By Merlin Chowkwanyun
Washington Post, June 12, 2019
The battle for universal health care has come a long way. Today, the House Ways and Means Committee is holding a hearing on Medicare-for-all, and the plan has recently gained support from high-ranking Democrats, including several presidential contenders. It’s traction that would have been unimaginable even a decade ago.
Even so, the fight for Medicare-for-all will be a war. “You should not be the guinea pigs in some far-left social experiment,” Senate Majority Leader Mitch McConnell (R-Ky.) recently opined. These remarks echo the pitched battle over the Affordable Care Act a decade ago and the famous ads that helped bring down President Bill Clinton’s health-care plan, featuring the fictitious couple Harry and Louise, who fanned fears of limited doctor choice by remarking, “They choose. We lose.”
But the opposition to national health insurance extends far beyond fighting against the policy itself. Its roots are in the McCarthy period of the 1950s, when the medical profession purged from its ranks those doctors with any hint of leftist political orientation, removing critical voices of dissent from the mainstream health policy conversation.
In the half-century since, the profession and its lobbyists have frequently fought against expanded government financing of health care for all. And they have effectively ingrained those critiques into the larger political dialogue, making any kind of debate about health care about not just medicine, but also fundamental faith in government and the welfare state. Until we understand this legacy, we won’t be able to transcend it and have a sober dialogue about the future of health care in the United States.
In 1950, the Journal of the American Medical Association (JAMA) published an editorial by FBI Director J. Edgar Hoover warning about metaphorical “communist germs” and urging physicians to forward “any information of this nature” to the bureau.
Hoover’s editorial wasn’t just some oddity. As the Cold War alignment hardened, the medical establishment vigorously policed its own ranks for any hint of “red” leanings, which meant working closely with the most repressive elements of the government, including the FBI. In this climate, support for left-leaning public policies put doctors’ livelihoods at risk.
In 1951, during a hearing on the motion picture industry, the House Un-American Activities Committee (HUAC) called Los Angeles physician Murray Abowitz to testify about his association with a group called the National Council of Arts, Sciences and Professions (CASP), which HUAC had concluded was “anti-American, pro-Soviet.” HUAC asked Abowitz about other activities, too, including his work with the Civil Rights Congress, a racial justice organization made up heavily, though not exclusively, of Communist Party members.
After the hearings, Abowitz promptly lost his job at Cedars of Lebanon Hospital in Los Angeles (now merged and known as Cedars-Sinai). So did two other doctors, Alexander Pennes and Richard Lippman, an eminent expert on kidney disease, whose names came up in Abowitz’s testimony.
What cost these doctors their jobs? Throwing themselves into progressive causes. That included fighting for national health insurance, higher wages for interns and residents, and an end to racism in hospitals. Lippman had recently helped research a pamphlet that documented patterns of exclusion in Los Angeles facilities, and it didn’t hold back on identifying offending facilities by name. But embracing civil rights so visibly was professionally dangerous, particularly in an era when the American left and the Communist Party were major engines of civil rights agitation.
The 1951 hearing was just the start. A few months later, in January 1952, HUAC returned, broadening its scope to examine “Communist Activities Among Professional Groups in the Los Angeles Area.” An osteopath named Louise Light named names. Soon, Harold Koppelman, a surgeon at Queen of Angels Hospital, received a subpoena from HUAC. It cost him his job. Four additional physicians at Cedars suffered the same fate when they, too, received HUAC summonses.
These firings were the result of an elaborate red-baiting operation constructed by the medical profession, working with government organs such as HUAC and the FBI. In 1952, an FBI agent reported receiving a call from a Cedars trustee who asked him for any information that would help in “establishing” Lippman’s subversive activities.
Two years later, when a state-level analogue to HUAC held hearings on communist infiltration into the medical ranks, it did so at the behest of the Los Angeles County Medical Association (LACMA). During the hearings, it became clear that LACMA’s leaders had been tracking the activities of left-wing Los Angeles physicians for some time. They had monitored protests against the Cedars firings, even attending some events.
Efforts to remove any “red” presence didn’t just involve ferreting out doctors with any hint of leftist political ties or activism. The profession also attacked groups. Into the late 1940s, the Association of Internes and Medical Students (AIMS) was a large activist organization that fought for better working conditions for young physicians, built alliances with like-minded medical students around the world and supported civil rights and national health insurance.
This activism brought it into the crosshairs of the powerful American Medical Association, then at the height of a crusade against government-funded insurance.
The AMA acted swiftly. It opened an investigation of AIMS, writing in JAMA, one of the most influential publications in American medicine, that the organization was “exhibiting communistic tendencies.” A year later, another JAMA commentary criticized AIMS’s support for national health insurance and higher wages and drew on these earlier accusations of communist affiliations to undermine its credibility. It ominously warned that students who joined AIMS might “risk considerable embarrassment.”
The AMA campaign culminated in a report concluding that AIMS regularly published those “affiliated with organizations and institutions that have been cited as Communist fronts” and that it had “a general reputation of being a left wing organization.” The AMA could not, it concluded, “lend its support” to AIMS.
AIMS’s stigmatization had immediate consequences. At an individual level, it cost Sheppard Thierman, an intern at Kings County Hospital, his job. Advertisers withdrew from AIMS’s publication, starving it of its main revenue source. Issues grew scarcer, then thinner, then nonexistent. AIMS chapters withered away.
These episodes — and many others like them — explain why the medical profession has been so averse to national health insurance until very recently. Not only did doctors risk stigma if they supported it in the 1950s, but many on the left also had their careers derailed, skewing the profession’s political complexion.
While doctors’ politics, and accordingly, attitudes toward national health insurance, are starting to shift, the toxic residue of these purges remain. The silencing of progressive physicians during the Cold War has long narrowed the horizons of what was possible in health care. Our health-care system is worse for it, clearly not serving all Americans well. The profession must grapple with its legacy of political repression and how it has shaped American health care, and then reevaluate what policies might lead to better care for all.
Merlin Chowkwanyun is an Assistant Professor of Sociomedical Sciences at Columbia University’s Mailman School of Public Health.