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Health Insurance

Hulton Archive/Getty

Compulsory insurance of the worker against the mischances of sickness is the reform now in the order of the day. The institution is already established in Germany, Austria, Hungary, Luxemburg, Norway, Holland, Great Britain, Russia, Rumania, Serbia, Greece. When a social reform has won success in Russia and the Balkan States, one may suppose that it is about to receive a hearing in the United States of America. And now three of our chief industrial states, New York, Massachusetts and New Jersey, are discussing sickness insurance bills, under the more optimistic name,  “health insurance." These bills spring largely from a common source and are almost identical in terms. If they pass, the manual worker, or any other employee with salary under $1,200 a year, will be assured medical and surgical attendance and nursing through a period of sickness extending to six months; medical and surgical supplies up to a cost of $50, and money benefits equivalent to two-thirds of his wages for a period not longer than six months. In return for his advantages under the law, he will be forced to contribute, in the ratio of his earnings, towards two-fifths of the aggregate cost of insurance. His employer will contribute another two-fifths, and the remaining fifth will come out of the state budget. 

It is a complicated project, so it is urged, destined to tax rather seriously the administrative capacities of the state. It is a burdensome project which will make the cost of production greater in the states that adopt it. It is un-American. Such are the chief objections that are being raised against the proposed laws. As for the first, the German Empire manages to administer a somewhat more complicated system insuring over 14,000,000 employees. Great Britain is successfully administering a system insuring a number of employees only a trifle less great. We are surely capable of handling our comparatively simple problem. As for the second objection, unless we are a decidedly more unhealthy people than the German or the British, the cost to the employer will not exceed two percent of the wages bill. The industries of a state are hardly placed in jeopardy by a two percent advance in wages, even if there is no return in efficiency. But anything that tends to improve the health of the working population is certain to advance the interest of the employer in some measure. Not improbably the employers' contribution to the health insurance funds will in the long run prove an excellent investment. 

Let us fall back, then, on the objection that health insurance is un-American. It is un-American in the sense that it is new to America, as it was new to Great Britain four years ago and to all the world thirty-two years ago. It is a natural outcome of modern industrialism, which is very much the same the world over, producing everywhere the same kind of industrial population, without land to maintain or roof to shelter them, with slender reserves for a rainy day, with the mutual-aid groupings of the earlier order shattered, and with health often weakened by urban life and factory strain. In America as in the older countries there are hundreds of thousands of workers to whom a week's illness is a serious embarrassment, a month's illness a calamity. One third of the applicants for charity in New York State are driven to seek aid by sickness. Experts estimate the annual loss to our workers from sickness at three-quarters of a billion a year. Almost a war budget, it would seem, and thrown upon a class that finds it none too easy to make ends meet. But what makes the matter more serious, the burden is unevenly, perversely distributed. It falls more heavily upon women workers than upon men, more heavily upon the low-paid than upon the highly paid classes. To redistribute this burden so that the stronger will take their share seems not inherently un-American. 

But redistribution of burdens is not the only object of sickness insurance. We have vastly more sickness than is necessary. Think of the thousands of men in our industry at the early stages of tuberculosis, of the other thousands just beginning to develop other organic lesions. They shrink from consulting physicians; instead, they rack themselves to pieces at their work, largely because they can not afford to be ill. There is no need to dwell upon the enormous increase in volume of sickness resulting from initial neglect. It has been estimated that prompt medical attention would save our working class one-third of their' days of illness—say, one quarter of a billion dollars. It is hardly un-American to seek to check so huge a waste. 

Health insurance in Germany has been the most powerful force making for the elimination of tuberculosis. Collective pressure is brought to bear upon the type of man, so familiar in every country, who goes about with the mark of disease upon him, yet falls to consult a physician, fearing the worst. The adoption of health insurance by Great Britain led to a national movement to control tuberculosis. According to Commons and Andrews, the British act brought to light a huge mass of suffering, especially among women workers, that had never received proper medical or surgical attention. 

We have seen in our own country what indirect advantages may be had from similar legislation. As a result of the enactment of workingmen's compensation laws and the attendant agitation of the question of industrial accidents, our business men launched a great “safety first" campaign, which has already attained notable results and promises far greater results in the future. Health insurance will give the American business man a direct, pecuniary interest in combating tendencies toward disease in the general population. There is no more efficient organizer in the world than the American business man. If once it is proved to him that he is justified in turning his talents to the solution of problems of public health, we may expect very rapid progress toward the removal of conditions destructive of the stamina of the people. We are late in entering the field of health insurance, but there is reason to believe that in a generation we may be attaining results more significant than those that have been attained by any other nation.