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We are of the opinion that the Federal aid recommended above, although specifically limited in terms of the annual maximum cost, meets the needs of a sound program of economic security against this risk arising out of illness.

Summary of Conditions Which May Be Required of Approved State Systems of Health Insurance by the Proposed Federal Law

1. The State shall establish a health insurance law which accepts the provisions of the Federal law and which will require contributions from employed persons or from employed persons and their employers, such contributions to be a fixed percent of earnings.

2. Federal grants shall be made in respect to persons having wages not exceeding $250 per month.

3. The State law may specify persons in certain occupations or employed in establishments having less than a specified number of persons as excluded from the group from whom such contributions are required.

4. Federal aid shall be available for other persons who fall within similar income limits and are admitted under necessary administrative regulations to voluntary participation in the health insurance law.

5. The State may specify a lower limit of earnings below which persons shall not be required to contribute to a health insurance system, provided that appropriate payments in their behalf are made by their employers or from State and local public funds.

6. The State law shall entitle insured persons and their dependents to physicians' services and hospital care, and may also entitle them to such services in dentistry and nursing and to such medicines and appliances as the State law may specify.

7. The State shall set up a single State authority responsible for the administration of the law throughout the State, and necessary authorities within subdivisions of the State for the local administration of the law.

8. The State shall grant such representation in the administration of the law to the professions and agencies concerned with furnishing medical services as will be conducive to the maintenance of high standards of service and the advancement of the sciences and arts concerned with the care, study, and prevention of disease; and in particular shall provide:

a. for a State board or medical authority, responsible to the general State authority administering the law, and having immediate jurisdiction over the medical features of the law;

b. for such additional professional boards or authorities as may be deemed necessary by the State, affecting respectively hospitals, dentistry, and other professions or agencies which may be concerned with furnishing services;

c. for freedom on the part of all licensed practitioners of medicine and dentistry to furnish or to decline to furnish services under the law;

d. for freedom of choice, under rules of procedure necessary to maintain standards of service and economy of administration, on the part of the patient from among all local practitioners and agencies entitled to furnish services under the law;

e. for determination, at the initiation of the professional authority, of specialist services to be furnished under the law and for the designation of those entitled to furnish such services;

f. for participation on the part of the professions and agencies concerned in furnishing service in the determination of standards and procedures of remuneration and in the adjudication of differences or disputes affecting professional matters.

9. The State law shall exclude agencies organized for profit from the administration of the act in the State and its subdivisions.

10. The State shall provide for the proper care and safeguarding of health insurance funds and shall make full and complete reports to the Social Insurance Board in accordance with the rules and regulations to be prescribed by the Board.

11. The public health authorities of the State and its localities shall be closely correlated with the administration of the law.

Suggestions for State Legislation

Health Insurance operated through state-wide systems cannot be uniform throughout the States or even within a State which has widely different conditions of occupation, density of population or available facilities for medical care. It is expected that as certain economic problems of medical care are solved through insurance some of the inadequacies in the supply of professional personnel will be rectified through better distribution and in the supply of hospitals and other Institutional facilities through their construction in areas where they are needed and can be supported. Such adjustments will come especially as between urban and rural areas. There will still remain, however, differences in conditions which will require differences in the plan and administration of health insurance practice.

It is not practicable to outline a single pattern for health insurance in the States. It is possible, however, to outline suggestions for State legislation which will utilize the results of our studies and meet the goals of our proposals.