1. Lubell, Samuel and Everett, Walter, “Rehearsal for State Medicine,” Saturday Evening Post, 17 December 1938.Google Scholar On the National Health Conference, see Interdepartmental Committee to Coordinate Health and Welfare Activities, The Need for a National Health Program: Report of the Technical Committee on Medical Care (Washington, D.C., 1939)Google Scholar ; idem, Proceedings of the National Health Conference, July 18-20, 1938 (Washington, D.C., 1938)Google Scholar ; idem, Toward Better National Health (Washington, D.C., 1939).Google Scholar On health care initiatives in the 1930s more generally, see Hirshfield, DanielThe Lost Reform: The Campaign for Compulsory Health Insurance in the United States from 1932-1943 (Cambridge, Mass., 1970)CrossRefGoogle Scholar , and Fox, Daniel, Health Policies, Health Politics: The British and American Experience, 1911-1965 (Princeton, N.J., 1986), chaps. 4-5 passimCrossRefGoogle Scholar.

2. Farm Security Administration, Annual Repor[s], 1943-44, 1944-45 (Washington, D.C., 1944-1945).Google Scholar The FSA medical programs have received only passing mention in histories of health care reform or New Deal agricultural policy. For example, Baldwin's, SidneyPoverty and Politics: Rise and Decline of trie Farm Security Administration (Chapel Hill, N.C., 1968)Google Scholar devotes only two paragraphs to the medical program. More recently, the FSA health program in the South has been well documented in Taylor, Brenda Jeanette, “The Farm Security Administration: Meeting Rural Health Needs in the South, 1933-1946” (Ph.D. Dissertation, Texas Christian University, 1994).Google Scholar Yet Taylor's account is largely descriptive, and she makes little effort to place her study in a larger historiographic context. Also largely descriptive is Grey, Michael, “Poverty, Politics, and Health: The Farm Security Administration Medical Care Program, 1933-1945,” Journal of the History of Medicine and Allied Sciences 44 (June 1989): 320–50.CrossRefGoogle Scholar See also his much briefer, “The Medical Care Programs of the Farm Security Administration, 1932 through 1947: A Rehearsal for National Health Insurance?” American Journal of Public Health 84 (October 1994): 1678–88.CrossRefGoogle Scholar Grey attributes the origins of the program to both humanitarian and economic concerns and the program's decline to the reluctance of doctors to continue the program given improved economic conditions. Unfortunately, Grey's articles appear in journals that most political historians, I suspect, rarely read.

3. Skocpol, Theda, “Bringing the State Back In: Strategies of Analysis in Current Research,” in Evans, Peter, Rueschemeyer, Dietrich, and Skocpol, Theda, eds., Bringing the State Back In (New York, 1985), 3–37.CrossRefGoogle Scholar See also , Skocpol, “Political Response to Capitalist Crisis: Neo-Marxist Theories of the State and the Case of the New Deal,” Politics and Society 10 (1980): 155–201CrossRefGoogle Scholar.

4. Marsh, James and Olsen, Johan, “The New Institutionalism: Organizational Factors in Political Life,” American Political Science Review 78 (1984): 734–89.Google Scholar For a discussion of how the “new institutionalism” has affected both history and political science, see Robertson, David, “Politics and the Past: History, Behavioralism, and the Return to Institutionalism in American Political Science,” in Monkkonen, Eric, ed., The Uses of History Across the Social Sciences (Durham, N.C., 1994)Google Scholar.

5. Leuchtenburg, William, “The Pertinence of Political History: Reflections on the Significance of the State in America,” Journal of American History 73 (December 1986): 585–600.CrossRefGoogle Scholar

6. Gordon, Colin, New Deals: Labor, Business, and Politics, 1920-1935 (New York, 1994)Google Scholar ; Brinkley, Alan, The End of Reform: New Deal Liberalism in Recession and War (New York, 1995).Google Scholar Gordon places greater emphasis on the role of organized economic interests (especially big business), but he also acknowledges that his own approach is “eclectic,” drawing from a variety of perspectives (including state-centered perspectives). Brinkley still holds that groups and forces “outside” the state “shape the behavior of the state.” But while policy debates and initiatives “were not confined to the states,” he notes, “they did exist largely in a world of elites—intersecting networks of liberal policymakers, journalists, scholars, and intellectuals, both inside and outside of government” (12-13). Brinkley also notes his debt to, and disagreements with, the state-centered approach (and political science more generally) in a thoughtful forum in Studies in American Political Development 11 (Spring 1977)Google Scholar.

7. Theda Skocpol, “State Formation and Social Policy in the United States,” in idem. Social Policy in the United States (Princeton, N.J., 1995).Google Scholar Skocpol makes this same point in the introduction to her multiple-award-winning Protecting Mothers and Soldiers: The Political Origins of Social Policy in the United States (Cambridge, Mass., 1992).Google Scholar See also James Patterson's useful review of Skocpol's recent work in Journal of Policy History 9 (1997): 256–61.CrossRefGoogle Scholar Like Patterson, I welcome “her attention… to the key role of the state,” but 1 think that “she slights the role of reformers and outside interest groups” (260).

8. Finegold, Kenneth and Skocpol, Theda, State and Party in America's New Deal (Madison, Wis., 1995).Google Scholar Skocpol and Finegold attribute the success of the AAA and the failure of the NRA largely to different degrees of “state capacity.” That is, the AAA could rely upon a preexisting network of institutional resources and policy intellectuals in the Department ot Agriculture, the Bureau of Agricultural Economics, the Extension Services and the state land-grant colleges to implement agricultural policy. The NRA, on other hand, had no comparative institutional network to implement industrial policy.

9. In focusing on state autonomy, I realize that I am slighting another component of what Skocpol and Finegold call “stateness”: the concept of “state capacity.” However, in light of their conclusions about the AAA, the state-capacity argument is less useful in explaining the demise of the FSA. For the FSA, housed within the USDA and working with the BAE and Extension Service, had access to the same institutional network. Moreover, the FSA, a relatively small and inexpensive program, required much less “state capacity” than the more costly and bureaucratic AAA. It is therefore difficult to see the failure of the FSA as a result of inadequate state capacity. On the components of “stateness,” see Skocpol and Finegold, 51-53. For a concise critique of the limits of the state-centered approach to New Deal agricultural policy (and one to which I am greatly indebted), see Gilbert, Jess and Howe, Carolyn, “Beyond ‘State vs. Society’: Theories of the State and New Deal Agricultural Policies,” American Socio-logical Review 56 (April 1991): 204–20CrossRefGoogle Scholar.

10. , Brinkley, Trie End of Reform, especially 3–6, 265f.Google Scholar ; quote at p. 7. See also his “Idea ot the New Deal State,” in Gerstle, Gary and Fraser, Steven, eds., The Rise and Fall of the New Deal Order, 1930-1980 (Princeton, N.J., 1989)Google Scholar.

11. For overviews of New Deal agricultural policy, see Saloutos, Theodore, “New Deal Agricultural Policy: An Evaluation,” in , Dubofsky, ed., The New Deal: Conflicting Interpretations and Shifting Perspectives (New York, 1992)Google Scholar , and Kirkendall, Richard, “The New Deal and Agri-culture,” in , Braeman, et al., eds., The New Deal: The National Level (Columbus, Ohio, 1975).Google Scholar For an overview of the Farm Security Administration, see Baldwin, Sidney, Poverty and Politics: The Rise and Decline and the Farm Security Administration (Chapel Hill, N.C., 1968).Google Scholar On the AAA, see Skocpol and Finegold, State and Party, passim.

12. Williams, R. C., “Development of Medical Care Plans for Low Income Families,” American Journal of Public Health 30 (June 1940): 725–35.CrossRefGoogle Scholar See also Will Alexander to Henry Wallace, 7 June 1939; James McCamy to C. B. Baldwin, 22 August 1939; C. B. Baldwin to Wallace, 10 July 1939; Harry Brown to Alexander, 15 September 1939 (and attached correspondence), all in “Medical Service” file, Box 3019, United States Department of Agriculture, General Correspondence of the Secretary, 1938-1945, Record Group 16, National Archives, College Park, Md. [hereafter GC, USDA, RG-16].

13. On the poor state of rural health, see Mott, Frederick and Roemer, Milton, Rural Health and Medical Care (New York, 1948)Google Scholar ; FSA, Toward Farm Security (Washington, D.C., 1941)Google Scholar.

14. FSA Annual Reports, 1943-1944, 1944-45Google Scholar ; FSA, Group Medical Care for Farmers (Washington, D.C., FSA Publication 75, 1941)Google Scholar ; Goldman, Franz, “Medical Care for Farmers,” Medical Care 3 (February 1943): 19–35Google Scholar.

15. Starr, 243-66. Some of the principal actors and investigators of the CCMC, such as Michael Davis and Isadore Falk, became leading advocates of national health insurance in the late 1930s and 1940s—Davis through his positions on various philanthropic research foundations, and Falk as a representative of the Social Security Board.

16. Committee on the Costs of Medical Care [, Falk, , Isadore, et al.], The Costs of Medical Care; a Summary of the Investigations on the Economic Aspects of the Prevention and Care of Illness (Chicago, 1933).Google Scholar On the elimination of a heath insurance provision from the final draft of the Social Security bill, see also Starr, 266-80; Fox, chaps. 3-4 passim. According to Anthony Badger, the Technical Committee on Medical Care drafted a proposal on health insurance for the Committee on Economic Security, which drafted the Social Security legislation. However, the Committee on Economic Security withheld reports on health insurance for fear that its inclusion might jeopardize the entire package. See Badger, Anthony, The New Deal: The Depression Years, 1933-1940 (New York, 1989), 232–37CrossRefGoogle Scholar.

17. On Davis's role in the FSA, see the correspondence between Davis and Alexander (and other FSA officials) in the “Health and Hygiene” files, Box 66, General Correspondence of the Farm Security Administration, Washington Office, Record Group 96, National Archives, College Park, Md. (hereafter GC, RG-96]. On the “experimental opportunities” presented by the medical program, see especially E. E. Agger to Michael Davis, 30 July 1935. See also Davis to Alexander, 16 January 1936, and the enclosed memorandum, “Medical Care in Rural Sections: Suggestions for Local Managers of Resettlement Administration,” signed by Davis and dated 16 January 1936, Box 67, GC, RG-96. On its implementation, see memorandum, “Medical Care Procedure, February 24, 1936”; and Robert Oleson to E. E. Agger, 25 February 1936, in “Health and Hygiene” files, Box 67, GC, RG-96. On Davis and the work of the Julius Rosenwald Fund, see Fund, Julius Rosenwald, Eight Years of Work in Medical Economics, 1929-1936: Recent Trends and Next Moves in Medical Care (Chicago, 1937).Google Scholar On his continuing participation in the debate over national health care, see his series of articles in Survey Graphic starting in January 1945 and continuing into 1946. See also , Davis, Medical Care for Tomorrow (Chicago, 1955)Google Scholar.

18. Williams, “Development of Medical Care Plans,” passim. The assumption that the plan would have broader implications was a frequent theme in the FSA correspondence; see, for example, E. E. Agger to Davis, 30 July 1935, Davis to Alexander, 4 February 1938, Box 66, GC, RG-96.

19. The role of philanthropic foundations raises questions about whether the network of reformers and intellectuals that debated and designed policies were “inside” or “outside” the state and, as such, points further to the limits of “state autonomy.” For example, as G. William Domhoff has argued, the participation of foundations was the key mechanism by which ruling elites could influence the policymaking process. For a summary of Domhoff s position, see the several essays in his The Power Elite and the State: How Policy Is Made in America (New York, 1990).Google Scholar For a response to elite theory, see , Skocpol and , Finegold, State and Party, 165–74Google Scholar.

20. Williams, R. C., “Development of Medical Care Plans for Low Income Families,” American Journal of Public Health 30 (July 1940): 725–35.CrossRefGoogle Scholar For the kinds of criticism to which Williams was responding, see , Lubell and , Everett, “Rehearsal for State Medicine,” Saturday Evening Post, 17 December 1938Google Scholar.

21. The overview of the program is based on a variety of sources in the FSA files, RG 16. However, for summaries, see FSA Annual Reports; FSA, Toward Farm Security; U.S. House of Representatives, 78th Cong., 1st sess., Select Committee of the House Committee on Agriculture, Hearings… to Investigate the Activities of the Farm Security Administration, Part IV, 1613-1633.Google Scholar A good popular account is Hellman, Richard, “The Farmers Try Group Medicine,” Harpers’ Magazine (July 1940)Google Scholar.

22. , Hellman, “Farmers Try Group Medicine,” and JAMA, 19 December 1942.Google Scholar

23. JAMA, 19 December 1942.Google Scholar

24. The Limits of State Autonomy FSA reports and publications always stressed the high degree of cooperation with local medical societies. See, for example, any of the sources cited in note 10 above.

25. On the problems of localism, federalism, and the piecemeal nature of the American welfare state, see, for example, Patterson, James, America's Struggle Against Poverty, 1900-1980 (Cambridge, Mass., 1981)Google Scholar ; Gordon, Colin, New Deals, especially 33–34Google Scholar ; Badger, Anthony, The Neu Deals, conclusion; and Bary Karl, The Uneasy State: The United States from 1915 to 1945 (Chicago, 1983), especially 1–7Google Scholar.

26. On the favorable reports of doctors and clients who participated in the FSA plans, see the results of the AMA survey printed in JAMA, 19 December 1942.

27. On the ambiguous impact of World War II on New Deal politics, see Brody, David, “The New Deal and World War II,” in , Braeman et al., eds., The New Deal; Brinkley, The End of Reform, chaps. 7-8 passimGoogle Scholar ; idem, “The Two World Wars and American Liberalism,” in idem, Liberalism and Its Discontents (Cambridge, Mass., 1998)Google Scholar ; Hamby, Alonzo, “Sixty Million Jobs and the People's Revolution: The Liberals, the New Deal, and World War II,” Historian 30 (August 1968)CrossRefGoogle Scholar ; and Polenberg, Richard, War and Society: TJie United States, 1941-1945 (Philadelphia, 1972), especially chap. 3Google Scholar.

28. On the experimental programs, see FSA Annual Reports, 1943-44, and 1944-45. See also the section on experimental programs in U.S. House, Hearings… on the Farm Security Administration, Part IV, 1613-33. That the war in Europe and the increasing demand for American foodstuffs provided an opportunity to expand FSA programs, especially the health programs, see C. B. Baldwin to Paul McNult, 21 October 1941 (before American entry into the war), and John Fisher to Samuel Bledsoe, 10 December 1941 (only two days after U.S. entry), both in Box 292, GC, USDA, RG-16.

29. Ibid.

30. Information on the Hamilton County program is taken from several sources in Boxes 447-449, Records of the Cooperative Associations, 1935-54, RG-96. For an analysis of similar problems faced in the South by a BAE economist, see Montgomery, James, “Experimenting in Rural Health Care,” Rural Sociology (June 1945): 296–307Google Scholar.

31. On the impact of the war, see FSA Annual Reports, 1943-1944, 1944-45Google Scholar ; , Mott and , Roemer, Rural Health, 395–431Google Scholar ; and Ziegler, Mark, Weinerman, E. R., and Roemer, Milton, “Rural Prepayment Medical Care Plans and Public Health Agencies,” American Journal of Public Health, December 1947, 1578–85CrossRefGoogle ScholarPubMed.

32. Ibid.; see also , Roemer and , Mott, Rural Health, chap. 12 and pp. 400–422.Google Scholar See also Grey, “Poverty, Politics, and Health,” passim. Grey sees doctor dissatisfaction with reimbursements as a key cause of the decline of the plans during World War II and plays down the effects of wartime population movements. However, the FSA and BAE analysts and partici-pants discussed here saw wartime movements as a key factor in the instability created by high turnover.

33. , Mott and , Roemer, Rural Health, 408–22 and Parts VII and VIII, passim.Google Scholar

34. Patterson, James, Congressional Conservatism and the New Deal: The Grotith of a Conservative Coalition in Congress, 1933-1939 (Lexington, Ky., 1967)Google Scholar ; Brinkley, Alan, The End of Reform, chap. 7Google Scholar.

35. One of the best discussions of the political attacks on the FSA remains McConnell's, GrantThe Decline of Agrarian Democracy (Berkeley, 1953).Google Scholar For contemporary accounts of the political battle, see Stephens, Oren, “FSA Fights for Its Life,” Harpers Magazine (1942-1943), 479–87Google Scholar , and “Health on the Farm,” New Republic, 3 March 1947. See also the , Cooley Committee's Final Report on the Activities of the Farm Security Administration, U.S. House, 78th Cong., 2d sess., House Report No. 1430 (Washington, D.C., 1944)Google Scholar.

36. Starr, 280-89; Poen, Monty, Harry S. Truman Vs. the Medical Lobby (Columbia, Mo., 1979), 31–36Google Scholar ; Gordon, Colin, “Why No Health Insurance in the United States.’ The Limits of Social Provision in War and Peace, 1941-1948,” Journal of Policy History 9.3 (1997): 280–81Google Scholar.

37. “Statement of Arthur Altmeyer, Chairman, Social Security Board,” Hearings… On S. 1606, reprinted in JAMA, 20 April 1946, 1172-73; Altmeyer, Arthur, “How Can We Assure Adequate Health Insurance for All the People?” Social Security Bulletin (December 1945)Google Scholar ; Falk, Isadore and Cohen, Wilbur, “Social Security for Farm People,” Journal of Farm Economics 28 (February 1946): 84–96CrossRefGoogle Scholar.

38. United States Department of Agriculture, Inter-bureau Committee on Post-War Programs, Better Health for Rural America: Plans of Action for Farm Communities (Washington, D.C., 1945), 32.Google Scholar

39. Ibid., Acknowledgments.

40. Ibid., 13-21.

41. Anderson's report printed in United States Senate, 79th Cong., 2d sess., Committee on Education and Labor, Hearings on S. 1606: A Bill to Provide for a National Health Program (hereafter, Hearings on S. 1606] (Washington, D.C., 1946), Part 3, 1159–78Google Scholar.

42. “Statement of Dr. Frederick Mott, Chief Medical Officer, Farm Security Administration, Department of Agriculture,” Ibid., 1178-1210, quote at 1179.

43. For an overview of Farm Bureau opposition to the FSA, see McConnell, chaps. 6-9 passim. For accounts of the Farm Bureau's opposition by contemporaries, compare Kile's, Orville Merton celebratory The Farm Bureau Through Three Decades (Baltimore, 1948)Google Scholar and the highly critical McCune, Wesley, The Farm Bloc (Garden City, N.Y., 1943).Google Scholar On opposition to the FSA in the South and West, see, for example, Baldwin, 325-404; Sitkoff, Harvard, A New Deal for Blacks: The Emergence of Civil Rights as a National Issue (New York, 1978), 65-74, 126–32Google Scholar ; Daniel, Pete, Breaking the Land: The Transformation of Cotton Culture Since 1880 (Urbana, Ill., 1985), 243Google Scholar ; Stein, Walter, California and the Dust Bowl Migration (Westport, Conn., 1973), 140–62Google Scholar.

44. “Statement of James Patton, President, National Farmers Union,” Hearings on S. 1606, 1210-31.

45. To a certain extent, the FSA's refusal to generate political support for its plans parallels what Brinkley observes about the National Resources Planning Board, which showed a “blithe indifference to the political climate in which it was operating.” , Brinkley, End of Reform, 256.Google Scholar In addition, Ann Orloff observes that “executive policy initiatives depended for their success on mass pressure being exerted on Congress.” To be sure, Orloff points out that popular pressure is never enough by itself and policymakers were “largely able to insulate the process from popular demands.” Still, “popular pressures were critical in providing an opening for elite initiatives.” See Orloff, Ann Shola, “The Political Origins of America's Belated Welfare State,” in , Weir, , Orloff, and , Skocpol, eds., The Politics of Social Policy in the United States (Princeton, N.J., 1988), 67–69Google Scholar.

46. Report on Rural Conference in “Organization Section,” JAMA, 9 March and 8 June 1946. See also JAMA, 13 and 20 July and 31 August 1946.

47. JAMA 16 and 30 March and 8 June 1946.

48. Ibid., 14 January 1945.

49. “Statement of Mrs. Charles Sewell,” Hearings on S. 1606, 1381–1400,Google Scholar also reprinted in JAMA, 15 June 1946. On the OPA, see , Brinkley, The End of Reform, 160Google Scholar.

50. “National Conference on Rural Health,” JAMA 131 (8 June 1946), 533–61.Google Scholar On low rural enrollments in Blue Cross and other private plans, see “Statement of Arthur Altmeyer,” reprinted in JAMA, 20 April 1946.

51. In addition to reports on the rural conference, see the congressional testimony re-printed by JAMA for the following dates: 9, 16, 23, and 30 March; 13, 20, and 27 April; 4, 11, 18, and 25 May; and 1 and 8 June 1946.

52. On the growth of “the Blues,” see Starr, 295-310. On the growth of private health insurance and its impact on the debate over national health insurance more generally, see Gordon, Colin, “Why No Health Insurance in the United States?” 296f.Google Scholar On the AMA's initial opposition to even private health insurance, see Burrow, James, AMA: Voice of American Medicine (Baltimore, 1963), chap. 12.Google Scholar On the growth of medical society service plans, see JAMA, 15 January, 5 February and 4 October 1944; 13, 20 January; and 18 August 1945. On California, see JAMA, 20 February 1943, and “California's Health Insurance Drama,” Survey Graphic, November 1945.

53. Stevens, Beth, “Blurring the Boundaries: How the Federal Government Has Influenced Welfare Benefits in the Private Sector,” in , Weir, , Orloff, and , Skocpol, eds., The Politics of Social Policy in the United” StatesGoogle Scholar ; idem, “Labor Unions, Employee Benefits, and the Privatization of the American Welfare State,” Journal of Policy History 2.3 (1990): 233–60.Google Scholar See also Rosner, David and Markowitz, Gerald, “Hospitals, Insurance, and the American Labor Movement,” Journal of Policy History 9.1 (1997): 74–95CrossRefGoogle Scholar ; Derikson, Alan, “Health Security for All? Social Unionism and Universal Health Insurance, 1935-1958,” Journal of American History 80 (1994): 1333–56CrossRefGoogle Scholar.

54. On the Hill-Burton Act, see Starr, 348-51.

55. JAMA, 17 March 1945; 8 June; 6, 13 July 1946.

56. Starr, 342-42, 348-51. For an overview of Hill-Burton and its long-term consequences, see Lave, Judith and Lave, Lester, The Hospital Construction Act: An Evaluation of the Hill-Burton Program, 1948-1973 (Washington, D.C., 1974)Google Scholar.

57. Brinkley, End of Reform, passim. For an earlier assessment of the postwar liberal faith in “the politics of growth,” see Wolfe, Alan, America's impasse: The Rise and Fall of the Politics of Growth (New York, 1980).Google Scholar More recently, James Patterson has argued that economic growth provided the underpinnings of postwar liberalism and its “grand expectations.” See Patterson, James T., Grand Expectations: The United States, 1945-1974 (New York, 1996)Google Scholar.