Justice for All (38 page)

Warren may or may not have sensed that, but he knew enough not to rely solely on the organization's good will. Beneath his pitch, then, was a subtle threat. California's working middle class, Warren reminded the doctors, lived with the danger of a catastrophic health event. And that situation—millions of people living in fear—was not suited to stability. Stimulated by the promises of the New Deal, those residents would demand more from their government. If they did not get something soon, Warren warned, they might well demand a program more far-reaching than Warren was prepared to give or than the medical establishment could endure. Many of those who wanted better health care, Warren reminded Gilman, did not share their appreciation for private enterprise. They could not be expected to remain silent forever. Having posed the threat, Warren then, in broad strokes, proposed a publicly financed insurance program, guaranteed by the state but designed to be self-supporting.
³
Employees would pay 1.5 percent of their salaries, up to $4,000 a year, into the system, an amount that employers would match. The money would be collected by the state and administered by an eleven-person board overseeing the new California Health Service Authority. Those members would be appointed by the governor. The act specified that three would represent employers, two would be drawn from organized labor, and one from a state employee association; three would be doctors, one would be a dentist, and one member would be the state director of Public Health. Any California worker earning more than $300 a year would be eligible for coverage—the very poor already received health care through the publicly funded system of county hospitals. Benefits would pay for doctors' services, specialty care as ordered by a doctor, hospitalization for up to three weeks, drugs, X-rays, nursing care, and treatment of severe dental problems. Dependents also would receive coverage. Crucially, patients would be free to choose any doctor who was enrolled in the system. The authority would set “rates, fees or charges” for doctors in the system, but no doctor would be required to register, and those charges would not necessarily be uniform throughout the state.

Warren emphasized that the program did not compel patients to use the insurance, nor did it compel doctors to enroll in the system. Only one aspect of the proposal was compulsory: workers and employers would be bound to contribute to it, and their mandatory contributions would provide the pool of capital that would pay for insurance for all those who qualified.
⁴

Warren saw himself not as an advocate for a radical notion but rather as a proponent of a sensible, modest social program. He compared it to California's Workmen's Compensation System (now known as Workers' Compensation). That program, adopted during Hiram Johnson's years, provided for worker and employer payroll deductions, which were pooled and used to underwrite insurance that paid medical bills for employees who were hurt at work. “Before adoption of Workmen's Compensation in California in 1915, an employee injured on the job was in very much the same situation as an employee and his family today when confronted with serious illness or non-industrial injury,” Warren's staff emphasized in an internal memo.
⁵

Discussing this with Gilman, Warren thought he sensed the doctor's support, and he moved to capitalize on it. At his request, Gilman arranged for Warren to make a presentation to the CMA's executive committee, which Warren did on December 13, appearing on a stage at the Family Club in San Francisco with Gilman and John M. Cline, another leader of the association.
⁶
Cline remembered the discussion as “very vague,” with Warren parrying the doctors' queries but offering few specifics. In hindsight, it seems obvious that the doctors interpreted Warren's vagueness as tactical, but their suspicion reflected their basic misunderstanding of the governor. Warren was principally interested in a program that would insure middle-income Californians; he was, as he often was in complex and important matters, flexible on the details. Concerned that Warren was playing them, the doctors hedged. “This is a matter far too important to the health and welfare of the people of California and to the medical profession for any group of twenty men to decide,” Cline concluded. “This will require a special meeting of our House of Delegates to discuss.”
⁷

While the doctors misjudged Warren, he did the same with them. In his case, wishful thinking clouded his analysis of the CMA. He left their initial gathering believing that the reaction was at worst noncommittal and at best promising—Sweigert, for instance, described Warren as having gotten “a nice reception”
⁸
—when in fact the doctors harbored grave doubts that they withheld from him. Compounding the misjudgments on both sides was a misunderstanding about the process: Cline said he concluded the meeting believing he had a promise from Warren that no public statement would be forthcoming until the legislature convened in January and that the CMA had until then to formulate its response. Warren had no intention of waiting that long.

On December 29, the governor unveiled his plan to the public. “I am not for State medicine,” he declared. But he had given up on voluntary programs, Warren added, “because everybody will not join.”
⁹
In support of his argument that health care was lacking, Warren noted that more than a third of Californians called to military service in the war—“38 out of every hundred of our boys,” as he put it
¹⁰
—were rejected as “medically substandard.” He thereby linked his program to the national defense effort, seemingly a strong argument in those still-tense days of war.

Early reaction was temperate, as the state's Republican press contemplated this latest move by the governor. The proposal, the
Los Angeles Times
offered cautiously, “raises questions that need mature consideration.” Tactically, the governor also bolstered his case by embedding the proposal in his larger package of legislative proposals for the coming year. That package also included Warren's support for an extension of the tax cuts enacted in 1943, the single aspect of his record that had the strongest support among conservatives.
¹¹

For the Medical Association, however, the public announcement was not only a surprise but one with the strong suggestion of a betrayal. They countered with an insistence that they would not accept any plan that in any way hampered the medical profession's control over medical services.
¹²
And when they began to raise the alarm, Warren too felt deceived, believing he already had secured the association's support or at least neutrality. “The doctors thought he'd double-crossed them, and he thought they'd double-crossed him,” one member of Warren's staff confided to biographer John Weaver. “I believe he thought at first he could win them over, but we couldn't even get a doctor to come help us draw up a bill.”
¹³

On January 8, 1945, Warren welcomed the legislature back to Sacramento. His address to the legislators, carefully tuned by his staff and pored over by him in the early days of the year, reflected his optimism about California and his commitment to its betterment.
¹⁴
In terms reminiscent of his Inaugural Address two years earlier, Warren again sounded the call to Progressive state action, embarked upon by a state flush with tax revenue. And he again trumpeted the virtues of cooperation between his office and the legislative leadership, alluding to the darker period during Olson's administration when no such cooperation existed. “I report to you that your government is sound,” Warren said, “sound in finances, in integrity and in conformation to the spirit and the policies established by your honorable body.”
¹⁵

As Warren spoke, World War II was entering its final months. Paris had been liberated the previous August, followed by Brussels and Antwerp. Rommel, implicated in an attempt to kill Hitler, was dead by his own hand. Soviet troops pressed Hitler from the east, the Battle of the Bulge was under way, and the American fleet had regained control of the Pacific, moving toward the recapture of the Philippines on its way toward Japan. With the end of the war in sight, Warren framed his speech through the eyes of California's soon-to-be-returning servicemen:

 

Health insurance—sensitive to the implications of the word “compulsory,” Warren chose to label his program “prepaid” medical insurance—was squarely a part of the society that Warren argued those veterans were entitled to come home to. “Public health has always been considered the responsibility of community and State,” Warren said. “I want to see it remain such a responsibility. . . . We have had enough investigation and enough talk to be ready for action. We have ample evidence that our people desire the protection. This is the time for action.”
¹⁷

The fundamental liberalism of Warren's inaugural had escaped notice. Not this time. The California Medical Association turned its full legislative energy to the defeat of Warren's proposal, and to do that it enlisted a natural ally, Clem Whitaker. They instructed him to kill any compulsory health insurance bill advanced by Warren or anyone else. Angered by their treatment by Warren in 1942 and philosophically opposed to a proposal they saw as socialistic, Whitaker and Baxter set out to destroy the principal policy objective of the Warren administration. For Whitaker and Baxter, this was business but also something more—a chance to get even.

Clem Whitaker believed in attack. “You can't wage a defensive campaign and win,” he liked to tell clients.
¹⁸
When he had worked for Warren in 1942, Whitaker had been most pleased by the campaign's challenge to Governor Olson's war record; now he and Warren were on different sides, and Whitaker recognized that Warren's plan was vulnerable to criticism from the same quarter that had criticized Olson's—the conservative California press. In one sense, such criticism was unlikely: Warren was a Republican, after all, and one elected with overwhelming press support in 1942. But this plan was different, and Whitaker knew his audience. He had been working reporters and editors for years, through initiative campaigns, the anti-Sinclair effort in 1934, the campaign to defeat Ham and Eggs. And he knew publishers, too. In California, they were generally Republicans and conservatives, and though many supported Warren, Whitaker suspected he could sour them on the health care proposal if it was presented to them as a challenge to the free market. So Whitaker and Baxter labeled Warren's plan “socialized medicine,” and they tapped the CMA's vast political budget—every member of the organization was levied a mandatory fee to help support the campaign
¹⁹
—and began to work on the press. They took out ads, they wrote feature stories and analyses, and they and their employees personally visited hundreds of newspaper offices up and down the state. Initially, about 50 of California's papers expressed at least mild support for Warren's proposal; after Whitaker and Baxter had gotten to them, the number dropped to about 20. Those opposing the plan started at about 100; by the end, 432 California papers had expressed opposition to its passage.
²⁰

Whitaker occasionally put pen to paper himself, and one of his columns captures the inflated sense of alarm marshaled against Warren's proposal. “National Health Insurance,” Whitaker wrote, “with the cost being deducted from workers' paychecks, as proposed in California, has existed in England since 1911—and has been in operation long enough, therefore, to permit of realistic appraisal. Except for Nazi Germany, where the system may be considered in suspension, the British system furnishes the outstanding example of a government-controlled medical program.”
²¹
“Government-controlled,” “National Health Insurance,” the wry evocation of “Nazi Germany”—these were all earmarks of a Whitaker and Baxter effort. In his column and in the campaign he managed, Whitaker went on to sneer at British inefficiencies and to complain of oppressive state oversight. As the campaign built, the Warren program thus became synonymous simultaneously with soft socialism and dangerous fascism, a neat trick of political invective.

Opponents took the threat personally. Warren aides complained that once the doctor learned who their boss was, they would be refused treatment; political allies reported that they suddenly found themselves accused of being Communists.
²²
“It was amazing,” Virginia Daly, Warren's eldest daughter, recalled more than sixty years later. “Suddenly, my father was hated.”
²³

Warren was understandably taken aback, but he professed to have expected this reaction. “I was not surprised, of course, to witness opposition to the program develop,” he said in a radio address on February 21, 1945. “Such proposals invariably develop passionate friends and violent foes. Such is the case here. But the comforting thing from my viewpoint is that the opposition has not argued, and I believe will not attempt to argue, that the people of our state are receiving or have ever received adequate medical care. On the contrary, it is generally admitted that such care is not now available.”
²⁴
Warren tried to return the issue to “facts,” citing the health problems of draft-age young men uncovered by the Selective Service system, and stressing that he was open to suggestion for amendments to his proposal as written, so long as any alternative provided for universal coverage of the state's middle class. Trying to cool the debate off, Warren urged listeners to ask that “further light instead of heat be turned upon the subject.”