“Does the United States Need a Medical Revolution?” Communism, Birth Control, and National Health Insurance in 1940s New York
Dr. Cheri Appel (1901-2003), the clinic’s medical director, was the child of Ukrainian Jewish immigrants. One of five women to graduate NYU medical school in 1927, she completed her residency in gynecology at Morrisania Hospital, worked at Margaret Sanger’s Birth Control Clinical Research Bureau on West 16th Street, and in 1932 assisted Sanger in opening a birth control clinic funded by Nancy Carnegie Rockefeller in Portchester, New York. In 1934, Dr. Appel traveled with Sanger to the Soviet Union. While Sanger lectured, Appel visited Moscow hospitals. “To read the New York Communist press back then,” Appel recalled later, “one would have concluded that birth control was alive and well in every Soviet clinic, and family planning part of the diet.” On the contrary, she said, neither material nor instruction was readily available. Appel had brought “a very large carton of diaphragms” with her to the Soviet Union, intending to train doctors and patients in the use of combining diaphragm use and spermicidal jelly. Unfortunately, since rubber was in short supply in the Soviet Union, and could not be spared for non-military materials like diaphragms, such items were widely unavailable to the non-elite. In fact, Appel’s only patients ended up being the female gynecologists she met in the Moscow hospitals. Abortions were the only method of “family planning” available in the Soviet Union at the time, Appel reported in frustration -– one morning in Moscow, she witnessed five abortions in five hours -– without anaesthesia.
While Appel was frustrated that the Soviet system hardly lived up to its image, she noted that Soviet morbidity rates for abortion were very low, and abortion-related mortalities “were nonexistent.” This differed significantly from the situation back at home. Because American abortions were often done illegally, the procedure could be life-threatening. In 1935, New York City’s Health Department reported dozens of cases of septicemia from abortion per month. As a result of her Soviet experience, Appel became thoroughly and permanently disillusioned with the Soviet system, and even more committed to providing safe and accessible health care for women in the United States.  When the International Workers Order offered her the position as head of their new clinic, she accepted, in spite of the IWO’s close relationship with the American Communist Party. The IWO’s birth control clinic became the first center for women’s health established by a fraternal organization in the United States, and the only birth control clinic operating on an insurance system. It offered the opportunity to become a model for similar programs nationwide, something Appel and her colleagues clearly found appealing.
Founded in 1930 as a pro-Soviet breakaway from the Workmen’s Circle, a Jewish fraternal society, the IWO offered affordable health and life insurance on a pre-paid plan. By the mid 1930s, the IWO claimed 35,000 members in New York City, divided among almost 300 lodges, organized according to language sections. The IWO became the “first insurer to include contraception in its benefit package.” IWO leaders linked economic issues relating to sex and reproduction to larger structural challenges bound up with poverty and the system of waged labor. As Elizabeth Temkin has remarked, “the actuarial is political:” the IWO’s fraternal insurance plan allowed working-class New York women a form of sexual, and economic, autonomy. “Even in the short time of the center’s existence, the center has shown its worth,” an IWO publication proclaimed in 1940. “Our numbers show the significant cost which American mothers pay both in terms of cash and in terms of health, due to abortions and a shortage of information regarding motherhood.” IWO leaders regarded their birth control clinic as a cutting-edge response to the economic crisis of the Depression, and saw health insurance as a major vehicle for broader social reform.
By 1940, the IWO’s City Central Committee had enrolled 18,000 members in its medical plan, and, through family plans it provided low-cost medical care, through neighborhood physicians, to almost sixty thousand people. The family plan cost 50 cents per month, or $6 a year (about $100 in 2016 dollars). For a single person, the plan cost 35 cents per month, or $4.20 per year (roughly $70 in 2016 dollars). The medical plan included visits to the doctor’s office, as well as house calls. There were about one hundred neighborhood physicians in the IWO insurance network. In addition, the IWO provided access to specialists, available on a pay-as-needed, discounted basis. For example, while the normal fee for a major operation such as appendectomy started at $150, an IWO member undergoing a procedure with an IWO surgeon paid only $50. Similarly, pre-natal and delivery care cost about $150 through many insurance plans, but on the IWO plan, it cost about $75. The IWO also invested in preventative care: in 1937, it began offering free Wasserman tests to diagnose syphilis, and in 1939 it began to offer an annual chest x-ray to screen for tuberculosis. IWO officials considered these campaigns successful both in terms of saving lives, and in terms of limiting insurance costs for all by catching medical problems before the cost of treatment skyrocketed.
Dave Greene, a New Yorker who joined the IWO in 1931, became secretary of the Central Committee in 1937, and the following year became an example of how the IWO’s insurance plan could protect workers from wage and job loss due to illness. One morning, without warning, Greene woke coughing up blood. An IWO internist paid a house call, and concluded that Greene required a chest X-ray. The doctor made a follow-up visit, bringing along a portable X-ray machine. The x-ray was then examined offsite by the IWO’s pulmonologist, who diagnosed incipient tuberculosis. Greene was sent to the IWO’s sanitarium upstate in Liberty, New York. As a benefit of his insurance coverage, Greene received sick benefits of $20 per week for thirty weeks, which covered the complete cost of his stay in the sanitarium, including room and board, and daily visits from his doctor. Greene spent three months in Liberty, and then returned to his job with the IWO. He later remarked, “I owe my life to the fact that I had available to me, through the medical plan, services when I needed it, without having to worry about whether I had the money available at the time to cover the cost of it.”
IWO leaders hoped that experiences like Greene’s would prompt many Americans to demand a national health insurance plan from the federal government. While fraternal insurance plans were necessary, IWO officials argued that the health care they provided should be regarded as only a stopgap measure. They believed that affordable health care was a right that all citizens should enjoy, and lobbied the Roosevelt administration to pass a national health care bill. In 1938, IWO Vice President John Middleton attended the President's National Health Conference, where the possibility of a federal, universal, medical care program was discussed. A bill sponsored by Senator Robert Wagner of New York, proposing action on the 1938 conference proposals, gained little traction. But the issue re-appeared in 1943 in the form of the Wagner-Murray-Dingell Social Security Bill. Nicknamed the “Cradle to Grave” bill, the bill aimed to achieve a “unified national social insurance system,” consisting of public employment, old-age retirement insurance benefits, permanent disability insurance, unemployment insurance, maternity insurance, medical and hospitalization insurance, and social insurance. The IWO immediately threw its support behind the bill. While the Senate did not approve the bill, Wagner, Senator James Murray (Montana), and Representative John Dingell Sr. (Michigan) continued to emphasize the issue, especially after Roosevelt introduced his “Economic Bill of Rights” in 1944, which included “the right to adequate medical care.”
After President Roosevelt died in 1945, President Truman faced opposition from all sides. In May 1945, Wagner, Murray, and Dingell re-introduced their social security bill. The bill again failed, but the Senators and Representative kept trying to push the President to make national health care a priority. In November 1945, President Truman acceded, introducing a five-point health program which included hospital construction; expansion of public health services; benefits covering losses due to illness and disability; and a prepaid medical costs system. On the same day, Senators Wagner and Murray and Representative Dingell introduced yet another bill, the National Health Act (concurrently introduced in the senate as S.1606, and in the House of Representatives as H.R. 4730), which incorporated President Truman’s program and the 1945 Wagner-Murray-Dingell Social Security Bill, S. 1050 (H.R. 3293). The bill was sent to committee, yet again, where it was held without action.
One week after the National Health Act bill of 1945 was introduced, the IWO held a Social Security Conference in Washington D.C, attended by IWO leaders from across the country. At this conference, IWO leaders planned a national campaign to rally for the passage of the Wagner-Murray-Dingell Social Security Bill and the National Health Act. IWO leaders aimed to collect one million signatures on a petition for the passage of the Wagner-Murray-Dingell Bill. The leaders also hoped to raise a $25,000 Social Security Fund in order to distribute copies of the bills and to launch extensive radio broadcasts, films, posters, leaflets, meetings, demonstrations, and other forms of mobilization to rally public support for the passage of the bills.
IWO leaders argued that the fight for social security was integrally linked to struggles against racial injustice and anti-Semitism. IWO official Max Bedacht believed that national security depended on social security. After winning the war against fascism abroad, IWO leaders like Bedacht believed that the fight for fascism continued at home. At the IWO’s Social Security Conference, Bedacht declared, “If we fight for all of these things to benefit all of the people, Negro and white alike, Jew and gentile, foreign and native born, we will make a very powerful contribution to the defeat of fascism…The most fruitful source of the strength of racist propaganda comes from mass misery,” he claimed. “The racist propagandists invariably put the blame for such misery on helpless and innocent minorities. Therefore, reducing the dangers of misery for the masses automatically reduces the chances of fascism to win proselytes for their anti-democratic and murderous theories and practices.” Bedacht urged all IWO members to fight for national health care, social security, and all measures that would ensure racial and economic equality in the postwar U.S.
The principle source of resistance to the Wagner-Murray-Dingell bills and the National Health Act came not from American brownshirts, as IWO leaders feared, but rather from professional associations such as the American Medical Association (AMA). The AMA had opposed federal regulation of medical services since the 1920s. In the 1940s, they regarded state-run medicine as a step perilously close to Germany’s National Socialism; a June 1943 editorial in the AMA’s journal cautioned that the bill would make the American Surgeon General into a “virtual Gauleiter [a high-ranking Nazi paramilitary office] of American medicine,” arguing, “it is doubtful if even Nazidom confers on its ‘Gauleiter’ the powers which this measure would confer on the Surgeon General...” Later in 1943, the journal warned that the bill proposed “a complete revolution of medical practice in the United States,” and questioned the need for such radicalism, which entailed abolishing America’s cherished medical professionals and replacing them with “salaried political bureaucrats.” Furthermore, journal editors worried that “quality of care would degrade under a federal system of healthcare, where both doctors and patients would be at the whims of a “dictator’s will.” .
In December 1945, after President Truman submitted his plan for a National Health Program, and the Wagner-Murray-Dingell bill was reintroduced in the Congress, the AMA warned that “federal compulsory sickness insurance is the first step toward a regimentation of utilities, of industries, of finance, and eventually of labor itself,” the same kind of regimentation that “led to totalitarianism in Germany and the downfall of that nation.” “Now, if ever, those who believe in the American democracy must make their belief known to their representatives, so that the attempt to enslave medicine…will meet the ignominious defeat it deserves,” the editorial declared. That year, the AMA spent $1.5 million on lobbying efforts against national health measures, at the time “the most expensive lobbying effort in American history.”
When Truman won reelection in 1948, “the AMA thought Armageddon had come.” It responded by increasingly linking all aspects of national health legislation to socialism. As American-Soviet tensions heightened and the war in Korea began, the AMA’s efforts at discrediting Truman’s National Health Act found success, as politicians and citizens worried that America could fall prey to Soviet-style socialism. This fear heightened after the arrest of Julius Rosenberg, himself an IWO insurance policy holder, for atomic espionage, in 1950. At the same time, the New York State Insurance Commission ruled that the International Workers Order had violated its insurance charter; its close association with the Communist Party was considered a hazard to national security. In 1951, the IWO’s birth control clinic was forced to close, and, after an unsuccessful appeal, the International Workers Order was liquidated. IWO members’ insurance policies were transferred to corporate insurance plans, where the rates, especially for aging working-class immigrants and blacks, were often significantly higher.
Dr. Cheri Appel continued to direct the IWO’s birth control clinic throughout the 1940s, and in so doing she became interested in the psychological basis of women’s health issues. She completed a residency in psychiatry and underwent training in non-Freudian psychoanalysis. In 1955, she opened a private practice out of her home. She maintained this private practice until she was 95.
Representative John Dingell Sr. continued to introduce the Wagner-Murray-Dingell bill every year until his death, in 1955. In that year, his son John Dingell Jr. took his father’s seat in the House of Representatives, and he too continued to introduce national health care bills regularly throughout his tenure. At the end of 2014, John Dingell Jr. retired from Congress after serving twenty-nine full terms, making him the longest serving member of Congress in the history of that body. On March 21, 2010, when H.R. 3590, President Obama’s Affordable Care Act, passed a vote in the House of Representatives, Congressman Dingell Jr. declared that, finally, “healthcare is not a privilege, it is a right.”
As debates over the Affordable Care Act and its fate flare throughout this election season, few recall the fierce rhetoric and political battles waged over these same issues in the 1940s. Causes such as adequate and affordable medical care, including birth control, continue to inflame passions and inspire partisanship in the American public sphere. By looking to the history of these debates, we can better understand the national tenor of these issues today.
Jennifer Young is a Ph.D. Candidate in History at New York University, and currently serves as Digital Learning Curator for the YIVO Institute. Her dissertation focuses on the International Workers Order and interracial politics within New York's Communist movement.
 New York Times, February 6, 1921, p. 111.
 International Workers Order, Tsenyoriker yubiley fun internatsyonaler arbeter ordn [Yiddish: Ten-Year Jubilee of the International Workers Order] (New York: 1940), 460.
 Health and Hygiene 6, no. 2 (August 1937): 70.
 Elizabeth Temkin, “Contraceptive Equity: the Birth Control Center of the International Workers Order,” American Journal of Public Health (October 2007): 1742.
 Cheri Appel, “Glasnost Only Brought Soviet Sex into the Light,” New York Times, February 13, 1990.
 Cheri Appel, “Glasnost Only Brought Soviet Sex into the Light,” New York Times, February 13, 1990.
 Elizabeth Temkin, “Contraceptive Equity: the Birth Control Center of the International Workers Order,” American Journal of Public Health (October 2007): 1740.
 Personal communication, Dr. Mimi Daitz, regarding her mother, Dr. Cheri Appel, May 18, 2012. See also, Mimi Daitz, “My Mother, the Doctor -– A Memoir,” Journal of International Women’s Studies 16, no. 3 (July 2015): 320. Special thanks to Dr. Daitz for sharing memories of her family with me, and for encouraging my research in this area.
 Temkin, “Contraceptive Equity” (2007): 1740.
 Id., 1737.
 IWO, Tsenyoriker yubiley (1940), 460.
 Testimony of Dave Greene, Record on Appeal, vol. VI, p. 4082, In re International Workers Order, 305 N.Y. 258 (1953).
 Testimony of Dave Greene, Record on Appeal, Vol. VI, 1953, p. 484-485.
 “IWO Conference on Social Security Held in Washington,” Jewish Fraternalist (January 1946): 3.
 “Wagner-Murray-Dingell Bill for Social Security,” Journal of the American Medical Association (June 26, 1943): 600.
 “Does the United States Need a Medical Revolution?” Journal of the American Medical Association (October 16, 1943): 418.
 “Does American Medicine Need a Dictator?” Journal of the American Medical Association (October 30, 1943): 564.
 “The President’s National Health Program and the New Wagner Bill,” Journal of the American Medical Association (December 1, 1945): 950.
 “The President’s National Health Program and the New Wagner Bill,” Journal of the American Medical Association (December 1, 1945): 953.
 Karen S. Palmer, “A Brief History: Universal Health Care Efforts in the U.S.,” Physicians for a National Health Program. Accessed June 20, 2016, http://www.pnhp.org/facts/a-brief-history-universal-health-care-efforts-in-the-us.
 Palmer, “A Brief History.”
 “Have You Heard?” The Grapevine: Alumni Newsletter of the NYU School of Medicine 4, no. 1 (2003): 9. https://www.med.nyu.edu/sites/default/files/school2/grapevine_fall_03.pdf.
 Mimi Daitz, “My Mother, the Doctor -– A Memoir,” Journal of International Women’s Studies 16, no. 3 (July 2015): 323.
 John Nichols, “Congressman John Dingell, D – Healthcare is a Right,” The Nation, February 24, 2014, http://www.thenation.com/article/congressman-john-dingell-d-healthcare-right/.
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