⏐ PUBLIC HEALTH THEN AND NOW ⏐

“Won as a Public Issue

Using Cartoons and Comics to Fight National
”
Health Care Reform, 1940s and Beyond
| Heidi Katherine Knoblauch, MA, MPhil

On March 23, 2010, President Barack Obama signed the Patient socialist, costly, bureaucratic, a
Protection and Affordable Care Act (ACA) into law. As it went hindrance to scientific progress,
through Congress, the legislation faced forceful resistance. Indi- and detrimental to the doctor–
viduals and organizations opposing the ACA circulated propa- patient relationship. As part of its
ganda that varied from photographs of fresh graves or coffins with opposition, the National Physi-
the caption “Result of ObamaCare” to portrayals of President cians’ Committee for the Exten-
Obama as the Joker from the Batman movies, captioned with the
sion of Medical Service, a
single word “socialism.” The arguments embedded in these im-
lobbying organization closely
ages have striking parallels to cartoons circulated by physicians
associated with the AMA, com-
to their patients in earlier fights against national health care.
Examining cartoons used in the formative health care reform missioned and distributed car-
debates of the 1940s provides a means for tracing the lineage toons directed against national
of emotional arguments employed against health care reform. health care reform. Although the
(Am J Public Health. 2014;104:227–236. doi:10.2105/ AMA’s opposition to national
AJPH.2013.301585.) health care has been docu-
mented extensively, few scholars
have looked at the images the
PRESIDENT BARACK OBAMA the Joker from the Batman mov- National Physicians’ Committee
signed the Patient Protection and ies, captioned with the single used to sway the public.1
Affordable Care Act (ACA) into word “socialism.” This use of As various pieces of legislation
law on March 23, 2010. As it imagery to portray universal were proposed for health care
went through Congress, the ACA health care reform as socialist reform, the AMA mounted large-
faced forceful opposition from was by no means a new tactic. scale campaigns against national
individuals and organizations From 1939 through 1962, the health care.2 In 1949, soon after
armed with images that varied American Medical Association President Harry Truman came
from photographs of fresh graves (AMA) focused much of its politi- out in support of the Wagner–
or coffins with the caption cal and monetary power on argu- Murray–Dingell Bill, the AMA
“Result of ObamaCare” to por- ing that any type of government hired the San Francisco political
trayals of President Obama as health care system would be public relations firm Whitaker

February 2014, Vol 104, No. 2 | American Journal of Public Health Knoblauch | Peer Reviewed | Public Health Then and Now | 227

“Still Just as Hard to Swallow” is a
cartoon included in a pamphlet
created by the National Physicians’
Committee titled Showdown on
Political Medicine, ca. 1946.
Source. Cartoon by Edmund Waller
“Ted” Gale, Jr. Courtesy of Photo-
graphy Collection, Harry Ransom
Center, The University of Texas at
Austin.
228 | Public Health Then and Now | Peer Reviewed | Knoblauch
⏐ PUBLIC HEALTH THEN AND NOW ⏐
and Baxter to carry out a National
Education Campaign.3 The firm
was effective in molding public
opinion.4 Its principals believed
lobbying [was] a waste of time
and money because it [was] in-
conclusive. Not only is the com-
position of the legislature al-
ways changing, but legislatures
are like women—you have to
keep buying them candy and
flowers. But a campaign won as
a public issue will stay won—for
some years at least.5
To negatively affect public
opinion on national health care,
Whitaker and Baxter relied on
pairing a single image—a well-
known painting titled The Doc-
tor—with the word “socialism” on
everything from pamphlets to
posters to stamps.6 This image of
a doctor treating a young female
patient has, rightly, been associ-
ated with the AMA’s long cam-
paign against national health
insurance, but it is by no means
the only instance when organized
medicine used images, cartoons,
or the word “socialism” as a
tactic.7
The cartoons used in the
formative debates over national
health care can illuminate the
origins of the emotional opposi-
tional rhetoric that surrounds
current health care reform.
Undoubtedly, cartoons can be a
form of entertainment, but they
have also been shown to effec-
tively convey information to
readers.8 Cartoons have been
used to advocate for and to fight
against health care reform.9 It is
no accident that the AMA chose
cartoons as a weapon in the fight
to sway public opinion. Here, I
examine political cartoons
intended to convey partisan
information and produce a
response from the reader.10
These political or editorial car-
toons create narratives that emo-
tionally engage the reader in a
way text cannot.11 Condensing
abstruse arguments into a more
palatable visual form through the
use of metaphor and wit helped
these cartoons create simple
frameworks for understanding
complex issues.12 The inherent
ability of cartoons to emotionally
engage the reader renders them
difficult to combat with facts and
social research.13 These qualities
made cartoons a useful tool for
the National Physicians’ Commit-
tee. Conversely, advocates of
health care reform have tirelessly
attempted, usually without suc-
cess, to use reason and argu-
ments based on facts to combat
the emotional arguments deliv-
ered in cartoons circulated by
the National Physicians’
Committee.14
Cartoons distributed by the
National Physicians’ Committee
are not the sole reason that
national health care reform has
struggled to gain traction in the
American Journal of Public Health | February 2014, Vol 104, No. 2
United States, but they are one
piece of a complex matrix of
explanations.15 In the 1940s, the
National Physicians’ Committee
deliberately included cartoons in
materials distributed to patients
because its leaders believed car-
toons were effective at conveying
arguments against national
health care—specifically, that
national health insurance is
socialist. To this end, cartoons
were an integral part of pam-
phlets distributed by physicians
working with the National Physi-
cians’ Committee. These pam-
phlets urged readers to take
action against health care reform
by writing to their public repre-
sentatives and enrolling in volun-
tary health insurance programs.16
Later AMA publications contin-
ued to urge patients to enroll in
private health insurance because
it “increase[d] the availability of
good medical care to the Ameri-
can people” and took “the eco-
nomic shock out of illness,”
without resorting to a socialist
nationalized health care system.17
All of the cartoons discussed
here were placed in pamphlets
calling on readers to take action
against national health care. The
cartoons reinforced the argu-
ments made in the text of the
pamphlets and helped elicit an
emotional reaction from the
viewer.18 Because the National
Physicians’ Committee regularly
commissioned these political
cartoons and included them in
material it sent to physicians to
distribute to the general public,
we can assume that it found
these cartoons to be an effective
way to influence readers and
reinforce the arguments made in
the text of the pamphlets.19
The National Physicians’ Com-
mittee was founded in 1939. A
group of physicians created the
committee when Senator Robert

F. Wagner introduced the
National Health Act of 1939, also
known as the Wagner Bill. The
Wagner Bill would have created a
national health program adminis-
tered by the states and funded by
the federal government. After
referring the bill to the Committee
on Education and Labor, Senator
Wagner arranged for 11 hearings.
Organized labor and several wel-
fare and agricultural groups testi-
fied in favor of the bill. The AMA,
American Hospital Association,
and American Dental Association,
among others, testified against the
Wagner Bill. For 10 years, even
after the Wagner Bill was over-
shadowed by World War II, the
National Physicians’ Committee
functioned as the primary mouth-
piece for AMA leaders against
national health care reform.
Many physicians praised the
National Physicians’ Committee’s
efforts and donated money to
help it defeat national health
care. Physicians who were
supportive wrote the committee
praising its efforts. One California
physician wrote, “Please be
assured that I will do anything in
my power to help extend the
good work you gentlemen have
started.”20 The committee and
those who supported its work
engaged in many types of propa-
ganda, but, most importantly, the
committee created material for
physicians, pharmacists, and hos-
pitals to give to patients and
other health care providers. An
unknown author of a column in
the Journal for the American Med-
ical Association took pride in
how quickly the brochures cre-
ated by the committee spread,
telling readers,
These pamphlets, with suitable
placards, were placed in every
physician’s office where the
general public quickly used
them and took them to their
February 2014, Vol 104, No. 2 | American Journal of Public Health
⏐ PUBLIC HEALTH THEN AND NOW ⏐
friends. They were likewise These cartoons were part of a
placed in hospitals, drug stores
package of health care informa-
and other public places.21
tion that emphasized that
national health care would be too
Physicians who supported the
costly and would hurt the econ-
efforts of the committee eagerly
omy. They effectively communi-
helped circulate the materials. A
cated an affective opinion to the
physician from West Virginia wrote,
reader.24 The cartoons made no
I have read the copy of Achilles rational arguments and conveyed
Heel of American Medicine and no facts about the budget of the
am in full sympathy with the legislation; they simply employed
principles and plans as outlined
in the pamphlet and your letters. scare tactics to great effect. Their
If you will send me 500 copies primary purpose was to sway
of the booklet and the personal public opinion against the
folders, I will gladly send them
with a personal letter to 500
physicians personally asking that
they give their support to this all
important movement.22
Many of these handouts
included cartoons. One pam-
phlet, created around 1946,
contains two cartoons that
emphasize the cost of health care
reform.23 On the cover is a car-
toon drawing of President Tru-
man asking a beat-up Uncle Sam,
“How about some health insur-
ance?” In this image, Uncle Sam’s
battered body is covered with
bandages representing a series of
injuries suffered by America.
One broken leg is caused by lack
of production and the other from
the atomic bomb. The wounds
on his head and neck are a result
of labor strikes and Pearl Harbor.
The worn-out Uncle Sam
responds to Truman, “Do I have Wagner–Murray–Dingell Bill,
to take a physical examination?” which was introduced in 1943 by
On the back of the pamphlet is a Senators Wagner and James "It's All Mixed and Ready to
cartoon entitled “Still Just as Murray of Montana and Repre- Swallow” is a cartoon included in a
Hard to Swallow” portraying an sentative John Dingell of Michigan. pamphlet created by the National
academic figure wearing a cap Physicians’ Committee titled
The National Physicians’ Com-
Political Medicine, ca. 1943.
and gown holding out a large mittee was most fearful of the
spoon with a gigantic “$ocialized Wagner–Murray–Dingell Bill Source. Cartoon by Jay N. ‘Ding’
Darling. Courtesy of the Jay N. ‘Ding’
Medicine” pill to a petrified tax- because it proposed to add health
Darling Wildlife Society.
payer. The taxpayer crouches in insurance to the Social Security
fear while the academic smiles Bill, a move strongly opposed by
and says, “But it has been sugar- the majority of AMA leaders.
coated! It isn’t the ‘General Wel- Another booklet created by
fare Pill’ anymore. Now we call the National Physicians’ Committee,
it the ‘National Health Pill!’” Political Medicine, uses cartoons
Knoblauch | Peer Reviewed | Public Health Then and Now | 229
 ⏐ PUBLIC HEALTH THEN AND NOW ⏐
to foster distrust of the govern-
ment program and emphasize
the importance of private
research and health care.24a On
the front page of this pamphlet, a
cartoon shows Congress as an
old woman pouring a bottle titled
“Socialized Medicine $3 Billion a
Bottle,” into an oversized spoon,
ready to give it to the petrified
“Public,” who is being strangled
by a “Political Quack.” In the
foreground, a man carrying a
briefcase labeled “Medical Sci-
ence” is tied and gagged in a
chair, looking on and unable to
do anything. In the background,
a funeral for “Free Enterprise” is
attended by several mourners.25
Likewise, the back of Political
Medicine uses a five-panel comic
to argue that if the government
socializes medicine, access to
medical care will be a bureau-
cratic mess.26 Through the story
of a man who is unable to receive
medical care because he has not
filled out the proper government
documentation, this cartoon cre-
ates an imagined reality to pull on
the readers’ heartstrings.27 In the
first panel of this image, a man
suddenly falls ill and his wife
rushes to the phone crying, “Send
a doctor quick!” The next panel
shows a bureaucrat, with his legs
leisurely crossed, in front of a
local political board. The bureau-
crat tells the frantic wife to “ask
your postmaster for questionnaire
N9 96-8-4801-220, fill out in
triplicate, and mail to this office.”
The following panel shows her
filling out the necessary paper-
work, which appears onerous and
includes such questions as “Who
did you vote for in the last elec-
tion?” “Give three reasons for call-
ing a doctor.” ”Have you filed
your income tax?” With the large
document in her hand she turns
to her husband and asks, “What
would you say was your most
230 | Public Health Then and Now | Peer Reviewed | Knoblauch
prominent symptom, Dear?” The
husband’s agonizing pain does not
allow him to answer. The follow-
ing panel shows the husband in
worse condition, almost on his last
breath. On the right side of the
panel his wife answers the door
and receives a letter, which says,
Owing to the seriousness of
your ailment your application
has been referred to the Wash-
ington Office—see enclosed
form NP U.S.-6034-8-XYZ, fill
out and return.
The wife appears shocked and
disheartened at the magnitude of
this new paperwork. Finally, in
the last panel, a doctor trium-
phantly appears at the door with
a bag labeled “Government Doc-
tor” and asks, “Did you send for
a doctor?” An undertaker greets
him, and two coffins (presumably
for the sick man and his wife)
have replaced the ailing man’s
bed.
These panels are accompanied
by summaries meant to reinforce
the emotional narratives of the
cartoons and offer concrete and
proactive steps for the reader to
take in response. Next to the
Political Medicine comics, the
National Physicians’ Committee
listed “Two Things to Remem-
ber.” First,
The political distribution of
medical care would entail mak-
ing a public record of the char-
acteristics and most intimate
and sacred personal relation-
ships of each and every patient.
It goes on to say that the “pri-
vacy of every human being
would be invaded and violated.”
Second,
The effectiveness of medical
care is wholly dependent on the
skill of the physician. The
American Doctor is a human
being. . . . He should be free to
act as an individual. Bureau-
cratic direction would destroy
American Journal of Public Health | February 2014, Vol 104, No. 2
the factor that is the secret of
his effectiveness.
At the end of this list of things
to remember, readers were
encouraged to “WRITE A LET-
TER” to their congressional rep-
resentatives and senators.
Readers were told to “be defini-
tive and direct” and to “do it
now—TODAY—before it is too
late.”28
Featuring these cartoons in the
pamphlets was meant to shape
the opinion of the reader.29 Each
of these cartoons conveyed its
message quickly and aggres-
sively.30 This was the goal of the
National Physicians’ Committee,
which proudly declared that one
pamphlet, The Achilles Heel of
American Medicine, could be
“read in five minutes” and gave
details quickly and concisely.31
As part of a brochure that also
told readers to write into their
representatives and senators,
these cartoons were meant to
help stir readers to action.
In 1948, recognizing that car-
toons were an effective means of
drumming up opposition to
national health insurance, the
National Physicians’ Committee
offered cash rewards for cartoon-
ists able to effectively portray
“the meaning and implications of
political distribution of health
care services in the United
States.”32 The committee proudly
announced, “Over a period of
years, it has been our privilege to
reprint many cartoons portraying
artists’ appraisal of the Political
Distribution of Medical Care in
the United States.”33 The contest
offered nine awards, ranging
from $100 to $1000, depending
on how effective the cartoon was
in conveying the committee’s
message. The requirements for
submission were that the cartoon
was already published, the

committee received permission
from the publisher to reprint the
cartoon, and the cartoonist sub-
mitted six copies of the engrav-
er’s proof of the original
illustration.34 Flyers announcing
the contest encouraged cartoon-
ists to write in for
a FREE Package of supplemen-
tal data . . . with the objective
of preserving in the United
States our system of Freedom
of Enterprise to the end that—
Doctors of Medicine may retain,
in the public interest, their per-
sonal independence—their indi-
vidual and collective integrity
and effectiveness.35
The supplemental data sent to
editors and cartoonists asserted
that national health insurance
was socialist and that those who
proposed health care reform
were similar to Adolf Hilter.36
The National Physicians’ Commit-
tee claimed that “socialized medi-
cine is a key mechanism of the
Communists for the conquest of
this nation” and that “socialized
health care was not designed to
provide better medical care for
more people” but had always
“been adopted and used to create
economic dependence and con-
solidate political control.”37
Senator Murray, a liberal
Democrat from Montana who
coauthored the Wagner–Murray–
Dingell Bill, exposed the
National Physicians’ Commit-
tee’s tactics.38 In May of 1948,
Murray displayed to the Senate
a full-page announcement of the
cartoon contest that the commit-
tee published in Editor & Pub-
lisher. Murray declared that the
reprinted cartoon included in
the advertisement, which also
graced the front page of Political
Medicine, made the true purpose
of the contest quite clear.39 Sen-
ator Murray expressed his frus-
tration at the committee’s most
February 2014, Vol 104, No. 2 | American Journal of Public Health
⏐ PUBLIC HEALTH THEN AND NOW ⏐
recent attempt to sway the
public:
The basic line of attack of [the
cartoon contest] propaganda is
quite simple. It is to smear the
whole project as socialized
medicine, relying on the effect
of the horrendous word “social-
ism” to scare ordinary minded
citizens away. Not content with
this snide attack, they are now
labeling the proposal out-and-
out communistic. Riding the
wave of our present interna-
tional difficulties they are
working the “Red menace” for
all it is worth.40
Senator Murray said he had
no quarrel with the cartoonist
who drew the cartoon shown in
the contest advertisement. He
believed that the cartoonist had
“his right to present his own
views through his syndicated car-
toon strip” and that he could
even admire the skill with which
the [cartoonist] managed to com-
press into one picture all the prej-
udices and fears of those vested
interests which are arrayed
against this proposed legislation.
However, Senator Murray did
object to the
outrageous and cynical attempt
on the part of the National Phy-
sicians’ Committee to bribe the
cartoonists of America into
helping them spread their pro-
paganda.41
The Washington Post reported
that Murray exposed “the sordid
propaganda tactics of . . . an
undercover instrument of the
American Medical Association”
and condemned the cartoon
contest:
the “contest” rules leave no
doubt that this is a subtle bribe
to cartoonists to support or op-
pose certain political beliefs (ac-
cording to how you look at it)
and to obtain general circula-
tion for those beliefs in newspa-
pers and magazines.42
The Washington Post said that
all physicians were subject to the
shame of the cartoon contest.
The paper called it “a form of
malpractice” on the part of doc-
tors and concluded,
Doctors can best cure [this mal-
practice] by excising its source.
Their ideas and interests need
better and more honest repre-
sentation than they have re-
ceived from the National Physi-
cians’ Committee.43
A group of physicians who
had formed an organization
called the Committee for the
Nation’s Health wrote to Editor &
Publisher praising its editors for
their condemnation of the car-
toon contest.44 They declared,
We physicians, as members of a
scientific profession, want to see
this subject of medical care han-
dled in a scientific spirit and ac-
cording to ethical principles.45
They went on to say,
The name, National Physicians’
Committee, may cause some lay-
men to assume that it speaks for
all members of the medical pro-
fession. This is emphatically not
so. Many physicians are opposed
to the aims and purposes of the
National Physicians’ Committee,
and many more are ashamed of
the methods it constantly uses.46
Even in the face of harsh criti-
cism, the National Physicians’
Committee circulated America’s
Vital Issue, a pamphlet with a
cartoon on every page, and
emphasized that
[the] most important single
issue confronting the American
people is: Compulsory Health
Insurance—the Nationalizing of
Health Service—the Political
Distribution of Health Care.
All of the images in the pam-
phlet lead the reader to believe
that national health insurance is
Knoblauch | Peer Reviewed | Public Health Then and Now | 231
 ⏐ PUBLIC HEALTH THEN AND NOW ⏐
“Mechanical Treatment” is a cartoon included in a
pamphlet created by the National Physicians’
Committee titled America’s Vital Issue, ca. 1948.
Source. Cartoon by Cecil Jenson.
socialist and un-American. Seven
of the eight cartoons include the
word “socialism,” and the one
that does not uses the term “state
medicine.”47
Two of the cartoons warn that
doctors will become uncaring,
mechanical, and disrespectful if a
universal health care system is
instituted. On a page titled
“Mechanical Treatment,” a patient
is pictured face to face with a
robot physician toting a socialized
medicine flag and a bag full of
antiquated tools—such as a saw,
corkscrew, and knife—more analo-
gous to a carpenter’s belt than to
a medical bag. The robot doctor’s
chest displays a slot to insert coins
as well as buttons that correspond
to illnesses and encourages the
patient to push a button to receive
treatment. The patient looks hor-
rified, pulling up his bed sheets in
a fearful response to the mechani-
cal monster of socialized medi-
cine. The corresponding text
reads,
It should be understood that in
every country where Compulsory
232 | Public Health Then and Now | Peer Reviewed | Knoblauch
Health Insurance has been
tested, it has resulted in less ef-
fective care, in routine and me-
chanical treatment. The system
puts a bureaucrat between the
doctor and his patient.48
The page after “Mechanical
Treatment” is titled “Politicians
and Babies” and pictures a
mechanical stork with a hat
labeled “Doc Stork” carrying a
baby. The stork’s square-framed
body is labeled “socialized medi-
cine” and its tail, which looks
more like a rudder, is labeled
“government control.” Its body,
hooked up to a helicopter rotor,
looks especially like a military
machine. A man is running on
the ground with his arms
stretched up in the air, screaming
“Heaven Forbid!”49
These two cartoons suggest
that if health care reform is
brought to America, our benevo-
lent, caring, heroic physicians will
be replaced by—or transformed
into—scary mechanical arms of
the government. In other words,
the doctor–patient relationship
will be destroyed by the mecha-
nistic, uncaring bureaucratic
machine.
The other cartoons in the
pamphlet argue that health care
reform will hamper freedom and
individuality. In a cartoon titled
“Rights of the American People,”
a large healthy tree symbolizing
liberty is constricted by the para-
sitic tendrils of “Social Legisla-
tion,” “Socialism,” “Communism,”
and “Slavery.” This image is
accompanied by text emphasiz-
ing Americans’ right to freedom:
The American people have the
right to do whatever they want
to do. A small minority want to
exchange our way of life for So-
cialism or for Communism with
its atheism, its slave labor, its
controls by police and its con-
centration camps. The danger
lies in the possibility of the
American Journal of Public Health | February 2014, Vol 104, No. 2
change coming without people
knowing that the trade is being
made. The Socialists say, “The
goal of Socialism will be eventu-
ally reached through encroach-
ment; followed by step by step
legislation; that a little here and
a little there will soon amount
to the whole.”50
Pairing this extreme antiso-
cialist rhetoric with images func-
tions to further the conception
of universal health care as a
Communist plot and, conse-
quently, extremely un-American.
In this particular image, health
care reform is equated to a con-
striction of liberty and freedom
of choice.
Organized medicine's use of
cartoons to sway public opinion
declined after the cartoon contest
was exposed, and the National
Physicians’ Committee became
less vocal. Subsequently, the
AMA hired Whitaker and Baxter,
the San Francisco public relations
firm, to rebrand the fight against
health care. Whitaker and Bax-
ter, like the National Physicians’
Committee, focused on getting
literature to patients. Although it
used imagery, predominantly the
image of The Doctor, it avoided
cartoon images because of the
bad press the cartoon contest
brought the AMA, the National
Physicians’ Committee, and doc-
tors in general.
Despite the decline of the
National Physicians’ Committee’s
use of cartoons, local medical
societies created images opposing
health care reform that paralleled
pamphlets created by the National
Physicians’ Committee. In 1950,
the Baltimore City Medical Soci-
ety’s Committee on Public Medi-
cal Education commissioned a
16-page comic book, The Sad
Case of Waiting Room Willie. In
this comic, Willie falls ill but is
unable to obtain medical care
 ⏐ PUBLIC HEALTH THEN AND NOW ⏐

“When the Government ‘Socializes’ Medicine” is a cartoon included in a pamphlet titled Political Medicine, ca. 1943.
Source. Cartoon by Jay N. ‘Ding’ Darling. Courtesy of the Jay N. ‘Ding’ Darling Wildlife Society.

February 2014, Vol 104, No. 2 | American Journal of Public Health Knoblauch | Peer Reviewed | Public Health Then and Now | 233

because of a health system that is
overrun with “malingerers.”51 This
comic book was, in the words of
its creators, meant to “dramatize
the unfavorable aspects of social-
ized medicine in a form that is
readable, entertaining, and non-
technical enough to reach all the
voters.”52 Emphasizing that this
comic book would “reach thou-
sands who do not read the more
formal treatises prepared on the
subject or listen to what promises
to be a ‘purely educational’ radio
program,” the committee sug-
gested that it should be distrib-
uted widely and placed in every
waiting room.53
The AMA veered away from
using cartoons until Congress
and the country at large became
embroiled in a heated debate
over the King–Anderson Bill.
The bill, which was a precursor
to Medicare, caused some physi-
cians to threaten that they would
not treat patients.54 These boy-
cotts, and letter-writing cam-
paigns targeted at physicians,
threatened the viability of the
bill. At a rally for Medicare in
Madison Square Garden, Presi-
dent John F. Kennedy said,
The AMA is doing very well in
its efforts to stop this bill. . . . I
hope that one by one the doc-
tors of the United States will
take the extraordinary step of
not merely reading the journals
and the publications of the
AMA, because I do not recog-
nize the bill when I hear those
descriptions. . . . [T]he mail
pours in, and at least half of the
mail which I receive in the White
House—on this issue and others—
is thoroughly misinformed.55
Emotional arguments similar
to those employed against the
Wagner–Murray–Dingell Bill
were used in the fight against the
King–Anderson Bill.
By 1962, visual anti–health
reform rhetoric was already
234 | Public Health Then and Now | Peer Reviewed | Knoblauch
⏐ PUBLIC HEALTH THEN AND NOW ⏐
well established. Although car-
toons were not used to the
same extent, those employed
continued to associate national
health insurance with socialism.
In A Case Against Socialized
Medicine, one image shows
Uncle Sam walking through the
dessert carrying a load of sup-
plies. He takes off his hat and
wipes his head by a pool of
“Socialized Medicine.” Uncle
Sam is clearly tempted to drink
from the pool but, before he
does, he looks over to his right
and sees the legs of a skeleton
and a note posted on a nearby
cactus that reads, “Don’t drink
it—I did.” The text next to this
image says,
Bismarck of Germany invented
Compulsory Health Insurance.
He established the system to
place the masses under obliga-
tion to him and make them ser-
vants of his Government. The
bureaucracy that was built af-
terwards became the single
greatest source of strength for
Adolf Hitler and his ruthless
rise to power.56
In another cartoon in this bro-
chure, “From a Man with Experi-
ence,” an arm labeled “Britain” is
reaching up through a thick layer
of ice labeled “socialized medi-
cine,” handing a sign that reads
“BEWARE.” The man in the title
signifies Britain, suggesting that
the British assumed that the ice—
socialized medicine—would pro-
vide enough support for their
country. Unfortunately it has
cracked, and Britain is now
drowning.57
The visual rhetoric of cartoons
used to oppose national health
care has been eerily consistent
over the course of the 20th cen-
tury. Although organized medi-
cine is no longer spearheading
the campaign against health care
reform, the public has taken up
the rhetoric of its earlier efforts,
particularly the rhetoric found in
the cartoons the National Physi-
cians' Committee distributed.
Equating national health care
with socialism is still a common
tactic, and the emotional ratio-
nale presented in cartoons used
in early campaigns against
reform are used to this day. In
2012, when litigation regarding
the constitutionality of the ACA
was before the Supreme Court,
Representative Michelle Bach-
mann spoke out against Obam-
acare. As she spoke, one man
held a sign that read “Keep Your
Politics Out of my Healthcare,”
and another held a sign that said,
In medicine the DOCTOR PA-
TIENT RELATIONSHIP is
paramount GOVERNMENT
coming between them is a
VIOLATION OF THEIR
INDIVIDUAL RIGHTS.58
Other protesters carried post-
ers of President Obama pictured
as the Joker from the Batman
movies with “socialism” printed
underneath.
A Web site dedicated to coun-
tering the “blatant bias of the
mainstream media,” called Patriot
Update and sponsored by Patriot
Depot, has a section of cartoons
opposing health care. The Web
site declares that
the mainstream media, with the
exception of Fox News and
some popular news web sites,
have become the official propa-
ganda arm of the radical left-
wing Democratic party.
In response, the site seeks to
provide accurate information to
readers. A cartoon on the site
features President Obama pre-
senting his national health care
plan to two Americas. The presi-
dent stands next to a large pill
of “ObamaCare Rx,” and one of
American Journal of Public Health | February 2014, Vol 104, No. 2
the audience members exclaims,
“That’s gonna be a hard pill
to swallow.” The other says,
“Psssst . . . It’s a Suppository.”59
This bears a striking resemblance
to a cartoon distributed by the
National Physicians’ Committee
in the 1940s.
Another Web site, NetRight-
Daily, is a project of Americans
for Limited Government.60 Like
Patriot Update, NetRightDaily has
a cartoon section.61 One cartoon
on the site caricatures President
Obama as a physician with a very
large syringe filled with “Social-
ized Medicine.” The caricature
takes the pulse of a patient,
representing “Public Opinion,”
who is pulling away in fear. The
president–physician, looking at
the syringe, says, “I’ve got my fin-
ger on the pulse and it’s RACING
with excitement!” Another
NetRightDaily cartoon reproduces
the image of President Obama as
the Joker. In this version, the
onlooker, representing the United
States of America says, “Interest-
ing I always thought he more
closely resembled Two-Face.”
These images illustrate that it is
no longer physicians who are dis-
tributing cartoons to patients. A
subsection of the general public
and conservative news outlets are
now the primary distributors.
The cartoons distributed by the
National Physicians’ Committee
created a visual vocabulary that
has been omnipresent in the
debates over national health care
ever since. Images have mobilized
opposition to national health care
by reiterating visual arguments
that first entered the debate
through cartoons. Although
health care reform has had some
successes, notably Medicare and
the ACA, the United States lacks
a system of national health
insurance comparable with those
in other countries. Part of the

reluctance to embrace a more
robust national health care pro-
gram stems from the application
of visual rhetoric and its ability to
shape the politics of health care
reform through a direct impact on
public opinion. Every push for
health care reform since the
Wagner Bill, including the ACA,
has been counteracted by emo-
tional arguments. Current anti-
ACA propaganda reimagines the
emotional arguments originally
promoted by the images and
cartoons used by the AMA, the
National Physicians’ Committee,
and Whitaker and Baxter
between 1939 and 1962. The
goal of the National Physicians’
Committee and Whitaker and
Baxter seems to have been real-
ized. With the help of images,
these two groups, working on
behalf of the AMA, presented
affective opinions that won health
care as a public issue “for some
years at least.” Q
About the Author
Heidi Katherine Knoblauch is with the His-
tory of Science and Medicine Department,
Yale University, New Haven, CT.
Correspondence should be sent to Heidi
Knoblauch, 333 Cedar St, Sterling Hall of
Medicine, L132, New Haven, CT 06520
(e-mail: heidi.knoblauch@yale.edu). Re-
prints can be ordered at http://www.ajph.
org by clicking the “Reprints” link.
This article was accepted July 21, 2013.
Acknowledgments
The Walter Lear Fellowship supported
the research for this article.
Many people made this article possi-
ble. I am indebted to the generous com-
ments and guidance provided by Ted
Brown, Stephen Casper, Naomi Rogers,
John Warner, Kelly O’Donnell, and Melissa
Grafe. I was lucky to have a wonderful
set of reviewers whose comments
helped me sharpen this article. This arti-
cle would not have been possible with-
out the support of my partner, Kelly L.
McNamee.
Endnotes
1. For some brief discussion of imagery
used in health care reform debates, see
February 2014, Vol 104, No. 2 | American Journal of Public Health
⏐ PUBLIC HEALTH THEN AND NOW ⏐
Beatrix Hoffman, The Wages of Sickness:
The Politics of Health Insurance in Pro-
gressive America (Chapel Hill, NC: Uni-
versity of North Carolina Press, 2001);
Jonathan Engel, Doctors and Reformers:
Discussion and Debate Over Health Pol-
icy, 1925–1950 (Columbia, SC: Univer-
sity of South Carolina Press, 2002);
Alan Derickson, Health Security for All:
Dreams of Universal Health Care in
America (Baltimore, MD: Johns Hopkins
University Press, 2005).
2. For more information on historical
opposition to health care reform, see
Daniel S. Hirshfield, The Lost Reform:
The Campaign for Compulsory Health In-
surance in the United States from 1932 to
1943 (Cambridge, MA: Harvard Univer-
sity Press, 1970); Theodore Marmor,
The Politics of Medicare (London, UK:
Routledge 1970); Paul Starr, The Social
Transformation of American Medicine:
The Rise of a Sovereign Profession and
the Making of a Vast Industry (New York,
NY: Basic Books, 1982); Ronald L.
Numbers, ed., Compulsory Health Insur-
ance: The Continuing American Debate
(Westport, CT: Greenwood Press,
1982); Alan Derickson, “Health and Se-
curity for All? Social Unionism and Uni-
versal Health Insurance, 1935–1958,”
Journal of American History 80 (1994):
1333–1356; Alan Derickson, “The
House of Falk: The Paranoid Style in
American Health Politics,” American Jour-
nal of Public Health 87 (1997): 1836–
1843; Jill Quadagno, One Nation, Unin-
sured: Why the US Has No National Health
Insurance (Oxford, UK: Oxford University
Press, 2005); Colin Gordon, Dead on
Arrival: Health Care and the Limits of So-
cial Provision in the United States (Prince-
ton, NJ: Princeton University Press,
2003); Beatrix Hoffman, The Wages of
Sickness: The Politics of Health Insurance
in Progressive America (Chapel Hill, NC:
University of North Carolina Press, 2001);
Beatrix Hoffman, Health Care for Some:
Rights and Rationing in the United States
Since 1930 (Chicago, IL: University of
Chicago, 2012); Paul Starr, Remedy and
Reaction: The Peculiar American Struggle
over Health Care Reform (New Haven, CT:
Yale University Press, 2011).
3. The AMA was willing to pay to influ-
ence public opinion and marshal oppo-
sition to health care reform. Including
paying Whitaker and Baxter an annual
fee of $100 000, the AMA expended
$1.6 million in 1949, $2.6 million
in 1950, $530000 in 1951, and
$255 000 in 1952 on what it called the
“National Education Campaign.” Frank
D. Campion, The AMA and US Health
Policy Since 1940 (Chicago, IL: Chicago
Review Press, 1984), 158.
4. Whitaker and Baxter had worked
successfully with the California Medical
Association in 1945 to fight the proposal
for statewide compulsory health insur-
ance in California. Governor of Califor-
nia Earl Warren proposed a health in-
surance program for California multiple
times between 1945 and 1949. He ar-
gued for a system of “health insurance
to which everyone contributes and
through which everyone will receive
benefits in time of sickness.” For more
information on Whitaker and Baxter’s
California campaign see: “Governor
Warren’s California Health Insurance
Program,” Journal of the American Medi-
cal Association 139 (1949): 1002–
1004.
5. Carey McWilliams, “Government
by Whitaker and Baxter,” Nation,
April 14, April 21, May 5, 1951,
346–348; 366–369; 419–421,
quoted in Theodore H. White, Breach
of Faith (New York, NY: Doubleday,
1976), 14–15.
6. For a detailed discussion of The Doctor,
see Jane Moore, “What Sir Luke Fildes’
1887 Painting The Doctor Can Teach Us
About the Practice of Medicine Today,”
British Journal of General Practice 58
(2008): 210–213.
7. Although Whitaker and Baxter has
been credited with introducing the
threat of socialism into the health care
debates, the word socialism was present
in the National Physicians’ Committee’s
oppositional rhetoric and visual images
long before the AMA hired Whitaker
and Baxter. For a discussion of Whitaker
and Baxter’s introduction of the word
socialism, see Jill Lepore, “The Lie Fac-
tory: How Politics Became a Business,”
New Yorker, September 24, 2012,
http://www.newyorker.com/
reporting/2012/09/24/120924fa_fact_
lepore (accessed October 23, 2013).
8. Desousa and Medhurts have identi-
fied four main functions of editorial car-
toons: entertainment, venting frustra-
tions against social leaders, agenda
setting, and distilling complex social is-
sues into a single frame. Michael A. De-
Sousa and Martin J. Medhurst, “Political
Cartoons and American Culture: Signifi-
cant Symbols of Campaign 1980,” Stud-
ies in Visual Communication 8, no. 1
(1982): 84–98.
9. Georges C. Benjamin, Theodore M.
Brown, Susan Ladwig, and Elyse Berk-
man, The Quest for Health Reform: A Satir-
ical History (Washington, DC: American
Public Health Association Press, 2013).
10. Thomas Milton Kemnitz, “The Car-
toon as a Historical Source,” Journal of
Interdisciplinary History 4, no 1 (1973):
81–93. Kemnitz makes a distinction
between joke cartoons and opinion
cartoons: joke cartoons are designed
to communicate humor, whereas
opinion cartoons are designed to con-
vey opinions.
Knoblauch | Peer Reviewed | Public Health Then and Now | 235
11. For more information on the ways
cartoons engage the reader, see Janis L.
Edwards, Political Cartoons in the 1988
Presidential Campaign: Image, Metaphor,
and Narrative (New York, NY: Garland
Press, 1997). For information on the de-
scription of cartoons as narratives, see
Alette Hill, “The Carter Campaign in
Retrospect: Decoding the Cartoons,” in
Rhetorical Dimensions in Media: A Criti-
cal Casebook, ed. Martin J Medhurst and
Thomas W. Benson (Dubuque, IA: Ken-
dall/Hunt, 1984), 182–203.
12. For more on cartoons creating
frameworks, see Edwards, Political Car-
toons in the 1988 Presidential Campaign.
13. Political cartoons are, by definition,
caricatures that are meant to be dis-
torted, exaggerated, and unfair, and this
makes them hard to combat with social
research. See Victor S. Navasky, “Why
are Political Cartoons Incendiary?”
New York Times, November 12, 2011,
http://www.nytimes.com/2011/11/13/
opinion/sunday/why-are-political-car-
toons-incendiary.html?_r=0 (accessed
November 1, 2012). For more on the
use political cartoons to shape public
opinion in the United States, see John
Adler and Draper Hill, Doomed by Car-
toon: How Cartoonist Thomas Nast and
the New York Times Brought Down Boss
Tweed and His Ring of Thieves (Garden
City, NY: Morgan James Publishing,
2008); Allan Nevins, A Century of
Political Cartoons: Caricature in the
United States from 1800 to 1900 (New
York, NY: C. Scribner’s Sons, 1944);
Charles Press, The Political Cartoon
(Madison, NJ: Fairleigh Dickinson Uni-
versity Press, 1981); Stephen Becker,
Comic Art in America (New York, NY:
Simon and Schuster, 1959); Roger A.
Fisher, Them Damned Pictures: Explora-
tions in American Political Cartoon Art
(New Haven, CT: Archon Books, 1996).
14. Beatrix Hoffman, “Health Care Re-
form and Social Movements in the
United States,” American Journal of Pub-
lic Health 93, no. 1 (2003): 75–85.
15. For a detailed description of the dif-
ferent explanations for why there is no
national health insurance in America,
see Colin Gordon, Dead on Arrival: The
Politics of Health Care in Twentieth-Cen-
tury America (Princeton, NJ: Princeton
University Press, 2003); Jill Quadagno,
One Nation, Uninsured: Why the US Has
No National Health Insurance (Oxford,
UK: Oxford University Press, 2005).
16. Frank D. Campion, The AMA and
US Health Policy Since 1940 (Chicago,
IL: Chicago Review Press, 1984).
17. “A.M.A. Advertising Program,” Journal
of the American Medical Association 143,
no. 8 (1950): 744. The article provides
a longer explanation for advertising

health care issues: “The American
Medical Association is embarking on a
nationwide advertising program for
two reasons. First, it is determined to
aid in every way possible in increasing
the availability of good medical care to
the American people through the me-
dium of voluntary health insurance. In
that respect, the advertising copy will
be designed to make the American
people ‘health insurance conscious’ and
to encourage the extension and devel-
opment of prepaid medical and hospi-
tal care as a means of taking the eco-
nomic shock out of illness. Second,
American medicine is determined to
alert the American people to the dan-
ger of socialized medicine and to the
threatening trend toward state social-
ism in this country.”
18. Cartoons presented with textual ar-
guments result in a greater opinion
change than the presentation of an
editorial alone or cartoon alone.
Del Brinkman, “Do Editorial Cartoons
and Editorials Change Opinions?” Jour-
nalism & Mass Communication Quarterly
45, no. 4 (1968): 724–726.
19. A contemporary article claimed,
“Today is the day of the picture. The
public has neither time nor wish for the
great editorials, which formerly did so
much to mold political history. The car-
toonist, no longer just a commentator
on the passing show, has become an
editorial writer who produces a leading
article in the form of a picture.” Isabel
Simeral Johnson, “Cartoons,” Public
Opinion Quarterly 1 (1937): 21–44.
20. Excerpts from letters received since
November 20, 1939, by the National
Physicians’ Committee for the Extension
of Medical Service, Chicago Illinois, De-
cember 8, 1939, box 174, folder 2669,
Isidore S. Falk Papers, Sterling Memorial
Library, Manuscripts and Archives, Yale
University, New Haven, CT.
21. “A Plan for Publicity Against Regimen-
tation of Physicians,” Journal of the Ameri-
can Medical Association 111 (1938): 1200.
22. Excerpts from letters received
since November 20, 1939, by the Na-
tional Physicians’ Committee for the
Extension of Medical Service, Isidore S.
Falk Papers.
236 | Public Health Then and Now | Peer Reviewed | Knoblauch
⏐ PUBLIC HEALTH THEN AND NOW ⏐
23. Showdown on Political Medicine (Chi-
cago, IL: National Physicians Committee
for the Extension of Medical Service, ca.
1946), Walter J. Lear Papers, US Health
Activism History Collection of the Insti-
tute of Social Medicine and Community
Health.
24. Scholarship has shown that car-
toons are “incapable of reasoned criti-
cism and detailed argument” but are
used frequently and effectively as a
means for “disseminating highly emo-
tional attitudes.” Kemnitz, “Cartoon as a
Historical Source.”
24a. Political Medicine (Chicago, IL:
National Physicians Committee for the
Extension of Medical Service, ca. 1943),
Walter J. Lear Papers, US Health Activ-
ism History Collection of the Institute of
Social Medicine and Community Health.
25. Political Medicine, Walter J. Lear
Papers, 1.
26. Ibid., 2.
27. “Cartoons are part of a mediated fil-
tering system that helps construction
and framing of social reality.” Linus
Abraham, “Effectiveness of Cartoons as
a Uniquely Visual Medium for Orienting
Social Issues,” Journalism & Communica-
tion Monographs 11, no 2 (2009): 117–
165.
28. Political Medicine, Walter J. Lear
Papers, 3.
29. “The more emotional a cartoon is,
the more likely it is to be involved in
shifts of attitude.” R. Asher and S. S.
Sargent, “Shifts in Attitude Caused by
Cartoon Caricatures,” Journal of General
Psychology 24, no. 2 (1941): 451–455.
30. “A cartoon generally conveys its
message quickly and pungently.” Kem-
nitz, “Cartoon as a Historical Source.”
31. National Physicians’ Committee for
the Extension of Medical Service to Wil-
liam F. Hewitt, November 16, 1939,
Isidore S. Falk Papers.
32. National Physicians’ Committee for the
Extension of Medical Service, “Announcing
Cash Awards for Cartoonists,” February
28, 1948, Isidore S. Falk Papers.
33. Ibid.
34. Ibid.
35. Ibid.
36. National Physicians’ Committee,
“An Editorial to Editors: Deceitful Ma-
nipulation of Draft Statistics,” Isidore S.
Falk Papers.
37. “An Editorial to Editors: Socialized
Medicine and Communist Purpose,”
Isidore S. Falk Papers.
38. “Sen. Murray Flays ‘Vicious’ Car-
toon Prizes,” Editor & Publisher, May 1,
1948, Isidore S. Falk Papers.
39. James Murray, “Free Press: Under-
mining,” Congressional Record 94, no. 4
(April 26, 1948): S4827–S4831.
40. Ibid.
41. Ibid.
42. “Press Bribery,” Washington Post,
May 7, 1948, http://search.proquest.
com/docview/152020593?accountid=
15172 (accessed October 23, 2013).
43. Ibid.
44. Committee for the Nation’s Health,
“To Editors From Doctors,” Editor &
Publisher, March 20, 1948, 55.
45. Ibid.
46. Ibid.
47. American’s Vital Issue (Chicago, IL:
National Physicians Committee for the
Extension of Medical Service, ca. 1948),
Walter J. Lear Papers.
48. Ibid., 5.
49. Ibid., 6.
50. Ibid.
51. Amos R. Koontz, “The Government
Cannot Force Socialized Medicine on
Us,” Journal of the American Medical As-
sociation 143, no. 12 (1950): 1113.
52. “Comics in the Fight against Gov-
ernment-Controlled Medicine,” Journal
of the American Medical Association 144,
no. 1 (1950): 46–47.
53. A letter sent out to physicians by
a local committee in Baltimore, which
included one copy of the comic book to
entice physicians to buy it “in lots of
one thousand or more,” urged “each
physician to order at least 200 copies,”
American Journal of Public Health | February 2014, Vol 104, No. 2
and went on to say that “societies
purchasing lots of a million or more”
would get a discounted rate. “Comics in
the Fight.”
54. Alfred E. Clark, “200 Jersey Doc-
tors Back Move To Boycott Kennedy
Health Plan,” New York Times, May 5,
1962:A1.
55. The AMA’s fervent opposition to
national health care was revived in
1961 as President Kennedy supported
the King–Anderson Bill, the precursor
to Medicare. “Text of President
Kennedy’s Address to Senior Citizens’
Rally at Garden,” New York Times,
May 21, 1962, http://search.proquest.
com/docview/116094732?accoun
tid=15172 (accessed May 23, 2013).
56. A Case Against Socialized Medicine
(Chicago, IL: American Medical Associa-
tion, ca. 1962), 3, Walter J. Lear Papers.
57. Ibid.
58. An image of this can be found at
Darell Tapp, “Is the Curtain Falling on
Obama? It’s Rising on Paul Ryan,”
http://www.examiner.com/article/is-the-
curtain-falling-on-obama-it-s-rising-on-
paul (accessed March 27, 2012).
59. This image appears on multiple
right wing sites, such as Patriot Update,
“A Hard Pill to Swallow,” http://www.
patriotupdate.com/oldsite/exclusives/
read/73/anti-obamacare-political-
cartoons (accessed December 2, 2012);
Soda Head, “A Hard Pill to Swallow,”
http://www.sodahead.com/united-
states/a-hard-pill-to-swallow-nopeouch/
question-2777821/?link=ibaf&q=
&esrc=s (accessed December 2, 2012);
KnoxNews, “A Hard Pill to Swallow,”
http://blogs.knoxnews.com/johnson/
2012/11/frankenstorm-of-obamacare-
loom.html (accessed December 2,
2012).
60. Americans for Limited Government,
NetRightDaily, http://netrightdaily.com
(accessed March 27, 2012)
61. For example, see http://netrightdaily.
com/category/cartoons/obama-toons
(accessed March 27, 2012).