As Congress inches ever closer to a final vote on health care reform, and as the likelihood of its passage increases, we may be faced at long last with the prospect that the work of a relatively unknown Presidential committee may finally be completed.
The body in question was the Committee on Economic Security (CES). It was appointed seventy-five years ago by Franklin D. Roosevelt to look into the critical question of how to provide the American people some measure of protection against the vagaries of modern industrial capitalism. The Committee was made up of four members of the FDR’s cabinet, who were advised and assisted by a number of academics and technical experts. It was chaired by FDR’s Secretary of Labor, Francis Perkins, and its primary responsibility was, as FDR said, to provide the President with “recommendations concerning proposals which in its judgment will promote greater economic security” against “several of the great disturbing factors in life.” These included unemployment, old age, and “risks arising out of ill health.”
As has been well documented by historians, the CES played a crucial role in fashioning the 1935 Social Security Act-the landmark piece of legislation that created old-age pensions, unemployment insurance, and welfare benefits for children and the handicapped. Less known, however, is the substantial work the CES did with respect to health insurance. Here, in language that is eerily familiar, the CES argued in its final report that “no national program of economic security can be regarded in any sense as complete or effective without adequate provision for meeting the risks to security which arise out of ill health.” Moreover, the report continued “economic insecurity from illness is not the consequence of a depression; it threatens people of small means even in good times.” Indeed according the CES, “every careful study of the economic experience of wage-earning families has revealed the inadequacy of individual savings to afford the full protection against the costs if ill health. This explains why tens of millions of families live in dread of sickness, why millions of families, who are independent and self sustaining in respect to the ordinary routine needs of life, sacrifice other essentials of decent living in order to pay for medical service,” or “go without needed medical care.”
Taking note of the huge financial losses incurred by the United States as a whole due to the costs of dealing with the problem of ill health, the CES came out in favor of establishing compulsory health insurance for all Americans. But, recognizing the strong political opposition to such a move within Congress and from the American Medical Association and other groups, the CES recommended that the President not include a program to address health within the legislation that was being drafted to establish social security and unemployment insurance. Rather Perkins and others on the committee suggested that the issue of health care be treated as a separate issue to be taken up later.
FDR took this advice and through the work of his 1938 Interdepartmental Committee on Health, his 1939 message to Congress and his 1944 speech detailing what he called his “Economic Bill of Rights” continued to press Congress and the public on the need to provide some form of health insurance to ordinary Americans.
In the end, however, the opposition to health care reform was too strong, and while the CES’s work in the area of social security and unemployment insurance were remarkably successful, their recommendations regarding serious national health care reform came to nothing.
Perhaps in the seventy-fifth anniversary year, it is time to complete their work.
David Woolner is a Senior Fellow and Hyde Park Resident Historian for the Roosevelt Institute.