Last week, the and several like-minded groups launched a campaign to defeat "Medicare for All" proposals, calling it the .
One of the rotating banner images on its Internet home page is a picture of Vladimir Lenin, the Soviet Union founder, and a quote: "Socialized medicine is the keystone to the arch of a socialized state."
The campaign, obviously, aims to stoke fears of Communist authoritarianism. That's no surprise -- "socialized medicine" has been the epithet thrown at every proposal for universal healthcare offered in the past 100 years.
But I was interested in the Lenin quote. In his priority list for establishing and defending the new state, did the architect of Soviet communism really put healthcare at the top?
Well, no. Turns out the quote is bogus, apparently made up from whole cloth. But it's not new. And its history reveals much about America's decades-long debate over the government's role in healthcare, and attempts by the American Medical Association (AMA) to shape it.
The backstory
It's well known that the AMA fought Medicare tooth and nail in the early 1960s, eventually throwing in the towel. But that was just one of a decades-long string of battles the AMA fought against the notion of universal health coverage. Just this week, a former AMA president told the House of Delegates, "I think we ought to put a stake in the heart of single-payer."
In fact, it wasn't until 1949 that the AMA stopped opposing any form of health insurance. In 1934, the House of Delegates passed a "statement of principles" that, among other things, declared that "no third party must be permitted to come between the patient and his physician in any medical relation."
I got this from Richard Harris's detailed history of the 1965 Medicare legislation, published in 1966 as a and in a book the same year titled .
Harris traced Medicare's origins through a series of proposals, beginning in 1920, for some kind of government role in helping people obtain healthcare when they couldn't pay out of pocket.
From the AMA's perspective, the scariest was the so-called . This was genuine, full-on universal medical, dental, and nursing home care, to be paid for through a dedicated income tax. President Roosevelt was believed to be supportive but his death in April 1945 derailed the legislation for a time, and support in Congress weakened.
The Wagner-Murray-Dingell bill's prospects brightened considerably in 1949, however, when President Truman threw his full support behind it after his 1948 election.
And that's when the Lenin quote surfaced. Remember, 1949 was the year the Soviet Union exploded an atomic bomb; Truman had already ordered a "loyalty program" to root out suspected Communists in the government. The Red Scare was well underway.
According to Harris, the AMA hired a public relations firm, Whitaker & Baxter, with long experience in fighting "socialized medicine." As part of what turned out to be a $4.5-million AMA campaign to defeat the bill -- that's $48 million in today's dollars -- the firm put out a about the legislation.
For example:
"Q. Who is for Compulsory Health Insurance?"
"A. The Federal Security Agency.... All who seriously believe in a Socialistic State. Every left-wing organization in America.... The Communist Party."
That label, "Compulsory Health Insurance," was not made up by Whitaker & Baxter. The bill's proponents used it as well. In 70-year hindsight, it's perhaps not surprising it went down to defeat.
The pamphlet went on to state that universal healthcare was a 19th century German invention and a common characteristic of authoritarian governments -- "whether Fascist, Nazi, Communist or Socialist" -- and that American paychecks could be taxed as much as 10% to pay for the program. (In fact, the proposal set the tax at 4% on no more than $4,800 of income.)
And then this:
"Q. Would socialized medicine lead to socialization of other phases of American life?"
"A. Lenin thought so. According to Lawrence Sullivan in his book 'The Case Against Socialized Medicine,' the founder of international revolutionary Communism once proclaimed socialized medicine 'the keystone of the arch of the Socialist State.'"
Harris's New Yorker article shortened the Lenin quote, omitting the reference to -- at 54 pages, really more of a nicely bound booklet -- which also was published in 1949. Here's how Sullivan framed it:
"The campaign for socialized medicine in the United States stems directly from Kremlin Communism. Lenin, the founder of international revolutionary Communism, once proclaimed socialized medicine 'the keystone of the arch of the Socialist State.' Nowhere in the world today is the profession of medicine more completely under the control of government than in the Soviet segments of Russia."
(No citation is given for the quote. I couldn't find out much about Sullivan -- his other works include Dead Hand of Bureaucracy and Bureaucracy Run Amuck [sic], suggesting a dislike of government in general. Anti-communist and anti-bureaucratic works by a Lawrence Sullivan with publication dates of 1959-1961, with that Sullivan identified as "coordinator of information, U.S. House of Representatives," but it's uncertain whether it's the same person. At any rate, The Case Against Socialized Medicine appears to be the original source.)
In total, Whitaker & Baxter distributed more than 54 million pieces of literature, at a cost of $1 million, on behalf of the AMA's successful effort to defeat the bill.
According to Harris, "The research staff of the Library of Congress has never been able to find this quotation, or anything like it, in Lenin's works." A , other scholars found.
But it lived on, and on, and on
Of course, debate over the government's role in healthcare didn't end with Wagner-Murray-Dingell or with Medicare's and Medicaid's passage in 1965. The quote has been recycled -- and debunked -- repeatedly up to the present day. (One oft-cited source for debunking is , The Social Transformation of American Medicine, although Starr attributed it to Harris.)
It certainly came up many times as the Affordable Care Act (ACA) was debated in 2009 and 2010. And it got new currency in 2013, when Ben Carson, MD -- whose political ambitions were just beginning to flower -- Fox News (where he had just landed a commentator gig) and in attacking the ACA.
That , where reporter Jean Marbella found Starr's effort to debunk the quote. However, noting that Starr is something of a liberal himself (he's a co-founder of the left-leaning American Prospect magazine), Marbella went further to determine whether there might be a basis for it.
"I reached out to David Walters, an administrator of an online Lenin archive, to see if he might have better luck, but he too came up empty," Marbella wrote shortly after Carson's Fox News appearance. "The closest Walters could get to approximating the sentiment if not the words of the Lenin quote comes from a 1919 party conference in which the leader said hunger, a lack of soap or fuel and 'lice that carry typhus' could 'prevent our tackling any sort of socialist development.'"
Marbella also called Mark Field, PhD, a (he died in 2015). He also scoffed at the idea of socialized medicine as Lenin's "keystone" in the socialist arch. "Lenin had more important areas to worry about," he told Marbella. "The priority for Lenin was industrialization and the ability to produce weapons of defense and attack."
But clearly the quote is too good to throw away just because it's fake.
Deputy Managing Editor Ian Ingram contributed to this article.