HEALTH INSURANCE FOR ALL
Murray, James E.
Health Insurance for All by JAMES E. MURRAY This is the first of a series of articles exploring the highly controversial field of medical economics. Senator Murray's argument for a national health...
...To any one who uses words honestly, "socialized medicine" means a system in which hospitals are owned and operated by government and the physicians and other practitioners are employees of government...
...But will that day of adequacy ever come without national health insurance...
...Last summer, after fen years of the present system, 89 Britons gave the service a favorable rating for every four who were unfavorable...
...Others who, with their dependents, generally cannot share the advantages of group insurance but must rely on higher-cost individual insurance or none at all include farm families, the self-employed, employees of small firms in many communities, domestic workers, migratory farm workers, the three million unemployed, and those persons whose health is already impaired to a degree that interferes with regular employment in an insurable group...
...News and World Report, rounding up British doctors' complaints in its issue of April 9, commented that you seldom meet anyone who advocates an end to the program...
...Under national health insurance, the doctors would not be employed by government...
...Temporary safeguards would be required to avoid a harmful bidding up of rates and prices...
...A Gallup Poll bears this out...
...67 per cent of the doctors said they would favor starting the program, against 31 per cent who would not...
...This is a valid concern...
...Since voluntary insurance is now paying only one-seventh of all bills actually incurred for medical care, it obviously is paying an even smaller fraction of the bills that ought to be incurred if all our people are to enjoy good health...
...Services of family doctors and specialists would be covered...
...Seven—Those persons, including the needy, who do not qualify as insured individuals, or their dependents, would receive the same health service as the insured...
...Some have suggested that introduction of national health insurance should await the day when we have enough doctors and hospitals...
...Also insured would be self-employed persons, all persons entitled to old-age, survivors, or disability benefits under the Social Security Act, and all who are entitled to an annuity under the Federal Civil Service Retirement Act...
...Add income losses from longjterm affliction, premature deaths, and work-conneoted disability, and the amount becomes several times larger...
...Ironically, many of our friends abroad regard the United States as an "underdeveloped area" for public health insurance...
...The nation cannot afford only a small fraction of protection...
...This is a big order...
...Within its limited availability and the fine print restrictions in the contracts, voluntary health insurance has helped millions of people to meet most of their hospitalization expenses and some of the expenses of surgery...
...Three—Each individual would be free to choose and to change his doctor, hospital, or dentist...
...What we have in operation is a multitude of diversified insurance plans, only partly coordinated...
...Almost daily we hear of some new and dramatic breakthrough in a critical area...
...Dental care and home nursing to a limited degree would also be given...
...National health insurance is that alternative...
...The need for action is in the financing and distribution of services...
...Such advances would help to limit medical care expenditures if other medical and economic developments pushing in the opposite direction had not created a persistent rise in the unit cost...
...Five—Each insured worker would pay 114 per cent of his income from employment—up to a limit of $90 a year on earnings of $6,000 or more...
...Two—Insured persons and their families would be entitled to comprehensive medical care...
...His report showed that the progress of medical science has been gratify-ingly wonderful, that its promise is tremendous...
...At the same time, British general practitioners were asked whether they would now favor starting the program if the choice were open...
...Up to now the approach has been on a piecemeal, temporizing basis, through segmented plans of voluntary insurance...
...Too many of us have been lulled by the dulcet assurances of the AMA, sedulously circulated by the advertising talents of Madison Avenue, that voluntary plans will take care of all our health needs...
...It calls for correspondingly broad action...
...National health insurance will back up existing needs for service with enough stable purchasing power to assure adequate and steady professional income...
...Gregg...
...In fact, there is no single canopy of voluntary health insurance...
...A typical list of medical services which could be purchased for $100 in 1945 had been marked up to $164 by March, 1957, a greater rise than for the consumer price index as a whole...
...But U.S...
...Significant items of expense are still generally considered uninsurable: • Dental care is as urgent, expensive, and difficult to budget for many families as is hospital, surgical, or medical care...
...Improved therapy and medicines have permitted a drastic shortening of hospital confinements for maternity cases and many ailments...
...If we continue the long wait for voluntary programs to do the job, we shall pay out many times more, over the next generation and longer, in wasted manpower, lost production, and needless suffering...
...curative treatment in the hospital, doctor's office, or patient's home...
...What is national health insurance...
...In 1955, the aggregate of medical care expenditures in 'the United States was nearly 18 billion dollars...
...laboratory and X-ray services...
...They would remain independent practitioners...
...Of course, the inauguration of national health insurance would mean a significant immediate increase in effective demand for health services...
...At the outset, primary attention would be given 'to improving the distribution of available services...
...Many of these developments were interpreted for readers of The Progressive by Selig Greenberg in the April issue...
...The newer medicines, newer technology, and more "specialized specialists" are not yet in the basic list priced by the Bureau of Labor Statistics...
...Vigorous opposition by leaders of organized medicine has retarded the spread of group clinics and insurance plans designed to give comprehensive prepaid protection...
...The big change would be in the method of paying bills...
...The British Medical Association has said its members "are pleased to be relieved of the labor of sending out bills and are glad that financial considerations need no longer play a part in deciding how frequently to visit a patient...
...It calls for a national health insurance program...
...when they are they will push actual costs still higher...
...Such insurance has long 'been accepted as routine in the Scandinavian countries and Western Europe...
...Socialized medicine has never been advocated by those who favor national health insurance...
...In 1955, about twcnthirds of our $18 billion medical care bill was paid by individuals, families, employers, and private philanthropy...
...There is no possibility that these separate systems could somehow coalesce into a generally protective canopy without creating intolerable overlaps and incredible waste...
...Personnel and facilities will increase more rapidly when, through insurance, the money to pay for services is assured in all areas...
...On the contrary, national health insurance would render unnecessary the further growth of government-operated medicine...
...Congress could add as much as $2 billion from general revenues...
...Senator Murray, long a front-line fighter for national health insurance, has been a member of the U.S...
...Actually, many people would have freer choice than now, because practitioners would be attracted to many areas now inadequately served...
...Employers would match these payments, just as they now do under the social security system...
...Only eight to ten million Americans have major medical expense insurance that covers the well-named "catastrophic" illnesses—and even for these people there are many individual exclusions of types of risks, as well as dollar-maxima and time-limits to the insurance protection...
...Yet the voluntary insurers and the dental profession have barely begun their first cautious studies of the possibilities of prepayment and group plans...
...This year it will probably exceed $20 billion—an average of more than $100 a year per capita...
...The health services which people must now forego are not reflected in the totals of current expenditures for health care...
...Hospitals would remain independent...
...These pressures threaten to become irresistible unless an adequate alternative is adopted...
...Gregg was talking about the beneficial effect of prepayment, through insurance, on both medical economics and medical technology...
...Otherwise the profession may be overwhelmed by the newly effective demands for service and the quality of care may be impaired...
...With national health insurance, we can eliminate barriers that have foreclosed adequate medical care for millions...
...In contrast with medical technology, the financing of medical care has evolved at a snail's pace...
...have assiduously endeavored to pin on national health insurance the false label of "socialized medicine" and to conjure up a picture of patients and doctors "regimented" by the federal government...
...Our medical care problem arises from inequalities: inequalities in incomes, in the needs for health services, in the availability of insurance protection, in the ready availability of medical services...
...This would include preventive and diagnostic examinations...
...About eleven per cent of all families accounted for 43 per cent of the charges for personal health services...
...Nine—Each state would develop a program to encourage maximum participation and efficient use of health practitioners and facilities, and also to improve the available supply and its distribution...
...It would distribute each person's costs over his working life instead of lumping them in his years of greatest adversity...
...Patients would be guaranteed free choice...
...The wish fosters the belief that rising costs will soon be covered by the spreading umbrella of voluntary health insurance...
...Senator Murray's argument for a national health insurance program for the United States will be followed in early issues by articles examining the operation of other and more all-embracing programs of state planning in medicine—up-to-date reports on the workings of socialized medicine in Great Britain, public-private health schemes in the Scandinavian countries, and the totally socialized system prevailing in the Soviet Union...
...Those who took part would be paid from the insurance fund in amounts and by methods which they or their representatives negotiated...
...Only some five million people are accorded the financial security and preventive benefits of comprehensive health-care contracts...
...Financial and other incentives would be provided to make practice more attractive in areas now neglected, to assure high standards of service, and to encourage constant improvement...
...A sixth of the nation's families were in debt for hospital and medical services...
...Many countries do operate systems of socialized medicine...
...They do not even get into the national income accounts, except in a negative sort of way, for they represent a tremendous, irretrievable loss of productive power, lowering the national income below what it would otherwise be...
...Senate for 23 years.— The Editors...
...James H. Means of the Massachusetts General Hospital pointed out that "Blue Shield added to Blue Cross does not really constitute a comprehensive health plan...
...To say that voluntary insurance has not solved and is not likely to solve the problem of insuring good medical care for everyone is not to belittle or deny its positive contributions...
...One inescapable fact emerges: the price tag on the package marked "good medical care"—always too high for many families—is growing too fast for most of us...
...Medical schools will expand, augmenting the supply of doctors, when the effective demand for them gets tangible expression through the insurance system...
...About one-third was paid by government military personnel and veterans, the five million persons on public assistance, the mentally ill, the tubercular, and public community hospitals and clinics...
...Voluntary health insurance has shown that risk-sharing and prepayment are feasible...
...Improved services are technically feasible...
...special appliances and eyeglasses...
...An adequate program, moreover, would distribute each year's costs over the whole population instead of letting it be concentrated on those who suffer illness in the year...
...Short-term non-occupational illness and disability alone were responsible for wage losses estimated at $6.6 billion in 1955...
...An adequate program must protect each family and individual against all significant risks, include adequate preventive services, and remove present barriers to early treatment...
...In their efforts to befog the issue of public policy, spokesmen for the A.M.A...
...If one considers the people and the types of risk now denied insurance, it becomes clear the 1955 rate of expansion cannot possibly be maintained...
...The federal role would be limited substantially to collecting funds for distribution through the states to local practitioners and service agencies, and to establishing broad operating standards...
...The truth is that the umbrella simply is not big enough, cannot spread its protection fast enough, is too thin, and has too many holes to do the job...
...Timid and temporizing proposals, like the Eisenhower Administration's flimsy plan for reinsurance, will not make a dent on the problem...
...The situation is almost certainly worse today...
...It tackles the problem as a whole, just as a first-rate general practitioner concerns himself with the whole individual, not with specific symptoms alone...
...Eight—Insurance operations would be managed within local areas under a plan adopted by each state...
...Freedom and privacy in the doctor-patient relationship would be safeguarded...
...Alan Gregg, an eminent medical authority and vice president emeritus of the Rockefeller Foundation, recently observed that for an insurance payment of $100 a person a year, medical science "could give a service the like of which has not ever been known, a service of a thoroughness, convenience, and efficacy such as to reduce the incidence, the severity, and the cost of present illness in our population...
...Nothing less will do the job...
...Ten—At current levels of employment and earnings, the payroll contributions would be about $6 billion a year...
...Pressures are mounting inexorably for expansion of these publicly operated systems of medical care and for opening them to additional selected categories of individuals...
...If the costs of medical care continue to rise," says the Department, "the volume of benefits must increase even more if the same level of protection previously afforded is to be continued...
...How far have we actually progressed in covering medical risks by • insurance...
...Four—Physicians, dentists, and others providing services would be assured full freedom of professional practice, including the right to accept or reject any patient...
...Forty-five countries t had public health and maternity insurance programs in 1955 compared with 23 in 1935...
...The answer is emphatically in the negative, because Dr...
...For a far larger number, the insurance proves to be negligible or zero...
...It is important to note that these price comparisons are cast in terms of an unchanging list of medical services based on spending patterns of 1951-52...
...the more costly prescribed medicines...
...Each would be free to locate where he wishes and to participate in the insurance plan or stay out...
...Since January 1953, the average cost of medical care has advanced more than 14 per cent...
...Soon, as the number of practitioners and facilities became more nearly adequate, emphasis could shift to general improvement of standards of service...
...One—It is a nationwide insurance system on a contributory basis, similar to our successful, time-tested programs of old-age and survivors' insurance and unemployment insurance...
...This in itself would raise the general level of health...
...It would be a specific goal of the program to make available in all health-service areas the full range of medical, hospital, and other personal health services...
...In 1957, the American people, beguiled by propaganda of the American Medical Association, are still recapturing through health insurance only a small part of their medical care expenses...
...Many diseases formerly considered chronic, or requiring extended hospital treatment, are now quickly curable...
...The Department of Health, Education, and Welfare reports that the rise in benefits was "only sufficient to increase by 1.8 percentage points the coverage of ithe national medical care bill...
...The proportion of the • medical bill insured differs widely for individual families...
...This is, by a wide margin, the most rapid increase for any component of the price index, and a factor in the more than four per cent increase in overall living costs...
...One further fact should be obvious: many more Americans could afford the 1957 model if medical economics were as up to date as medical technology—and as dedicated to the general welfare...
...But about a third of our population still does not have even the most common type of protection, hospital-expense insurance...
...Five years ago, Dr...
...Almost half of the $18 billion was "potentially insurable," as indicated in a report of the Department of '. Health, Education and Welfare...
...In 1952-53, half a million families had medical bills exceeding their entire annual income...
...MEDICAL RESEARCH and tech-nology have recorded fabulous advances in the dozen years since World War II...
...The states would be encouraged to make agreements with voluntary health services and insurance plans...
...The United States itself has plenty of selective examples of this approach in our military and veterans hospitals and other public institutions...
...The total would equal nearly 90 per cent of present "potentially insurable" private expenditures for medical care...
...National health insurance offers a comprehensive approach...
...For a fortunate few, all or nearly all the expense is covered...
...Has this high level of expenditure for medical care brought us the high level of service envisaged by Dr...
...The 15 million Americans over age 65 find themselves with limited or shrinking insurance protection, or entirely excluded from health insurance, at the very period in life when they have the most need for medical services and are least able to budget for the cost...
...In achieving its recent expansion, voluntary insurance has skimmed the cream...
...While health insurance benefit payments in 1955 (the latest year reported) were nearly one-sixth higher than in 1954, the need was climbing almost as fast...
...We can provide all the American people with a quality and completeness of health service the like of which has never been known...
...In j practice, only $1 in every $7 was ac- \ tually insured...
...The American Medical Association often points to the growing pains of the British National Health Service as signs of failure...
...Thirty years is a long time to wait when an effective solution is already at hand...
...But assume it could continue: it would be 30 years or more— 1986 or later—before voluntary insurance covered substantially all the expenses considered by the Department to be "potentially insurable," i. e., the fees of physicians, hospitals, dentists, and nurses, and one-third of expenditures for drugs and appliances...
...and most important, 'the two together make no provisions for preventive medicine...
...The insurance fund would pay their premiums...
...Financing would be arranged between the health-insurance system and appropriate public agencies...
...Six—Members of a voluntary health insurance plan that meets minimum standards could continue to obtain their medical services from that plan...
Vol. 21 • June 1957 • No. 6
