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3. That some Federal subsidy be provided through the public health program for the assistance of State and local communities in developing plans for salaried or subsidized physicians in sparsely settled rural areas in which medical services are not available or are insufficient.

III. The Insufficient Support in Many Localities of Certain Medical Services Important to the Public Health.

Tuberculosis, syphilis, crippling diseases of children, and cancer (especially as regards its diagnosis) are examples of conditions which are the concern of the whole community as well as the individual sufferer because of the expensiveness of treatment, their communicability, or other reasons. Medical service for these and similar conditions (such as trachoma or hook-worm in certain localities) are recognized public responsibilities in some States and communities but are not so recognized or are inadequately supported in many others.

Physicians have traditionally given their service without any direct financial compensation in clinics maintained by health departments and hospitals. The recently increased requirements of clinic service and the reductions in medical income have created a widespread and justifiable demand for the payment of physicians for their work in clinics, Not the least of the reasons for so doing is the need for placing these important medical services upon a basis of effectiveness which often cannot be maintained with an unpaid staff, however full of good will its members may be.

Two suggestions have been urged by one or more of our advisory boards, as follows:

1. That in the expenditure of Federal funds for health and medical services by the United States Public Health Service and other Federal bodies, it be the policy to expect and urge that physicians be paid in any clinics maintained by health departments and other agencies which are financially assisted by Federal funds; and the allocations to States and localities by these Federal agencies should be adjusted accordingly.

2. That public attention should be called by the Appropriate agencies in the Federal government to the need of more adequate local tax appropriations and arrangements with physicians medical societies, hospitals, or clinics to supply effective medical care to persons who are legally dependent, but who do not come within the scope of the relief system, and to other persons who, while self-sustaining during health, are not able to pay professional or hospital fees during sickness and who would not be able to contribute to a health insurance plan should such plan be enacted into law.

While institutional care of persons afflicted with mental diseases or tuberculosis is almost everywhere accepted as a public responsibility, the provision of hospital beds for patients with these conditions is insufficient in many localities. It has been proposed by one or more of our advisory boards:

3. That Federal aid be extended to States or local governments as part of a public works program for the building of new mental or tuberculosis hospitals, or of additions to existing public institutions for such cases, where the need is shown to exist.

It is estimated that $450,000,000 is annually spent on palliative dentistry by only a small part of the population, and that about three-fourths of the people secure little or no dental care except in emergencies. Although systematic dental care should be available to all in any adequate system of medical service, the importance and ultimate economy of preventive dentistry are strongly emphasized by our Dental Advisory Committee. It was proposed:

4. That the appropriate Federal agency undertake, in cooperation with the dental profession, a well-organized community experiment and research project in order to obtain information necessary to guide the future of preventive dentistry as a public health measure.

D. INSURANCE AGAINST TEMPORARY DISABILITY

In our report transmitted to the President on January 15, 1935, we called attention to the fact that the economic risks arising out of illness fall into two broad classes: (1) the loss of income when disabling illness strikes the wage-earner, and (2) the costs of medical care for the wage-earner and his dependents. We propose to consider these two classes of risk separately because the practical measures which may be proposed to deal with them are different in certain fundamental respects.

We have already pointed out that:

"On the average, 2.25 percent of all industrial workers are at all times incapacitated from work by reason of illness. Each year above one-eighth of all workers suffer one or more illnesses which disable them for a week, and the percentage of the families in which some member is seriously ill is much greater. . . . A relatively small but not insignificant number of workers are each year prematurely invalided, and 8 percent of all workers are physically handicapped.

"When earnings cease, dependency is not far off for a large percentage of our people.