The American Medical Association Campaigns against Health Insurance Legislation in the 1950s and the 2000s: Fear vs. Compassion

Author: Melissa Stone

The American Medical Association (AMA) has been on both sides of the national health reform campaign since the beginning of the twentieth century when the American Association for Labor Legislation first proposed a national health insurance plan.  As the largest association of physicians and medical students in the United States, the AMA deeply cares about health care legislation and how it will influence physicians, specifically with regards to their incomes.  Over the years, the AMA has used the media to be an advocate for endorsing physicians’ views on health care legislation, and this coverage has been given much clout.  In the 1950s, the AMA was vehemently opposed to any changes to the current health care system, whereas in the 2000s, the AMA had a more nuanced view on health care since the organization fought for more health insurance for the less fortunate but disagreed with how the government proposed to do this.  In both instances, the AMA enacted a large-scale media campaign opposing the reform, claiming health insurance controlled by the government would limit patients’ choices and freedoms.  However, to invoke an anti-health care legislation sentiment in the 1950s, the AMA appealed to the public’s panic of a Socialist agenda while in the 2000s, the AMA appealed to the public’s sympathy for the less fortunate.  Ultimately, through these campaigns, the American people have responded more strongly to fear than to compassion. 

The AMA enacted a strong fear campaign in the 1950s when physicians felt that they were trapped and had to take drastic measures.  The saga of Truman’s health care bill started in June 1943, when Senator Robert Wagner, Senator James Murray, and Representative John Dingell introduced the Wagner-Murray-Dingell (WMD) bill, a proposal to expand the Social Security Act to include additions such as health insurance.  The AMA, fervently against this bill since government sponsored health insurance could cause physician’s reimbursements to decrease, watched this bill and quietly began aligning itself with other organizations.  However, the bill showed little promise since the nation was mostly preoccupied with World War II, and consequently, the bill died in committee.  At the end of 1944, President Roosevelt revived the topic of health care and when Harry Truman became President after Roosevelt’s death in April 1945, Truman continued Roosevelt’s interest in developing a national health care system.  When Truman revised the WMD bill and proposed it to Congress in November 1945, this marked the beginning of Truman’s crusade for a national health care system.[1]

Truman’s WMD bill contained many characteristics that left it vulnerable to being charged with Socialism.  When Truman spoke to Congress in November 1945 after submitting the revised health care bill, Truman contended that there were “certain rights which ought to be assured to every American citizen [such as] the right to adequate medical care and the opportunity to achieve and enjoy good health [and] the right to adequate protection from the economic fears of sickness.”  In addition to creating incentives for recruiting physicians to rural areas and forming national standards for hospitals, Truman proposed a single universal comprehensive health insurance plan funded by the government.  Although Truman said multiple times in his speech, “This is not socialized medicine,” his plan for creating a national health care system reminded many of Socialist ideals and caused many to believe that he was proposing “socialized medicine.”  As defined by Karl Marx, a renowned Socialism political theorist, Socialism is the inevitable political system resulting from internal tensions leading to the fall of capitalism.  This political system is characterized by a public means of production and allocation of resources.  In his proposed health care bill, Truman projected that the government would fund his program “by distributing the costs” and establishing a “common health fund” in order “to attain our objective of adequate medical care, good health, and protection from the economic fears of sickness and disability.”  Similarly, Marx described Socialism occurring when “capital is converted into common property…for the common good of all.”  Truman later explained that his program would benefit from a “legal requirement on the population to contribute” and a “compulsory social insurance system,” statements that stressed the concepts of forcing citizens to do something, similar to Socialism’s “compulsory brotherhood of men.”  These potential links to Socialism were vulnerabilities in Truman’s health care bill, and the AMA would later exploit them.[2],[3]

However, there briefly appeared to be some hope for the AMA, prolonging the strike of its mass campaign.  In 1946, Senator Robert Taft introduced the Taft-Smith-Ball (TSB) bill to counteract the WMD bill.  This bill would have the government provide subsidies to individuals to purchase their own private health care, something that the AMA favored.  When it appeared over the next couple of years that many legislatures were against the TSB bill and in favor of the WMD bill, the AMA started to plan its “national education campaign,” meaning the AMA national attack on the WMD bill.[4]

Through media campaigns opposing Truman’s bill in 1949 and 1950, the AMA exploited the fears of Socialism in the public mind.  The time from 1947 to 1957 is known as the Second Red Scare, an era which Ellen Schrecker, a historian specializing in the Second Red Scare, described as a time when “the country [was] in the grip of a reign of terror or hysteria,” characterized by the “fear of government sanction” and the constant “threat of the Communist conspiracy.”  Family and friends were condemning each other as Socialists, and the House Committee on Un-American Activities falsely convicted many without any proper evidence.  Workers would have an annual loyalty review and according to Marty Jezer, a labor union historian and activist, many workers would fail the review for unfounded reasons and the workers’ lives would be “ruined everywhere and forever,” making them unable to find alternative employment.  In 1949 and 1950, the country was in a state of panic and the AMA was easily able to capitalize on this fear.[5],[6]

In the campaign against Truman’s bill, the AMA spent over $1.5 million, the most expensive lobbying effort of the time, and the first major advertising campaign ever undertaken by the AMA, an organization whose code of ethics shunned advertising.[7]  The campaign was composed of advertisements on television, radio, newspapers, and magazines.[8]  During this campaign, the AMA called Truman’s bill “socialized medicine” and claimed that Truman White House staffers were “followers of the Moscow party line.”[9]  Pamphlets created by the AMA with a liberty bell on the front stated claims such as, “Would socialized medicine lead to socialization of other phases of American life? Lenin thought so.  He declared socialized medicine is the keystone to the arch of the socialized state.”  And, “the voluntary way is the American way.”[10]  In 1949 alone, the AMA distributed 55 million pamphlets to over 100 million people.  The President of the AMA wrote in the Journal of the American Medical Association that the plan “would not only jeopardize the health of our people but would gravely endanger our freedom.  It is one of the final, irrevocable steps toward state Socialism and every American should be alerted to the danger.”[11]  In October of 1950, a full-page ad with a spread eagle and an American flag at the top ran in many national newspapers across the country with the slogans: “Who runs America?  You and your neighbor run America!”  This ad stated that “keeping [America] running for liberty and for freedom” is the job for “you and the man next door.”  However, the ad went on to state “that freedom has been attacked here recently” due to the “un-American excursion into State Socialism;” yet, doctors were “ready to fight for—to sacrifice for—to die for…the prideful security of a free and self-reliant people!”[12]  Television and radio ads used the slogan: “Guard your health – guard your pocketbook – socialized medicine would rob both.”[13]  These advertisements reached out to the average American and to arouse his or her patriotism for American ideals: liberty, freedom, and sovereignty.  Doctors were portrayed as the heroes who were working hard to maintain these American ideals whereas the government was the villain embodying Socialism. 

Furthermore, the AMA’s campaign reached out to the American individual and had characteristics of a grassroots movement that contrasted the more bureaucratic government. The AMA paid for its campaign by having members contribute $25 in order to prevent what the AMA called “the enslavement of the medical profession.”[14]  Although the AMA could not formally endorse personal lobbying, many of its members conducted letter-writing campaigns and legislators were lobbied by their own personal physicians.[15]  More than 190,000 letters and 120,000 personal phone calls were made for this campaign.  The President of the AMA in November 1950 stated “thousands of doctors and their wives, exercising their rights as individual citizens, did take an active part in election activities in many areas of the country.  And let us be thankful that they did.”[16]  Newspaper ads paid by the AMA stated that “that ‘grass roots’ signals Congress” and that thousands of local organizations of all sorts were supporting the movement against Truman’s health care bill.[17]

In the 1950s, the AMA went to unprecedented lengths and used extreme measures to insure the defeat of Truman’s health care bill, and many historians believed that it worked.  During the course of the campaign, the AMA contradicted and condemned the government.  The campaign encroached on the public’s lives by telling them what they should do and believe, and if they didn’t listen to the AMA, they would be un-American – something that was greatly feared during this time.  However, these tactics worked and Jill Quadagno, former President of the American Sociological Association, believes that “during the 1940s the AMA shaped the ‘political will’ ” and was able to  “frame national health insurance as a Communist plot and its supporters as communists.”[18]  Some historians even go so far as to claim, “The AMA’s war chest also helped to defeat over 80% of pro-health insurance legislators in 1950.”[19]  Polls showed that over 75 percent of the American people in 1949 knew that the AMA opposed Truman’s bill and that even though the Truman administration stressed that the plan was not “socialized medicine,” most American citizens, even those who were in support of the plan, thought that the plan endorsed “socialized medicine.”  Furthermore, between 1945 and 1949 and among those who were aware of Truman’s health insurance plan, public support for Truman dropped from 58 to 36 percent, a significant decrease for only four years.[20]  By 1950, the AMA knew that its campaign efforts had paid off.  The President of the AMA in November 1950 stated that “any compulsory health insurance bill today would go down to defeat by at least a 2 to 1 vote.”[21]  By the end of 1950, Truman stopped lobbying for his national health care plan.  He recognized that there wasn’t very much support for the bill and he had higher priorities to focus on, such as the emerging Korean War.  Through its scare tactics linking the bill to Socialism, the AMA had won its war against Truman’s health care bill. 

In 2007, the AMA was not content with the current health care system and recognized that there were tens of millions of uninsured citizens in the United States, many of whom would either not seek medical treatment or go bankrupt trying to pay for medical treatment.  Although many doctors voluntarily do pro bono work, a physician has to pay for equipment, staff, and overhead.  When a doctor treats a patient without health insurance, the patient would often either not pay for treatment or would pay a lower rate than a typical reimbursement from health insurance.  The AMA launched the Voice for the Uninsured campaign in 2007 during the early presidential primaries in order to instigate change in the current health care system.  In 2008, the AMA spread its campaign across the nation, and more than $15 million was spent for the campaign from 2007 to 2010.[22] 

However, the focus of this modern campaign was complex because the AMA sought to not only expand health insurance but also to expand health insurance in a specific manner.  In the AMA Proposal for Reform, showcased in the Voice for the Uninsured campaign, the AMA proposed that the government provide subsidies to its citizens to purchase their own private health insurance as opposed to having a national health insurance plan subsidized by the government.[23]  Whereas the government wanted there to be a health care system with few options, since this system would be cost efficient for them, the AMA wanted everyone to have the freedom to choose their own health insurance, regardless of government assistance.  If the government is restricting the type of health insurance that a person could have, this restricts the type of health insurance that a doctor could choose to accept.  If the reimbursement for a particular health plan is very low, the doctor may refuse to accept the plan but if many people are on a government-sponsored plan, which will most likely have a very low reimbursement rate, doctors will be forced to accept the plan and suffer the low reimbursements. 

Under President Obama, the Health Care and Education Reconciliation Act was passed as an amendment to the Patient Protection and Affordable Care Act in 2010, and the AMA was not in favor of this package.  Although it extended health care coverage in the United States, it would not provide individuals with great freedom in choosing their health insurance.  Prior to the passing of this package, the AMA once again launched a large-scale media campaign concerning health insurance; but, in this modern instance, the AMA’s tactic was very different. 

The AMA’s Voice for the Uninsured campaign exhibited “Stories of the Uninsured” to elicit a sympathetic response from the American people.  One such story describes “Toya’s problem” in which although she “is a typical 10-year old kid whose favorite pastime is jumping rope,” she has cancer and her parents cannot “afford medical insurance or pay her mounting medical bills.”  And thus, “without health insurance Toya can’t receive the care her survival depends on.”  The AMA is appealing to the heart of the American people and hoping that they will feel sorry for these poor individuals who are suffering due to the government’s refusal to provide them with subsidized health insurance.   The AMA further tried to invoke sympathy from the American people through articles in newspapers.  Nancy Nielson, former AMA President, proclaimed in the American Medical News that she suffered from not having health insurance as a graduate student and could not even afford to feed her young children.  Whereas the campaign of the 1950s invoked fear from the public, the AMA’s modern campaign invoked sympathy and sought out hope for reform.[24],[25]

Furthermore, the Voice for the Uninsured campaign focused on communities and targeted individuals across the country, similar to the grassroots campaign of the 1950s.  Advertising was on taxi tops, billboards, buses, kiosks, and airports.  Trains would have a huge billboard on the side with the picture of a young attractive child and a sign above stating: “People without health insurance live sicker and die younger.”[26]  The AMA stressed that this was a problem of the average American and thus, everyone should care: “many Americans need to look no further than their own families and friends or neighbors to find someone without health insurance,” claims AMA President Nancy Nielsen.[27]  The Voice for the Uninsured campaign also stressed democratic ideals, similar to the campaign of the 1950s.  In the AMA proposal for health care reform, the AMA stresses the need to maintain “freedom of choice” and “fair rules of the game.”[28]  Although the AMA’s health care campaign of the early 2000s was similar to the campaign of the 1950s in terms of visibility to the American public, reaching out to the average person, and stressing democratic ideals, the recent campaign was not as effective. 

The political, social, and cultural climate of the 2000s greatly differed from that in the 1950s, and this influenced the AMA’s campaigns.  In the 2000s, the Red Scares were long over and there was a greatly lessened fear of Socialism.  Although there were some rallies in the 2000s stating that Obama’s health care plan was “socialized medicine,” this support was not as nearly as great as it was in the 1950s.  In the 1950s, a mass campaign to the American people concerning government legislation was less common than in the 2000s and thus, people in the 2000s were more likely to ignore the AMA campaign.  Furthermore, Jill Quadagno believes that the AMA was effective in the 1950s because at the time, “their objectives coincided with those of employer groups, insurance companies, and trade unions,” whereas there was more opposition to the AMA’s campaign in the 2000s.[29]  Additionally, by 2007, many organizations had been lobbying for a national health care system for decades and many more recognized the current American health care system as a problem that would only get worse with time.  As the largest and most powerful organization of physicians in the country, many Americans trust the AMA and in the 2000s, “poll after poll shows that the American people trust them to do the right thing on reform as well.”[30]  The New York Times claims that the AMA “has more influence than any other organization in the health care industry.”[31]  Although the AMA was very influential, it was not the same organization in the 2000s as it was in the 1950s.  Whereas the vast majority of physicians in the 1950s were in the AMA and it was an indirect requirement to be able to practice at most hospitals, only 22% of physicians in America were members of the AMA in 2007.  Furthermore, the AMA did not have as much clout in the 2000s as it did in the 1950s and many historians agree that the AMA “may not be what it once was.”[32]  Because America was in a very different state in the 2000s than in the 1950s, the AMA tailored its campaigns accordingly.  However, by using a relaxed compassion campaign as opposed to an aggressive fear campaign, the AMA did not achieve its goal in having the government provide the less fortunate with subsidies to purchase their own private health insurance.[33]

The AMA campaigns of the 1950s and the 2000s had many common characteristics, such as appealing to democratic ideals and burgeoning from a grassroots movement, but the campaigns were remarkably different in tone, one was of fear and the other of compassion and this is what made all the difference.  Many marketing studies have shown that fear is an effective weapon in advertising.  Additionally, some studies have compared different advertising techniques and have revealed that fear campaigns, such as those used by the AMA in the 1950s, are more effective than guilt campaigns, those used by the AMA in the 2000s.[34],[35] Although there was much more opposition to the AMA’s campaign in the 2000s than in the 1950s, those ads in favor of Truman’s health care bill were most often sympathy ads, such as showing a mother with a sick son for whom she cannot afford to care, and these ads were remarkably similar to the sympathy ads by the AMA in the 2000s.[36]  This further showed the triumph of fear over sympathy in advertising.  The climate of the 1950s made America prone to a fear campaign and the loss of clout in the 2000s could have made the AMA believe that it couldn’t enact a similar aggressive campaign as it had in the 1950s.  Most importantly, the difference in tone between the two campaigns was one of the most influential characteristics that allowed the campaign of the 1950s to succeed and that of the 2000s to fail.


[1] The Papers of the Presidents, Special Message to the Congress Recommending a Comprehensive Health Program, 1945 (Washington, DC: American Presidency Project).

[2] Ibid

[3] Karl Marx, Friedrich Engels, and Gareth Stedman Jones, The Communist Manifesto (United States: Penguin Classics, 2002). 25.

[4] Social Security Administration, Social Security History, Chapter 3, http://www.ssa.gov/history/corningchap3.html.

[5] Ellen Schrecker, The Age of McCarthyism: A Brief History with Documents (New York, NY: Penguin Classics, 2002). 209, 267.

[6] Marty Jezer, The Dark Ages: Life in the United States (Cambridge, MA: South End Press, 1982). 84.

[7] Paul Starr, The Social Transformation of American Medicine (United States: Library of Congress, 1982).

[8] Beatrix Hoffman, “Health Care Reform and Social Movements in the United States,” American Journal of Public Health 93, no. 1 (2003): 75-85.

[9] Poen, Monte M.,”National Health Insurance,” in Richard S. Kirkendall (ed.), The Harry S. Truman Encyclopedia (Boston: G.K. Hall & Co, 1989): 251.

[10] “The Voluntary Way is the American Way.” AMA Pamphlet, 1950.

[11] Elmer L. Henderson, “Statement on Truman Health Plan,” Journal of the American Medical Association 140, no. 1 (1949): 114-119, 114.

[12] “Display Ad 59 – No Title,” Chicago Daily Tribune, October 8, 1950, http://www.proquest.com.

[13] “The American Medical Association: Power, Purpose, and Politics in Organized Medicine,” Yale Law Journal 63, no. 7 (1954): 950.

[14] Social Security Administration, Social Security History, Chapter 3, http://www.ssa.gov/history/corningchap3.html.

[15] Beatrix Hoffman, “Health Care Reform and Social Movements in the United States,” American Journal of Public Health 93, no. 1 (2003).

[16] “Organization Section,” Journal of the American Medical Association 144, no. 15 (1950). 1268.

[17] “Display Ad 59 – No Title,” Chicago Daily Tribune, October 8, 1950, http://www.proquest.com.

[18] Jill Quadagno, Why the United States has No National health Insurance: Stakeholder Mobilization Against the Welfare State (Boston, MA: G.K. Hall & co., 1989), 251.

[19] Anne-Emanuelle Birn and others, “MD Struggles for National Health Reform in the United States,” American Journal of Public Health 93, no. 1 (2003): 90.

[20] Michael Schiltz, Public Attitudes Toward Social Security (Washington, DC: US Government Printing), 136.

[21] “Organization Section,” Journal of the American Medical Association 144, no. 15 (1950). 1268.

[22] Nancy Nielsen, “Voice for the Uninsured campaign growing stronger,” American Medical News, September 15, 2008.

[23] American Medical Association, “Expanding health insurance coverage and choice: The AMA proposal for reform,” (Health Policy Group, 2008).

[24] http://www.voicefortheuninsured.org

[25] Nancy Nielsen, “Voice for the Uninsured campaign growing stronger,” American Medical News, September 15, 2008.

[26] http://www.voicefortheuninsured.org

[27] Minnesota Medical Association, “ ‘Voice for the Uninsured’ ads permeated conventions,” September 10, 2008.

[28] American Medical Association, “Expanding health insurance coverage and choice: The AMA proposal for reform,” (Health Policy Group, 2008).

[29] Jill Quadagno, Why the United States has No National health Insurance: Stakeholder Mobilization Against the Welfare State (Boston, MA: G.K. Hall & co., 1989), 251.

[30] Minnesota Medical Association, “ ‘Voice for the Uninsured’ ads permeated conventions,” September 10, 2008.

[32] Julie Rovner, What happened to the AMA’s clout? National Public Radio, June 15, 2009.

[33] Ken Ringle, “AMA worries about memership decline, decreased clout,” The Milwaukee Journal, April 23, 1984, 31.

[34] Linda Brennan and Wayne Binney, “Fear, guilt, and shame appeals in social marketing,” Journal of Business Research 63, no. 1 (2010).

[35] John Burnett and Richard Oliver, “Fear appeal effects in the field: A segmentation approach,” Journal of Marketing Research 16, no. 2 (1979).

[36] “Display Ad 63 – No Title,” New York Times, October 27, 1950, http://www.proquest.com.

 

Appendix

Figure 1. “The Voluntary Way is the American Way.” AMA Pamphlet, 1950.

 

 

 Figure 2. “Display Ad 59 – No Title.” Chicago Daily Tribune, October 8, 1950. http://www.proquest.com

 

Figure 3. Minnesota Medical Association.“ ‘Voice for the Uninsured’ ads permeated conventions.” September 10, 2008.

 

Figure 4. http://www.voicefortheuninsured.org

 

Bibliography

American Medical Association. “Expanding health insurance coverage and choice: The AMA proposal for reform.” Health Policy Group, 2008.

Birn, Anne-Emanuelle, Brown, Theodore M., Fee, Elizabeth, and Walter J. Lear. “MD Struggles for National Health Reform in the United States.” American Journal of Public Health 93, no. 1 (2003): 83-91.

Brennan, Linda and Wayne Binney. “Fear, guilt, and shame appeals in social marketing.” Journal of Business Research 63, no. 1 (2010): 140-146.

Burnett, John and Richard Oliver. “Fear appeal effects in the field: A segmentation approach.” Journal of Marketing Research 16, no. 2 (1979): 181-190.

“Display Ad 59 – No Title.” Chicago Daily Tribune, October 8, 1950. http://www.proquest.com.

“Display Ad 63 – No Title.” New York Times, October 27, 1950. http://www.proquest.com.

Henderson, Elmer L. “Statement on Truman Health Plan.” Journal of the American Medical Association 140, no. 1 (1949): 114-119.

Hoffman, Beatrix. “Health Care Reform and Social Movements in the United States.” American Journal of Public Health 93, no. 1 (2003): 75-85.

Jezer, Marty. The Dark Ages: Life in the United States. Cambridge, MA: South End Press, 1982.

Marx, Karl, Friedrich Engels, and Gareth Stedman Jones. The Communist Manifesto. United States: Penguin Classics, 2002.

Minnesota Medical Association. “ ‘Voice for the Uninsured’ ads permeated conventions.” September 10, 2008.

Monte M. Poen. “National Health Insurance,” in Richard S. Kirkendall (ed.), The Harry S. Truman Encyclopedia. Boston: G.K. Hall & Co, 1989.

Nielsen, Nancy. “Voice for the Uninsured campaign growing stronger.” American Medical News, September 15, 2008.

“Organization Section.” Journal of the American Medical Association 144, no. 15 (1950). 1268-1270.

Quadagno, Jill. Why the United States has No National health Insurance: Stakeholder Mobilization Against the Welfare State. Boston, MA: G.K. Hall & co., 1989.

Ringle, Ken. “AMA worries about membership decline, decreased clout.” The Milwaukee Journal, April 23, 1984, 31.

Rovner, Julie. What happened to the AMA’s clout? National Public Radio, June 15, 2009.

Schiltz, Michael. Public Attitudes Toward Social Security. Washington, DC: US Government Printing.

Schrecker, Ellen. The Age of McCarthyism: A Brief History with Documents. New York, NY: Penguin Classics, 2002.

Social Security Administration, Social Security History, http://www.ssa.gov/history/corningchap3.html.

Starr, Paul. The Social Transformation of American Medicine. United States: Library of Congress, 1982.

“The American Medical Association: Power, Purpose, and Politics in Organized Medicine.” Yale Law Journal 63, no. 7 (1954): 937-1022.

The New York Times. Times Topics: American Medical Association http://topics.nytimes.com/topics/reference/timestopics/organizations/a/american_medical_association/index.html?scp=3&sq=%22voice%20for%20the%20uninsured%22&st=cse.

The Papers of the Presidents, Special Message to the Congress Recommending a Comprehensive Health Program, 1945. Washington, DC: American Presidency Project.

“The Voluntary Way is the American Way.” AMA Pamphlet, 1950.

Your Medical Program…Compulsory- or- Voluntary?” AMA Pamphlet, 1949.

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