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The Administration of the Marshall Plan and British Health Policy

Published online by Cambridge University Press:  27 April 2009

Daniel M. Fox
Daniel M. Fox
Affiliation:
Milbank Memorial Fund
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Extract

The United States made Marshall aid to European countries (1947–51) contingent upon bilateral agreements about major issues of economic and social policy. Because the implementation of the Marshall Plan in Britain coincided with the inception of the National Health Service (NHS), the bilateral agreements negotiated between Britain and the United States addressed the relationship between economic recovery and a new health policy that offered universal coverage for services that were fully funded from tax receipts.

Type
Articles
Information
Journal of Policy History , Volume 16 , Issue 3 , July 2004 , pp. 191 - 211
Copyright
Copyright © The Pennsylvania State University, University Park, PA. 2004

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References

Notes

1. There is substantial literature on both the Marshall Plan and the history of the National Health Service. I draw heavily on the literature about the Plan in the general discussion of Marshall aid in the first section; less so in the balance of the article. Two books by Michael Hogan are essential for understanding Marshall aid in its broad political and economic context: The Marshall Plan: America, Britain, and the Reconstruction of Western Europe, 1947–52 (New York, 1987)Google Scholar and A Cross of Iron: Harry S. Truman and the Origins of the National Security State, 1945–1954 (Cambridge, 1998)Google Scholar. Another important overview is Milward, Alan S., The European Rescue of the Nation State (Berkeley and Los Angeles, 1992)Google Scholar. Two articles by Charles S. Maier are important to understanding U.S./U.K. relations around the Marshall Plan: “American Visions and British Interests: Hogan's Marshall Plan,” Reviews in American History 18, no. 1 (1990): 102–111CrossRefGoogle Scholar, and “Alliance and Autonomy: European Identity and the U.S. Foreign Policy Objectives in the Truman Years,” in Lacey, Michael, ed., The Truman Presidency (Cambridge and New York, 1989)CrossRefGoogle Scholar. Other monographs that provide useful details of Marshall Plan implementation from an American perspective include: Arkes, Hadley, Bureaucracy, the Marshall Plan, and the National Interest (Princeton, 1972)Google Scholar, and Miscamble, Wilson D., George F. Kennan and the Making of American Foreign Policy, 1947–1950 (Princeton, 1992)Google Scholar. For a British perspective on Marshall aid, see Pelling, Henry, Britain and the Marshall Plan (London, 1988)CrossRefGoogle Scholar; Burnham, Peter, The Political Economy of Postwar Reconstruction (New York, 1990)CrossRefGoogle Scholar; Carew, Anthony, Labour Under the Marshall Plan: The Politics of Productivity and the Marketing of Management Science (Detroit, 1987)Google Scholar; and Chick, Martin, Industrial Policy in Britain, 1945–1951 (Cambridge, 1998)Google Scholar. Burnham and Carew are critical of American motives and actions. Pelling and Chick generally agree with their American colleagues and, by implication, Milward that on balance Marshall aid hastened recovery and economic growth and that American intrusiveness in policy, when it occurred, did not compromise the goals of the Attlee government. Donald Sasson takes a more jaundiced view of American purposes and influence in One Hundred Years of Socialism: The West European Left in the Twentieth Century (London, 1996)Google Scholar. Brusse, Wendy Asbeek, in Tariffs, Trade, and European Integration (New York, 1997)Google Scholar, argues that, in the broad European context, Marshall aid assisted national recovery without compromising domestic consumption.

There is also a rich literature on the background and inception of the National Health Service. The NHS was enacted in 1946 and began to serve patients in July 1948: hence critical policy decisions had to be made at the same time that policymakers in the United Kingdom and the United States were making critical decisions about Marshall aid. This article takes the widely held view that by the end of the war there was a strong cross-party consensus about many of the major policies that governed the NHS. That view is articulated, among other places, in Klein, Rudolf, The Politics of the National Health Service, 4th ed. (New York, 2000)Google Scholar, and Fox, Daniel M., Health Policies, Health Politics: The British and American Experience, 1911–1965 (Princeton, 1986)CrossRefGoogle Scholar. Charles Webster emphasizes Labour's unique contribution to the NHS more than Klein or I do, in The Health Services Since the War, vol. 1, Problems of Health Care: The National Health Service Before 1957 (London, 1988)Google Scholar. All three authors have used most of the same sources.

2. A useful brief history is Ambrose, Stephen F., “When the American Came Back to Europe,” in “The Marshall Plan: A Legacy of 50 Years,” International Herald Tribune, 28 May 1997, 5Google Scholar; see also Hogan, The Marshall Plan.

3. Pogue, Forrest C., George C. Marshall: Statesman, 1945–1959 (New York, 1989), 207.Google Scholar

4. Mee, Charles L. Jr., The Marshall Plan (New York, 1984), 169Google Scholar; “Certain Aspects of the European Recovery Problem from the US Standpoint,” Department of State, Policy Planning Staff, probably summer of 1947, from the Clark Clifford Papers, in Student Research File B, Box 1, Harry S Truman Library, Independence, Missouri.

5. “Certain Aspects” (n. 4 above), 32–33.

6. Hogan, n. 5 above, 293–94.

7. Bartlett, C. J., The Special Relationship: A Political History of Anglo-American Relations Since 1945 (London and New York, 1992), 39.Google Scholar

8. Millis, Walter, ed., The Forrestal Diaries (New York, 1951), 302.Google Scholar

9. U.S. Congress, House, Committee on Foreign Relations, 80th Congress, Hearings on United States Foreign Policy for a … European Recovery Program, 17 December 1947, 12–29 January, 3–12 February 1948, 1275ff.

10. Rose, Lisle A., The Cold War Comes to Main Street: America in 1950 (Lawrence, Kan., 1999), 129.Google Scholar

11. U.S. Congress, House (n. 9 above), 1824.

12. Thomas K. Finletter to W. Averell Harriman, 11 May 1948, Harriman Papers, Library of Congress, Manuscript Division, Box 266.

13. Department of State Policy Statement, 11 06 1948, Foreign Relations of the United States, vol. 3Google Scholar, Western Europe (Washington, D.C., 1974), 1092.Google Scholar

14. Minutes of committee on “Social Services in Western Europe,” 5 March 1948. FO 371/71838, Public Record Office, Kew, U.K.

15. Ibid., 8 April 1948.

16. Smith, Dai, Aneurin Bevan and the World of South Wales (Cardiff, 1993), 255.Google Scholar

17. Memorandum from British Embassy, Washington, D.C., to the Foreign Office, 6 February 1948, quoting Reuther's testimony of a day earlier. FO 371/68022–24, Public Record Office.

18. Smith, Aneurin Bevan, 255.

19. Memorandum from British Embassy, Washington, D.C., to the Foreign Office, 13 February 1948, enclosing a U.S. congressional committee report. FO 371/71747, Public Record Office. Ewing and the chief executive of the British Medical Association, Charles Hall, made a joint broadcast on CBS during his visit to London. Hall defended the goals and mechanisms of the NHS. There is no record in Ewing's files of any negative criticism of the broadcast in the United States: Papers of Oscar E. Ewing, Box 30, Truman Library, Independence, Missouri.

20. F. A. Johnston to C. S. Dewey, 7 October 1948, AID/ECA/ Mission to U.K., Office of Chief of Mission U.K., Subject Files of Thomas K. Finletter, 1948–49, Box 2, RG 469, National Archives of the United States, College Park, Md.

21. U.S. Congress, Senate, Committee on Foreign Relations, 81st Cong., 1st sess., A Bill to Amend the ECA of 1948, Executive Session, February 1949, 48.

22. Ibid., 49. Raucher, Alan R., Paul G. Hoffman: Architect of Foreign Aid (Lexington, Ky., 1985), 71Google Scholar, implies that Hoffman was less than candid with Congress: “Of all the participating governments, the British caused Hoffman the most trouble.”

23. U.S. Congress, Senate (n. 21 above), 124.

24. Ibid., 155, 170–71.

25. Ibid., 172. Finletter was kept well informed about the details of British budgets for health and social services: for example, staff memorandum to TKF (Finletter), 2 April 1949, Box 3, in n. 39 above.

26. Ibid.

27. Minutes reporting Parliamentary Question to A. Bevan, 27 January 1949, FO 371/77835, Public Record Office.

28. Ibid. A copy of Mayhew's speech is in this file, in UR 2287.

29. Telegram from Ambassador Oliver Franks to London, 25 February 1949, 1136, in ibid.

30. Boyle, Peter G., “Oliver Franks and the Washington Embassy, 1948–1952,” in Zametica, John, ed., British Officials and British Foreign Policy, 1945–1950 (Leicester, 1990), 196; also cited in Franks, n. 47 above.Google Scholar

31. The Economist, 5 March 1949, 408.

32. Oliver Franks to Ernest Bevin, 28 February 1949, Bevin Papers (microfilm), FO 800/511, Public Record Office.

33. The Economist, n. 31 above. In fact, a memorandum to Ernest Bevin, 28 February 1949, in FO 800/511 (PRO) summarizing British newspaper commentary on Mayhew, indicates that most press comment on the speech was favorable.

34. Christopher Mayhew to Ernest Bevin, “Personal,” 27 February 1949, in FO 371/77835, Public Record Office.

35. Williams, Philip M., ed., The Diary of Hugh Gaitskell, 1945–1956 (London, 1983), 139Google Scholar, and Carew, n. 16 above, 97.

36. The Economist, 25 June 1949, 1175–76.

37. Bullock, Allen, Ernest Bevin: Foreign Secretary, 1945–1951 (London, 1984), 717.Google Scholar

38. F. R. Hoyar Miller to Roger M. Makins, 11 July 1949, FO 371/77839 (UR 7896), Public Record Office.

39. Hogan, The Marshall Plan, 227.

40. Ibid., 248–49.

41. Hennessy, Peter, Never Again: Britain 1945–1951 (London, 1992), 397.Google Scholar

42. Boyle (n. 30 above), 197. See also Danchev, Alex, Oliver Franks: Founding Father (Oxford, 1993), 87Google Scholar, on Franks's ability to “explain the welfare state to Washington in straightforward humanitarian terms.”

43. Jones, Kit, An Economist Among Mandarins: A Biography of Robert Hall, 1901–1988) (Cambridge, 1994), 100.Google Scholar

44. “Fundamental Discussions with the United States,” 9 March 1950, T232/199, Public Record Office.

45. W. Averell Harriman to Harry S Truman, 13 March 1950; Harry S Truman to W. Averell Harriman, 20 March 1950. Copy in papers of John W. Snyder, 1946–52, Box 35, Truman Library.

46. W. Averell Harriman, telegram to Chief of ECA Mission, London, 3 May 1950: AID/ECA Mission to the U.K., Office of the Chief of Mission, Subject Files of John Kenney, 1949–50, Box 1; copy of telegram from Dean Acheson to Ambassador-London, 20 April 1950, enclosed. National Archives.

47. Abramson, Rudy, The Life of W. Averell Harriman, 1891–1986 (New York, 1992), 406–439.Google Scholar

48. “Notes on a conversation after lunch,” 9 May 1950, FO 800/517, E. Bevin Papers, Public Record Office.

49. Ibid.

50. Williams, The Diary, 174, 231–32, 239.

51. Minutes of a meeting at the State Department, 10 October 1950, T232/198, Public Record Office. See also Williams, The Diary of Hugh Gaitskell, 207.

52. Minutes (n. 51 above).

53. Telegram, Foreign Office to Washington Embassy, 21 October 1950, FO 371/87014, Public Record Office.

54. Bullock, Ernest Bevin, 824.

55. Pelling, Britain and the Marshall Plan, 116.

56. Mr. Aneurin Bevan (Statement), Parliamentary Debates (Hansard), 5th series, vol. 487, House of Commons Official Report, Session 1950–51 (487 H.C. Deb. 5), Columns 35–43. (London, 1951).

57. Ibid.

58. Arthur M. Schlesinger Jr. to W. Averell Harriman, 20 September 1948, Harriman Papers, Box 270, Library of Congress. This letter, marked “Secret,” was only declassified in 1998.

59. At a seminar in London about my book, Health Policies, Health Politics, a British colleague said, in an example typical of my point, “We know you, like all Americans, are up to something. We just don't know what it is.” See also Goodman, Geoffrey, ed., The State of the Nation: The Political Legacy of Aneurin Bevan (London, 1997).Google Scholar

60. Skidelsky, Robert, John Maynard Keynes, vol. 3Google Scholar, Fighting for Britain, 1937–1946 (London, 2000), 492.Google Scholar

61. Peden, G. C., The Treasury and British Public Policy, 1906–1959 (Oxford, 2000), 418.CrossRefGoogle Scholar

62. Ibid., 423.

63. “The Long Term Economic Problems of the UK,” memorandum prepared by the Departments of State and Treasury and the European Cooperation Administration with “concurrence at the staff level in the three agencies,” 5 January 1952, RG 469, Records of the U.S. Foreign Assistance Agencies, 1948–61, Mission to the U.K., Office of the Chief of Mission, Correspondence of Malcolm Hogg. National Archives.

64. Fox, Daniel M. and Kassalow, Jordan S., “Making Health a Priority of U.S. Foreign Policy,” American Journal of Public Health 91 (10 2001): 1554–1556.CrossRefGoogle Scholar