HEALTH INSURANCE LEGISLATION

· 1.

BY WILLIAM DRAPER LEWIS

Professor of Law

PENNSYLVANIA'S SICKNESS PROBLEM

Forty-six and sixty-seven hundredths per centum of the men examined for the first draft in Pennsylvania were rejected for physical causes. The rate of rejections for the whole United States was only 29.11 per cent.

Philadelphia and Pittsburgh have the highest infant mortality rates of any cities in the United States. The rates among the children of the laboring classes are noticeably higher than the averate rates for the entire community. The idea that our city is healthy because many working men own their own homes is, as far as the health is concerned, essentially false. These facts concerning our city and state do not make pleasant reading, but they are facts which we citizens should know. They show that Pennsylvania has a sickness problem. The fair way to state the case is that the whole United States has a sickness problem, and that in Pennsylvania the problem is particularly acute.

The industrial loss due to sickness is very great. Our industries are losing about 16,000,000 working days each year, because of sickness among employees. Illness among employees and their families seriously reduces the industrial efficiency of employees and has a considerable effect on the labor turn over.

More than 120,000 employees in Pennsylvania are sick every day in the year, or an average of six days per year for each wage worker. In a recent sickness survey in Kensington, based on a study of a year's sickness history of 743 families (3,198 persons) it was found that the average duration of sickness among the wage workers was thirty-nine days. The Workmen's Compensation Act was passed to meet in a more scientific way the losses due to industrial accidents, and yet the wage

workers of the state are losing annually $33,000,000 in wages, because of sickness-more than four times the loss from industrial accidents, and nothing has been done to meet the problem.

2. THE BURDEN OF SICKNESS

Sickness is an evil imposing three distinct kinds of burden: (a) The pain and suffering incident to the illness;

(b) The care of the sick person;

(c) His or her incapacity for work.

3. HEALTH INSURANCE DEFINED

Definitions are seldom very satisfactory. The term "health insurance," sometimes called "sickness insurance," can properly be given to any plan which places in whole or in part the burden of carrying the cost of the care of a sick person, or the cost of compensating the sick person for the loss of earning power on a fund supported by regular payments.

Practically, however, the term health insurance as used in current discussions is at the present time a plan for the insurance of the health of the wage workers. No one is seriously discussing health insurance for the entire community. On the other hand interest in the health insurance of the wage worker is general and becoming more pronounced, especially among those more directly concerned-the wage worker himself and his employer.

4. INVESTIGATIONS UNDER WAY IN THE UNITED STATES The Legislatures of eight states have created commissions charged with the duties of investigating sickness among wage workers; the economic results of such sickness and the different plans in force in other countries or proposed in this country for the health insurance of the man and woman who work for wages. Pennsylvania is one of these states, a Health Insurance Commission to investigate these subjects and report them having been created by the Legislature of 1917.

A reason for the creation of these commissions is the growing appreciation of the significance of certain facts, namely, that there is no more important factor in a Nation's progress than the health of those who carry on production; that sickness among the wage workers is the principal cause of destitution and that America is almost the only country, other than the countries of the Far East, which has not in actual operation a system of health insurance for wage workers.

5. THE SCOPE OF THE PENNSYLVANIA COMMISSION'S

INVESTIGATION

The problem which the Pennsylvania Commission is investigating is the problem of wage workers who fall sick. That problem is a distinct problem; only, I believe, to be solved when we cease to confuse it with other grave problems of the modern industrial state. The commission has no roving commission to investigate sickness, and no desire to rove. For instance, I am asked, "what does the commission propose to do with the man who won't work, when he falls sick?" I can only reply: that man is not our problem. Or, I am asked, "What about the man who cannot get work and who through lack of proper food and shelter becomes ill?" Again, I can only reply: that while the problem of unemployment, of the maladjustment between the labor supply and demand, is one of the pressing problems which must be faced in this reconstruction period which is before us, it is not the problem of the employed man or woman who becomes sick.

7. THE LIFE STORY OF JOHN CALLAHAN

The problem of the Pennsylvania Health Insurance Commission is the problem of John Callahan. That is not his name, but it will do. The story is true. It is a typical story. Its chief incidents are events in the lives of hundreds of selfrespecting, hard working workmen and their families in this and every other state.

Seventeen years ago John Callahan entered the employ of a

great railroad as foreman. Heaven had not made him a genius and the state had not insisted on his receiving as a child more than a rudimentary education. But he was a steady worker; his habits were good and even though his physical appearance did not seem to correspond to engravings of Longfellow's Village Blacksmith, like that worthy, "He owed not any man."

And the task of keeping out of debt had not been easy. For John Callahan had married young and children had come fast. Nevertheless, he had kept out of debt, though it is probable that his wages, fair as they were when compared with the general rate of wages for the kind of work he performed, were not ever quite sufficient to insure enough food to maintain a good health standard in a family consisting of a wife and six small children.

However, that may be, he did not go into debt. He even saved something as the years passed. Furthermore, he took advantage of the two avenues of protection against sickness open to him; he joined a lodge and he became a member of the Insurance Establishment Fund of the railroad company which employed him, a fund in which all the administrative expenses were paid by the company. He was occasionally sick. Usually a cold. But he never stopped work. He could not afford to stop. True, if he had stopped work on account of illness, the two funds in which he was insured would have begun to make payments, but both these payments together would have been far below the wage which he received when at work, and that wage was barely sufficient to support his family, not to speak of the added cost due to the illness. So John Callahan remained at work, in spite of the fact that colds came more frequently and held on longer. But one day he could not go to work. He would be able to go tomorrow. Days and then weeks passed. The morrow of health did not come. The payments from the lodge and establishment funds, while they lasted, supplied only a fraction of his necessities. The savings of years quickly disappeared. The account at the corner grocer was unpaid; so was the doctor's bill. The wife cut down her allow

ance of food and took in washing, with the result that she was taken ill. So were four of the six children. Things went from bad to worse. Ready money became a dire necessity, but this man and his family were not mendicants. Credit from those two great carriers of the cost of sickness among wage workers, the doctor and the provisions dealer, they would ask; help with the children from neighbors they would accept, but not charity. Therefore $25 was borrowed from one of that accursed class who feed on the necessities of the poor. The usurer charged 10% a month. The money gone, another $25 had to be borrowed.

In the case of the particular John Callahan I have had in mind, the end of the downward course came when the sick mother carried her sick baby to the hospital, and that institution's social department found out the true facts and began the long work of re-establishing the family as a self-supporting unit; a task never to be quite completely accomplished. For although the mother was restored to health after long treatment in the hospital, and four of the six children are now well, tuberculosis will probably always claim two as invalids while the father will never be physically capable of hard manual work.

John Callahan is only one of thousands whose life history is the same. Only the details and the endings differ. He did not die; he did not become, like so many, permanently in the dependent class, because of the charity he was ultimately obliged to take. Yet think of the moral danger of permanent injury to his self-respect. Think also of the waste. Two persons invalided for life; two others ill for months; the breadwinner's earning capacity permanently reduced. And why? All because the wage worker could not afford to stop work for a few days when he was too ill to work. Disregard, if you will, the unnecessary human suffering. Look at it from the coldblooded point of view of cost to the community-a cost carried by the doctor, the neighbor, the contributor to the hospital, individual and state, and of the loss to industry of his productive power. How inefficient and bungling it all seems!