Chapter 6 Roaring Twenties to the Great Depression, 1920–1932
The 1920s were a period of economic growth and transition. Real wages for most workers increased, while stock prices advanced as much during the 1920s as they had in the previous three decades. The US census of 1920 revealed that, for the first time, a majority of Americans lived in cities and towns with at least 2,500 residents. The 1920s also boasted a uniquely modern culture that celebrated the fast pace of cosmopolitan life. Yet in many ways, the United States was still mired in the past. Progressive reformers sought to publicize the tragedy of preventable diseases and child mortality among the poor. However, it was not until after the discovery that millions of draftees in World War I were malnourished and medically unfit for military service that these reformers had the attention of the federal government. Despite recent advances in medicine, childbirth remained the second-leading cause of death among women.
The emergence of modern medicine permitted child mortality rates to decline significantly among the wealthy, but few other Americans enjoyed regular access to physicians. For the urban poor and many rural dwellers, an average of one in three children died before their fifth birthday. Progressives attempted to counter these trends through federal action. However, conservatives perceived these attempts as symptomatic of the excessive growth of government during the previous two decades. The contest regarding federal support for health care programs for women and infants personifies the transition from Progressivism to more conservative ways of thought regarding the role of government. This transition from Progressivism to conservatism was one of the leading dynamics of the 1920s.
Although the middle and late 1920s saw a resurgence of conservative thought, Progressive ideas about reform would continue into the early 1920s. Grassroots campaigns by the newly formed League of Women Voters, along with a variety of other women’s clubs and Progressive organizations, seized the message of military preparedness. They sought to convince voters that prenatal care and other health programs were vital to the nation’s well-being. Even conservative groups such as the Daughters of the American Revolution joined the chorus of voices calling for federal intervention to improve prenatal and early childhood care. In response, Congress approved the Sheppard-Towner ActThe first federally funded program encouraging social welfare, the Sheppard-Towner Act provided matching grants for communities to develop women’s health clinics and other programs designed to reduce infant mortality. in 1921. The Sheppard-Towner Act was based on a bill introduced by Montana congresswoman Jeanette Rankin in 1919. The law provided federal matching grants for state-operated women’s health clinics and other programs designed to safeguard the health of women and infants. The Sheppard-Towner Act was the first federally funded program in the nation’s history designed to promote social welfare. The law was hardly radical, however, as it provided only modest funding through matching grants to states and communities. These entities were required to provide at least 50 percent of the funding for the health clinics and prenatal programs. They were also responsible for administration and operation of these programs. The availability of federal subsidies spurred the construction of several thousand health clinics in cities and small towns. The greatest impact may have occurred in isolated rural areas served by traveling nurses and distance-learning programs that trained community midwives.
The Sheppard-Towner Act suggested a new partnership between government, technology, and privately owned hospitals and medical practices. It also reflected growing expectations by citizens toward the federal government. In 1920s America, nearly all federal revenue was dedicated to national defense and repayment of wartime loans. Social welfare was regarded as an obligation of state and local government. Sensing the possibility that success of the Sheppard-Towner Act might lead to more government intervention in their industry, the American Medical Association (AMA) attacked the federally subsidized women’s clinics as “socialized medicine.”
The AMA launched a campaign against the growth of the federal government into the private sector. The AMA also attempted to cut off funding for the clinics and eliminate further government subsidies for medical services, even those for women and infants. Attorneys representing the AMA pointed out that the Tenth Amendment designated all powers not specifically enumerated in the Constitution to the states. As a result, they argued, providing federal funds for women’s clinics was unconstitutional. When the US Supreme Court rejected this argument, the AMA continued its attack against “Socialism” in the private sector of medicine.
The AMA continued to lobby against the Sheppard-Towner Act throughout the 1920s. Meanwhile, the political climate continued its drift away from the liberalism of the Progressives and towards more conservative views regarding the proper role of government. As a result, Congress eliminated federal appropriations for the clinics in 1929. Although the law had been popular, many began to view its provisions as undue interference within the private sector. Later that same year, a financial crisis led many Americans to reconsider the need for federal government activism. Ironically, the federal government was called upon to intervene on behalf of the private sector as the health of the nation’s financial system was on the verge of collapse.