...inducing Americans' fears of communism, fascism, and socialism."

The original Astroturf campaign. This 1918 brochure was promulgated to defeat health care reform in New York State. University of Rochester historian Theodore Brown says historians traced the addresses on the brochure back to the addresses of two private health insurers. The insurers ran a front campaign that appealed to public fears to defeat health care reform.

Going positive... but not winning. This 1919 image was part of the American Labor Legislative Review's response to the "Labor's Attitude" brochure. The ALLR, with the broader Progressive movement, started the campaign in 1918 for state health coverage.

Another attempt.In the late 1940s, President Harry S. Truman tried to pass a robust health care reform bill. Here, he's speaking to the 1949 Convention of the American Federation of Labor.

Red-baiting in the Operating Room. Truman was unable to get his health bill passed. The same scare tactics and red baiting by health insurance companies and the medical establishment turned the public against health care reform. Editorial cartoons like this one were far from subtle in trying to tie health care reform to communism.

More red-baiting metaphors. Another 1940s era cartoon that equates health care reform with communism. In this one, the Soviet-controlled scissors of socialized medicine cut the hair of U.S. medical science.

Coverage for the poor and elderly. Lyndon Johnson signing Medicare & Medicaid as part of the Social Security Act. Johnson was the first president to pass substantive health care reform in the United States.

New era, same scare tactics. More recently, government efforts at expanding health coverage have been similarly equated with the bogeyman of socialism, as in this cartoon about the State Childrens Health Insurance Program.

How does this happen anyway? After nearly a century of red-baiting every effort at health care reform, insurance companies and the medical establishment have effectively convinced many Americans to oppose reforms that would benefit them. Or in the case of this recent cartoon, reforms that they already enjoy.

The History of US Health Reform

Mon, 08/17/2009 - 16:08

Listen to the radio version of this story.

by Leigh Ann Caldwell

“Socialism is socialism. I'll give you the facists of the 1920s and 30s. If you don't like Nazi Germany, I'll give you Mussolini's Italy. Or I can give you the Soviet Union anytime in the 70s, 80s and 90s. I can give you the North Koreans today. Socialism is socialism where ever it is or whatever you call it.”

- Rush Limbaugh, Monday August 11th, 2009

These days, Rush Limbaugh's talk compares Obama to Hitler, health care to Nazi Germany, Democrats to socialists. He has excited well organized followers to take that message to the public. They show up at Congressional town halls across the country. At the least, they hold signs outside the forums that read “Obama is a socialist.” It's a bit more serious when they shout down others who are trying to speak. At the worst, they draw a swastika on Congressional offices, which is what happened to the office of Representative David Scott of Georgia.

This rhetoric is not new. It dates back to 1915 - the first time the government considered health care reform. Since people started to organize in favor of heath care, opponents have stirred up hateful opposition, inducing Americans' fears of communism, facism, and socialsim.

The short version of a long history of health reform efforts

At the turn of the 20th century, few Americans had health coverage. For most people, health care took place in the home. Only the wealthiest had health insurance. It was purchased from private insurance companies. An estimated one-third of union workers contributed into something called a sick fund. Each worker would put in about a dime per week. If he got sick, co-workers would check on him to confirm, then he would receive half a weeks worth of wages for every week he was out.

At around 1910, unions, including the laregest union, the International Ladies Garment Workers Union, and the Progressive Movement organized against hazards on the job. That movement grew to become the first campaign for government provided health coverage. The battle was fought in several Northeastern states. Doctors aligned with labor and the progressives because they thought their income would rise above the paltry sum they received at the time.

Overseas, Europe had been experimenting with the idea of government run health care. Great Britain and Germany were the first to adopt it. But the idea was new to the US.

As momentum grew and states began to take up the proposal in 1917, private insurance companies stepped in. Joined by other medical businesses, insurance companies led an intense propaganda campaign. They enlisted people to hand out brochures, talk to the public and the media. They rhetoric is much the same as is heard today. On the bully pulpit, people incited fears of socialism and anti-German sentiment in the US.

Theodore Brown, Historian at the University of Rochester in New York, says they used “scare tactics.” They took “advantage of the hysterical atmosphere of America's recent entry into the first world war, also post the Russian Revolution.”

Brown provided a brochure from 1918 that reads “Socialistic leaders endorse this scheme, majority of others oppose.” The brochure also says “Compulsory State Health Insurance, also known in German as Reichshranken-Versicherung.” It says its from the New York League for Americanism.

“It was presented as the work of a pro democracy organization, but very enterprising historians have tracked down the addresses listed on this particular pamphlet to two locations. They are the exact addresses of private insurance companies,” Brown said.

It was the first time that special interest formed an organized campaign to defeat a proposal, a technique that is used to this day as industry groups often use front groups to advertise for or against an issue.

Consequently, the efforts to expand health insurance failed in New York and several other states.

Their intense campaign helped to persuade the liberal American Medical Association to switch its position. The AMA joined the side of the insurance companies, hospitals, and other business groups to oppose any effort at government provided health care. It is a special interest coalition that would continue for the next hundred years. Their initial campaign in 1918 was so damaging that health reform wasn't discussed again until the Great Depression.

Later health reform efforts foiled, as well

During the Depression, President Franklin Delano Roosevelt attempted to revive the idea of government health coverage amidst dramatic unemployment. But the powerful business interests pressured and convinced Roosevelt to drop the proposal.

John Murray, Professor of Economics at the University of Toledo says “FDR killed [health reform] because he didn't want the inclusion of health insurance to endanger the legislative success of social security.”

The health care debate was once again reignited during World War II. Wage freezes prompted employers to provide health insurance as an incentive for workers. As the fighting ended on the battlefields across Europe and Asia, President Harry Truman introduced a national health care plan, but Professor Theodore Brown says a war inside the US erupted – a war of words. References to communism and Nazi Germany resurfaced with excess.

“All those tactics that were tried in the late teens and early 20's were brought out again and amplified and it became very very ugly,” Brown said.

New era, same scare tactics. More recently, government efforts at expanding health coverage have been similarly equated with the bogeyman of socialism or socialized medicine, as in this cartoon about the State Childrens Health Insurance Program.

Nearly every decade since the early 1900's, Presidents have attempted to implement some form of expanded health coverage, but most failed.

Lyndon Johnson was the only one with success with the passage of Medicare and Medicaid. It benefited seniors - a powerful voting block - as health care costs began to rise to unaffordable levels.

The current tactics of opponents strike a similar chord and could be taken from the same playbook that has been used for the past century. Opponents use the media and public squares to incite peoples' fears and hatred. Opponents have always prevailed.

Feeling the pressure from the vocal opposition, President Obama this week went on the offensive. Not only is he taking his argument to the people, but he has changed he language of the debate. Instead of calling it health care reform, he began using the term health insurance reform, an attempt to dispel fears that the government will control people's health care.

FSRN by PRAC/FSRN is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 United States License.