When historians of the future come to examine the origins of the movement for social advance that gives the present its distinction, they doubtless will be impressed by the antithetical impulses that generated our enthusiasm for reform. They will find the passion of the humanitarian yoked with the zeal of the scientist; the sentimentalist and the rationalist fighting side by side against the established order. Rebellion born of pity joins hands with rebellion born of exact knowledge and clear analysis. It matters little that one sees the enemy as injustice and suffering, the other as stupidity and waste. Pseudo-science may bring down on its head the imprecations of the humanitarian; scientists may curse the “insane fringe” of the army of sentiment. But the two forces work together.
Just now the doctors are on the offensive against the present economic and industrial regime. Surgeon General Gorgas of the army has almost a set speech on the relations between wages and the public health. On many occasions within the year his account of the part played by increased pay in cleaning up the Canal Zone has impressed audiences and newspaper readers. Now comes the United States Public Health Service with a bulletin on health insurance by two of its staff—Dr. B.S. Warren, surgeon, and Mr. Edgar Sydenstricker, statistician. Their report covers a long investigation begun in cooperation with the Commission on Industrial Relations. Incidentally, the almost complete silence that followed the issuing of this report affords another instance of the need of expert publicity if valuable government investigations are to show better results than the encumbering of shelves.
Not less important than the outlines of a plan for state and federal systems of compulsory insurance for wage earners is the impressive array of statistical information here gathered to show the deterioration wrought by industrialism in the bodies of the wage-workers. To read the twenty-eight pages into which the authors have compressed the gist of all knowledge available regarding the health of wage-workers in this country is to come to a staggering realization of the stupid and amazing atrocity of which our industrial regime is a present guilty.
No effort is made to estimate the number of preventable deaths among wage-earners. But in the twenty-eight pages devoted to a discussion of conditions causing sickness, there is a multiplication of specific instances telling more forcefully than could any eloquent summary of the heavy day-by-day toll of life and health taken by conditions that are inherent in our industry and not controlled by the individual.
It is in its insistence upon the economic factor that we find something almost revolutionary in this bulletin issued by men who are supposedly strangers to social reform and that passion for making over the world which Art Young calls the “cosmic hunch.” There are striking paragraphs all through the discussion of inadequate diet, housing conditions, community environment, women in industry, over-crowding, and infant mortality. “It is clearly evident,” we are told, “that the tendency during the period 1900-1913 has been toward an impoverishment of the diet of families with low incomes.” Eight hundred dollars is the least an average family can properly subsist on, and less than one-half the families of wage-workers in the principal manufacturing and mining industries have been found to have family incomes of that amount, while nearly one-third have incomes less than $500. And in conclusion there is the plain statement that “from the foregoing it is evident that underlying all other economic factors affecting the wage-earners’ health is the fact of poverty. The wage and income investigations seem to indicate that fully one-half of the people employed in the principal manufacturing and mining industries have not been able in recent years to earn an income sufficient to maintain a healthy standard of living.” The array of damaging facts is here used to introduce health insurance as a substantial remedy, in admitting its validity the reader surely must be impressed with the need of more radical readjustments.
From a discussion of causes, Dr. Warren and Mr. Sydenstricker pass to an assessment of responsibility. They suggest the cost of an adequate system of prevention and relief as 50 cents a week for each insured person, of which the employee is to contribute 25 cents, the employer 20 cents, and the public 5 cents. Protest against this division will come from the superficial radical, who, in his animus against the employer, wishes him to pay the whole bill. This would sanction and perpetuate insufficient wages by assuming that they always will be paid, and permitting the employer to plead that he is meeting the cost of the havoc they cause.
So far as they are able, wage-workers are rapidly adopting health insurance of their own accord. Dr. Warren and Mr. Sydenstricker point out the high cost of privately administered insurance, the undemocratic and sometimes unfair character of systems instituted by the large employing corporations, and the failure of trade and labor unions to initiate insurance schemes on any adequate scale. Only a small portion of wage-workers are now insured, and there is no likelihood that the more poorly paid workmen who stand most in need of insurance will obtain it in time to prevent a deterioration that society cannot permit.
“The great mass of low-paid, unskilled workers” we are told, “are seldom found among those insured in union, establishment, mutual society and commercial insurance company funds. It is not going too far to say that the situation in the United States at present is not nearly as good as the situation in Great Britain prior to the passage of the National Insurance act.”
Compulsory health insurance administered by the government is nearly as old as the nation. “As early as July 16, 1798, Congress enacted a law taxing all vessels of the United States merchant marine 20 cents per month for every person employed on board and providing authority for deducting this amount from the wages of such persons. This fund was appropriated for the relief of sick and disabled seamen and constituted the marine hospital fund. In 1885 the capitation tax was repealed and a tonnage duty was imposed on shipping.”
Dr. Warren and Mr. Sydenstricker do not undertake to present here a detailed plan for federal and state health insurance. They content themselves with a convincing exposition of its need, and with pointing out some of the considerations that must govern the authors of an effectual law. Heaviest emphasis is laid on the paramount importance of so administering any scheme of insurance that all agencies shall be brought into cooperation to prevent disease, not merely to relieve its victims. The failure to provide such cooperation is the most serious defect of specific plans thus far offered to American legislatures.
The health-insurance system can be linked with the health-promoting agencies, we are assured, by providing an efficient staff of medical officers detailed from the federal or state health departments, but subject to the regulations issued by the insurance commission; by providing a fair and sufficient incentive for active assistance by the medical profession; and by providing for a close cooperation of the health-insurance system with state, municipal and rural health departments and boards. The medical staff would act as referees to prevent malingering and would certify the payment of all benefits. With such a check, freedom could be allowed the insured to call in his family physician. It is not necessary to point out the possibilities of disease prevention which may be expected from the visits into the home by a skilled sanitarian in addition to the attention of the family physician. The report adds:
The freedom of choice of physicians on the part of insured persons and the payment of the physicians on a capitation basis regardless of whether their patients are sick or well, should offer every incentive to physicians to keep their patients well and to endeavor to please by rending their most efficient service. The wage earner would seek the advice of his family physician earlier and oftener in case of all ailments, and thus the physician in preventing serious diseases.
The special value of this discussion is the understanding shown by the authors of the peculiar problems to be met in applying such a system to a people that resents any governmental interference with the personal life of the individual. The recommendation that insured person be permitted to call in their family physicians is an instance. After full investigation the authors are confident that this freedom is not incompatible with an efficient and conical administration. They have caught the psychology of those representatives of labor who look with suspicion on governmental welfare work. Those who have nothing but impatience for this suspicion do not realize the real danger to democratic ideals that lies in the numbers and energy of those who frankly do not believe in democracy, who believe instead in regimentation and discipline for the wage-earners.
There are indications that organized labor will not much longer persist in stolid opposition to the assumption by government of such serves as the insurance of the people against sickness. President Gompers of the American Federation of Labor has reached a sort of compromise with the Socialists, as represented in Congress by Mr. Meyer London, on a bill calling for the appointment of a commission to study the subject of sickness and unemployment insurance, and report within a year. Mr. Gompers contented himself with an amendment to the original resolution specifically directing that the investigation include the possibility of meeting the need of insurance through voluntary organizations of wage-earners. Mr. Gompers himself opposes government-administered insurance. But there is a large and growing number of trade-union leaders who do not share his fear that such service will weaken the morale of the workers and prevent their enlistment in the struggle for industrial democracy. Mr. Gompers’s opposition could be more easily justified if the field would otherwise be left free to the labor unions. But already many great employing corporations have resorted to compulsory sickness insurance schemes partly for the purpose of binding their employees to them and thus strengthening their position against the unions. As between the fraternal good offices of government and the paternal and feudalistic welfare schemes of a private corporation, organized labor’s choice, it seem should be clear. Under government insurance, the wage-earner carries its benefits with him from job to job. Today tens of thousands of wage earners receive less substantial benefits in the form of a special privilege that can be withdrawn at any time by the employer.