Falk, I. S. (Isidore Sydney), 1899-1984

Public health specialist.

Isidore Sydney Falk, bacteriologist, public health medical economist, and social security expert, received his Ph.B. from Yale in 1920, and his Ph.D. in 1923. Falk was a professor of bacteriology at the University of Chicago from 1923-1929; a research associate at the Milbank Memorial Fund from 1933-1936; with the Division of Research and Statistics, Social Security Administration from 1936-1954, and was director from 1940-1954; worked as a private consultant from 1954-1960; and was a professor of Public Health at the Yale School of Medicine from 1961-1968. Falk served as a health consultant for the United Steelworkers of America from 1958-1980, and was executive director of the Community Health Care Center Plan from 1970-1979.

Public health specialist, medical economist.

Isidore Sydney Falk, bacteriologist, public health medical economist, and social security expert, received his Ph.B. from Yale in 1920, and his Ph.D. in 1923. Falk was a professor of bacteriology at the University of Chicago from 1923-1929; a research associate at the Milbank Memorial Fund from 1933-1936; with the Division of Research and Statistics, Social Security Administration from 1936-1954, and was director from 1940-1954; worked as a private consultant from 1954-1960; and was a professor of Public Health at the Yale School of Medicine from 1961-1968. Falk served as a health consultant for the United Steelworkers of America from 1958-1980, and was executive director of the Community Health Care Center Plan from 1970-1979.

Isidore S. Falk has been a leading figure in American health care for more than fifty years. Best known for his activism on behalf of national health insurance, Falk has had a multifaceted career as a researcher, government administrator, consultant, educator, and founder and director of a health maintenance organization. In addition to national health insurance, his areas of activity have included medical care, medical economics, bacteriology and social security.

Falk was born in Brooklyn, New York, in 1899. In 1915 he accompanied C.-E. A. Winslow, then newly appointed as the Anna M. R. Lauder Professor of Public Health, to Yale to serve as his lab assistant. The position represented the beginning of a forty-year relationship with Winslow, who became his mentor, colleague and friend. In 1917 Falk started as a special student at Yale and received a Ph.B. degree (Sheffield Scientific School) in 1920 and the Ph.D. degree in public health in 1923. In the latter year he accepted an appointment as assistant professor of hygiene and bacteriology at the University of Chicago (associate professor, 1926; professor, 1929). While in Chicago he conducted research on influenza, eugenics of infant welfare, and immunology. He held concurrent positions with the Chicago Department of Health and was appointed director of surveys in 1926.

The formation of the Committee on the Costs of Medical Care in 1927 signaled the beginning of a movement for rationalization of medical care and development of a national health program, succeeding the 1912-1920 debate over health insurance legislation by individual state governments. Falk joined the movement in 1929, accepting an appointment, as associate director of the Committee on the Costs of Medical Care, then in the second of its five year program of studies. In addition to his administrative duties, Falk coauthored three of the committee's twenty-seven studies, including The Incidence of Illness and the Receipt and Costs of Medical Care among Representative Families (1933), the first longitudinal study of health care in the United States, and the staff's analysis of all the studies, The Costs of Medical Care: A Summary of Investigations on the Economic Aspects of the Prevention and Care of Illness (1933). He also contributed to the committee's benchmark final report, Medical Care for the American People (1932).

Following the dissolution of the Committee on the Costs of Medical Care, Falk served as a research associate of the Milbank Memorial Fund from 1933 to 1936. His major work included research on health indices with Knud Stouman and on national health insurance. Portions of the latter research were published in Falk's major work, Security Against Sickness (1936).

In 1934 Falk and his colleague, Edgar Sydenstricker, were loaned by the Milbank Memorial Fund to the Committee on Economic Security, a cabinet-level committee created by President Roosevelt to develop an American social insurance program. Sydenstricker and Falk conducted the committee's studies of health care, the most controversial area of social insurance. Because of opposition from organized medicine, health care proposals were delayed and the committee's report was sent to Congress in January 1935 without a recommendation for health insurance. The Sydenstricker-Falk report, "Risks to Economic Security Arising Out of Illness," was filed in June 1935, but, because of continued opposition, was not published. The report contained four specific recommendations for federal action: subsidies for state-run health insurance programs, aid for local public medical facilities and services, temporary disability insurance, and further study of permanent disability insurance.

Although the Social Security Act, which was passed by Congress in August 1935, did not include health insurance provisions, it did authorize the Social Security Board (later Administration) to study and make recommendations concerning the "maturation" of American social insurance. The board's research and development functions were lodged in a powerful Bureau of Research and Statistics, which initially was also responsible for training the staff of the board's operating subdivisions. In addition, President Roosevelt took two steps following the passage of the act which assured that health insurance would remain a viable issue. First, he created an Interdepartmental Committee to Coordinate Health and Welfare Activities which in 1937 formed a Technical Committee on Medical Care to draft a comprehensive national health program. Second, he directed that the Sydenstricker-Falk report be sent to the Social Security Board for further study.

In late 1936 Falk joined the Social Security Board, first as director of health and disability studies and then as assistant director of the Bureau of Research and Statistics; he was appointed director in 1940. In 1937 he was appointed as the board's representative to the newly established Technical Committee on Medical Care. Under Falk's leadership (1937-1953), the Bureau of Research and Statistics conducted research and developed proposals in all areas of social insurance and performed a wide variety of related functions. The bureau gathered data on state and private sector medical and social welfare activities in this country and on foreign programs, worked with the Public Health Service and other federal agencies, provided assistance to members of Congress, and acted as an advocate for social and health programs.

Falk at the same time undertook a number of special projects. During the 1946 bituminous coal strike he drafted a health and welfare plan for the United Mine Workers of America at the request of Secretary of the Interior Julius Krug. The plan was part of the "Krug-Lewis agreement" and provided the basis for the union's pioneering Welfare and Retirement Fund. Also in 1950 and 1951, Falk conducted a survey in Haiti in response to its request for technical assistance in designing social insurance legislation.

The demand for compulsory national health insurance, however, quickly became Falk's, and the bureau's, most visible and most controversial position. In late 1937 and early 1938 Falk collaborated with the other members of the Technical Committee on Medical Care in drafting "A National Health Program," which was published in February 1938. The report contained five recommendations for federal support for health programs: grants to states for health insurance programs, grants to states for direct medical care programs for welfare recipients and the medically indigent, permanent disability insurance, grants-in-aid for hospital construction, and expansion of existing public health and maternal and child health programs. Later in the year Falk and his colleagues on the Technical Committee began drafting legislation which incorporated the committee's recommendations.

In January 1939 President Roosevelt sent "A National Health Program" to Congress for study. The next month Senator Robert F. Wagner of New York introduced the health program bill in Congress. Wagner's National Health Bill, S.1620, represented the beginning of a collaboration between Wagner (later joined by Senator James E. Murray and Representative John Dingell) and the bureau which lasted for a decade and which produced a succession of major health and social welfare bills. S.1620 also represented the beginning of a sustained national debate over a national health program and compulsory health insurance which gained momentum in 1943 and continued through the late 1940s.

In 1942 Falk and the bureau staff began drafting a broad social insurance proposal which replaced the earlier federal-state approach to health insurance with a totally federal program. In May 1943 Senators Wagner and Murray and Representative Dingell introduced the new proposal in Congress. The first Wagner-Murray-Dingell bill (S.1161) consisted of a compulsory federal health insurance program, permanent and temporary disability insurance, maternity and death benefits, and expansion of existing federal social welfare programs. In May 1945 the bill was reintroduced in Congress (S.1050).

Falk remained in the forefront of the debate over national health insurance during the period. He participated in researching and drafting legislative proposals. He developed new approaches and programs. He served as an advocate of health insurance within the Social Security Board and as a coordinator and intermediary with the Public Health Service, other federal agencies, congressional staffs, and a number of private groups and individuals.

During the period 1943 to 1945 Falk also assisted Judge Samuel Rosenman, counsel to Presidents Roosevelt and Truman, in drafting a presidential message on national health and health insurance. The message, which Truman sent to Congress in November 1945, was the first administration-sponsored health insurance proposal. The second Wagner-Murray-Dingell bill of 1945 (S.1606) incorporated the message's proposals. S.1606, which was drafted primarily by Falk and colleagues from other agencies, retained only the compulsory health insurance program from the earlier bills. S.1606 was reintroduced, with additional sponsors, in 1947 (S.1320) and 1949 (S.1679).

As the debate over national health insurance intensified, Falk and the Bureau of Research and Statistics became a focus for criticism for organized medicine and Congressional opponents of the Wagner-Murray-Dingell bills. During the same period Marjorie Shearon, a former employee of both the bureau and the Public Health Service, began a personal and vituperative campaign against Falk and the bureau which continued until Falk's resignation in 1954. In 1947 the Senate Subcommittee on Health and the Senate Subcommittee on Publicity and Propaganda investigated respectively the role Falk played in drafting health insurance legislation and the influence which the bureau and other federal agencies exerted on Congress in the area of social insurance. Although Falk effectively refuted charges put forth by both committees, Congress sharply reduced the bureau's budget in the following year. As a result the bureau was reduced to division status.

In 1950 Falk began developing an alternative to the by then moribund Wagner-Murray-Dingell bills. Taking a more modest and less controversial approach, he drafted a proposal for health insurance for Social Security beneficiaries, the prototype of the 1965 Medicare Act.

During the late 1940s and early 1950s the drive for social health legislation was thwarted by conservative forces in Congress and in the country. During 1953, the first year of the Eisenhower administration, federal social and health agencies were reorganized and many of the administrative staff were dismissed or forced to resign. In December 1953 Falk decided to sever his relationship with the Social Security Administration, and submitted his resignation. At the same time he was offered an appointment with the International Bank for Reconstruction and Development (World Bank) to participate in a general economic and social survey of the Federation of Malaya and the Crown Colony of Singapore in preparation for their independence from Great Britain. The Social Security Administration granted Falk a leave of absence for the duration of the survey. His resignation from the Social Security Administration became official in October 1954.

The World Bank appointment represented the first of four important surveys which Falk was to conduct as a private consultant between 1954 and 1960: surveys of public health and social welfare in Malaya and Singapore (1954) and in the Republic of Panama (1955-1956), both for the World Bank; a survey of health services and facilities in the Canal Zone (Panama) (1957) for the Canal Zone Government; and a survey of union health programs (1958-1960) for the United Steelworkers of America (U.S.W.A.). The Malaya and Singapore survey, which Falk conducted with his wife, had an immediate impact; the recommendations in their report on education were enacted into law even before the final mission report, The Economic Development of Malaya (1956), could be published.

In 1958 Falk became a health consultant for the United Steelworkers of America, a position he retained until 1980. His major work with the U.S.W.A. consisted of a large-scale study of the union's health program to (1) analyze existing union health-care programs (which were provided by third-party contracts) and (2) to develop proposals for union-operated group practice plans similar to those of the United Mine Workers Welfare and Retirement Fund. The study lasted two years and produced a number of reports, although the final report (ca. 1961) was not published because of objections from the steel industry. Although the union-proposed pilot medical centers were attempted in several cities, the only one completed was in Sault Ste. Marie, Canada. Falk served as a consultant in the development of this clinic. Through the 1960s and 1970s he participated in contract negotiations as a U.S.W.A. consultant.

In 1961 Falk returned to Yale, accepting an appointment as professor of public health (medical care) in the newly reorganized Department of Epidemiology and Public Health. Falk, John D. Thompson, and E. Richard Weinerman, who joined the faculty in 1962, founded and developed the department's medical care program. Falk retired from active teaching in 1968, although he has continued to serve as a lecturer in the department.

From the time Falk returned to Yale he worked to realize his long-term goal: the development of a community group practice prepayment plan in New Haven, to be linked with a medical teaching institution. Through a series of steps--obtaining public and private funding for planning and initial operations, generating support from labor unions and other community groups, securing special enabling legislation--Falk and his colleagues succeeded in overcoming formidable obstacles. In 1971 the Community Health Care Center Plan began operation with Falk as executive director and vice chairman of the board of directors. C.H.C.C.P., which in 1975 became the first fully qualified health maintenance organization under the 1973 federal H.M.O. Act, developed into a viable and nationally recognized program during Falk's nine-year term as executive director (1970-1979).

In addition to his professional appointments, Falk has made significant contributions to medical care in other areas. He has published several monographs and almost three hundred journal articles, and he has played an important role in a number of professional organizations, including the American Public Health Association, the Committee for the Nation's Health, the Committee on Research in Medical Economics, and the Group Health Association of America. His work with the Committee for National Health Insurance has been of special importance. The committee was founded in 1968 by Walter Reuther, president of the United Auto Workers, to mobilize popular support for national health insurance. Falk served as chairman of its Technical Committee from 1968 to 1980, directing the development of the Health Security Act (first introduced in 1971) and the Health Care for All Americans Act (1979). These two bills, both sponsored by Senator Edward M. Kennedy and others, constituted the best-known health insurance proposals of the 1970s.

Isidore Sydney Falk died on October 4, 1984.

For further biographical information see transcripts of the two interviews with Falk conducted by the Columbia University Oral History Project, Series V, folders 2633-2635.