Health Taxes?

By use of the rhetorical "May we?" for "We want," Secretary of the Interior Dr. Ray Lyman Wilbur last week indicated the main solution which the Committee on the Cost of Medical Care will recommend next November.

That major recommendation will be: communities--cities, counties or States, but not the Nation--should help pay the medical bills of all the citizens by means of taxes.

Dr. Wilbur, who is chairman of the Committee on Cost, was in Manhattan last week for the annual meeting of the eminent advisers of the Milbank Memorial Fund. To William Henry Welch of Johns Hopkins, Livingston Farrand of Cornell, Haven Emerson of Columbia, Charles-Edward Amory Winslow of Yale, Hugh Smith Cumming of the U. S. Public Health Service and men of similar potency, Dr. Wilbur said:

"If we organize our talent for producing medical services economically and efficiently, we shall undoubtedly find that the cost is not too great for our present society. For inadequate medical services, produced with all the wastes inherent in the individualized practice, we now pay about $30 per capita annually. With organized, coordinated effort we should be able to provide ample medical services of good quality to all people, and with proper remuneration to the professional personnel, for costs of somewhere between $20 and $50 per capita per year.

"If all but the indigent can pay the price, we merely face the technical task of devising suitable methods of collecting the charges. On the other hand, if we find that there are substantial groups of our people who, though not indigent, nevertheless have so little surplus over the bare essentials of life that they cannot reasonably be expected to pay the cost of decent medical service, economically provided, we face a different and somewhat more vexing problem.

"If we expect charity to meet the cost we are faced with the fact that charity, when obviously labeled as such, is distasteful to self-respecting people, and is too erratic and inadequate to meet such a large national problem.

"May we, in such cases, turn to the local, and perhaps the State, government and expect that it will meet a sufficient share of the cost to bring the charge to individual families within their reach? May we expect that local officials will agree that the protection of the people's health is as important, although not as costly, a social responsibility as the education of their minds? May we assume that methods can be worked out that will enable the local government to help carry the financial burden without placing the dead hand of official red-tape or politics on scientific progress and skilled service?"

The greatest problem in putting through what is virtually communal health insurance is to keep politicians from chiseling their commissions out of the expenditures.

If this program does not go. then--Dr. Wilbur's investigators believe--insurance companies will be obliged to provide health insurance. Fraternal societies have been doing that for their members a long time. It is what churches do when they maintain hospitals in which congregation members get cheaper rates than do the general public. The medical services of railroads, ships, lumber camps, rubber plantations form a kind of group insurance from which all employes benefit and to which they indirectly contribute. Certain tentative modifications of such insurance methods are now functioning. Dr. Wilbur referred to a Los Angeles clinic which provides almost complete medical service to several groups of employed persons for $2 a person a month.

The American Medical Association does not like that kind of thing. It implies that doctors are hired to tend the insured. The A. M. A. has persistently and vigorously opposed every move to make hirelings of doctors.

The A. M. A. policy gives particular significance to another insurance gesture, to which Dr. Wilbur referred last week. School teachers and certain other staid individuals of regular habits in Dallas, Texas each pay 50-c- a month to Baylor Hospital. For that premium the hospital takes care of them when they get sick. The unusual significance, apart from the novelty of the plan, is that the foremost doctor on Baylor Hospital staff is Edward Henry Gary, who next May becomes president of the A. M. A.

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