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Health Care Reform and History

Class 3: The Battle over National Health Insurance


After World War Two, Harry Truman was the first U.S. president to propose a comprehensive system of national health insurance. The American Medical Association launched the first professional public relations campaign in history to oppose the president’s plan, which was defeated by 1950. Following the failure of national health insurance, employers bargained with labor unions to establish health insurance coverage for employees. Private, employer-based health insurance came to define the U.S. health system. However, the limitations of this type of health insurance, which did not cover the poor or senior citizens, would lead to demands for Medicare and Medicaid in the 1960s.

Class Resources
Primary Sources
  • Truman, Harry S. “Special Message to the Congress on Health and Disability Insurance,” Washington, DC, May 19, 1947. The American Presidency Project. Available online at
  • Cartoons. America’s Vital Issue. Pamphlet. Chicago, IL: National Physicians’ Committee for the Extension of Medical Services, 1940s, cartoons on pages 1, 3, and 5. From National Library of Medicine Modern Manuscripts Collection, Microfilm.
  • “Still Just as Hard to Swallow.” Showdown on Political Medicine. Pamphlet. Chicago, IL: National Physicians’ Committee for the Extension of Medical Services, 1946, cartoon on back cover page. From National Library of Medicine.
Secondary Sources
  • Blumenthal, David., and James A. Morone. “Harry Truman: We’ll Take the Starch Out of Them—Eventually.” In The Heart of Power: Health and Politics in the Oval Office. Berkeley: University of California Press, 2005, pp. 57–98.
  • Hoffman, Beatrix. “Rationing by Coverage: The Rise of Private Health Insurance.” In Health Care for Some: Rights and Rationing in the United States since 1930. Chicago: The University of Chicago Press, 2012, pp. 90–116.
Discussion Questions:
  1. Explain President Harry Truman’s national health plan and its relationship to postwar reconstruction.
  2. Describe the American Medical Association’s (AMA) publicity campaign against Truman’s health plan (Cartoons and Blumenthal and Morone, 91–93). What kinds of arguments did the AMA use to persuade the public?
  3. According to Blumenthal and Morone, what factors were most important in the defeat of Truman’s health plan?
  4. Why did private health insurance expand dramatically in the 1950s? What are differences between private health insurance coverage and the national health insurance coverage proposed by Truman?
  5. How did the limitations of private health insurance help lead to Medicare and Medicaid?
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