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Population Coverage and Contributions. -- A State law should require that employed persons, themselves or jointly with their employers, within certain limits of income (for example, up to $250 per month) would pay into a State fund a specified percentage of earnings, and would be entitled to receive medical services, in health and in sickness, for themselves and their dependents. The population which a State law required to be covered would, for practical purposes, have to be defined in terms of employed persons, although the social purpose of the plan involves medical service also to their families. A State law may fix the upper income limit lower or higher than $250 per month, but it would receive no Federal aid toward the cost of benefits furnished to persons with incomes in excess of this figure. Earnings named in money figures may here be interpreted as applying to urban populations, and may require adjustment with respect to rural population and perhaps with respect to differences in cost of living between different sections.

Certain groups of persons, such as those who are employed in small businesses, also farmers and farm laborers, domestic servants, employees of small establishments, cannot be brought into a contributory health insurance scheme as readily as industrial employees. Such persons may not be required to be insured by law, but should be admissible to insurance on a voluntary basis if within the income limits specified.

As has already been pointed out, a minimum limit of earnings may be specified by State law below which contributions to health insurance funds are not required. Employed persons whose earnings are below this limit and their dependents, together with persons who have no incomes, may be brought into health insurance by payment of appropriate amounts in their behalf from public funds of the locality or of the State, or both. In this way the scheme of medical care for persons in need of public assistance and their families might be unified, if desired, with medical care under the contributory health insurance system.

The families of farmers and of farm laborers and the population of predominantly rural areas should be brought into health insurance on a basis appropriate to the conditions in such areas. In the more sparsely settled communities the use of physicians, salaried or subsidized from tax funds or from contributed health insurance funds, may be a proper method.

So far as may be practical, an upper income limit for those who are required by legislation to be insured should agree with similar limits for unemployment compensation and disability insurance.

A payment of about 4 percent of earnings from the population groups of small and moderate incomes would be sufficient to provide most of the medical services required. The law might, however, as described below, provide for only certain forms of medical service with a correspondingly diminished rate of contribution, and might provide that a certain share of the contribution shall be paid by the employer, particularly for persons with smaller incomes. In addition, the contributions of employed persons or of employed persons and their employers might be supplemented by contributions from the State.

Medical Benefits. -- Insured persons and their dependents should be guaranteed care, in health and in sickness, without waiting period and without payment except through their previous contributions. Such care may include any or all of the following six classes of service (exclusive of care for Injuries and diseases caused by or arising out of employment) and should so far as is possible, include at least the first three:

(1) Care in health and in sickness by a general practitioner of medicine in the home, office, clinic or hospital;

(2) Specialist services, when needed, in the home, office, clinic, or hospital;

(3) Hospital, clinic, and laboratory services;

(4) Specified dental services;

(5) Specified nursing services in the home;

(6) Expensive medicines and appliances (not ordinary drugs and medicines).

Since public medical services, through health departments, welfare departments, or other governmental agencies, now provide certain special services for practically the whole population (for example, care of mental disease and certain communicable diseases), these should not be covered by health insurance.

Professional Relations, Responsibility and Remuneration. -- A State law should place primary responsibility upon the medical and allied professions for the quality and standards of medical care, and should grant such representation in the administration of the law to the professions and agencies concerned with furnishing medical care as will conduce to the maintenance of high standards of service and to the advancement of the sciences and arts concerned with the study, care, and prevention of disease.

Such matters as the control of professional personnel, the supervision of medical service, the maintenance of high standards of practice and the control of undesirable practices should be the primary responsibility of local and State professional boards which are made parts of the administration. All patients should be free to choose their physician or dentist from among the local practitioners who engage in insurance practice. All legally qualified practitioners who subscribe to necessary rules of procedure should be free to engage in insurance practice and to accept or to reject insured persons who choose them. The practitioner should likewise be free to engage in private non-insurance practice to whatever extent he desires, provided that this does not interfere with obligations which he has already accepted toward insured patients.