What organization was the first to campaign for a national health insurance program in the United States quizlet?

Am J Public Health. 2014 February; 104(2): 227–236.

Abstract

On March 23, 2010, President Barack Obama signed the Patient Protection and Affordable Care Act (ACA) into law. As it went through Congress, the legislation faced forceful resistance. Individuals and organizations opposing the ACA circulated propaganda that varied from photographs of fresh graves or coffins with the caption “Result of ObamaCare” to portrayals of President Obama as the Joker from the Batman movies, captioned with the single word “socialism.” The arguments embedded in these images have striking parallels to cartoons circulated by physicians to their patients in earlier fights against national health care. Examining cartoons used in the formative health care reform debates of the 1940s provides a means for tracing the lineage of emotional arguments employed against health care reform.

PRESIDENT BARACK OBAMA signed the Patient Protection and Affordable Care Act (ACA) into law on March 23, 2010. As it went through Congress, the ACA faced forceful opposition from individuals and organizations armed with images that varied from photographs of fresh graves or coffins with the caption “Result of ObamaCare” to portrayals of President Obama as the Joker from the Batman movies, captioned with the single word “socialism.” This use of imagery to portray universal health care reform as socialist was by no means a new tactic.

From 1939 through 1962, the American Medical Association (AMA) focused much of its political and monetary power on arguing that any type of government health care system would be socialist, costly, bureaucratic, a hindrance to scientific progress, and detrimental to the doctor–patient relationship. As part of its opposition, the National Physicians’ Committee for the Extension of Medical Service, a lobbying organization closely associated with the AMA, commissioned and distributed cartoons directed against national health care reform. Although the AMA’s opposition to national health care has been documented extensively, few scholars have looked at the images the National Physicians’ Committee used to sway the public.1

As various pieces of legislation were proposed for health care reform, the AMA mounted large-scale campaigns against national health care.2 In 1949, soon after President Harry Truman came out in support of the Wagner–Murray–Dingell Bill, the AMA hired the San Francisco political public relations firm Whitaker and Baxter to carry out a National Education Campaign.3 The firm was effective in molding public opinion.4 Its principals believed

lobbying [was] a waste of time and money because it [was] inconclusive. Not only is the composition of the legislature always changing, but legislatures are like women—you have to keep buying them candy and flowers. But a campaign won as a public issue will stay won—for some years at least.5

“Still Just as Hard to Swallow” is a cartoon included in a pamphlet created by the National Physicians’ Committee titled Showdown on Political Medicine, ca. 1946.

Source. Cartoon by Edmund Waller “Ted” Gale, Jr. Courtesy of Photography Collection, Harry Ransom Center, The University of Texas at Austin.

To negatively affect public opinion on national health care, Whitaker and Baxter relied on pairing a single image—a well-known painting titled The Doctor—with the word “socialism” on everything from pamphlets to posters to stamps.6 This image of a doctor treating a young female patient has, rightly, been associated with the AMA’s long campaign against national health insurance, but it is by no means the only instance when organized medicine used images, cartoons, or the word “socialism” as a tactic.7

The cartoons used in the formative debates over national health care can illuminate the origins of the emotional oppositional rhetoric that surrounds current health care reform. Undoubtedly, cartoons can be a form of entertainment, but they have also been shown to effectively convey information to readers.8 Cartoons have been used to advocate for and to fight against health care reform.9 It is no accident that the AMA chose cartoons as a weapon in the fight to sway public opinion. Here, I examine political cartoons intended to convey partisan information and produce a response from the reader.10 These political or editorial cartoons create narratives that emotionally engage the reader in a way text cannot.11 Condensing abstruse arguments into a more palatable visual form through the use of metaphor and wit helped these cartoons create simple frameworks for understanding complex issues.12 The inherent ability of cartoons to emotionally engage the reader renders them difficult to combat with facts and social research.13 These qualities made cartoons a useful tool for the National Physicians’ Committee. Conversely, advocates of health care reform have tirelessly attempted, usually without success, to use reason and arguments based on facts to combat the emotional arguments delivered in cartoons circulated by the National Physicians’ Committee.14

Cartoons distributed by the National Physicians’ Committee are not the sole reason that national health care reform has struggled to gain traction in the United States, but they are one piece of a complex matrix of explanations.15 In the 1940s, the National Physicians’ Committee deliberately included cartoons in materials distributed to patients because its leaders believed cartoons were effective at conveying arguments against national health care—specifically, that national health insurance is socialist. To this end, cartoons were an integral part of pamphlets distributed by physicians working with the National Physicians’ Committee. These pamphlets urged readers to take action against health care reform by writing to their public representatives and enrolling in voluntary health insurance programs.16 Later AMA publications continued to urge patients to enroll in private health insurance because it “increase[d] the availability of good medical care to the American people” and took “the economic shock out of illness,” without resorting to a socialist nationalized health care system.17 All of the cartoons discussed here were placed in pamphlets calling on readers to take action against national health care. The cartoons reinforced the arguments made in the text of the pamphlets and helped elicit an emotional reaction from the viewer.18 Because the National Physicians’ Committee regularly commissioned these political cartoons and included them in material it sent to physicians to distribute to the general public, we can assume that it found these cartoons to be an effective way to influence readers and reinforce the arguments made in the text of the pamphlets.19

The National Physicians’ Committee was founded in 1939. A group of physicians created the committee when Senator Robert F. Wagner introduced the National Health Act of 1939, also known as the Wagner Bill. The Wagner Bill would have created a national health program administered by the states and funded by the federal government. After referring the bill to the Committee on Education and Labor, Senator Wagner arranged for 11 hearings. Organized labor and several welfare and agricultural groups testified in favor of the bill. The AMA, American Hospital Association, and American Dental Association, among others, testified against the Wagner Bill. For 10 years, even after the Wagner Bill was overshadowed by World War II, the National Physicians’ Committee functioned as the primary mouthpiece for AMA leaders against national health care reform.

Many physicians praised the National Physicians’ Committee’s efforts and donated money to help it defeat national health care. Physicians who were supportive wrote the committee praising its efforts. One California physician wrote, “Please be assured that I will do anything in my power to help extend the good work you gentlemen have started.”20 The committee and those who supported its work engaged in many types of propaganda, but, most importantly, the committee created material for physicians, pharmacists, and hospitals to give to patients and other health care providers. An unknown author of a column in the Journal for the American Medical Association took pride in how quickly the brochures created by the committee spread, telling readers,

These pamphlets, with suitable placards, were placed in every physician’s office where the general public quickly used them and took them to their friends. They were likewise placed in hospitals, drug stores and other public places.21

Physicians who supported the efforts of the committee eagerly helped circulate the materials. A physician from West Virginia wrote,

I have read the copy of Achilles Heel of American Medicine and am in full sympathy with the principles and plans as outlined in the pamphlet and your letters. If you will send me 500 copies of the booklet and the personal folders, I will gladly send them with a personal letter to 500 physicians personally asking that they give their support to this all important movement.22

Many of these handouts included cartoons. One pamphlet, created around 1946, contains two cartoons that emphasize the cost of health care reform.23 On the cover is a cartoon drawing of President Truman asking a beat-up Uncle Sam, “How about some health insurance?” In this image, Uncle Sam’s battered body is covered with bandages representing a series of injuries suffered by America. One broken leg is caused by lack of production and the other from the atomic bomb. The wounds on his head and neck are a result of labor strikes and Pearl Harbor. The worn-out Uncle Sam responds to Truman, “Do I have to take a physical examination?” On the back of the pamphlet is a cartoon entitled “Still Just as Hard to Swallow” portraying an academic figure wearing a cap and gown holding out a large spoon with a gigantic “$ocialized Medicine” pill to a petrified taxpayer. The taxpayer crouches in fear while the academic smiles and says, “But it has been sugar-coated! It isn’t the ‘General Welfare Pill’ anymore. Now we call it the ‘National Health Pill!’”

These cartoons were part of a package of health care information that emphasized that national health care would be too costly and would hurt the economy. They effectively communicated an affective opinion to the reader.24 The cartoons made no rational arguments and conveyed no facts about the budget of the legislation; they simply employed scare tactics to great effect. Their primary purpose was to sway public opinion against the Wagner–Murray–Dingell Bill, which was introduced in 1943 by Senators Wagner and James Murray of Montana and Representative John Dingell of Michigan. The National Physicians’ Committee was most fearful of the Wagner–Murray–Dingell Bill because it proposed to add health insurance to the Social Security Bill, a move strongly opposed by the majority of AMA leaders.

“It's All Mixed and Ready to Swallow” is a cartoon included in a pamphlet created by the National Physicians’ Committee titled Political Medicine, ca. 1943.

Source. Cartoon by Jay N. ‘Ding’ Darling. Courtesy of the Jay N. ‘Ding’ Darling Wildlife Society.

Another booklet created by the National Physicians’ Committee, Political Medicine, uses cartoons to foster distrust of the government program and emphasize the importance of private research and health care.24a On the front page of this pamphlet, a cartoon shows Congress as an old woman pouring a bottle titled “Socialized Medicine $3 Billion a Bottle,” into an oversized spoon, ready to give it to the petrified “Public,” who is being strangled by a “Political Quack.” In the foreground, a man carrying a briefcase labeled “Medical Science” is tied and gagged in a chair, looking on and unable to do anything. In the background, a funeral for “Free Enterprise” is attended by several mourners.25

Likewise, the back of Political Medicine uses a five-panel comic to argue that if the government socializes medicine, access to medical care will be a bureaucratic mess.26 Through the story of a man who is unable to receive medical care because he has not filled out the proper government documentation, this cartoon creates an imagined reality to pull on the readers’ heartstrings.27 In the first panel of this image, a man suddenly falls ill and his wife rushes to the phone crying, “Send a doctor quick!” The next panel shows a bureaucrat, with his legs leisurely crossed, in front of a local political board. The bureaucrat tells the frantic wife to “ask your postmaster for questionnaire N9 96-8-4801-220, fill out in triplicate, and mail to this office.” The following panel shows her filling out the necessary paperwork, which appears onerous and includes such questions as “Who did you vote for in the last election?” “Give three reasons for calling a doctor.” ”Have you filed your income tax?” With the large document in her hand she turns to her husband and asks, “What would you say was your most prominent symptom, Dear?” The husband’s agonizing pain does not allow him to answer. The following panel shows the husband in worse condition, almost on his last breath. On the right side of the panel his wife answers the door and receives a letter, which says,

Owing to the seriousness of your ailment your application has been referred to the Washington Office—see enclosed form NP U.S.-6034-8-XYZ, fill out and return.

The wife appears shocked and disheartened at the magnitude of this new paperwork. Finally, in the last panel, a doctor triumphantly appears at the door with a bag labeled “Government Doctor” and asks, “Did you send for a doctor?” An undertaker greets him, and two coffins (presumably for the sick man and his wife) have replaced the ailing man’s bed.

These panels are accompanied by summaries meant to reinforce the emotional narratives of the cartoons and offer concrete and proactive steps for the reader to take in response. Next to the Political Medicine comics, the National Physicians’ Committee listed “Two Things to Remember.” First,

The political distribution of medical care would entail making a public record of the characteristics and most intimate and sacred personal relationships of each and every patient.

It goes on to say that the “privacy of every human being would be invaded and violated.” Second,

The effectiveness of medical care is wholly dependent on the skill of the physician. The American Doctor is a human being… . He should be free to act as an individual. Bureaucratic direction would destroy the factor that is the secret of his effectiveness.

At the end of this list of things to remember, readers were encouraged to “WRITE A LETTER” to their congressional representatives and senators. Readers were told to “be definitive and direct” and to “do it now—TODAY—before it is too late.”28

Featuring these cartoons in the pamphlets was meant to shape the opinion of the reader.29 Each of these cartoons conveyed its message quickly and aggressively.30 This was the goal of the National Physicians’ Committee, which proudly declared that one pamphlet, The Achilles Heel of American Medicine, could be “read in five minutes” and gave details quickly and concisely.31 As part of a brochure that also told readers to write into their representatives and senators, these cartoons were meant to help stir readers to action.

In 1948, recognizing that cartoons were an effective means of drumming up opposition to national health insurance, the National Physicians’ Committee offered cash rewards for cartoonists able to effectively portray “the meaning and implications of political distribution of health care services in the United States.”32 The committee proudly announced, “Over a period of years, it has been our privilege to reprint many cartoons portraying artists’ appraisal of the Political Distribution of Medical Care in the United States.”33 The contest offered nine awards, ranging from $100 to $1000, depending on how effective the cartoon was in conveying the committee’s message. The requirements for submission were that the cartoon was already published, the committee received permission from the publisher to reprint the cartoon, and the cartoonist submitted six copies of the engraver’s proof of the original illustration.34 Flyers announcing the contest encouraged cartoonists to write in for

a FREE Package of supplemental data … with the objective of preserving in the United States our system of Freedom of Enterprise to the end that—Doctors of Medicine may retain, in the public interest, their personal independence—their individual and collective integrity and effectiveness.35

The supplemental data sent to editors and cartoonists asserted that national health insurance was socialist and that those who proposed health care reform were similar to Adolf Hilter.36 The National Physicians’ Committee claimed that “socialized medicine is a key mechanism of the Communists for the conquest of this nation” and that “socialized health care was not designed to provide better medical care for more people” but had always “been adopted and used to create economic dependence and consolidate political control.”37

Senator Murray, a liberal Democrat from Montana who coauthored the Wagner–Murray–Dingell Bill, exposed the National Physicians’ Committee’s tactics.38 In May of 1948, Murray displayed to the Senate a full-page announcement of the cartoon contest that the committee published in Editor & Publisher. Murray declared that the reprinted cartoon included in the advertisement, which also graced the front page of Political Medicine, made the true purpose of the contest quite clear.39 Senator Murray expressed his frustration at the committee’s most recent attempt to sway the public:

The basic line of attack of [the cartoon contest] propaganda is quite simple. It is to smear the whole project as socialized medicine, relying on the effect of the horrendous word “socialism” to scare ordinary minded citizens away. Not content with this snide attack, they are now labeling the proposal out-and-out communistic. Riding the wave of our present international difficulties they are working the “Red menace” for all it is worth.40

Senator Murray said he had no quarrel with the cartoonist who drew the cartoon shown in the contest advertisement. He believed that the cartoonist had “his right to present his own views through his syndicated cartoon strip” and that he could

even admire the skill with which the [cartoonist] managed to compress into one picture all the prejudices and fears of those vested interests which are arrayed against this proposed legislation.

However, Senator Murray did object to the

outrageous and cynical attempt on the part of the National Physicians’ Committee to bribe the cartoonists of America into helping them spread their propaganda.41

The Washington Post reported that Murray exposed “the sordid propaganda tactics of … an undercover instrument of the American Medical Association” and condemned the cartoon contest:

the “contest” rules leave no doubt that this is a subtle bribe to cartoonists to support or oppose certain political beliefs (according to how you look at it) and to obtain general circulation for those beliefs in newspapers and magazines.42

The Washington Post said that all physicians were subject to the shame of the cartoon contest. The paper called it “a form of malpractice” on the part of doctors and concluded,

Doctors can best cure [this malpractice] by excising its source. Their ideas and interests need better and more honest representation than they have received from the National Physicians’ Committee.43

A group of physicians who had formed an organization called the Committee for the Nation’s Health wrote to Editor & Publisher praising its editors for their condemnation of the cartoon contest.44 They declared,

We physicians, as members of a scientific profession, want to see this subject of medical care handled in a scientific spirit and according to ethical principles.45

They went on to say,

The name, National Physicians’ Committee, may cause some laymen to assume that it speaks for all members of the medical profession. This is emphatically not so. Many physicians are opposed to the aims and purposes of the National Physicians’ Committee, and many more are ashamed of the methods it constantly uses.46

Even in the face of harsh criticism, the National Physicians’ Committee circulated America’s Vital Issue, a pamphlet with a cartoon on every page, and emphasized that

[the] most important single issue confronting the American people is: Compulsory Health Insurance—the Nationalizing of Health Service—the Political Distribution of Health Care.

All of the images in the pamphlet lead the reader to believe that national health insurance is socialist and un-American. Seven of the eight cartoons include the word “socialism,” and the one that does not uses the term “state medicine.”47

“Mechanical Treatment” is a cartoon included in a pamphlet created by the National Physicians’ Committee titled America’s Vital Issue, ca. 1948.

Source. Cartoon by Cecil Jenson.

Two of the cartoons warn that doctors will become uncaring, mechanical, and disrespectful if a universal health care system is instituted. On a page titled “Mechanical Treatment,” a patient is pictured face to face with a robot physician toting a socialized medicine flag and a bag full of antiquated tools—such as a saw, corkscrew, and knife—more analogous to a carpenter’s belt than to a medical bag. The robot doctor’s chest displays a slot to insert coins as well as buttons that correspond to illnesses and encourages the patient to push a button to receive treatment. The patient looks horrified, pulling up his bed sheets in a fearful response to the mechanical monster of socialized medicine. The corresponding text reads,

It should be understood that in every country where Compulsory Health Insurance has been tested, it has resulted in less effective care, in routine and mechanical treatment. The system puts a bureaucrat between the doctor and his patient.48

The page after “Mechanical Treatment” is titled “Politicians and Babies” and pictures a mechanical stork with a hat labeled “Doc Stork” carrying a baby. The stork’s square-framed body is labeled “socialized medicine” and its tail, which looks more like a rudder, is labeled “government control.” Its body, hooked up to a helicopter rotor, looks especially like a military machine. A man is running on the ground with his arms stretched up in the air, screaming “Heaven Forbid!”49

These two cartoons suggest that if health care reform is brought to America, our benevolent, caring, heroic physicians will be replaced by—or transformed into—scary mechanical arms of the government. In other words, the doctor–patient relationship will be destroyed by the mechanistic, uncaring bureaucratic machine.

The other cartoons in the pamphlet argue that health care reform will hamper freedom and individuality. In a cartoon titled “Rights of the American People,” a large healthy tree symbolizing liberty is constricted by the parasitic tendrils of “Social Legislation,” “Socialism,” “Communism,” and “Slavery.” This image is accompanied by text emphasizing Americans’ right to freedom:

The American people have the right to do whatever they want to do. A small minority want to exchange our way of life for Socialism or for Communism with its atheism, its slave labor, its controls by police and its concentration camps. The danger lies in the possibility of the change coming without people knowing that the trade is being made. The Socialists say, “The goal of Socialism will be eventually reached through encroachment; followed by step by step legislation; that a little here and a little there will soon amount to the whole.”50

Pairing this extreme antisocialist rhetoric with images functions to further the conception of universal health care as a Communist plot and, consequently, extremely un-American. In this particular image, health care reform is equated to a constriction of liberty and freedom of choice.

Organized medicine's use of cartoons to sway public opinion declined after the cartoon contest was exposed, and the National Physicians’ Committee became less vocal. Subsequently, the AMA hired Whitaker and Baxter, the San Francisco public relations firm, to rebrand the fight against health care. Whitaker and Baxter, like the National Physicians’ Committee, focused on getting literature to patients. Although it used imagery, predominantly the image of The Doctor, it avoided cartoon images because of the bad press the cartoon contest brought the AMA, the National Physicians’ Committee, and doctors in general.

Despite the decline of the National Physicians’ Committee’s use of cartoons, local medical societies created images opposing health care reform that paralleled pamphlets created by the National Physicians’ Committee. In 1950, the Baltimore City Medical Society’s Committee on Public Medical Education commissioned a 16-page comic book, The Sad Case of Waiting Room Willie. In this comic, Willie falls ill but is unable to obtain medical care because of a health system that is overrun with “malingerers.”51 This comic book was, in the words of its creators, meant to “dramatize the unfavorable aspects of socialized medicine in a form that is readable, entertaining, and non-technical enough to reach all the voters.”52 Emphasizing that this comic book would “reach thousands who do not read the more formal treatises prepared on the subject or listen to what promises to be a ‘purely educational’ radio program,” the committee suggested that it should be distributed widely and placed in every waiting room.53

“When the Government ‘Socializes’ Medicine” is a cartoon included in a pamphlet titled Political Medicine, ca. 1943.

Source. Cartoon by Jay N. ‘Ding’ Darling. Courtesy of the Jay N. ‘Ding’ Darling Wildlife Society.

The AMA veered away from using cartoons until Congress and the country at large became embroiled in a heated debate over the King–Anderson Bill. The bill, which was a precursor to Medicare, caused some physicians to threaten that they would not treat patients.54 These boycotts, and letter-writing campaigns targeted at physicians, threatened the viability of the bill. At a rally for Medicare in Madison Square Garden, President John F. Kennedy said,

The AMA is doing very well in its efforts to stop this bill… . I hope that one by one the doctors of the United States will take the extraordinary step of not merely reading the journals and the publications of the AMA, because I do not recognize the bill when I hear those descriptions… . [T]he mail pours in, and at least half of the mail which I receive in the White House—on this issue and others—is thoroughly misinformed.55

Emotional arguments similar to those employed against the Wagner–Murray–Dingell Bill were used in the fight against the King–Anderson Bill.

By 1962, visual anti–health reform rhetoric was already well established. Although cartoons were not used to the same extent, those employed continued to associate national health insurance with socialism. In A Case Against Socialized Medicine, one image shows Uncle Sam walking through the dessert carrying a load of supplies. He takes off his hat and wipes his head by a pool of “Socialized Medicine.” Uncle Sam is clearly tempted to drink from the pool but, before he does, he looks over to his right and sees the legs of a skeleton and a note posted on a nearby cactus that reads, “Don’t drink it—I did.” The text next to this image says,

Bismarck of Germany invented Compulsory Health Insurance. He established the system to place the masses under obligation to him and make them servants of his Government. The bureaucracy that was built afterwards became the single greatest source of strength for Adolf Hitler and his ruthless rise to power.56

In another cartoon in this brochure, “From a Man with Experience,” an arm labeled “Britain” is reaching up through a thick layer of ice labeled “socialized medicine,” handing a sign that reads “BEWARE.” The man in the title signifies Britain, suggesting that the British assumed that the ice—socialized medicine—would provide enough support for their country. Unfortunately it has cracked, and Britain is now drowning.57

The visual rhetoric of cartoons used to oppose national health care has been eerily consistent over the course of the 20th century. Although organized medicine is no longer spearheading the campaign against health care reform, the public has taken up the rhetoric of its earlier efforts, particularly the rhetoric found in the cartoons the National Physicians' Committee distributed. Equating national health care with socialism is still a common tactic, and the emotional rationale presented in cartoons used in early campaigns against reform are used to this day. In 2012, when litigation regarding the constitutionality of the ACA was before the Supreme Court, Representative Michelle Bachmann spoke out against Obamacare. As she spoke, one man held a sign that read “Keep Your Politics Out of my Healthcare,” and another held a sign that said,

In medicine the DOCTOR PATIENT RELATIONSHIP is paramount GOVERNMENT coming between them is a VIOLATION OF THEIR INDIVIDUAL RIGHTS.58

Other protesters carried posters of President Obama pictured as the Joker from the Batman movies with “socialism” printed underneath.

A Web site dedicated to countering the “blatant bias of the mainstream media,” called Patriot Update and sponsored by Patriot Depot, has a section of cartoons opposing health care. The Web site declares that

the mainstream media, with the exception of Fox News and some popular news web sites, have become the official propaganda arm of the radical left-wing Democratic party.

In response, the site seeks to provide accurate information to readers. A cartoon on the site features President Obama presenting his national health care plan to two Americas. The president stands next to a large pill of “ObamaCare Rx,” and one of the audience members exclaims, “That’s gonna be a hard pill to swallow.” The other says, “Psssst … It’s a Suppository.”59 This bears a striking resemblance to a cartoon distributed by the National Physicians’ Committee in the 1940s.

Another Web site, NetRightDaily, is a project of Americans for Limited Government.60 Like Patriot Update, NetRightDaily has a cartoon section.61 One cartoon on the site caricatures President Obama as a physician with a very large syringe filled with “Socialized Medicine.” The caricature takes the pulse of a patient, representing “Public Opinion,” who is pulling away in fear. The president–physician, looking at the syringe, says, “I’ve got my finger on the pulse and it’s RACING with excitement!” Another NetRightDaily cartoon reproduces the image of President Obama as the Joker. In this version, the onlooker, representing the United States of America says, “Interesting I always thought he more closely resembled Two-Face.” These images illustrate that it is no longer physicians who are distributing cartoons to patients. A subsection of the general public and conservative news outlets are now the primary distributors.

The cartoons distributed by the National Physicians’ Committee created a visual vocabulary that has been omnipresent in the debates over national health care ever since. Images have mobilized opposition to national health care by reiterating visual arguments that first entered the debate through cartoons. Although health care reform has had some successes, notably Medicare and the ACA, the United States lacks a system of national health insurance comparable with those in other countries. Part of the reluctance to embrace a more robust national health care program stems from the application of visual rhetoric and its ability to shape the politics of health care reform through a direct impact on public opinion. Every push for health care reform since the Wagner Bill, including the ACA, has been counteracted by emotional arguments. Current anti-ACA propaganda reimagines the emotional arguments originally promoted by the images and cartoons used by the AMA, the National Physicians’ Committee, and Whitaker and Baxter between 1939 and 1962. The goal of the National Physicians’ Committee and Whitaker and Baxter seems to have been realized. With the help of images, these two groups, working on behalf of the AMA, presented affective opinions that won health care as a public issue “for some years at least.”

Acknowledgments

The Walter Lear Fellowship supported the research for this article.

Many people made this article possible. I am indebted to the generous comments and guidance provided by Ted Brown, Stephen Casper, Naomi Rogers, John Warner, Kelly O’Donnell, and Melissa Grafe. I was lucky to have a wonderful set of reviewers whose comments helped me sharpen this article. This article would not have been possible without the support of my partner, Kelly L. McNamee.

Endnotes

1. For some brief discussion of imagery used in health care reform debates, see Beatrix Hoffman, The Wages of Sickness: The Politics of Health Insurance in Progressive America (Chapel Hill, NC: University of North Carolina Press, 2001); Jonathan Engel, Doctors and Reformers: Discussion and Debate Over Health Policy, 1925–1950 (Columbia, SC: University of South Carolina Press, 2002); Alan Derickson, Health Security for All: Dreams of Universal Health Care in America (Baltimore, MD: Johns Hopkins University Press, 2005)

2. For more information on historical opposition to health care reform, see Daniel S. Hirshfield, The Lost Reform: The Campaign for Compulsory Health Insurance in the United States from 1932 to 1943 (Cambridge, MA: Harvard University Press, 1970); Theodore Marmor, The Politics of Medicare (London, UK: Routledge 1970); Paul Starr, The Social Transformation of American Medicine: The Rise of a Sovereign Profession and the Making of a Vast Industry (New York, NY: Basic Books, 1982); Ronald L. Numbers, ed., Compulsory Health Insurance: The Continuing American Debate (Westport, CT: Greenwood Press, 1982); Alan Derickson, “Health and Security for All? Social Unionism and Universal Health Insurance, 1935–1958,” Journal of American History 80 (1994): 1333–1356; Alan Derickson, “The House of Falk: The Paranoid Style in American Health Politics,” American Journal of Public Health 87 (1997): 1836–1843; Jill Quadagno, One Nation, Uninsured: Why the US Has No National Health Insurance (Oxford, UK: Oxford University Press, 2005); Colin Gordon, Dead on Arrival: Health Care and the Limits of Social Provision in the United States (Princeton, NJ: Princeton University Press, 2003); Beatrix Hoffman, The Wages of Sickness: The Politics of Health Insurance in Progressive America (Chapel Hill, NC: University of North Carolina Press, 2001); Beatrix Hoffman, Health Care for Some: Rights and Rationing in the United States Since 1930 (Chicago, IL: University of Chicago, 2012); Paul Starr, Remedy and Reaction: The Peculiar American Struggle over Health Care Reform (New Haven, CT: Yale University Press, 2011)

3. The AMA was willing to pay to influence public opinion and marshal opposition to health care reform. Including paying Whitaker and Baxter an annual fee of $100 000, the AMA expended $1.6 million in 1949, $2.6 million in 1950, $530000 in 1951, and $255 000 in 1952 on what it called the “National Education Campaign.” Frank D. Campion, The AMA and US Health Policy Since 1940 (Chicago, IL: Chicago Review Press, 1984), 158.

4. Whitaker and Baxter had worked successfully with the California Medical Association in 1945 to fight the proposal for statewide compulsory health insurance in California. Governor of California Earl Warren proposed a health insurance program for California multiple times between 1945 and 1949. He argued for a system of “health insurance to which everyone contributes and through which everyone will receive benefits in time of sickness.” For more information on Whitaker and Baxter’s California campaign see: “Governor Warren’s California Health Insurance Program,” Journal of the American Medical Association 139 (1949): 1002–1004.

5. Carey McWilliams, “Government by Whitaker and Baxter,” Nation, April 14, April 21, May 5, 1951, 346–348; 366–369; 419–421, quoted in Theodore H. White, Breach of Faith (New York, NY: Doubleday, 1976), 14–15.

6. For a detailed discussion of The Doctor, see Jane Moore, “What Sir Luke Fildes’ 1887 Painting The Doctor Can Teach Us About the Practice of Medicine Today,” British Journal of General Practice 58 (2008): 210–213. [PMC free article] [PubMed]

7. Although Whitaker and Baxter has been credited with introducing the threat of socialism into the health care debates, the word socialism was present in the National Physicians’ Committee’s oppositional rhetoric and visual images long before the AMA hired Whitaker and Baxter. For a discussion of Whitaker and Baxter’s introduction of the word socialism, see Jill Lepore, “The Lie Factory: How Politics Became a Business,” New Yorker, September 24, 2012, http://www.newyorker.com/reporting/2012/09/24/120924fa_fact_lepore (accessed October 23, 2013)

8. Desousa and Medhurts have identified four main functions of editorial cartoons: entertainment, venting frustrations against social leaders, agenda setting, and distilling complex social issues into a single frame. Michael A. DeSousa and Martin J. Medhurst, “Political Cartoons and American Culture: Significant Symbols of Campaign 1980,” Studies in Visual Communication 8, no. 1 (1982): 84–98.

9. Georges C. Benjamin, Theodore M. Brown, Susan Ladwig, and Elyse Berkman, The Quest for Health Reform: A Satirical History (Washington, DC: American Public Health Association Press, 2013)

10. Thomas Milton Kemnitz, “The Cartoon as a Historical Source,” Journal of Interdisciplinary History 4, no 1 (1973): 81–93. Kemnitz makes a distinction between joke cartoons and opinion cartoons: joke cartoons are designed to communicate humor, whereas opinion cartoons are designed to convey opinions.

11. For more information on the ways cartoons engage the reader, see Janis L. Edwards, Political Cartoons in the 1988 Presidential Campaign: Image, Metaphor, and Narrative (New York, NY: Garland Press, 1997). For information on the description of cartoons as narratives, see Alette Hill, “The Carter Campaign in Retrospect: Decoding the Cartoons,” in Rhetorical Dimensions in Media: A Critical Casebook, ed. Martin J Medhurst and Thomas W. Benson (Dubuque, IA: Kendall/Hunt, 1984), 182–203.

12. For more on cartoons creating frameworks, see Edwards, Political Cartoons in the 1988 Presidential Campaign.

13. Political cartoons are, by definition, caricatures that are meant to be distorted, exaggerated, and unfair, and this makes them hard to combat with social research. See Victor S. Navasky, “Why are Political Cartoons Incendiary?” New York Times, November 12, 2011, http://www.nytimes.com/2011/11/13/opinion/sunday/why-are-political-cartoons-incendiary.html?_r=0 (accessed November 1, 2012). For more on the use political cartoons to shape public opinion in the United States, see John Adler and Draper Hill, Doomed by Cartoon: How Cartoonist Thomas Nast and the New York Times Brought Down Boss Tweed and His Ring of Thieves (Garden City, NY: Morgan James Publishing, 2008); Allan Nevins, A Century of Political Cartoons: Caricature in the United States from 1800 to 1900 (New York, NY: C. Scribner’s Sons, 1944); Charles Press, The Political Cartoon (Madison, NJ: Fairleigh Dickinson University Press, 1981); Stephen Becker, Comic Art in America (New York, NY: Simon and Schuster, 1959); Roger A. Fisher, Them Damned Pictures: Explorations in American Political Cartoon Art (New Haven, CT: Archon Books, 1996)

14. Beatrix Hoffman, “Health Care Reform and Social Movements in the United States,” American Journal of Public Health 93, no. 1 (2003): 75–85. [PMC free article] [PubMed]

15. For a detailed description of the different explanations for why there is no national health insurance in America, see Colin Gordon, Dead on Arrival: The Politics of Health Care in Twentieth-Century America (Princeton, NJ: Princeton University Press, 2003); Jill Quadagno, One Nation, Uninsured: Why the US Has No National Health Insurance (Oxford, UK: Oxford University Press, 2005)

16. Frank D. Campion, The AMA and US Health Policy Since 1940 (Chicago, IL: Chicago Review Press, 1984)

17. “A.M.A. Advertising Program,” Journal of the American Medical Association 143, no. 8 (1950): 744. The article provides a longer explanation for advertising health care issues: “The American Medical Association is embarking on a nationwide advertising program for two reasons. First, it is determined to aid in every way possible in increasing the availability of good medical care to the American people through the medium of voluntary health insurance. In that respect, the advertising copy will be designed to make the American people ‘health insurance conscious’ and to encourage the extension and development of prepaid medical and hospital care as a means of taking the economic shock out of illness. Second, American medicine is determined to alert the American people to the danger of socialized medicine and to the threatening trend toward state socialism in this country.”.

18. Cartoons presented with textual arguments result in a greater opinion change than the presentation of an editorial alone or cartoon alone. Del Brinkman, “Do Editorial Cartoons and Editorials Change Opinions?” Journalism & Mass Communication Quarterly 45, no. 4 (1968): 724–726.

19. A contemporary article claimed, “Today is the day of the picture. The public has neither time nor wish for the great editorials, which formerly did so much to mold political history. The cartoonist, no longer just a commentator on the passing show, has become an editorial writer who produces a leading article in the form of a picture.” Isabel Simeral Johnson, “Cartoons,” Public Opinion Quarterly 1 (1937): 21–44.

20. Excerpts from letters received since November 20, 1939, by the National Physicians’ Committee for the Extension of Medical Service, Chicago Illinois, December 8, 1939, box 174, folder 2669, Isidore S. Falk Papers, Sterling Memorial Library, Manuscripts and Archives, Yale University, New Haven, CT.

21. “A Plan for Publicity Against Regimentation of Physicians,” Journal of the American Medical Association 111 (1938): 1200.

22. Excerpts from letters received since November 20, 1939, by the National Physicians’ Committee for the Extension of Medical Service, Isidore S. Falk Papers.

23. Showdown on Political Medicine (Chicago, IL: National Physicians Committee for the Extension of Medical Service, ca. 1946), Walter J. Lear Papers, US Health Activism History Collection of the Institute of Social Medicine and Community Health.

24. Scholarship has shown that cartoons are “incapable of reasoned criticism and detailed argument” but are used frequently and effectively as a means for “disseminating highly emotional attitudes.” Kemnitz, “Cartoon as a Historical Source.”

24a. Political Medicine (Chicago, IL: National Physicians Committee for the Extension of Medical Service, ca. 1943), Walter J. Lear Papers, US Health Activism History Collection of the Institute of Social Medicine and Community Health.

25. Political Medicine, Walter J. Lear Papers, 1.

26. Ibid., 2.

27. “Cartoons are part of a mediated filtering system that helps construction and framing of social reality.” Linus Abraham, “Effectiveness of Cartoons as a Uniquely Visual Medium for Orienting Social Issues,” Journalism & Communication Monographs 11, no 2 (2009): 117–165.

28. Political Medicine, Walter J. Lear Papers, 3.

29. “The more emotional a cartoon is, the more likely it is to be involved in shifts of attitude.” R. Asher and S. S. Sargent, “Shifts in Attitude Caused by Cartoon Caricatures,” Journal of General Psychology 24, no. 2 (1941): 451–455.

30. “A cartoon generally conveys its message quickly and pungently.” Kemnitz, “Cartoon as a Historical Source.”

31. National Physicians’ Committee for the Extension of Medical Service to William F. Hewitt, November 16, 1939, Isidore S. Falk Papers.

32. National Physicians’ Committee for the Extension of Medical Service, “Announcing Cash Awards for Cartoonists,” February 28, 1948, Isidore S. Falk Papers.

33. Ibid.

34. Ibid.

35. Ibid.

36. National Physicians’ Committee, “An Editorial to Editors: Deceitful Manipulation of Draft Statistics,” Isidore S. Falk Papers.

37. “An Editorial to Editors: Socialized Medicine and Communist Purpose,” Isidore S. Falk Papers.

38. “Sen. Murray Flays ‘Vicious’ Cartoon Prizes,” Editor & Publisher, May 1, 1948, Isidore S. Falk Papers.

39. James Murray, “Free Press: Undermining,” Congressional Record 94, no. 4 (April 26, 1948): S4827–S4831.

40. Ibid.

41. Ibid.

43. Ibid.

44. Committee for the Nation’s Health, “To Editors From Doctors,” Editor & Publisher, March 20, 1948, 55.

45. Ibid.

46. Ibid.

47. American’s Vital Issue (Chicago, IL: National Physicians Committee for the Extension of Medical Service, ca. 1948), Walter J. Lear Papers.

48. Ibid., 5.

49. Ibid., 6.

50. Ibid.

51. Amos R. Koontz, “The Government Cannot Force Socialized Medicine on Us,” Journal of the American Medical Association 143, no. 12 (1950): 1113.

52. “Comics in the Fight against Government-Controlled Medicine,” Journal of the American Medical Association 144, no. 1 (1950): 46–47.

53. A letter sent out to physicians by a local committee in Baltimore, which included one copy of the comic book to entice physicians to buy it “in lots of one thousand or more,” urged “each physician to order at least 200 copies,” and went on to say that “societies purchasing lots of a million or more” would get a discounted rate. “Comics in the Fight.”.

54. Alfred E. Clark, “200 Jersey Doctors Back Move To Boycott Kennedy Health Plan,” New York Times, May 5, 1962:A1.

55. The AMA’s fervent opposition to national health care was revived in 1961 as President Kennedy supported the King–Anderson Bill, the precursor to Medicare. “Text of President Kennedy’s Address to Senior Citizens’ Rally at Garden,” New York Times, May 21, 1962, http://search.proquest.com/docview/116094732?accountid=15172 (accessed May 23, 2013)

56. A Case Against Socialized Medicine (Chicago, IL: American Medical Association, ca. 1962), 3, Walter J. Lear Papers.

57. Ibid.

59. This image appears on multiple right wing sites, such as Patriot Update, “A Hard Pill to Swallow,” http://www.patriotupdate.com/oldsite/exclusives/read/73/anti-obamacare-political-cartoons (accessed December 2, 2012); Soda Head, “A Hard Pill to Swallow,” http://www.sodahead.com/united-states/a-hard-pill-to-swallow-nopeouch/question-2777821/?link=ibaf&q=&esrc=s (accessed December 2, 2012); KnoxNews, “A Hard Pill to Swallow,” http://blogs.knoxnews.com/johnson/ 2012/11/frankenstorm-of-obamacare-loom.html (accessed December 2, 2012)

60. Americans for Limited Government, NetRightDaily, http://netrightdaily.com (accessed March 27, 2012)

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