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(5) The duration of the benefit period not to exceed 26 weeks in any 52 consecutive weeks; resumption of eligibility to further benefit upon completion of a benefit period to require a qualifying period of insured employment. When first established, the law might provide for a benefit period not to exceed 13 weeks;

(6) Eligibility to be defined for those who may receive "extended" benefit because they have lost their insured status by reason of change of residence or of occupation;

(7) Maternity benefit, equal to ordinary disability benefit for a maximum period of 12 weeks (6 weeks before and 6 weeks after childbirth), to be available to gainfully occupied women who abstain from gainful employment and receive prenatal care for at least four months prior to childbirth; a lump-sum maternity benefit of $15 might in addition be furnished to each insured woman who is gainfully occupied, to the dependent wife of an insured person, and to the widow of an insured person, who receives prenatal care for at least four months prior to childbirth,

It is anticipated that, under a system of disability insurance designed along the indicated lines, from one person in each eight to one in each fourteen will become eligible to receive benefits of longer or shorter duration each year. It may therefore be expected that an active interest will soon develop among insured persons in the provisions of the system, in its administration, in the regular payment of contributions, and in the technique of collecting benefits. Because the benefits furnished by disability insurance are in their nature comparatively frequent and inevitable, it will be highly desirable that there shall be integration of the local administrative facilities which may be developed for disability insurance, unemployment compensation and other measures designed to give economic security.

E. HEALTH INSURANCE

We have submitted proposals for the development of more adequate public health services and of more extensive facilities for public medical services, and have recommended a system of insurance against wages lost on account of disabling illness. There remains the problem of enabling self-supporting families of small and moderate means to budget against the costs of medical care needed by their members.

When reporting to the President on January 15, 1935, we expressed the view that this major problem also required application of the insurance principle. We added:

"We are not prepared at this time to make recommendations for a system of health insurance. We have enlisted the cooperation of the advisory groups representing the medical and dental professions and hospital management in the development of a plan for health insurance which will be beneficial alike to the public and the professions concerned. We have asked these groups to complete their work by March 1, 1935, and expect to make a further report on this subject at that time or shortly thereafter. Elsewhere in our report we state principles on which our study of health insurance is proceeding, which indicate clearly that we contemplate no action that will not be quite as much In the interests of the members of the professions concerned as of the families with low Incomes."

Our research staff prepared a series of proposals which were submitted to our professional advisory boards in November. These proposals were then revised and again submitted, in January and February, to these advisory boards and to the Nursing Advisory Committee which we had created in the interim. In the interim also the staff and its associate members conferred with the officers of the Bureau of Medical Economics of The American Medical Association. It is very gratifying to us that the distinguished members of these boards gave generously of their time to examine critically the plans developed by our staff and aided us greatly by their counsel.

During the course of these conferences every substantial technical question raised by any member of these boards was met by appropriate revision of the tentative proposals or by the addition of new proposals. It is significant that the changes made as a result of these conferences did not require any important alteration in the general pattern of our proposed system of health insurance. We are therefore confident that the general pattern is sound.

We pointed out in our first report that insurance against the costs of medical care is neither new nor novel. In the United States we have had a long experience with sickness insurance, both on a non-profit and on a commercial basis. Commercial sickness insurance has been too expensive for people of small means.

Some plans recently started to deal with medical costs, some under commercial and some under professional auspices, have not been insurance plans at all, but merely plans for paying sickness bills by installments. Installment payment or credit bureaus, whether operated by commercial or non-profit agencies, by professional or lay groups, do not offer a sound solution of the public need for security. Nor can the voluntary organization and administration of a credit bureau by parties interested in its finances be accepted as a proper substitute for the broad responsibilities of public authority.