Isaac Max Rubinow (1875-1936), a medical doctor and holder of a doctorate in social statistics, worked for 25 years in the field he called “social insurance.” During the Progressive Era (1900-14), he was a well-known advocate for a comprehensive insurance system, one that covered workers’ compensation (then struggling for recognition), unemployment insurance, health insurance and old-age pensions (as it was then called).
He had both likely and unlikely allies: university professors and intellectuals were among the expected supporters, although the approval of the American Medical Association was a welcome surprise. One antagonist — labor unions — was not anticipated. Rubinow’s principal target, after all, was working people too poor to afford insurance for themselves and their families.
But Samuel Gompers, the head of the American Federation of Labor, argued that a livable wage was what workers needed; with that, they would preserve their dignity and pay for their own insurance.
Rubinow wrote, lectured and lobbied for his proposals. He sat on the American Medical Association’s Committee on Insurance and was an active member of the American Association of Labor Legislation, a major reform-lobbying organization. He wrote statistical reports and authored the first major treatment of the subject, “Social Insurance, with Special Reference to American Conditions” (1913), which became a standard text in the field.
In 1919, he accepted Henrietta Szold’s offer to become the first medical director of the Hadassah Medical Unit in British-mandated Palestine.
Szold was president of Hadassah, the Zionist organization of Jewish-American women interested in helping the Jewish settlers in Palestine. Though Jewish, Rubinow was not a likely candidate for this position. By his own account, he had been a social activist for most of his career, not a practicing physician. (He had only practiced medicine on the lower east side of New York for four years, 1899-1903). Further, he was not a Zionist and had a cultural tie to Judaism, not a religious one.
But he accepted the challenge, and challenge it was. But Palestine gave him the opportunity to test and implement his ideas on social insurance as well as on how medicine should be practiced.
For four years he struggled against multiple constituencies who opposed his plans, but ultimately he established the medical infrastructure that remains to this day. He was later to say that his Hadassah experience was his greatest accomplishment.
But his victories did not come easily: he battled European Jews who looked suspiciously upon American Jews; he angered Hebraists because he never learned to speak Hebrew; he fought the British establishment’s indifference to the needs of the residents; and he upset religious Jews because Hadassah facilities treated patients on the Sabbath.
By 1921, he had succeeded in getting all Hadassah doctors to be full-time staff with no outside private practice. He instituted a four-tier scale for patients based upon ability to pay, with the wealthiest paying full fare. He provided health insurance to all of Hadassah employees; within a few years, Hadassah was one of the largest employers in Palestine. And within his brief tenure there, he established a nursing school in Jerusalem with all classes conducted in Hebrew.
Besides social insurance, Rubinow believed in social medicine. It became clear early on that children needed vaccinations against small pox, cholera, diphtheria and other diseases; so he sent nurses into the schools to administer the vaccinations. Undernourished children in Jerusalem received free milk from the neighborhood Hadassah milk stations.
Besides the four hospitals in the Hadassah system (one in Jerusalem, one in Tel Aviv, one in Tiberias and one in Haifa), they started clinics in smaller towns, villages and the collective farm communities to serve the people. The nursing school trained Arab Christian women so they could serve their communities while Hadassah hospital, particularly the main one in Jerusalem, also took care of Arab patients.
After four grueling years, Rubinow returned to the U.S. and a subsequent career in Jewish social service. He lived to see the passage of the Social Security Act, for which he took a little credit, but not the enactment of his total social-insurance package.
Today, the United States is on the cusp of fulfilling the final piece of that package. Rubinow recognized that in America incremental change was the only way major reform could occur. With patience, determination and a stubborn insistence on remaining true to the vision, Rubinow’s vision surely remains a model for contemporaries intent on health reform.
June Sochen is professor emerita of history at Northeastern Illinois University. She spends winters in Naples and lives in Evanston, Ill., and Elkhorn, Wis., at other times of the year.