History of the body

For the socialization of medicine! The CPUSA and Universal Healthcare in the 1930s

This is the fifth and final post in a series on the American Communist Party’s health journal from the mid-to-late 1930s, Health and Hygiene. This final post looks at the CPUSA’s national health policy and its call for universal healthcare, an issue that still affects Americans today.

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Health insurance and medical co-operatives

One of the underlying problems of health policy in the United States has been health insurance and people’s access to the health system. As part of President Roosevelt’s New Deal reforms in the 1930s, some form of free-to-access government funded healthcare system was proposed, but opposition from the American Medical Association (AMA), the health insurance industry and some politicians prevented this reform from being realised. The Communist Party and the editors of Health and Hygiene supported health insurance is a first step towards the ‘socialization of medicine’, with three physicians writing in June 1935, ‘We contend that genuine socialization can come only through the establishment of a comprehensive system of social insurance.’ Such a programme, according to these physicians, would provide:

  1. Full medical and dental attention to all working people – workers, farmers, and professionals, employed and unemployed, and their families.
  2. Control only by those who are interested in its honest and efficient functioning, those who give the care and those who receive it.
  3. Financing through taxation of those sections of our population which are able to pay, that is, those in the higher-economic brackets.

They highlighted the problems of the current state of healthcare in the United States by stating that in 1929, before the onset of the Great Depression, only 20 per cent of the working class had any form of dental care, and that 50,000 people would die per annum from sickness and ill health, due to the lack of a proper healthcare system. While the AMA opposed this form of healthcare, these three physicians argued that was also in the economic interests of healthcare professionals. Their reasoning was thus:

Just as the people in general seek doctors to treat them, so the practitioners today – more and more of them – seek patients to treat. There is genuine unemployment among the practitioners even as there is among those who would be patients…

What keeps the patient from the doctor? The answer is clear and simple: He cannot pay for medical and dental care.

However in another article in October 1937, Kingsley Roberts, the Medical Director of the Bureau of Cooperative Medicine, claimed that compulsory health insurance was panacea as it still meant that the poorest people only received treatment from the doctors with the lowest levels of competency. The alternative to this that Roberts proposed were medical co-operatives, which distributed costs evenly amongst its members and encouraged ‘group practice’, where ‘[o]rganized groups of physicians representing all branches of medical science’ are available for consultation within one cooperative. For Roberts, cooperative medicine made ‘a direct attack on the economic problems of present-day medicine with a view of making the best in medical science available to the people on the most favourable terms.’ Another article by Roberts from March 1938 succinctly defined the medical cooperative as:

the method by which numbers of lay-men band together and make periodic, fixed, pre-payment for the medical services of a number of physicians employed to keep them well and to give them regular medical attention when they need it.

The journal noted that most local medical societies, as well as the AMA, opposed these cooperatives, but the Medical Society of the County of New York was praised for embracing medical cooperatives, with journal calling this ‘statement given out by a group of 430 progressive physicians… a forward step’. Roberts concluded his article by declaring:

Active cooperation between progressive doctors and lay organizations is essential if consumer of medical service are to take their rightful part in arranging for more adequate distribution of medical care to all the people. The doctors who wish to support cooperative health organizations must struggle against the national medical officialdom which is grossly misrepresenting them. Laymen must fight reactionary propaganda which has confused and misled in the past.

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The national health program of the CPUSA

The call for the creation of medical cooperatives was what Trotskyists would have later described as ‘a transitional demand’, implemented before the socialisation of the health system as part of a workers revolution. Writing in the The Communist, William Z. Foster stated that the ‘preservation of the health of the people as a political question should, therefore, be the concern of the government’, proposing ‘a federal health program to guard the people’s physical welfare’. Foster acknowledged that ‘capitalist exploitation… deteriorates the workers’ health’ and that ‘only under a socialist system [would] the people’s health be fully protected’, it was important to recognise that ‘by insistent and intelligent mass struggle the toilers can accomplish very much even under capitalism in protecting their health.’ Therefore Foster argued:

It is the political task of the Communist Party to give all possible aid in the development of a national health program and in the organization of the struggle in support of it.

As seen throughout the run of Health and Hygiene, Foster emphasised that there were a number of different areas of social policy that needed to be addressed to create a positive effect on the health of the American working class. This included higher wages, strengthened food and drug quality laws, the abolition of slums and unsanitary low-rent housing, strengthened laws relating hazardous workplaces, increased rests and recreation for workers, economic safeguards (such as pensions and unemployment payments), and greater health education. Foster admitted that ‘[t]he labor movemebt has in the past grossly neglected the whole matter of the people’s health’, but claimed that the Communist Party was taking the issue seriously now, ‘giving its support to the progressive body of doctors who constitute the Medical Advisory Board of the Daily Worker.’ Like the physicians who wrote about health insurance and medical cooperatives, Foster encouraged the Communist Party, as part of the broad Popular Front, to campaign for a national health program, predicting that ‘health and social security legislation will be one of the main arenas of political struggle during the next few years.’ At the same time, Foster maintained that the various areas of struggle outlined above were areas where workers could achieve significant victories at the local level, while the larger national health program campaign moved more slowly.

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Conclusion – into the inter-imperialist era

The journal, for reasons unknown, wound up in late 1938, even though further issues were promoted. But this happened to several journals produced by the CPUSA during the Popular Front era as the Party entered the inter-imperialist era when the Soviet Union signed a Non-Aggression Pact with Nazi Germany. Most of those who were on the journal’s editorial board remained in the Communist Party and were involved in other ‘front’ organisations during and after the Second World War.

In his book The Lost World of British Communism, Raphael Samuel suggested that during the Popular Front period, the Communist Party of Great Britain was very concerned with appearances and promoted ‘cleanliness and respectability’ amongst its members. Reading through the pages of Health and Hygiene, this concern can also be detected within the Communist Party of the USA. The journal promoted an outwardly Marxist viewpoint of health and healthcare, but at the same time, relied on the authority of its contributors as respected members of medical community. While praising the healthcare system of the Soviet Union, there was little in the journal that explicitly advocated a socialist revolution and the editors were very much concerned with promoting practical and immediate advice for its readers, as well as short-term and tangible campaign goals for trade unions and other organisations.

This three year print run of Health and Hygiene reveals an insight into how left-leaning progressives viewed medicine, disease and healthcare in the 1930s, at a time when the Federal Government under Franklin D. Roosevelt was moving (somewhat) to the left with his New Deal reforms. Although there was support within the CPUSA (and by the journal) for most of the reforms undertaken by the Democrats, the journal continually campaigned for the working class, in their trade unions and other local organisations, to take control of their own health, especially pushing for greater safety in the workplace, tougher consumer protection laws, and a reform of social housing across the nation.

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A socialist guide to sex: The CPUSA and sex education in ‘Health & Hygiene’

This is the second part of a series of blog posts on the Communist Party of the USA’s health journal from the 1930s, Health and Hygiene. This post is dedicated to the coverage of sex and birth control issues in the journal. The first post can be found here.

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Sex and masturbation

Although sex education, particularly influenced by the purveyors of eugenics and social Darwinist birth control, was widespread in the United States in inter-war period, it wavered between pragmatism and upholding traditional Christian morality, including abstinence before marriage and from masturbation. The journal tried to counter this moral view of sex with a progressive and ‘matter of fact’ attitude towards sex and masturbation. The journal pronounced that many sexual ‘difficulties’ related back to the ‘morality taught to us in childhood’, which was ‘derived from religion’ and thus, ‘Questions about sex are lied about or completely repressed.’ Although many people may have moved away from religion in their adult life, the journal proposed that many were still unconsciously wedded to these beliefs. For example:

We may no longer believe that God will punish us for masturbation but we continue to believe that our masturbation has weakened our body and injured our sex organs.

The purpose of this morality was to make people compliant in the face of capitalism and bourgeois authority. The journal argued that ‘guilt feelings aroused by sex makes people timid before authority and afraid to fight for their rights.’ Therefore the fight against capitalism entailed a fight against conservative attitudes to sex, with the debut issue of the journal stating:

Just as we must fight to overthrow the present vicious economic system so we must fight against the wrong attitudes to sex [that capitalism] has implanted in us.

This Christian morality was blamed for sexual ‘frigidity’ in women and couples not enjoying sex after marriage, but the journal still warned against sex before marriage. When a young woman wrote to the journal in January 1936, saying her fiancé ‘think we should have sex relations before we get married’ and that she often thought ‘he is right and that it is only prejudice that keeps me from it’, the journal’s psychiatrist replied:

it might seem at first that it would be wiser for you to have sexual relations with your friend before you marry. This is not the case. Sexual relations are a part of life and cannot be isolated from it. To be satisfactory they must be part of an acceptable relationship.

The journal suggested that ‘[e]ven when we have consciously emancipated ourselves from [traditional feelings about sex], they continue to linger on, as unconscious feelings of guilt’. This could, the journal warned, bring on sensations of guilt for the young women, especially if found out by family and friends. The journal warned that her fiancé may also change his mind if they had pre-marital sex:

your friend, though he had the best intentions in the world, might easily, as a result of his own unconscious feelings of guilt about sex, feel that you had degraded yourself by having such an affair with him, and this might endanger his love for you.

Despite this warning against sex before marriage, the journal featured several articles discussing ‘frigidity’ in women, which argued that women needed to feel liberated from traditional views about female sexuality and be more willing to enjoy sex for sex’s sake within the realm of a heterosexual and monogamous marriage. According to an article in the journal from March 1936, 1 in 4 married women in America ‘get so little pleasure from sexual relations that they can be called frigid.’ This concept was borne out of the fascination with Freudian psychoanalysis in the United States in the inter-war period and proposed that women had internalised traditional morality that denied that women had ‘sexual curiosity, desire or knowledge’. The journal suggested that to overcome this ‘frigidity’, the woman had ‘to “let go” sufficiently to enjoy sexual relations’, while the role of the man in developing a sexual relationship was downplayed. As the journal stated, ‘[t]he husband’s skill and technique are factors to a certain extent, but their importance has been exaggerated.’

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As well as being taught from an early age that ‘only men and “immoral” women [had]… sex desires’, the journal’s psychiatrist pointed to another range of factors that they claimed caused ‘frigidity’. These included ‘improper methods of birth control’, such as the withdrawal method where ‘[t]he women’s uncertainty that the man will withdraw in time, especially when combined with a fear of pregnancy, may be of decisive importance.’ Another factor was the linkage of sex with large families and poverty, with the journal suggesting that to some young women, ‘Sex becomes synonymous with children one cannot afford to have, and a deep fear of pregnancy may result.’

An article published a few months later concluded that the combination of a husband’s encouragement, along with possible help from a psychiatrist, could help a married woman to overcome her frigidity. It stated:

Such a woman responds to gentleness, kindness, and affection during the daily round of life as well as during sexual relations. Encouraging her to express herself, giving her the feeling that her place in her husband’s affections is secure, encourages her to discard these relics of childhood. Tact and patience on the husband’s part will often result in the gradual development of an adult reaction to sex.

 In an exhibition of the journal’s Communist Party origins, it put forward the Marxist argument that women’s frigidity came from her inferior status within the capitalist system and the ‘solution to this problem… can only be a social one.’ The journal surmised:

Individual women may be cured, but most of them continue suffering and a million new cases crop up for the few that are helped. Just as our society creates frigid women, so a rational society could create normal ones. Women’s inferior position and their sexual exploitation are merely parts of the larger exploitation on which our society is based.

Sexual ‘weakness’ in men and their attitudes to sex were handled differently by the journal, and much less column space was dedicated to this issue. While a female reader was explicitly discouraged from partaking in pre-marital sex, the journal discussed a man’s sexual history without any criticism, writing:

When he was about seventeen or eighteen he had his first sexual experience and at this time ejaculated almost before he began intercourse. However, after a few experiences of this kind his ability improved and he had no further trouble except on rare occasions. He continued more or less regular sexual relations with different girls.

‘Weakness’ in this case was ‘rapid ejaculation’, or is better known today as premature ejaculation. The cause of this, the journal suggested, was that the man was ‘anxious and over-anxious to please [his wife], to be an ideal mate for her.’ The solution to premature ejaculation was, according to the journal, was to stop ‘worrying about not being the ideal’ and to be himself, alongside some possible help from a psychiatrist.

More room was dedicated to the topic of masturbation over the run of the journal. Famous psychiatrist and former member of the National Committee for Mental Hygiene, Frankwood E. Williams wrote a substantial article on the subject for the journal in November 1935 (less than a year before he died). Williams stated that there was ‘nothing surprising’ and ‘nothing unhealthy’ about masturbation, especially by adolescents and unmarried people. Psychiatrists were particularly concerned of the supposed mental and physical effects of sexual frustration and the journal advocated masturbation to relieve this tension. Williams wrote that people who engaged in masturbation should not feel guilty for doing so, but at the same time warned about masturbating ‘too frequently’, cautioning that for some ‘masturbation may become a permanent substitute for normal sexual intercourse.’ As humans were seen as social animals, Williams argued in the journal that sexual intercourse was preferable to masturbation and that it should be preferably only undertaken by married people ‘when the wife is absent or ill, or intercourse for any reason is at the time impossible.’ Williams’ main argument that it was anxiety and guilt caused by people worrying about masturbating that did the damage, concluding, ‘it is not the masturbation which is harmful, but the worry it produces.’ Like other discussions of female sexuality in the journal, discussion about female masturbation saw it as ‘more complicated’, but did acknowledge that ‘[m]asturbation interests women as well as men’.

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An illustration of the myths of masturbation

Birth control and abortion

By the 1930s, the concept of birth control had won acceptance amongst a significant number of Americans, although, as today, a vocal moral minority campaigned heavily against the promotion of birth control, especially to adolescents and unmarried people. At the same time, birth control became for many synonymous with eugenics and social Darwinism, which the Communist Party and the journal’s editors strictly condemned. The journal strongly advocated for knowledge of effective birth control methods to be provided to all women and called for the repeal of all anti-birth control laws. This was portrayed as a class issue:

While the wealthy upper classes have been able to obtain the necessary information wherever and whenever they desired it regardless of the laws, those who have the greatest need for birth control information – the low-income classes – have been unable to obtain it.

The journal enthused that a number of birth control centres were being opened by workers’ organisations, but warned against other centres or clinics run by religious organisations or for profit. With regards to the former, the journal criticised the Catholic Church for its promotion of the ‘rhythm method’ as an effective method of birth control. ‘There is not enough scientific evidence’, the journal’s Eric Matsner stated, ‘to prove that the average woman can rely on this method.’ But in a later issue, the journal conceded:

most women will prefer not to rely on the “safe period” as a method of birth control… However, the “safe period” does work in some cases, and for a woman whose religious scruples will not allow her to use other methods, it may be recommended as better than no method at all.

With regards to the latter, the journal warned:

The public should be on guard against a number of so-called “birth-control clinics” which have been opened by commercial firms. The interest of these firms is naturally not in the reliability of the advice given, but in selling their products.

From this, the journal also warned against birth control methods and ‘abortion’ pills being peddled by many, which were ineffective, costly and possibly dangerous. Writing on birth control methods, Matsner that a suitable doctor needed to consulted for the preferred method of birth control to be effective, which was the insertion of a diaphragm (not mentioned by name in the journal). Matsner wrote:

It cannot be too strongly emphasized that the woman who buys a contraceptive device at the drug store and attempts to fit herself runs a great risk of becoming pregnant. Only a physician, and a qualified one at that, can prescribe the size and type of contraceptive she needs. Yet a company that is doing a nation-wide business through drug stores sells its contraceptive device with the claim that “one size fits all normal women”.

With regards to abortion, in an article by Vivian Terry written in June 1935, the journal noted that there were ‘many medicines on the market that are supposed to bring on menstruation’, but Terry stressed:

All of these preparations, regardless of the name given to the product or the claims made for it, or the testimonials to substantiate these claims, are worthless. There is no drug, or combination of drugs, which when taken by mouth will with certainty produce abortion.

There were some pills that could cause miscarriages, but these pills only worked by causing ‘generalized poisoning’ of the woman who had taken them.

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An illustration accompanying an article warning about ‘abortion by pill’

The journal also lamented that at this time, there was a difficulty, even with doctors, in determining pregnancy and that many women became needlessly worried if their period was late. Because the ‘optimum time’ for an abortion is ‘between three and four weeks after a missed period’, the journal suggested that many women were avoiding getting an accurate diagnosis from a doctor and thus, ‘if the menstrual period is a week late they rush directly to the abortionists who emphatically assure them that they are pregnant and advise an immediate operation.’ The journal noted that it was estimated that around 150,000 abortions were performed annually in the United States and acknowledged that many women attempted to obtain one for a myriad of reasons, ‘whether it be heart disease, kidney disease, disease of the nervous system and so forth’. But the journal did not advocate making abortion legal so it could be properly regulated, instead proposing:

since abortions in the United States are still illegal and must be performed secretly at terrific expense and danger to the patient, the only solution to the problem is the use of scientific methods of birth control.

Eugenics and sterilisation

While many who advocated for birth control in the United States did so on the basis of eugenics, the journal was steadfast in its criticism of eugenics and the sterilization of ‘undesirable’ sections of the population. The journal argued that eugenics was based on faulty science from its very foundations:

The eugenicist starting from the crude notions that like produces like entertain the fallacy that superior children must come from superior parents. They have the notion that if the people with brains stopped breeding the next generation would all be morons… The eugenicist… is convinced that the genius ought and therefore does come from parents of what they call the better class; that morons come from morons, that good people come from good people, that criminals come from criminals, etc. None of these thins are so.

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Believing that ‘heredity is all important and environment negligible’, the journal called those who advocated eugenics as ‘propagandists for the exploiting class’. The reason that eugenicists called for the eradication of certain races, classes or political groups was, the journal suggested, because these were the groups of people that the ruling class and eugenicists feared. The eugenicists pushed for sterilization of these groups under the vague terms of ‘degenerate, feeble-minded, criminal [or] insane’, but the journal argued that this was ‘fake science’. Arguing that sterilization was ‘a fascist attack on workers’, the journal proclaimed:

Eugenicists are attempting to maintain the domination of a decaying class… Behind the hypocritical moral tone and all the mystical hokum about class and race superiority is a typical fascist attempt to obscure, disrupt and divide.

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The journal highlighted that the Nazi regime had, since January 1934, been using sterilization (as well as castration) against undesirable people and that these methods were being used around the world, partially inspired by the Nazis. The journal emphasised that the United States had been sterilizing ‘the so-called unfit’ since 1907 and that 12,000 people had been sterilized by 1932. It reminded readers that eugenicists were ‘irrational’ and talked ‘nonsense with a purpose’, concluding:

We must fight the attempt of the eugenicists to divide us on the basis of color, class, or race.

Stay tuned for the next section on vegetarianism, smoking and cosmetics tomorrow!