I thought this evening that I would talk with you a little about Congress and give you some idea of its workings and the problems that we face. If you should desire to influence it or merely understand it, it is important that you should know its structure. I can give you one good reason for understanding its make-up.
I think that it would be useless to deny that in the not too distant future – if the past experience of social legislation is a guide – the Congress is going to turn its attention toward the entire field of public health. As evidence note the title of an article by Russell Davenport in the March issue of Fortune Magazine, “Health Insurance Is Next.”
Both the Administration and the Republican Party have sponsored bills now before Congress dealing with national health insurance.
The Administration viewpoint is contained in the Senate Bill S. 1779, the Murray-Dingell Bill, and In House Bills H. R. 4312 and 4313, and calls for a compulsory health insurance system based on a contributory payroll tax.
These are several Republican approaches – most important of these are contained in S. 1970 The Flanders –Ives Bill, and in S. 1581, the Taft Bill.
The Flanders-Ives Bill proposes federal subsidies, furnished through the states, to help develop a national system of private voluntary prepayment group insurance plan.
The Taft Bill calls for federal grants in aid to states to underwrite and expand existing state and local programs for the “medically indigent.”
As you all know, the Administration Plan has been the most talked about and written about.
While it is not my desire tonight either to espouse or disavow the Administration’s compulsory health insurance plan, I thought that you might be interested in hearing a brief summary of the major arguments both for and against it which were brought out in the hearings before the Senate subcommittee on labor and public welfare a year ago.
The main arguments for the plan were these:
The present inadequacies of American health care call for federal intervention on a broad scale to protect the general welfare.
The compulsory method is the best way of assuring the necessary wide coverage which improves health and – by pooling risks – reduces per capita costs.
The patient doctor relationship would be improved because problems concerning ability to pay and collection would be removed.
Contributions would be made in proportion to income, but for equally complete health care, thus protecting the needy, low, and middle income families.
Compulsory nation-wide insurance is simpler and more direct and economical as to Administration than other proposed plans.
The main arguments against it were these:
Government intervention is now necessary since practice and the rapidly growing voluntary plans are demonstrating their effectiveness.
Nationalized health care would destroy the relationship between physician and patient and regiment both under a political bureaucracy.
Estimated costs would be greatly multiplied in practice, as has been proved in foreign – notably the British – experience.
The quality of medical care would decline because the health professions would be overburdened and professional interest would be diverted from science to politics. One result would be that young men of high standards would no longer enter the profession.
The program constitutes a broad step toward the complete socialization of our government and economy.
I am aware that many doctors, conscious of the progress that has been made under free medical systems, are opposed to government intervention into the health field – whether that intervention is of the type in the Administration plan or in any of the alternative proposals.
I fear that the continuation of such wholesale opposition might well prove to be near-sighted.
The increase in our population – the expanded cost of medical care – the misdistribution of hospitals, doctors, and nurses definitely stamp the field of public health as the next large field in which social legislation will be enacted.
This fact, I believe, is of importance to you as doctors and for this reason. Instead of merely opposing all legislative proposals in this field – you should begin to sift out the more acceptable elements of the many health plans and support legislation that will not only help to take care of some of the major problems facing our nation’s health – but that will also, and this is most important, permit doctors and medicine to be free of government control.
Legislation in health is coming – your advice on and support of the right type of legislation will be essential if American medicine is to continue its progress of the past.
But of all the problems we face, none are so vital and important as the cold war which is being waged with ferocious intensity in every corner of the globe.
This is especially true when we consider these words of George Kennan, the counselor of the State Department: “current Stalinist doctrine does not demand war. On the contrary, it also teaches that eventually capitalism will fall largely of its own weight, i.e. as a result of inner “contradictions” which the communists believe it embodies. They see the role of communism as one of the hastening the collapse of capitalism and assisting as a midwife at the birth of the socialist order. In theory, they seem inclined to regard this as primarily the task of the native communists in each country: and not of the soviet red army.”
Thus it might be said our chief objective in the cold war is to prevent native communists from seizing power by armed revolt. Our weapons in this twilight war are economic assistance, arms aid, and technical advice. We have believed that the freedom of Western Europe is most vital to our own security, and we have been attempting to keep it free by a series of desperate actions based on the belief that Russian expansion in that area can be successfully withstood.
The Truman doctrine as it applied to Greece and Turkey – the Marshall Plan, the Atlantic Pact, the Arms Aid Act – have all been a part of the grand design to consolidate the sixteen Western European countries into a buffer against the Soviet advance.
It would be a mistake to assume that the measures that I have recounted have each succeeded in full measure. While the Marshall Plan has helped bring about a tremendous economic recovery (for example in 1946 the industrial production of Europe was about 77% of the pre-war level. After two years of the economic recovery program production exceeds the pre-war level by 15%).
And while the communists in those countries who two years ago were bidding for power have been rolled back – there are still serious weaknesses in the European economy that would be readily apparent if the dollar subsidies were withdrawn.
Frequently, I understand, that after a patient with gout is given a treatment with the new drug, ACTH, his foot remains red and swollen, but he can walk around completely free from discomfort and pain. Perhaps the countries of Europe could be described in somewhat the same manner.
While there remains a demand for goods as a result of the shortages of the war – and while American dollars continue to be poured in – the basic weaknesses of the European economy will not be apparent.
Another source of concern to Europe’s responsible leaders is the knowledge certain that within the foreseeable future, unless some new terrifying weapon is invented, the soviet armies can overrun Europe swiftly within the limitations of their communications and transportation systems.
It is obvious that it takes courage to be anti-communist in those countries where Soviet armies can be passed on lines less than a few hours distance by air from the capitals of nearly all the Western European countries.
In order to give these men confidence we have taken a leading part in the forming of the Atlantic Pact which gives what might be called an American guarantee of the independence of these countries.
In addition we are endeavoring through the Arms Aid Act to assist Europeans to build their own defenses against a possible invasion of Western Europe by Russian armies.
Only the future can tell how successful our efforts have been. But we have devoted a great percentage of our patrimony to maintaining the independence of Western Europe.
In the Far East which we have neglected and ignored in favor of Western Europe, our policy has reaped the whirlwind.
With the loss of China to the communists, the communist pressure on Southeast Asia is mounting steadily.
The violent instability which has characterized the history of that area since the end of the Japanese war is the result of the pressure of two familiar political phenomena – communism and nationalism. Nationalism has expressed itself for the most part in protests against the western colonial systems.
The communists in Southeast Asia rarely sell communism. They sell nationalism. Their purpose, of course, in so doing is to secure control of the nationalist movements and to use them to the advantage of world communism.
This is especially true in Indo-China, the new frontier in the cold war. In that country the nationalist movement held the stirrup by which Ho Chi Minh, a communist of unusual ability, has mounted to control.
For the past three years, the French forces in that country who number nearly 150,000 have been engaged in a bitter death struggle with Ho’s forces. Mute testimony to the intensity of that struggle is the fact that more French officers are being killed each year in that far off country than are graduated from St. Cyr, the west point of France.
In an attempt to win back the support of the people, the French have installed the emperor, Boa Dai, and on February 2 created new Indo-Chinese states “independent within the French Union.” Unfortunately, the nationalist movement looks on Boa Dai as a French puppet and it will be difficult for him to catch the imagination of the people as long as the French are there; and if they leave, Ho would undoubtedly seize control.
The United States has been in a difficult position. Faced with the choice of supporting the French or the communists, we have had by necessity to choose the French, and have thus become involved with a colonial power which is opposed by the majority of the people. Our policy toward Indo-China is now made up of the following measures: 1) The United States has continually urged the French to adopt generous foresighted policies toward the nationalist movement. 2) We have recognized the new states created by the French action of February 2nd and have established a legation at Saigon. 3) United States officials have stressed to Asian audiences their own interests in Indo-China’s independence from the communists. 4) We are sending military assistance to the French to put down the communists. 5) We are drawing up plans for economic assistance to the Indo-China states.
Our state department believes that given a constructive French policy and able native leadership in the new Indo-Chinese governments, the strength and prestige of these governments should be sufficiently enhanced by United States backing to gain increasingly popular support.
In our efforts to prevent Indo-China from slipping into the communist orbit we are faced with a delicate and painstaking task.
But the stakes for which we are fighting are great; for not merely the fate of Indo-China hangs in the balance – not merely the fate of the whole of Southeast Asia, but in some measure the fate of the United States.
As President William F. Warren, the first president of your great university said in an address celebrating the 25th anniversary of the university: “I can only add that of all the incorporeal hereditamenta of our favored university, none are in reality so precious as those which it shares with every other. Faith in the truth, the spirit of absolute loyalty to all revelations of truth and duty, . . . These are the supreme treasures of all true scholars and teachers, . . . “To this work we this day solemnly dedicate ourselves anew; to this, earnestly invoking God’s good help, we will be faithful so long as “twice each day the flowing sea takes Boston in its arm.”
Speech source: Papers of John F. Kennedy. Pre-Presidential Papers. House of Representatives Files. Series 02. Speeches, 1946-1952. Box 95, Folder: "Boston University, 26 May 1950".