socialize our workmen's compensation laws. By that I mean the absolute exclusion of casulty insurance companies by the writing of risks under the workmen's compensation laws. The making of private profits out of the misfortunes of the workers is intolerable. It was a costly and inexcusable blunder to have allowed the casualty companies to make use of the compensation laws for the purpose of exploiting the injured workmen for profit. The way to remedy this blunder is to remedy it. All stock insurance companies should be excluded at the earliest possible moment from writing workmen's compensation insurance. All incentive for meddling in the administration of workmen's compensation laws should be taken away from insurance companies.

The next logical step after the revamping and extension of our workmen's compensation laws would be the enactment oi invalidity and old age insurance legislation. If a practical way can be found, I should favor contributory insurance to cover these hazards. However, I regard the payment by the worker in whole or in part, for insurance against invalidity and old age as a mere detail. It makes little difference in the results whether the workers pay or the state pays, as is demonstrated by the operation of the British non-contributory Old Age Pension Act. Administration is greatly simplified and rendered cheaper if insurance premiums are assessed on the different industries or the community as a whole.

For some time past_attention has been centered upon health insurance almost to the exclusion of all other forms of social or pseudo-social insurance. In fact, the term social insurance has been perverted in the minds of many to mean merely health insurance. As was to be expected, some of the most powerful insurance companies have professed a profound friendliness for the general principle of health insurance at the same time that they have strenuously fought any practical program for the establishment of a health insurance system.

Many curious arguments have been urged against health insurance. It is stated, on the one hand, that illness is relatively negligible in this country, and, on the other hand, that it is so widespread that any insurance scheme would necessarily break down because of the enormous expense involved. On the third hand, it is stated that we know nothing about how much illness there is in this country-whether there be much or little. It is

also argued that illness has none of the disastrous consequences in this country which obtain in the poorer and more populous European countries. It is asserted that the working people have incomes sufficient to enable them to hire physicians to care for themselves and their families; that a job always awaits the worker upon his recovering from illness. The experience of social workers certainly does not confirm these allegations. Illness is all too frequent in this country and is fraught with most serious consequences. Until after the outbreak of the great war unemployment had been the greatest curse of the workers of the country. Even today in the face of what is commonly denominated by employers as a terrific dearth of labor, men are still being scrapped at the age of forty, while in European countries men continue in active employment well beyond the age of sixty. Even if it is now true that workers who do not have too many white hairs may readily find employment, that has nothing to do with the question of providing adequate medical, surgical, and hospital treatment for the worker when he is ill and the payment of money benefits in order to sustain his family in something akin to decency during the period of his illness.

It is alleged that there are voluntary methods of providing adequately for working people. It is asserted confidently that nothing is known about the extent and the adequacy of voluntary benefit funds of trade unions, establishments, and mutual associations. It is a sufficient answer to this allegation to call attention to the 23rd Annual Report of the United States Commissioner of Labor in which are given the results of a very complete study of these voluntary sickness benefit funds. At the present time the United States Bureau of Labor Statistics is engaged in making another study of trade union and establishment funds. The conditions as shown in the 23rd Annual Report of the Commission of Labor Statistics have not materially changed. None of the trade union sick benefit funds provides for medical, surgical, and hospital treatment. Only a very few provide sanatoria and homes for the aged and disabled. All the voluntary agencies combined make quite inadequate provision for only a small minority of workers and they the least needy of them all. Under the voluntary system, if it be lawful to call such chaos a system, the people who are in most need of sickness and other insurance do not get it at all and only those who are best situated economically are able to purchase insurance.

If I believed that social health insurance was merely a system for dealing out doles in relief to the families and dependents of sick workmen, I would have very little enthusiasm for it. It is because I know that health insurance will call attention to the costliness of illness that I am in favor of universal compulsory health insurance. It took compulsory workmen's accident compensation to bring home to the employers the fact that every accident costs money whether it is compensated or not. We have already realized in part at least that accidents are terribly expensive; that the expensiveness of accidents did not begin with the enactment of compensation laws, but that some one must inevitably pay the piper. Before compulsory accident compensation laws were enacted the burden fell upon the workers almost entirely because the workers were least able to bear the burden and were, therefore, unable to escape bearing it. What is true of disabilities from accidents is true of disabilities from illness. Health insurance legislation can neither increase nor decrease the burdens due to illness, except as such legislation increases or decreases the amount of lost time due to illness. One effect of compulsory health insurance will be to remind employers very forcibly that sickness is uneconomical, wasteful; that sickness costs real money to the employer and the public; and that much existing illness is either preventable or curable.

A favorite argument against all social insurance is that it is socialism. This strikes me as being the most telling argument for socialism that could be uttered. Instead of condemning social insurance, it highly commends socialism. I do not happen to be a socialist, but if it is socialism to provide adequate protection to the lives, health and well-being of our working population, then let us have some more of the same.

Another stock objection to social insurance is the incompentence of public officials which leads to extravagance in administration. There is unfortunately much truth in this allegation. However, no trustworthy data as to the cost of state insurance as compared with private insurance has ever been worked out. From such data as exist, however, it appears that the premium rates under true social insurance could be increased 50 per cent because of incompetence and extravagance in administration and yet leave a margin in favor of social insurance as compared with private, competitive, profiteering insurance. If the public are unwilling to trust themselves to conduct insurance

economically, efficiently and honestly, they can still secure the benefits of social insurance by establishing mutual associations for the administration of the funds. A genuine mutual association has practically all the advantages of state conducted insurance mentioned above and it is free to conduct its affairs so as to secure the greatest efficiency.

AFFIRMATIVE DISCUSSION

INSURANCE OF THRIFT 1

If we could assume that all human beings were born with equal physical and mental stamina; that they were given an adequate preparation for life; that they never had to go without work for a great length of time; that they never had sickness of more than a few days duration; that they could hold their positions as long as they lived; that they will not live for an extended time beyond the point when they are compelled by advancing years to quit work; and that they will not die at a time when small children call for protection, we could rely upon individual thrift to provide for our wants throughout life. But life is not lived that way by the majority of people. Some are born with physical or mental weaknesses; some are handicapped by accidents or diseases in early life; some have sickness either of the worker or members of the family lasting months or years; in periods of depression some may be out of employment for months; large numbers live many years beyond the time when they can earn their living; while thousands die in the prime of life, leaving helpless dependents. Still others, from one calamity or another, such as fire, business failures, bank failures, and stock swindlers, lose the accumulation which they may have saved to meet life's contingencies. Mere saving by itself cannot provide safeguards against the overwhelming character of one of these many disasters that may come to the thrifty and thriftless alike. Individual thrift, as usually understood, cannot provide for these calamities because none of these calamities can be measured in the life of an individual.

No one can tell the extent to which one of these calamities may affect him. One cannot tell whether he is to be sick six days or six months during the coming year, or how many months unemployment may be forced upon him by business depression, or

1 From article by John A. Lapp, Managing Editor of Modern Medicine. Annals of the American Academy. 87 21-6. January, 1920.