Welfare state

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.