Dr. John H. Knowles: A Case of Politics

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And all I can say is the silence from Chicago has been deafening. If they hadn't opposed me it was too bad they didn't go public when they had the chance to and be in favor of it. After all I'm a member of the organization but that I don't know. I'm going to ask somebody else. I've given you the things that have been floated by the am pack that I'm for socialized medicine which is baller dash that I'm not a physician which is baller dash. And that I don't understand patient care and I'm a captive of the hospital in the rest of this country which is equally baller dash.

I might say that I have felt as if I was playing hamlet for the last five and a half months you know to be or not to be and as of right now it's not to be. The fatalistic acceptance of defeat by Dr. John H. Knowles who will not be the assistant secretary for health and scientific affairs. NET Special Projects presents Dr. John H. Knowles the case of politics in Boston NET correspondent Dick McCutchen. For Dr. Knowles director of the Massachusetts General Hospital it began more than five months ago. Secretary of health education and welfare Robert Finch offered Dr. Knowles the nation's top medical position that of assistant secretary for health and scientific affairs. Dr. Knowles quickly accepted and that was the last time in this controversy that anything moved quickly. Quietly but vigorously opposed by the American Medical Association and its potent political action committee by a conservative congressional block led by Senator Everett Dirksen the nomination of Dr. Knowles stayed alive but barely.

It had served to polarize and almost classic confrontation within the next administration of conservative and liberal elements the so called behind the scenes struggle spilled over into bitter personal attack on the floor of the Senate. Then last Friday secretary Finch conceded defeat his and Dr. Knowles and introduced his alternative choice. Ladies and gentlemen it's with some relief and a great deal of pride that I finally can announce we have a doctor in the house. In the nature of government I've always founded injury that heals the fastest wounded pride but the loss of one good man is compensated for by another very outstanding man. And maybe we're observing one of the oldest traditions in the medical profession by bringing in another doctor for consultation.

But I am very pleased to announce that I have recommended in the present this morning of course as recommended as his appointment for nomination. Dr. Roger Agerberg Dean of the School of Medicine at USC. You can gather I haven't had time to collect too many new thoughts. I have many old ones on the subject's pertinent to this position. I have been very much interested in the distribution of medical care over the past 10 or 12 years and feel that with respect to the biggest problems ahead of us the delivery of medical care is almost number one. If we add 30 or 40 million people to the present patients as Congress has voted we can't possibly do that by putting them through the same mill. It would swamp medicine create chaos and we have to find a new way of delivering medical care to many many millions of people.

Would you tell us just a little sir about your thoughts on Medicare and Medicaid or philosophy about the programs? That's a hell of a question the first thing in the morning. I think Medicare is rather well established is solving a problem. I think Medicaid which was initiated from a broad ideal has run a foul of a number of things and I don't know that one can blame any one person or any group for this. There was to be not only participation by states but innovations efforts to find out different ways of delivering medical care. If we don't find these then I think that Medicaid is going to have an extremely difficult road to home.

I think that's all. I think that's all. I don't think there is any answer to that. Obviously groups contribute not this is not a question solely of Republican recipients of campaign funds or conservative recipients of campaign funds. There were a lot of factors that are involved programmatic factors and I just don't think there's a satisfactory answer to that question here.

This case of politics has a direct and immediate impact on the lives and deaths of uncounted Americans. The quality and cost of medical care especially for the poor and aged is becoming an increasing national concern. The post now to be held by Dr. Egbert innovates and implements the programs that determine to some extent that medical care. There now has been a five-month delay in starting anything new or improving the old. In addition to Dr. Knowles we invited to this program Spokesman for those reportedly most opposed to him. Senator Dirkson, Republican Congressman Bob Wilson of California, Texas Senator John Tower, the American Medical Association and its Political Action Committee all refused. Dr. Knowles as you can see did not for which Dr. Knowles were grateful. Secretary Finch in replying to that question about the role that AMA political contributions had in your defeat said that there was no satisfactory answer to that.

Is there any satisfactory answer in your mind? Well, I don't think there's any satisfactory answer that's been displayed as thus far and I think in the public interest the people of this country deserve a straight answer. Let me say that the repeated use of the word controversy I rather object to because as it turned out it was 15 man 15 man board of trustees of the AMA plus an AMPAC plus Senator Dirkson and at the last Lurch Senator Tower and Representative Williams essentially against the entire rest of the country. How do you determine that?

Well, as long as this thing finally became a popular campaign rather than the appointment of a qualified man to the office as long as it degenerated into a popular campaign which should never allowed to be done again may I add. Essentially all the major medical organizations in this country went public for it the American nurses association representing as they said in their wire to President Nixon over 200,000 nurses. The association of American medical colleges representing all the faculties and medical schools and universities in this country the American public health association representing some 30 40,000 public health workers in this country. The American hospital association representing the 7,000 hospitals hospital workers in hospital administrators in this country you name them they all went public for it then in fact it was about as least controversial and appointment as has been considered thus far in the Nixon administration now on top of that. There were about I'd say 250 letters which I received copies of which were all for the nomination and there were to my knowledge there were about eight letters received in certain places against it.

So I object to the use of the word controversy because in fact there was no controversy just how this developed that the AMA Board of Trustees led by Dr. Anis thought somehow that they had the right to name the man to this office is beyond my can because in fact if we there are many things to be learned from this experience which I think will be very helpful. The first place the American people now know that this office exists and that the assistant secretary for health and scientific affairs is a most important post in government. Number two the first function of this man is to serve the public interest in health the people's interest in health first. Well in that context may ask you a question you call the decision entirely fair with this five month delay you think it was in fact entirely fair to this public you now mentioned.

Well I think in due course it will be shown to be entirely fair because the public in a free society have learned quite a bit. I hope that representative Williams out in California will learn something when he said over the weekend that of why heavens he says the doctors have a right to name this man well in fact neither doctors nurses or hospital directors have a right to name this man he should be a well qualified medical administrator. He should be named in the public interest he is not there to represent in this particular case the vested interests of the board of trustees the AMA and their ampak so I think this plenty to be learned here and I think all of this will net out quite well now when I said it was entirely fair. As I said at my hospital on Friday when the news broke it wasn't I won't say it was entirely fair to me as an individual or to my family to live in limbo and be often on up and down and experience the entire gamut of human emotions over five and a half months. But even that I certainly will not complain about because it's netted out in my own mind is a plus a very exciting experience I've learned a lot about the country a lot about national politics which I never knew before some of which dispirits me some of which makes me very happy.

But nonetheless I said it was fair because it was quite clear that President Nixon felt and I believe still feels that in fact he owed nothing to these particular groups that represent all the other forces in American medicine. The forces behind you the forces behind me which were every organization and bear in mind let's not fall into the trap that senator Dirksen did when he answered some of the letters that were sent to him because the answers were then sent to me in which he said 375 physicians must be heard in the selection of this man. Well first of all the senators should know that the AMA represents 210,000 physicians and that many of these 210,000 physicians went public either in groups such as the Monroe County Medical Society which said they represented a thousand physicians in upper New York state and sent their wire unanimously approving the appointment and so on. But nonetheless I think President Nixon felt as did his friends who went to see him on Wednesday in Thursday that their interests should be heard and that was it and I think that if the president has certain has incurred certain debts or has made certain promises during the campaign that it is only completely fair in the democratic tradition that he maintained his allegiance to those groups.

Bear in mind you don't find a lot of medical faculties and public health folks campaigning actively necessarily for republicans although this whole thing is full of irony of course it just so happened that I did campaign actively along with strange bedfellows Dr. Annis and ampak for the election of President Nixon feeling that it was very important that we should change administrations to try to break the deadlock in Vietnam. Saving our faces even more important at this juncture in Vietnam than it is for the traditional view we have of the Asian culture getting back to the AMA the AMA has denied that it actively opposed your nomination. You have called that not entirely factual what are the facts you know why it's baller dash heavenly days by in you end or by the fine silken hand behind the scenes they were most vigorously and actively opposing my nomination through ampak via Dr. Annis and ultimately through senator Dirksen and the final lurch was made by senator tower and representative Williams.

The ultimate irony of this is that while they kept this fox out of the chicken house boom 12 hours later they have a magnificent man Roger Eggerberg dear friend of mine he and I agree right down the line on what the problems are we both have been constructively critical of the AMA the ampak boys have shown their muscle but I couldn't be happier with the ultimate selection here Roger Egger of course Roger Eggerberg is a liberal Democrat that's further irony but at any rate the thing has been made public and I would predict that the voice vote will unanimously nominate this fine American and the country will move forward and as I told Bob Finch and Roger Eggerberg who I talked to at midnight on Thursday. I will do everything in my power to help them and to support them and to work in the public interest so all as well that ends well what do you think would have happened.

Excuse me had Dr. Eggerberg been nominated first I think Dr. Eggerberg had been nominated first he would have been knocked off ultimately by the same forces and then it's possible to Mr. Finch would have come to me in which point the thing would have been made public and passed in flying colors absolutely. You have asked for an investigation of ampak and the AMA's political action committee and at the same time you said you were proud to be a member of the AMA. I most certainly am is it difficult to reconcile those two states not at all I'm not one of I'm not a person to stand outside the public arena and throw spitballs and then go on home and got a distinction some of my colleagues who have just given up in despair on this arch conservative old man's club in Chicago I haven't I'm a hard working member of the AMA. The same board of trustees has just asked me to spend a year and a half on their long range planning committee which I've done gladly going to Chicago every month to work for them. I'm trying to change them I shall continue to do so I shall continue to pay my dues and I shall continue to work with the many reasonable moderate progressive forces within my American medical association.

Most certainly I'll continue to work in the public interest and through the established organization. And you think working within the AMA is right now your only route really. I'll work within them and I'm a member of the American Hospital Association. I'm a member of the American Association of Medical Colleges. I'm asked to testify in front of congressional committees and I most certainly will continue to speak to the issues and confront them the way I see them. Something that seems to disturb people about me is that I say publicly what we all say to each other privately and the more we can get this into the public arena the more change you're going to see in this country and I'm all for it. What makes Dr. Egbert acceptable where you were not? Well I think first of all the psychology of the situation right now is that everybody's absolutely fagged and exhausted the power of AMPAC and the conservative wing of the Republican party and the fundraisers have been modified all as well.

They couldn't conceivably have a further ruckus on this thing and they will certainly put Dr. Egbert right in. No question about it and if they don't I think we ought to get the Supreme Court into this issue. I think that the AMA Board of Trustees as they told me three or four months ago said well John if your name has finally made public by the president we're certainly prepared to send a letter of congratulations to you and Mr. Finch and the president. Well that's a very nice thing to say isn't it because they knew darn well if they had their way my name would never be made public and in fact it wasn't. But the instead of waiting five and a half months on the second go around the name was stuck right in as it should have been in the first instance on the 15th or 20th of January and there it is public. No chance for behind the scenes maneuvering and the AMA is now on record through their president of the AMA Dwight Wilber as congratulating the man and supporting him.

If anybody dashed stand up and cast a negative vote on him I'd like to never mind senatorial immunity I think the man ought to be asked exactly what in fact is the matter with this man. Because as Bob Finch and I know very well my particular case was absolutely clean as a whistle and I am not going to listen to the word controversy applied to me. If I have to repeat that until the day I die and I'd still like to have somebody stand up if they dare look like an old Arkansas turkey shoot if they did and state directly what in fact was their objection. Because I haven't heard anything substantial yet and in fact there isn't anything substantial period. Were there any overt pressures exerted on you in the past five and a half months to have you change your soften your views to make you if not less liberal at least more acceptable. No, as a matter of fact I was encouraged to be my own man in may I say I didn't need any encouragement to do that.

I did give a speech one time though at the dedication of a clinic in Washington where I was encouraged to if anything be more of what I was for rather than less. And I did attempt at one time to trace the evolution of American thought rugged individualism republicanism conservatism versus social welfare collective actions solve problems liberalism Democrats and so on. After I've given that speech somebody thought I was getting fuzzy because they were all waiting for me to open up on the issue. And of course silence at that particular juncture for the last five and a half months was the best weapon of power available to me. I might say that that I never had any intention of withdrawing from this battle over the five and a half months even though it was admittedly difficult on me the people around me in the hospital and certainly my wife and six children. But I had no intention of caving in because I thought that the issue had to be met publicly if I'd caved in two or three or four months ago.

The same stale script might well have been played on the next man until a pigeon of the board of trustees the AMA was firmly in sconce in that office on a long leash held firmly in Chicago. And being interested in teaching hospitals medical schools public health programs and the solution of obvious problems I certainly was going to do everything I could to prevent that from happening. What is your experience going to do to other doctors in the future who feel compelled to speak up on matters of the public interest. I think it's going to encourage them one and I most certainly think it will because I see it primarily in the medical students that are coming along now. Who are clutched with the desire to make change in medicine to get out into communities to practice medicine to go into the inner city areas to try to improve the distribution and the organization of medical care and its quality. And I think these students are the ones that are going to be pushing us we members of the faculty and we members of the AMA.

But you have gone through a five and a half month experience for you yourself described as difficult and demeaning. How is this going to be an inspiration to those who fall because I've lost no friends I've gained many new friends and I have the same old enemies. And they are outnumbered by the progressive forces in this country today. And I think that they have been temporarily set back by the ultimate pressure lurch into the White House by Senator Tower of Texas and Representative Wilson of California. But I think that's the last gasp at least I hope it is. Dr. Knowles, thank you very much. Thank you. Senator Edward Brooke of Massachusetts who had called Dr. Knowles to feed a calamity for the nation and accepted our invitation to appear tonight but had to decline because of the death this morning of his brother-in-law. To continue our examination of this case of politics in Washington here is Max Frankel of the New York Times Washington is rarely seen such a fuss over what is after all the job ranking three rungs below cabinet level.

This government's top health officer does not alas control all that much of the nation's largely private and local medical establishment. And it's no mark of this respect for Dr. Knowles to suggest that he hardly married to the five month political battle of such intensity. Yet a battle it was and almost everyone has come out very badly bruised. The explanation I think lies in the realm of symbolism to the liberals who clamored for his nomination Dr. Knowles became the symbol of forward looking medical administration recognizes the disparity between the high quality of American medical know how and the chaotic and costly way in which we deliver it to most of our citizens. And to the conservative leaders of the American Medical Association Dr. Knowles became a symbol of the rest of young doctors and hospital men who look more and more to government to organize a modern health care system and who may eventually deem it necessary for government to take a hand in fixing doctor schedules and fees. To Robert Finch president Nixon's intimate friend and secretary of health education and welfare the Knowles appointment came to be a symbol of his influence on a whole range of liberal causes from welfare reform to school desegregation.

And to senators Turks and in tower and their conservative friends in Congress the appointment came to be a test of their influence and the president's respect for the financial and political energies that they've rallied in his behalf and expect to rally again in years to come. In the end Mr. Nixon honored his political debt and then tried to modify Mr. Finch and the liberals with the appointment of the equally acceptable Dr. Roger Egbert. But it was the symbolism and not the substance of the issue of course that counted all along. And the president let it be known symbolically that in a confrontation he needed the right of center a little more than the left of center as indeed by all the conventional political arithmetic he does. And moreover he let it be known that liberal projects in his administration were extremely vulnerable to conservative attack. While not exactly repudiating Mr. Finch he certainly robbed his liberal friend of his most formidable weapon his wanted bankrupt influence at the White House.

Mr. Nixon undoubtedly thought that he was buying peace with this conspicuous but hardly fatal compromise yet he showed more clearly than ever before that he was a man who could be made to yield to intense pressure. And liberals and conservatives alike will not soon forget the lesson they will hound him hard from here on in. So from all of us it becomes obvious that this was and is more than just a slight case of politics. Perhaps it was best summed up by Dr. Knowles himself at his press conference last Friday. I feel that Secretary Finch's position has been quite clear for nearly five and a half months. The ultimate responsibility of course is President Nixon's in his wisdom as to what is best for the country. President Nixon's in his wisdom as to what is best for the country.

President Nixon's in his wisdom as to what is best for the country. President Nixon's in his wisdom as to what is best for the country. President Nixon's in his wisdom as to what is best for the country. This is NET, the public television network.