2.

A cash benefit equal to two-thirds of wages will relieve financial stress during the illness of the bread winner.

3. The maternity benefit provided for the wives of insured workmen and for insured women will supply a pressing need.

4. The funeral benefit provided by this bill meets one of the industrial worker's most deeply felt needs. C. The proposed method of dividing the cost among employer, employee, and state distributes the burden of sickness fairly and wisely.

I. The employer is partly responsible for illness and would benefit by its prevention.

2. The wage-earner is partly responsible for illness and would benefit by its prevention.

3. The state is partly responsible for illness and would benefit by its prevention.

4.

The proposed distribution of cost will put health insurance within reach of those who otherwise would lack it.

5. The proposed division of cost between employer and employee offers the advantages of democratic control.

D. Health insurance will stimulate the needed campaign for the prevention of illness.

TRADE UNION SICK FUNDS AND COMPULSORY HEALTH INSURANCE1

Trade unions, through voluntary action, have made attempts to provide forms of health insurance. While their actions may be regarded as purely experimental and have proven, in most instances, inadequate, yet they have been productive of much good. But the burden of taking care of workers who are ill and providing for them adequate hospital and medical service is altogether too great to be borne by these voluntary organizations. Besides, as a rule, those who need help most are those who fail to avail themselves of the benefits offered.

1 By William Green, Secretary-Treasurer, United Mine Workers of America. Stone Cutters Journal. 32 5-6. April, 1917.

The greatest burden, however, borne by the members of voluntary organizations providing for health insurance, and that which makes it well nigh unworkable, is the cost incident thereto. This is the experience of each and all. There is no exception to the rule. The report of the officers of the International Typographical Union, dealing with this special subject and showing the cost of maintenance of the printers' home for aged and disabled members of the union, together with the benefits paid to superannuated members, proves conclusively that it is only a question of time when the financial burden necessary to meet the payment of the cost of maintaining the home and the compensation to be paid as invalidity and old age pension claims will be so great that it can not be continued.

And why should the working people themselves bear this financial burden? There is no good reason why the care of the sick, the aged, and the disabled among the working classes should be borne by the working people alone. Industry and society at large should both be required to bear their share of this burden. It has been stated by eminent men who have given this subject much thought and who have investigated the matter carefully that a very large per cent of working people become permanently incapacitated because of lack of proper medical attention when ill. Even when the disability is not permanent the illness extends over unnecessary periods of time for this same

reason.

Inasmuch as each worker is a social unit society is vitally interested in promoting and maintaining at the highest standard the efficiency of each worker. Loss of time, inability to work, the removal of each social unit from the field of industrial activity, means, in the last analysis, a distinct loss to society at large. Looking at this matter from this point of view it is clearly obvious that society is benefited by promoting and preserving the health and vitality of each productive social unit.

Any scheme of health insurance, invalidity or old age pensions, in order to be successful, equitable, and just, must provide, in my opinion, that the cost incident thereto be borne by employer, employee, and the state. The adoption of such a plan would impose a minimum burden upon all classes of society.

Objection has been raised by some representative men, prominent in trade unions, to any compulsory plan of health insurance,

invalidity or old age pensions. The chief objection advanced is that the compulsory plan interferes with the freedom of the worker and curtails his normal activities; that it deprives him of his liberties and takes from him certain inherent rights that should not be interfered with. Such an objection, at first, would seem well founded. In fact it was vigorously advanced when compulsory compensation laws were first proposed. Employers of labor entered most emphatic objection to the passage of a compulsory workmen's compensation law on the ground that it interfered with personal freedom and liberty of action. In human affairs there is no such thing as absolute freedom and liberty of action. In all the normal activities of life one must so regulate himself and his affairs as to have proper regard for the rights of others. Society has ordered, through legislation on almost all subjects, that the freedom and liberty of every individual must, in some degree, be surrendered. There is more or less compulsion applied to the conduct of all human beings in all walks of life. Industrial development and the interrelations of society will not permit any person, no matter what may be his station in life, to become isolated or live unto himself alone. The social order requires that each unit must discharge certain duties. The care of those among the workers who are ill, incapacitated, or who through age are no longer able to earn a livelihood, will not be voluntarily assumed. Therefore, as a matter of public concern and in the interest of the public welfare, compulsory legislation, requiring the assumption of such care, seems to be the only feasible plan to which we can resort.

Personally, therefore, I do not share the belief of some men that a compulsory plan of health insurance will be detrimental to the wage-earners. As above stated, I can conceive of no other plan which would be successful. It seems to me that the experience of voluntary action and voluntary organizations fully justifies such a conclusion. It is of supreme importance, however, that any legislation of this character, providing for health insurance and for kindred forms of social insurance, should be drafted and proposed only after careful study, investigation, and mature deliberation on the entire subject. Health insurance should provide for proper medical care and hospital service, also weekly financial benefits, so that the incapacitated worker and his family may be properly cared for during his illness.

Invalidity and old age pensions, it seems to me, ought also to be paid out of a fund provided by employer, employee and the state, and administered by the state. In fact, this whole scheme of social legislation, herein referred to, ought to be exclusively under state control and administered by state authority. Employers and employees, as well as the state, should be proportionately and properly represented upon the boards of administration. This would overcome much opposition to compulsory action because each group of society would be justly represented. This fact would inspire confidence in the plan and insure the fullest and heartiest cooperation.

HEALTH INSURANCE 1

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 fourteen million 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 2 per cent of the wages bill. The industries of a state are hardly placed in jeopardy by a 2 per cent 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

1 New Republic. 6: 200-1. March 25, 1916.

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 threequarters 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 cannot 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 onethird 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 fails 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,