A little health reform history (and a quiz!)

Identify the source of the following statement:

The problem of providing satisfactory medical service to all the people of the United States at costs which they can meet is a pressing one. At the present time, many persons do not receive service, which is adequate either in quantity or quality, and the costs of service are inequitably distributed. The result is a tremendous amount of preventable physical pain and mental anguish, needless deaths, economic inefficiency, and social waste.

Was it:

A) President Barack Obama's speech to a joint session of Congress in 2010, his first official State of the Union address?
B) President Lyndon B. Johnson's "War on Poverty" address, actually his State of the Union 50 years ago last Wednesday?

C) A report to the American people from public health, medical, and social science
experts in 1932?

D) The 2012 platform of the Green Party of the United States?

The reports of the Committee on the Costs of Medical Care offer several lessons. First, they remind us of just how long we've been struggling with the problems of providing Americans with effective and affordable health care. Second, they suggest how much more work lies ahead of us, regardless of the ACA. Finally, they reveal how contested issues of social provision, taxation, and our nation's collective well-being have become in recent decades.

The Committee on the Costs of Medical Care began its work in 1926, following a conference in Washington to discuss problems arising from . . . the costs of medical care. Over the next several years it issued 26 reports on topics ranging from capital investment in hospitals to the costs of medicines, to organized medical services at Fort Benning, Ga. Many of the studies involved detailed investigations of small communities or local medical services, and they studied the health care provided by midwives, chiropractors, optometrists, and nurses, as well as what one report called "healing cults." Many were described briefly in report No. 27, A Summary of Investigations on The Economic Aspects of the Prevention and Care of Illness.

The group came about after attendees at the 1926 American Medical Association meeting, frustrated with the economic problems of the profession, decided to meet and tackle the problems. They reached out to Wilbur; others interested in looking for a comprehensive solution joined the group.

Given the period when committee-sponsored research took place, its members knew well how economic hardship limited access to needed health services and threatened the livelihoods of many professionals providing medical care. Despite this, in its final report (No. 28, Medical Care for the American People), the committee recommended  extending basic public health services, providing health insurance—including subsidies for those with low incomes—changes in the organization of medical practice, more coordination of health services, and improved training for health professionals.

The series of reports addressed the need for what was then called indigent care. They also acknowledged, in somewhat guarded terms, what we today call "health disparities," even though the committee's own investigations neglected to survey African Americans. And while the word "taxation" has become anathema to many today, it was discussed openly in 1932. The solution to resource disparities among communities was to be met through taxes, primarily from local and state funds but, the report concluded, "in certain areas Federal aid may also be necessary."

A minority report challenged many of the conclusions in the final report and stimulated the American Medical Association's opposition to the findings. Only two of the recommendations resulted in action. During the Depression the federal government did send money to the states for public health programs, and a Blue Cross insurance system was developed for voluntary prepayment of hospitalization costs. The other proposals in the majority report were ignored.

Janet Golden, a Rutgers University history professor, specializes in the histories of medicine, childhood and women.

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