Library Collections: Document: Full Text

March 7, 1935

Preliminary Draft (Revised after meeting of the Executive Committee of the Technical Board and the Sub-Committee on Health Studies.)

REPORT TO THE PRESIDENT OF THE COMMITTEE ON ECONOMIC SECURITY

FINAL REPORT ON RISKS TO ECONOMIC SECURITY ARISING OUT OF ILL HEALTH

TABLE OF CONTENTS

Letter of transmittal

Summary

A. Nature and magnitude of the risks

B. Public health services

C. Tax Supported medical facilities and services

The medical needs of persons for whom the government assumes some responsibility

The extensive and serious needs of many rural areas

The insufficient support in many localities of certain medical services important to the public health

D. Insurance against temporary disability

Suggestions for State legislation

E. Health insurance

General outline of the plan

Summary of conditions which may be required of approved State systems of health insurance by the proposed Federal law

Suggestions for State legislation

F. Conclusion

Appendix: Some further suggestions for a State health insurance law, professional relations, responsibility and remuneration

LETTER OF TRANSMITTAL

Washington, D. C., March , 1935.

THE PRESIDENT,
The White House.

Dear Mr. President: In your address to the Conference on Economic Security on November 14, 1934, you said:

"There is also the problem of economic loss due to sickness -- a very serious matter for many families with and without incomes, and therefore, an unfair burden upon the medical profession. Whether we come to this form of insurance sooner or later on I am confident that we can devise a system which will enhance and not hinder the remarkable progress which has been and is being made in the practice of the professions of medicine and surgery in the United States." The Committee on Economic Security has made careful studies of the problem of economic loss due to sickness, of American conditions and needs, and of measures which have been used to deal with the problem in America and in other countries. In its report of January 15th, 1935, the Committee made certain recommendations for the expansion of public health services to prevent ill health. These measures you recommended in your message of January 17th, 1935 to the Congress and they are incorporated in legislation now pending in the Congress. Our recommendations on other measures for protection against sickness and against the costs of medical care were postponed at the request of advisors in the fields of medicine, hospital management and dentistry, in order to allow for more time to study the professional aspects of tentative proposals developed by the Committee's staff.

The Committee is now ready to make a further report on the provisions for certain types of public medical services and for Federal-State plans of insurance against loss of wages due to sickness and against the costs of medical care among the lower income groups of the population.

For several months the Committee has had the valuable counsel and assistance of experts in the fields of medicine, public health, hospital management, dentistry and nursing, and, on the subject of health insurance, of the staff of the Bureau of Medical Economics of the American Medical Association. The technical assistance rendered by members of these groups or their membership on the advisory boards and committees should not be interpreted as committing them either for or against legislation for health insurance. The responsibility for this report rests solely with the Committee whose members have given careful consideration to the technical advice rendered as well as to various statements which have been made in response to invitations for expressions of opinion.

The present report contains a brief presentation and analysis of the needs for meeting the economic losses due to sickness and a series of recommendations for the extension of public medical facilities and services and for insurance against lose-sic- of wages due to sickness and against the costs of medical care. Taken together, the recommendations presented in our report of January 15th and in the present report constitute, we believe, at least the beginnings of a national program for the protection of the population against disease, for the promotion of the extent and quality of medical care, and for the protection of the people against economic insecurity arising out of illness.

Although we realize that a difference of opinion exists as to the advisability of establishing compulsory health insurance, we are convinced, after reviewing experience in this country and abroad, that the compulsory feature is essential to the accomplishment of the end in view. Nevertheless, our proposals on health insurance are especially cautious; they call for no drastic or hurried Federal action. In this field of social insurance, we are, in effect, merely proposing that the Federal government shall undertake to give small financial aid to those States which develop systems of health insurance designed with due regard to necessary safeguards. In view of the obvious needs of the low income groups of the population, less than this would leave us culpable of having failed the American people in their need for security against the financial burdens arising out of ill health.