COMMITTEE ON SOCIAL INSURANCE OF THE AMERICAN ASSOCIATION FOR LABOR LEGISLATION MILES M. DAWSON Consulting Actuary. Member of New York Bar. Director, New York School of Philanthropy. Actuary and Statistician. Formerly Expert, United Professor, Economics, Columbia University. Vice- LILLIAN D. WALD Head Resident, Henry Street Settlement ("Nurses' Secretary, American Association for Labor Leg- i INTRODUCTORY NOTE The public issue now uppermost is National Preparedness. To many it means millions for munitions. To others who realize the fundamental need of efficiency through industrial training and organization it is beginning to offer a vision of millions of men and women fit for the nation's service in times of peace no less than in the occasional time of war. Generalities and sounding phrases in the name of "social justice" are not satisfying. Something more specific that can be put into operation is required if we are to bring about the development and maintenance of American standards worth fighting for. One of the immediate steps in such a concrete program is Health Insurance. In December 1912 the American Association for Labor Legislation created the Social Insurance Committee which is pointing the way toward definite and practical preparedness against industrial sickness. Its aim has been to study conditions impartially, to investigate the operation of existing systems of insurance, to prepare carefully for needed legislation, and to stimulate intelligent discussion. In the spring of 1913 it organized the first American conference on social insurance; in July 1914, after much discussion and revision of proposals, it formulated a tentative statement of the essential "Standards" which it purposed to follow. Criticism received from physicians, employees and employers throughout the three and one half years of the committee's work was of the greatest assistance in formulating the tentative "Draft of an Act" for insurance against sickness which was first published in November 1915 and, with some elaborations, has already been introduced in Massachusetts, New Jersey, and New York. Meanwhile investigating commissions in California and Massachusetts have been created to report in January 1917 when bills for compulsory health insurance will doubtless be before the legislatures of the principal industrial states. In the preparation of the material for this special edition of the REVIEW members of the committee and of the office staff of the Association have attempted to present facts which will be of assistance to every state in the campaign which is but begun. JOHN B. ANDREWS, Secretary American Association for Labor Legislation IS HEALTH INSURANCE "PATERNALISM"? WILLIAM HARD In the city of Leipzig there is an institution which is sometimes said to be the finest specimen of Paternalism in all Germany. It exercises a stern jurisdiction, in matters of sickness, over some 200,000 wage-earners in Leipzig itself and in various adjoining districts. Whenever any one of its subjects falls sick, it sends a listed and guaranteed doctor immediately to his bedside. At the same instant it rushes medicines to him from a listed and certified drug store. It cures him in his home, if it can. If not, it drags him to a hospital and goes at curing him there. If, anyway, he dies, it provides money for his funeral. These things-and many others-it does (just as similar though smaller institutions all over Germany do) under general orders directly from Berlin. Still, I should hesitate to say that this institution-the Federation of Leipzig Sick Funds-is "philanthropic" in the cordial American sense of the word. In our large cities every year large numbers of wage-earners get medical advice and medical treatment from Visiting-Nurse Associations and from private and public dispensaries and from private and public hospitals without paying for any of it at all. They get it totally free. That is philanthropy. Some people might even call it Paternalism. The case of the wage-earners of Leipzig is brutally different. All Leipzig wage-earners, coming within the jurisdiction of the Federation of Leipzig Sick Funds, are compelled by the Imperial Government to pay weekly, out of their own pockets, a certain tribute to the Federation's treasury. This tribute amounts to twothird's of the Federation's running expenses. It is a stiff blow. Yet the Imperial Government remains unsatisfied. If those wageearners paid that money and got that medical care and did nothing more, they would be merely passive recipients of welfare. The 1 Extract from article "Who Keeps the Watch on the Rhine?" Reprinted by special permission from the Metropolitan Magazine of March, 1916. Imperial Government is determined that they shall be active dispensers of welfare. Thereafter, further, from their own number, they must elect two-thirds of the members of the "Committee" by which the affairs of the Federation are in general supervised; and these members of the "Committee" must choose two-thirds of the members of a second body called the "Directorate," by which the affairs of the Federation are immediately managed; so that the supervision and management of the Federation shall rest principally with the wage-earners themselves. The Federation of Leipzig Sick Funds spends $1,750,000 a year. Where, among us, is there so spacious a social-welfare institution operated under the daily control of wage-earners? The farmers of Arheilgen are encouraged toward Self-Help. The wage-earners of Leipzig-and of all other places within the Empire -are coerced into it The employers are coerced into it, too. They must pay one-third of the running expenses of all Sick Funds in all localities and they must elect one-third of the members of the "Committees" and of the "Directorates." These elections are particularly coercive for the persons elected. If you are an employer and you are honored by your fellow-employers with an election to the "Committee" or to the "Directorate," you may be a very busy man, with large business interests, but you have only five chances of escape. They are laid down for you in Article Seventeen of the Imperial Insurance Code. You may show that you already have more than one guardianship or trusteeship. You may show that your only employees are domestic servants. You may show that you are sick or infirm. You may show that you have more than four legal children under age (it being assumed apparently that such a domestic man should not be torn from his home). Or you may show that you are past sixty. If you cannot make any one of these showings, you serve. And if you neglect your duties, the chairman of the Directorate fines you, from time to time, up to a hundred marks, under Section Nineteen. At this point the bureaucrats of Berlin retire to their caves and compile statistics and grin at their victims. They have got a lot of private citizens into doing a lot of public work. Is it not the work of the state to look after the sick poor? Why else do we permit |