American Healthcare Roots: Isidore Sydney Falk

By Leslie Charles Coover

Isidore S. Falk (1889-1984)

I.S. Falk was born in Brooklyn, New York in 1899. In 1915 he became a laboratory assistant to Charles-Edward Amory Winslow, the Professor of Public Health at Yale Medical School (Roemer).

1915-29

In 1923 Falk earned a Ph.D. at Yale in public health, working in immunology and bacteriology. He taught hygiene and bacteriology at the University of Chicago from 1923 to 1929, becoming a full Professor (Ibid).

1929-35

In May 1927 eight philanthropic foundations created the Committee on the Costs of Medical Care (CCMC). In the early 1930s, Falk was recruited by Winslow to head the research staff at the CCMC. Although Dr. Falk was trained in bacteriology and immunology, he was deeply committed to the idea of universal healthcare coverage (Derickson, Health). In 1932 Falk authored a report with fellow staff members Refus Rorem and Martha Ring. The report provided conclusive evidence of empty hospital beds “while millions suffer and tens of thousands perish for lack of care” (Falk et al.).

The CCMC could not come up with a plan that would make healthcare available to everyone. There was much debate; ultimately, two main factions emerged: The majority backed voluntarism (i.e., private insurance) and community health centers as a way to work toward universal healthcare coverage (Derickson, Health).

The two most controversial recommendations in the majority opinion were that groups of physicians be organized, preferably around a hospital, and the costs of medical care should be shouldered by voluntary, group-insurance (Roemer). When the CCMC released its majority opinion, the American Medical Association (AMA) unleashed a furious public attack. An editorial in the December 3, 1932 issue of the Journal of the American Medical Association assailed the CCMC’s proposal for universal healthcare as an “incitement to revolution,” and called the committees backing of universal healthcare insurance “utopian fantasies” (Editorial, The Committee). Eight days after the CCMC issued is majority opinion, American voters elected Franklin D. Roosevelt to the presidency. In 1932, the year FDR was elected, Albert Milbank was the chairman of the board of the Borden Company. One of Milbank’s philanthropic activities was the Milbank Memorial Fund (MMF). The MMF was determined to use the work of the CCMC as a platform for a bold new healthcare initiative. In early 1933, Milbank predicted that the voluntary approach promoted by the CCMC would fail. He argued that compulsory insurance, organized on at least a state level, was what was needed to achieve universal coverage (Derickson, Health).

Falk worked closely with the MMF and on March 14, 1934 he sent a report to MMF advisors. He argued that a “growing public demand for more and better medical care” was becoming evident. He discerned an “increasingly impatient” public (Falk, Report). Two months later Falk stressed the unpredictability of medical expense was the culprit. He believed the problem could be best handled through group insurance (Falk, Formulating).

In June of 1934 FDR created the Committee on Economic Security (CES). Healthcare reform faced an uphill battle. Falk and Edgar Sydenstriker fought hard to make health protection a primary part of reform. However, from the outset they realized both President Roosevelt and the chair of the CES, Secretary of Labor Francis Perkins, were skeptical of healthcare reform. This was mainly due to the influence of the AMA and its allies. Opposition from these all-powerful interests could sink the whole social security plan (Derickson, Health).

Ultimately, healthcare reform became the sacrificial lamb. Falk and Sydenstriker presented the CES with a supplemental report. They urged that New Deal legislation, which was already under consideration, include a healthcare insurance section. The supplemental report was suppressed and Congress never discussed it (Ibid). In the early 1930s, the application of insurance to medical costs was a strange and fearful idea (Roemer).

Perhaps the Milbank Memorial Fund could have been more influential in getting healthcare reform on the New Deal agenda if it had mobilized grassroots support. But it did not—the outcome was disastrous. Medical opponents mounted a boycott of the infant formula and other products manufactured by the Borden Company. In March 1935, the MMF acquiesced and withdrew from the healthcare debate (Derickson, Health).

1936-1953

In 1936, Falk became the Assistant Director of the Bureau of Research and Statistics (BRS) of the brand-new Social Security Board, which later became the Social Security Administration. Two years later, in 1940, Falk became the Director of the BRS (Roemer). Unlike some union and civil rights advocates, Falk and other Social Security officials tried to avoid rights-rhetoric in favor of “the dry statistical language of needs assessment” (Derickson, Health).

Less than a month after Japan’s surrender, President Truman proposed an economic Bill of Rights, which included a “right to adequate medical care and the opportunity to achieve and enjoy good health” (Harry Truman). Truman advocated for universal healthcare insurance and Robert Wagner and James Murray in the Senate, and John Dingell in the House of Representatives, introduced a bill devoted exclusively to healthcare reform (a bill that was drafted largely by Falk) (Roemer). Partisan skirmishing began immediately. The Journal of the American Medical Association denounced the Wagner-Murray-Dingell Bill as an apocalyptic threat: “Let the people of our country realize that the movement for the placing of American medicine under the control of the federal government through a system of federal compulsory sickness insurance is the first step toward regimentation of utilities, of industries, of finance and eventually of labor itself” (Editorial, The President’s).

In November of 1946 the Republican Party won control of both houses of Congress. In hearings beginning in 1947 the Senate interrogated any federal official associated with healthcare reform. “Considerable witch-hunting preceded Senator Joseph McCarthy’s rampages of the early 1950s” (Derickson, The House). Marjorie Shearon, who had been one of Falk’s subordinates at the Social Security Board, mounted a scathing attack on her former boss. She claimed Falk was an evil and powerful genius who directed a plot to impose a “national medical service, . . . such as they have in Russia” (Taft).

Falk, Wilbur Cohen, and other Social Security administrators underwent grueling marathons of cross-examination during the summer of 1947 and the winter of 1948. In the dark mood of the Cold War, any vague, unfounded assertion of unpatriotic behavior received lengthy congressional attention. But the conservative offensive went far beyond notions of communist agitation. The possibility that healthcare insurance would extend to large numbers of African-Americans fueled the fires of white supremacist racial bigotry. The likelihood that federal healthcare insurance legislation would prohibit discrimination in the delivery of healthcare intensified the paranoia of southern conservatives (Derickson, Health).

Falk consistently advocated only mild liberalism. He sought modest redistribution of wealth (if any) under cautious forms of contributory healthcare insurance. Yet, his critics even stooped to xenophobic ramblings to demonize the man. A November 1947 article in Medical Economics entitled “The Man behind the Wagner Bill,” described Falk as “satanic, but . . . only because of hair above each temple” (The Man). I.S. Falk was Jewish. The unnamed author was clearly invoking the “medieval anti-Semitic image of the Jew as a horned, goatlike creature” (Derickson, The House).

It is noteworthy that domestic corporations and fledgling multinational enterprises played a major role in the anti-reform assault. Physicians enjoyed the active support of big business. Organizations that played a major role in blocking healthcare reform included “the National Industrial Conference Board, the US Chamber of Commerce, the American Enterprise Association, and executives of individual firms. The National Industrial Conference Board, not the American Medical Association, sent Marjorie Shearon to the Senate Republicans” (Ibid).

With the election of Dwight D. Eisenhower in 1952 a comprehensive national healthcare insurance plan seemed hopeless. Falk drafted a proposal for healthcare insurance that was limited to aged Social Security beneficiaries. A few years later it was introduced in Congress. After several revisions, in 1965, it became Medicare. In the winter of 1953, with the new political environment unfriendly to social legislation, Falk resigned from government service. (Roemer).

1954-1961

Dr. Falk served as an independent consultant on various health service and planning organizations during this period of his life. This included assignments in Malaya, Singapore, and Panama, but he mainly worked with the United Steel Workers of America on union healthcare programs (Ibid).

1961-1984

Dr. Falk returned to New Haven in 1961, this is where his career in healthcare started. From 1961 to 1968 he served as a professor at the reorganized Yale Department of Epidemiology and Public Health. When he retired, he became the Executive Director of a Community Health Center Plan, which began operation in 1971. This plan became the first health maintenance organization (HMO) in the nation under the 1973 Federal HMO Act (Ibid).

In an article in the American Journal of Public Health, Milton Roemer wrote, “On October 4, 1984 the American movement for national health insurance lost its most profound analyst and most eloquent advocate, when the life of I.S. Falk came to an end. In the more than half-century of work of I.S. Falk, one finds a remarkably accurate reflection of the social battles surrounding efforts to achieve a program of economic support to make essential health services available to the entire United States population” (Ibid).

Dr. Falk did not live to see the passage of The Patient Protection and Affordable Care Act (HR 3590), which was signed into law by President Obama on March 23, 2010. Nonetheless, many of the provisions in this act were goals he fought all his life for. The crucial elements of HR 3590 remind us of Falk’s consistency of vision and his “formidable, disciplined, crusading rationalism. He remained a consummate scientist in his passionate dedication to knowledge, his awesome research abilities, and his willingness to draw conclusions from the facts, even when these were politically unacceptable” (Stevens). He knew that the power of knowledge is what brings change.

Sources

Derickson, Alan. Health Security for All: Dreams of Universal Health Care in America. Baltimore: The Johns Hopkins University Press, 2005.

Derickson, Alan. “The House of Falk: The Paranoid Style in American Health Politics.” American Journal of Public Health 87.11 (Nov. 1997): 1836-1842.

Editorial. “The Committee on the Costs of Medical Care.” JAMA 99 (1932).

Editorial. “The President’s National Health Program and the New Wagner Bill.” JAMA
129 (1945): 950.

Falk, I.S., C. Rufus Rorem, and Martha D. Ring. The Costs of Medical Care: A Summary of Investigations on the Economic Aspect of the Prevention and Care of Illness. Chicago: University of Chicago Press, 1933.

Falk, I.S. “Formulating an American Plan of Health Insurance.” AALR
1934.

Falk, I.S. “Report to the Round Table on Medical Care.” Mar. 14, 1934.

Harry Truman to Congress, Sept. 6, 1945. Congressional Record. 91 (1945): 8368.

Roemer, Milton I. “I.S. Falk, the Committee on the Costs of Medical Care, and the Drive for National Health Insurance.” AJPH 75.8 (Aug. 1985): 841-848.

Stevens, Rosemary. “I.S. Falk and the Challenge of Facts.” AJHP 75.8 (Aug. 1985): 827-828.

Taft Papers, box 805, folder, Social Security-National Health-Marjorie Shearon, 1948.

“The Man behind the Wagner Bill.” Medical Economics (Nov. 1947): 47.

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