From the University of California at Berkeley, Berkeley, CA.
Few epidemiologists are familiar with the US Committee on the Costs of Medical Care (1927–1932) or with the role that epidemiology played in this early effort to reform heath care in the United States.
In the 1920s, many US health leaders were dissatisfied with progress in improving general health. This was despite gains in medical science at the end of the 19th century, and reforms in medical education following the 1910 publication of the “Flexner Report.” At the 1927 annual meeting of the American Medical Association, 60 representatives of medicine, public health, social science, and the general public came together to form a Committee on the Costs of Health Care. They elected a director (Ray Lyman Wilbur, former President of Stanford University and of the American Medical Association), and hired a director of research (Isidore S. Falk, later head of the Social Security Office of Research and Statistics). Eight major Foundations promised support, and a 5-year program of research was launched.1
Under Falk's direction, 26 studies were conducted by 50 research associates. The most important was a study of medical-care needs and services carried out among a national sample of 9000 families followed for 12 months. Results from these studies, provided the basis for 5 major recommendations: (1) preventive and therapeutic medical services should be provided by qualified experts; (2) basic health services should be available to all according to need; (3) the cost of medical care should be provided by insurance, taxation, or both; (4) evaluation and coordination of services should be carried out by agencies formed to exercise these functions; and (5) training of health and medical personnel should emphasize prevention and social issues.
These recommendations were never implemented. The fiercest opposition came from organized medicine. An Editorial in the Journal of the American Medical Association JAMA called the majority report an “invasion of governmental agencies into the practice of medicine,” and an “incitement to revolution.”2 These themes of antireform from 1932 resonate nearly 8 decades later in the rhetoric stirred up by legislation to reform the US medical care system.
1. Committee on the Costs of Medical Care. Medical Care for the American People: The Final Report of the Committee on the Costs of Medical Care.
Chicago, IL: University of Chicago Press; 1932.
2. The committee on the costs of medical care [editorial]. JAMA.