efit for burial expenses (Starr, 1982). Two-fifths of the cost would come from workers, two-fifths from employers, and one-fifth from state government; the total cost was estimated at 4 percent of wages. The objectives were to reduce the social costs of illness through effective medical care and incentives for disease and injury prevention.

In 1916 the American Medical Association (AMA) established its own Committee on Social Insurance to cooperate with the AALL in studying the issue and drafting legislation (Anderson, 1968; Harris, 1969; Starr, 1982). The group was chaired by Theodore Roosevelt's personal doctor (Alexander Lambert) and staffed by a Socialist physician (I. M. Rubinow). In the same year the AMA elected as its president Dr. Rupert Blue, then surgeon general of the United States. Dr. Blue called for adequate health insurance in his presidential address (Mullan, 1989). Moreover, an AMA trustees' report argued that it was better that they '''initiate the necessary changes than have them forced on us"' (Harris, 1969, p. 5). The AMA Committee on Social Insurance concluded that voluntary health insurance under private control was unworkable and urged support for state legislation.

By 1920, however, the stance of organized medicine switched from cautious cooperation to forceful opposition that lasted decades.⁸ One explanation is that the academically oriented leadership of the AMA was countered by "grass roots" practitioners who were reacting to the immediate reality of