unfolding Civil Rights issues and a nuclear test ban treaty with the Soviet Union. By this time, the Democrats had once again lost steam in their push to pass Medicare and their opponents within the AMA and Insurance Companies had been busy lobbying extensively within Congress.

The House Ways and Means Committee was still deadlocked on the issue but Mills, as head of the committee had earlier announced, "I want to make it clear that I have always thought there was great appeal in the argument that wage earners, during their working lifetime, should make payments into a fund to guard against the risk of financial disaster due to heavy medical costs. . . . I am acutely aware of the fact that there is a problem here which must be met." While this led many to believe that the hurdle in the house was cleared it was by no means a certainty and the Senate was also showing signs of changing its support in favor of more assurances for private insurers.

It was against this backdrop that another unforeseen incident changed the balance for Kennedy’s legislative programs. On November 22, 1963 Kennedy was fatally shot in Dallas, Texas. Lyndon Johnson, the vice president was sworn in and vowed to carry out Kennedy’s programs. Effective public support for opposition to the Medicare bill died with Kennedy that day in Dallas or at least with Johnson’s speech in support of his programs. This did not keep the AMA and Insurance companies from continuing the fight but their continued intransigent opposition did little to derail the bill after the overwhelming landslide election of Johnson the next year.

In July of that year, amidst growing public concern with Viet Nam, the Medicare bill passed through Congress. President Johnson signed Medicare into law after agreements had been reached with the AMA that guaranteed their continued control of prices which was all they were really interested in to start with. In the first four years that Medicare was in operation it paid for $17.9 billion of medical care for seniors. This money paid some $24.6 million in hospital bills and some 96.8 million doctor’s bills for covered seniors. It is hard to quantify the amount of suffering that went on in the four years that Reagan and the AMA managed to delay the passage of the bill, especially considering that 50% of seniors at the time both had no medical coverage and had less than $1000 in savings to pay for medical expenses.

The AMA pretended that the problem didn’t exist as long as they perceived it to be a threat to the income of the doctors that made up its membership. Reagan, for his part, not only pretended the problem didn’t exist at the time he later pretended that he didn’t campaign against Medicaid at all. In a televised debate with President Carter during the 1980 campaign, Carter accused him of campaigning against Medicare. Reagan denied he had done so by claiming he was simply in favor of the passage of another bill instead even though the record and Reagan’s LP speak plainly to the fact that Reagan was very much against Medicaid. In fact Reagan, as a paid shill of the AME, was in the forefront of the political battle to defeat it by working for the AMA in producing the LP.

There used to be a prominent commercial on TV that featured a spokesman proclaiming that he was not a doctor but he played one on TV. Much to our detriment as a nation Reagan later carried this charade to monumental proportions. He was not an economic expert but he played one in the White House. He was not a leader but he played one in the White House. He was really never much of anything beyond what he was when he worked for General Electric, a shill for big business who told stories that made people feel good while the corporate interests took over our economy.