"The smear that refuses to die
by John Gever, Managing Editor, MedPage Today
June 13, 2019
Last week, the American Conservative Union and several like-minded groups launched a campaign to defeat "Medicare for All" proposals, calling it the Coalition Against Socialized Medicine.
One of the rotating banner images on its Internet home page is a picture of Vladimir Lenin, the Soviet Union founder, and a quote: "Socialized medicine is the keystone to the arch of a socialized state."
The campaign, obviously, aims to stoke fears of Communist authoritarianism. That's no surprise -- "socialized medicine" has been the epithet thrown at every proposal for universal healthcare offered in the past 100 years.
But I was interested in the Lenin quote. In his priority list for establishing and defending the new state, did the architect of Soviet communism really put healthcare at the top?
Well, no. Turns out the quote is bogus, apparently made up from whole cloth. But it's not new. And its history reveals much about America's decades-long debate over the government's role in healthcare, and attempts by the American Medical Association (AMA) to shape it.
The backstory
It's well known that the AMA fought Medicare tooth and nail in the early 1960s, eventually throwing in the towel. But that was just one of a decades-long string of battles the AMA fought against the notion of universal health coverage. Just this week, a former AMA president told the House of Delegates, "I think we ought to put a stake in the heart of single-payer."
In fact, it wasn't until 1949 that the AMA stopped opposing any form of health insurance. In 1934, the House of Delegates passed a "statement of principles" that, among other things, declared that "no third party must be permitted to come between the patient and his physician in any medical relation."
I got this from Richard Harris's detailed history of the 1965 Medicare legislation, published in 1966 as a series in The New Yorker and in a book the same year titled A Sacred Trust.
Harris traced Medicare's origins through a series of proposals, beginning in 1920, for some kind of government role in helping people obtain healthcare when they couldn't pay out of pocket.
From the AMA's perspective, the scariest was the so-called Wagner-Murray-Dingell bill introduced in 1945. This was genuine, full-on universal medical, dental, and nursing home care, to be paid for through a dedicated income tax. President Roosevelt was believed to be supportive but his death in April 1945 derailed the legislation for a time, and support in Congress weakened.
The Wagner-Murray-Dingell bill's prospects brightened considerably in 1949, however, when President Truman threw his full support behind it after his 1948 election.
And that's when the Lenin quote surfaced. Remember, 1949 was the year the Soviet Union exploded an atomic bomb; Truman had already ordered a "loyalty program" to root out suspected Communists in the government. The Red Scare was well underway.
According to Harris, the AMA hired a public relations firm, Whitaker & Baxter, with long experience in fighting "socialized medicine." As part of what turned out to be a $4.5-million AMA campaign to defeat the bill -- that's $48 million in today's dollars -- the firm put out a 15-page "question and answer" pamphlet about the legislation.
For example:
"Q. Who is for Compulsory Health Insurance?"
"A. The Federal Security Agency.... All who seriously believe in a Socialistic State. Every left-wing organization in America.... The Communist Party."
That label, "Compulsory Health Insurance," was not made up by Whitaker & Baxter. The bill's proponents used it as well. In 70-year hindsight, it's perhaps not surprising it went down to defeat.
The pamphlet went on to state that universal healthcare was a 19th century German invention and a common characteristic of authoritarian governments -- "whether Fascist, Nazi, Communist or Socialist" -- and that American paychecks could be taxed as much as 10% to pay for the program. (In fact, the proposal set the tax at 4% on no more than $4,800 of income.)
And then this:
"Q. Would socialized medicine lead to socialization of other phases of American life?"
"A. Lenin thought so. According to Lawrence Sullivan in his book 'The Case Against Socialized Medicine,' the founder of international revolutionary Communism once proclaimed socialized medicine 'the keystone of the arch of the Socialist State.'"
Harris's New Yorker article shortened the Lenin quote, omitting the reference to Sullivan's book -- at 54 pages, really more of a nicely bound booklet -- which also was published in 1949. Here's how Sullivan framed it:
"The campaign for socialized medicine in the United States stems directly from Kremlin Communism. Lenin, the founder of international revolutionary Communism, once proclaimed socialized medicine 'the keystone of the arch of the Socialist State.' Nowhere in the world today is the profession of medicine more completely under the control of government than in the Soviet segments of Russia."
(No citation is given for the quote. I couldn't find out much about Sullivan -- his other works include Dead Hand of Bureaucracy and Bureaucracy Run Amuck [sic], suggesting a dislike of government in general. Anti-communist and anti-bureaucratic works by a Lawrence Sullivan appear on the libertarian Foundation for Economic Education website with publication dates of 1959-1961, with that Sullivan identified as "coordinator of information, U.S. House of Representatives," but it's uncertain whether it's the same person. At any rate, The Case Against Socialized Medicine appears to be the original source.)
In total, Whitaker & Baxter distributed more than 54 million pieces of literature, at a cost of $1 million, on behalf of the AMA's successful effort to defeat the bill.
According to Harris, "The research staff of the Library of Congress has never been able to find this quotation, or anything like it, in Lenin's works." A Democratic House member apparently made the original request, other scholars found.
Continued