Interview with Alvin David
by Peter A. Corning

Baltimore, Md.
June 6, 1966

Q: My first question this afternoon is this: I wonder if you could give me a little bit of biographical background and a little-bit about what jobs you held in the Social Security Administration.

David: Yes. Well, I have been in the Social Security Administration since 1936 and in all that time except for the first year I have been very largely, if not wholly, in the field of what we call pro gram planning, which is legislative planning for the most part, and the only exceptions were the period that I was in the office of the director of the bureau of old age and survivors' insurance back in the period from 1949 to 1953. At that time I was assistant to the director, but even at that time I was still very largely engaged in Program planning work and policy formulation that is closely related to the program planning or legislative planning work, and I never lost my contacts and close associations with the program planning people. So I have been in that area from the very beginning. The only other exception was the time I was in the Army during the war. I started to write proposals for legislation back in 1937.

Q: Including health insurance?

David: Well, no. Really health insurance was too far away at that time. We did talk about disability insurance, but not health insurance. I did write proposals for the consideration of the advisory council that made its report at the end of 1938. I worked on that kind of thing back in 1937 and I wrote big pieces of the specifications and the analyses and did a big part of the planning for what became the 1939 amendments. We didn't have very many people in that kind of work back there and the few that we had were not for the most part well suited to it. It boiled down to just a couple of people, including me, in this Bureau of Old-age and Survivors Insurance. Outside the Bureau there was Wilbur Cohen and several other people, but I was the one who did most of the early work in 1939 in the Bureau of Old and Survivors Insurance.

Then I worked on all the amendments ever since, and I have been in close contact with the Congressional committees--Ways and Means and Finance Committees--and their staffs as well as with staffs of individual Senators and Congressmen who had an interest.

On the 1956 legislation, which is where we got the disability amendments, I ought to say that we started this with a proposal that we made to the Congress I guess in 1947. We had minor legislation in '46. In '47 we had a bill which was Administration bill and it had in it provisions for both total disability and temporary disability. And we got clobbered on that in the Ways and Means Committee. We got clobbered on the temporary disability.

Q: That was a Republicans Congress as I recall.

David: Yes. But we would have been clobbered anyway. We didn't have anywhere near the necessary political stimulus behind it, and the opposition was well organized. They did a good job, made it quite uncomfortable and even embarrassing; sometimes, with the kinds of questions they had. We just did not have the kind of backing and support we needed.

Q: In view of the fact that you've had such a long history of being associated with the legislative process, I think you'd be in a very good position to make the comparisons between getting a bill through Congress back in the '30s and '40s as opposed to the '60s. Of course the issues were different, but I wonder if you can make comparisons.

David: Yes, you can. There is much more sophistication in Congress now. In those days they knew almost nothing about the principles and ideas, the theory, the whole background of Social Security. They were very naive. They are still quite naive in comparison to people who are expects. But they know much more than they did then, and they have a great deal more interest in the matter because now it is very clear that this is a tremendous political thing. In those days it amounted to very little. There were very few beneficiaries. There was very little public interest in it, and nobody realized the amount of political force--the gold that lay in these hills. It wasn't about 1951 or '52 that it became clear to the Congress that they were dealing with something that was quite big politically, that they were dealing with something that in comparison with the veterans' lobbies or the farm lobby and so forth, was at least potentially even bigger in terms of the number of people. They weren't organized but there was a vast number of people, and they began to see that this was important and it meant votes and it meant great interest on the part of their constituents. People began to write them letters about their problems, and it became more numerous because there were more beneficiaries. The rolls began to grow quite considerably after 1940's and 1950's. So the Congressional committees took a different attitude.

Q: Would you say that there was a commensurate decline in hostility at the same time toward Social Security?

David: Oh, I don't think there was ever a sharp change on hostility. I think it was a big change on interest and understanding. But the hostilities remained, I think, very little changed. There are some Congressmen and Senators who now don't think it is expedient to be as hostile as they were.

Q: Including perhaps a former Presidential candidate.

David: Yes, yes. But I have the feeling that when you look at the substance and the inside of their attitudes that they aren't much changed. There have been a few outstanding hostile members in the Congress--Tom Curtis in the Hays and Means Committee, Carl Curtis who used to be in the Ways and Means and now is in the Finance Committee, Bruce Alger when he was on the Ways and Means Committee, and several of the more conservative Republicans both on the Jays and Means Committee and the Finance Committee, and some of the Southern conservatives and Texas conservative groups have been hostile. But there has been a relatively small number and generally not very articulate. There are only a few who have been really articulate.

Q: On the other hand, I take it that Social Security has a good deal of support from among others in the Southern contingent.

David: That brings me back to Medicare. It's an amazing thing that there should be so big a difference in attitude toward Medicare as between the Northern and the Southern delegations in the House and in the Senate. Medicare came up for a vote in 1960 and in '62 and again in '64 before it was finally passed in '65. And my recollection is that the Southern Senators, both in '60 and in '62--there was more of a break when it was voted on in '64--voted against it, I believe without a single exception. All of the Southern Democrats voted against Medicare. All of the Northern Democrats voted for it.

It was a very amazing thing--not a single deviation. At first I thought that this might be related to some ulterior consideration, like some deal connected with civil rights. But when it was repeated in '62 under different circumstances, I began to see more clearly that this really represented something in their whole social setting and their attitudes and it was much sharper on Medicare than it was on any other issue. On any simple liberal versus conservative issue, this cleavage was never this sharp. It never was on anything I've ever heard, and I never was satisfied in my own mind that I could understand why there would be that difference.

Q: It was true, too, in '64 and '65?

David: To a considerable extent in '64, but of course in '64 we went over by a fairly big margin and some Southerners did come through, but there was still a difference; and part of this is rural versus urban, the rural communities depending relatively little on hospitals, using them less, and just not expecting to get as much out of the program.

Q: Farmers don't retire.

David: Well, that is one element, too, but on Medicare we tried to make it known that you didn't have to retire, which is the case. But of course you don't ever get anywhere near a full understanding of even a simple point like that. The whole Medicare operation was shot through with places where there was the grossest misunderstanding and misapprehensions and misconceptions about the program on the part of members of Congress and the public at large.

And I might say that there is considerable misconception and misunderstanding of the program on the part of many of those who supported it in the Congress.

Q: Could you think of a few examples offhand?

David: Well, you don't need to retire; of course there was misunderstanding about the original program that included only hospital insurance. There were many people who thought that it included insurance against the cost of doctors' bills. There were various options and there were provisions for deductibles. Those were widely misunderstood. The financing was very much misunderstood. There was a lot of misunderstanding about the proposed increases in the earnings base which at one time or another in the bills that were considered in the Congress were from $4800 which was the base in 1959 to $5000 or $5200. There was a lot of misunderstanding to the effect that the whole income from this increase in the earnings base was intended to finance Medicare instead of part of it going for increased benefits that would flow automatically from the higher earnings credits. The AMA and the insurance industry were great contributors to these misconceptions and helped to develop them and spread them and exploit them. I'd go out and talk to people and they'd say, "Yes, but this is the case about Medicare," and I'd say, "No, whoever told you that?" "Well, everybody seems to know that. The doctors and the insurance company and everybody have said it, and it's been in all of the papers." It just became known and nobody knew exactly how they knew it and how they heard it. But we had a great uphill fight on the basis of some of these things.

Q: What are some of the ways that you go about trying to counteract some of these misconceptions?

David: Well, it's not our business, you know, to counteract them. We are limited by law to activities in the planning field and studies and researches and so forth. We are not really expected under the law to do such a thing. The only thing that we could do would be to write speeches and articles which could be delivered by political appointees like, say, Wilbur Cohen, Under Secretary, and Bob Ball after he became a Political appointee. Under the rules we are not free to go out and counteract these things. Of course we have been called upon by people who are free when they ask us for this information, including Congressmen and Senators and we give them the information and they use it. But we can't run a public information program directed to clearing up misunderstandings to improve the chances for enactment of legislation. The law is quite clear that we're not supposed to try to influence the enactment of legislation, which is quite a difficult line to draw, and we have undertaken to answer questions and inquiries and give technical advice and assistance to people to ask for it. We hardly ever are asked for technical advice by the AMA or insurance companies; so that we did get requests for information and technical assistants from the proponents of the legislation--organized labor and senior citizens and so on.

Q: Could you identify some of the mayor proponents who requested information from you both in Congress and interest groups?

David: Well, the major proponents of course would be organized labor, the AF of L-CIO. I mentioned the senior citizens.

Q: How about Dr. Esselstyn's group, the physicians committee?

David: Yes, we would have inquiries and some contacts with them and various other people in the states and in less well organized groups who were interested in the program and tried to get it moved along and would us for the background information.

Among members of Congress, the leading proponent of course was Senator Anderson. Representative King was not as much of a force in this as his position and name on the bill would suggest.

Q: Senator Anderson was very definitely active, not just a figures head?

David: Oh, yes. He was a very active shaper of this proposal and there really was nothing that ever went into the bill that had his name on it that was not wholly developed with him--cleared and worked out with him. He didn't just rubber stamp something that was handed him by the Administration.

Q: This gets us back to the question I asked you originally about the comparison between the legislative process then and now. I wonder if you could perhaps go into a little more detail on the mechanics of getting legislation through Congress, the ways in which you have to organize yourself and the ways in which you have to deal with Congress. Are there any significant ways in which that process has changed over the years?

David: There are so many different ways in which we work with Congress, the differences depending on the magnitude and importance of the legislation. The way we would work with Congress on Medicare is quite different from the way we worked with them on some change in the provisions that affect the state and local government employees or nonprofit employees or ministers or, let's say, farm employees, domestic workers.

Q: In what way would it differ?

David: Well, it doesn't get the top level of attention Medicare received, the absolute top level of attention and interest in the Administration. It had become the key political issue by this time, so that nothing was done without participation, and very close participation, by the Secretary and by Wilbur Cohen and the White House. Nothing ever happened in Medicare that the White House was not fully abreast of. But these other things just are much more minor. There were only a few people affected. The Political dangers and the political potential for gain are extremely small, and so it is quite possible on one of these things for me at my level to go and work with the committee and work out something with them, and it gets reviewed and my superiors are apprized of it, but it's not something that makes that much difference.

Q: In other words, something like the Bureau of the Budget's clearance would be more or less a pro forma thing on some of the minor legislation.

David: The Bureau of the Budget's clearance under the rules is required on everything, no matter how small. But in the actual process, when you're there, you have gotten clearance for what is the original question or the original issue, but then details come up when you are there and you work them out. And by this time it's past the place where it's feasible to clear it, although there are times when this is not the case. I've been there at times when I have left the hearing room and called the Budget Bureau, Sam Hughes, for instance, to make sure that we didn't have any crossing of the wires on something that I was doing, which had gone to a level or stage beyond the stage at which we had discussed it. The normal and formal procedure in working with the Congress is that they ask us for a bill report and we write one and clear it through all the channels to the Secretary and then through the Budget Bureau before it goes to the Congress, even on the smallest things. But that' s not the complete story. We do work with the Committee on the technical side. We write legislation of more significance in our working with the committee staffs and with the legislative counsel, the draftsmen, than what we will have in many cases cleared. There are just too many technical details. And so when it comes to reporting on a bill, we will write this report and clear it. But when legislation is being hammered out in the committee, a hundred things need to be decided and can go any one of several ways and it isn't feasible to take all of those and present them to all levels in the Department and in the Budget Bureau. They just get worked out with the committee staff and with the legislative counsel. Now, on Medicare, I would say that almost the smallest things were reviewed and approved before they were included.

Q: These were even the things that otherwise might normally be worked out in the committee.

David: Yes. The tendency was for everything to be considered.

Q: How much during the Medicare fight was the Bureau of the Budget an active force as a restrainer or as a veto over provisions?

David: My recollection is really not very clear on all the details of Medicare. It was a little different from the normal legislative process. It had so many political ramifications that the people in the Budget Bureau weren't always close to, and I think that to a much greater extent than in normal legislative activity, the matter would get decided at the level of the Secretary and Wilbur Cohen and the White House, and of course in many cases the President, and usually on big things both Kennedy and Johnson were in on it.

Q: Such as accepting the voluntary option in '62, for example.

David: Oh, yes. In '65.

Q: I mean in '62--the Anderson-Javits bill.

David: Yes.

Q: In the case of Medicare, you did go through the Bureau of the Budget much more, but was much of it the sort of telephone conversation that you describe?

David: You say on Medicare?

Q: Yes.

David: This Medicare thing extends over a long period, and you have to distinguish between the formulation of bills that were introduced like the original Forand bill in 1957. Now, almost everything there went through a regular process of clearance all the way up through the Budget Bureau, and they reviewed the bills before they were sent up and introduced.

Q: Who 's "they" in the Budget Bureau? Was there somebody that you regularly deal with there? You mentioned Sam Hughes before. Was there anybody else? Is there a special division or department for Social Security ?

David: Yes. It's not just for Social Security. I forget what they do call it. I think it's called labor and welfare, labor and public welfare. It has Social Security and unemployment insurance and welfare and public assistance. First there is Hirst Sutton. At an earlier point Bill Carey and Roger Jones would be dealt with; still earlier Elmer Statts when he was the Assistant Director of the Bureau; Mike March, Milton Turen. I think those are the ones.

Q: In the case where you are going through the initial drafting process, and you get a clearer view of the Budget Bureau . . .

David: That kind of thing would be quite thoroughly reviewed and considerable time would elapse.

Q: Would the review process involve personal discussions?

David: Yes, we would go up there and sit around a table and talk about it.

Q: Who would be "we"?

David: Well, depending on the particular subject of this meeting, it would usually include the Commissioner. And if it was important enough Wilbur Cohen would be there and almost always I would have been there and Irv Wolkstein on Medicare. And wherever Title l9-- Medicaid as we now call it--or public assistance provisions were involved, Hawkins from the Welfare Administration would be there; and our draftsman, the man in the general counsel's office, our main support on legislative drafting, not only our support but the support of Congress, Sid Saperstein. Occasionally the General Counsel would be there, Alan Willcox.

Q: Is there any particular place and time of day when these things would take place. Were they usually morning conferences or afternoon? Did they go late into the evening sometimes?

David: At the Budget Bureau there would be regular hours--I can't say morning or afternoon; it would be both. When things would be discussed at the White House, that would tend to be done in the late, late afternoon or early evening. But I normally did not go to those. Wilbur Cc hen handled those mostly and Bob Ball would also have gone to those, but as a rule I did not participate in the White House discussions.

Q: Is the same true now for other people out here? In other words, none of the staff people below the level of Commissioner would be at the White house conferences.

David: That would be the rule, yes.

Q: In the Budget Bureau discussions, I presume they were not always the same, but did they have any kind of format or were they always very informal with no particular agenda and no following of rules of order or anything of that sort?

David: Oh, no, they wouldn't follow any rules of order--no. As a rule, we would have a subject or an issue or issues. These would be discussed. I can't recall that we ever had a formal agenda, nothing; as formal as that.

Q: Was there anybody who was usually the spokesman of the group from Social Security?

David: The Commissioner would be the spokesman unless Wilbur Cohen was there, in which case he would be the spokesman. But they worked very well together and they would divide that up without any problems. I was thinking, that I've left it not finished on this matter of how you work with the Budget Bureau and to what extent there was review. I started to say the in the bills that were sent up as administration bills, they would get thorough review.

But then when you got to working with the Ways and Means Committee on the drafting of an actual bill of theirs, then things moved too fast for very much Budget Bureau discussion. And on that, whenever we finished a section in the morning; and the Committee was moving to do this or that particular thing, there would be a direct White House get-together by telephone. And if the White House staff thought that the President would want to know about this, he was informed and quite often he would be. Sometimes he indicated that he would not be willing to go along with the proposal then there would be efforts made to get it chanced. There was very, very close contact with the White House and with relatively little opportunity for Budget Bureau participation because there was so little time and it just had to be done that fast.

Q: Let me clear up one minor point here in my own mind. In the case where a bill is drafted in the executive department and then is submitted to Congress as an administration proposal, it gets Budget Bureau clearance. Then despite this original clearance, does the committee then require a report on the administration's bill, and you have to go around again to the Budget Bureau?

David: Yes, that is correct. The bill as it gets sent up to the Congress is not the same as this bill that we're now asked to report on even though the words are the same--the language is the same. It doesn't have the same status. It has gone from us to the Congress as a rule as a kind of a technical service to an individual member or a committee chairman. Mr. Forand introduced the bill. It was given to him by the Administration. The Administration fully cleared it, but still on the record it was Mr. Forand's bill He drafted it; it was his bill.

Q: the same for the King-Anderson bill.

David: Yes. And then after it's introduced and the committee asks us for a report, the committee does not recognize that we wrote the bill or the Administration wrote the bill. They act as though this was Forand's bill, King's bill, and then they ask us for a report and we act like we are giving the report de novo. Although it is true that by reason of the lapse of time and developments in the meantime, sometimes we will make a comment, a suggestion that something be changed which we ourselves put in there.

Q: You' ve mentioned the White House several times. I wonder if you could explain who you're talking about at the White House, the White House staff, that you would deal with.

David: These are the assistants to the President. In Kennedy's day the chief person was Ted Sorensen, but now there are different people, depending on who happens to be the one assigned to any given field. They're all in the category of assistants to the President.

Q: I see. There's no particular person that you deal with there now.

David: Well, of course I myself don't deal with then, and they have been changing from time to time.

Q: Part of the Resident's well-publicized policy. It's affected you, too.

David: In the early days of the Johnson administration we used to have occasion quite often to address memoranda to Bill Moyers. We don't anymore.

Q: You mentioned also the White House intervention in the committee hearings and executive sessions. Could you be a little more specific about that? Do you recall any notable instances of White House intervention and what the issues were?

David: No. I can remember that there were a few occasions when the committee wanted to do something and the President felt the other way about it and would indicate so, and this is at a level that I feel that I can't contribute very much on. I don't really remember the details of any particular instance. But the fact that the President would not want to do something would be of importance in the committee-- I mean just the knowledge that he didn't want to do it would carry weight. And where that wasn't enough, the legislative liaison people from the White House would call on influential committee members and try to get them to change the direction.

Q: Do you have any knowledge of direct Presidential intervention?

David: You mean like where the resident would call up? Oh, I'm sure that the President did all kinds of direct personal intervention with Wilbur Mills on Medicare. I don't know that he ever did on specific provisions. I doubt it. But on trying to get Wilbur Mills to support Medicare, I'm sure he did that many times. I'm sure he not only called him up but had him come over to the White House and talked to him. Of course I don't know what kinds of things he used as arguments and considerations, but I have no question that that was done.

Q: What about differences between the way President Kennedy operated and handled Medicare and president Johnson? Are there any notable contrasts in your view?

David: Well, I have the distinct impression that President Johnson has been much more in a position where he could--his own personal style and approach fitted in with that--intervene and make his wishes known and exercise influence to a much greater extent than Kennedy. Now, this may have been due to the differences in the times and circumstances. But I believe it is more than that. I believe that Johnson does maintain a much tighter control and keeps much closer touch with the legislative process and has used his influence to a greater extent than Kennedy and probably has worked at it more. I think he has devoted himself to a greater extent on calling people on this on the telephone or getting them to come over to the White House and persuading them.

Q: It would be your impression then that president Kennedy except at certain well publicized times was rather aloof from the Medicare issue?

David: I don't think I'd go that far. I think he got close to it. All the major decisions on the Medicare legislation that was introduced while he was President were cleared with him and actually he made them. Where there was a problem or issue, where there was a difference of opinion between different supporters or even where there were questions between us and, let's say, the Department and Senator Anderson or the AF of L-CIO, any of these supporters, sometimes these things had to be finally ironed out for an administration bill; and Kennedy was the one who would have to decide, and he did decide all these matters that came to him. I can't say that he was aloof. He never was in a position where Medicare had a chance to be enacted while he was President. It wasn't in the Ways and Means Committee where they were working out a bill where they knew they were going to have the votes as was the case in 1965. After 1964--after that election--the Democrats went from 15-to-10 on the Ways and Means Committee; they went from 15-10 to 17-8. Then there was a replacement of one Democrat who didn't get elected or somehow or other he didn't stay on the committee, so there were three new faces on the committee and they were all Medicare supporters. Previously Mills, together with the Republicans and two other Southern Democrats, made a majority of at least 13-10 Republicans, Mills, and two Southern Democrats, namely Watts from Kentucky and Thompson from Texas, and perhaps one other person. Between them they had an easy majority--13 and sometimes 14. Now with the change to 17-8, there were eight Republicans and Mills, which would make nine, and the two or three Southern Democrats still made only 12. It was a 25-man committee, so 13 is what does it. When it went to 17 to eight they were out. They didn't have control anymore. So now they were putting together a bill. This situation never existed while Kennedy was President, and so he never had occasion to exercise influence on what was done in the committee which was writing a bill.

Q: Was this change to 17 to eight directly related to the Medicare issue?

David: Well, the choice of the additional members was made with a clear view to how they would vote on Medicare. The Democratic caucus with a majority of the Democratic membership was for Medicare. They didn't put anybody on the committee was going to vote against Medicare.

Q: There's a very interesting situation here if I understand it correctly. And that is that the Republicans and the Southerners . . .

David: It was quite clear that this change from 15-10 to 17-8 was not going t o be allowed to happen in a way that left Medicare still behind in the committee. Wilbur Mills opposed making the change, and for a little while it was uncertain whether it would be done, and there was some thought that perhaps he would agree to letting Medicare come out of the committee and be voted on on the floor, and there were some people who thought that he was being antagonized, that the administration would lose more than it would gain by insisting on this. But as far as I know, the President said, "Let's go ahead and make this change, " and Mills cooperated very well and it was made. I never saw any signs of antagonism.

Q: I wanted to ask you a question. It's my impression that you had a very interesting; situation here regarding Medicare where the Republicans and the southern Democrats together made a majority but if it was only an issue where it was among the Democrats, there was a majority for Medicare against a minority Southerners. And so what the majority of Democrats had to do was to extend control over their own party within the Ways and Means Committee, so that ultimately it would reflect not the split within the party but the viewpoint of the majority of the Democrats through a process of attrition as things opened up on the committee.

David: Yes, but I think that this generally was not quite that clear. It was that clear when the change was made from 15-10 to 17-8.

Q: You see, the hypothesis that I'm working on here is that in a sense it could be said that the Medicare issue had to be fought out within the Democratic party first. It was never a partisan issue between the parties but within the majority party.

David: That's correct. But I should say that that is not usually what you mean when you speak of attrition. Previously when there were changes made in the Ways and Means Committee as a result of a member not getting re-elected or getting elected to the Senate or retiring or something, his place would be filled by another person from the same background, often from the same state, so that attrition didn't change anything. Thus when a Southern Democrat graduated to the Senate or didn't get elected, another Southern Democrat of pretty much like views would be put on the committee instead.

Q: That's customarily true. Was this true with respect to Medicare during the years from, say, about '62 to '65? You see, if you look at the votes within the Ways and Means Committee over the years as the Congressional Quarterly has reported them, you get a definite increase from 17-8 when it was the Forand bill to 15-10, 13-12 before it finally passed.

David: But this I don't think can be attributed to the process of change in the membership except for this one change that I spoke of. I think it was a winning over of one more member who came to see that there was more to be said for casting his vote, not more to be said as far as the proposal was concerned. I don't think they changed so much on that. The change would be that there was more to be said for voting for it.

Q: I wanted to ask you to go back to the early '50s by way of getting started on the history of Medicare, reconstructing it as much of it as we can, and starting with the Wagner-Murray-Dingell bill and its demise. Can you recall any of the incidents connected with that issue in Congress and the ultimate recognition that it wasn't going to pass? Were you involved at that time?

David: Yes, but it was very clear that the Wagner-Murray-Dingell bill, insofar as the health insurance features of it were concerned, was not going to anywhere. There never was serious consideration in Congress. I had something to do with the formulation of the proposals and the drafting of the legislation. But there never was any work with Congressional committees on it. It never was seriously considered by them.

Q: And yet it was a formal administration proposal.

David: Yes. There were hearings, as a matter of fact. I shouldn't say it wasn't really considered. There were hearings, but it was clear that they never had anything like the necessary votes and were not going to pass that legislation.

Q: Is this hindsight now or did you have that feeling about it at the time, that this was something...?

David: The Wagner-Murray-Dingell bills were introduced in the late '40s and by the early '50s I think it was recognized generally in the administration--this was in the Truman administration--that health insurance as embodied in the Wagner-Murray-Dingell bill was not going to go anywhere. And it was at that time, about 1951, that the shift was made to hospital insurance and hospital insurance for beneficiaries only.

Q: Do you know anything about the origin of this proposal for beneficiaries only?

David: Well, as far as I know, the origin is quite clearly with Wilbur Cohen. I think Wilbur Cohen worked this out and persuaded Oscar Ewing this was a good thing to do and Oscar Ewing persuaded Truman that it was a good thing to do. It became an administration proposal in the late years of Truman's administration. Ewing went all out for it, took quite a lot of beating from the AMA, and I think it was very largely on account of that that he was not permitted to become Secretary when there was a proposal to establish the Department. The Congress did not allow that to happen and I think it was because of this.