the housing conditions of sick members. "Although," in the opinion of the German Imperial Insurance Office, "such investigations do not immediately reform all the evils, still their disclosure and publication and information given to the police, landlords, poor and school doctors and also to hospitals and tuberculosis sanatoria will help to improve the situation. The occupants of the dwellings are also informed of the probable cause of illness and are told of the necessity of sanitary lodgings."50 Housing reform has also been promoted by the German invalidity funds which have large reserves to invest. The actual increase in longevity of the German people during the operation of the insurance system is brought out in the accompanying table from the report of the National Conservation Commission, which shows that the rate at which life has lengthened in Prussia has been nearly twice as great as in other countries: United States: Massachusetts.. 1855 to 1893-1897, or 40 years.. 14 ...... Females ......16 II .29 .15 .15 "It is probably no accident," states the commission in commenting on this progress, "that the maximum rate obtains in Prussia which is probably the most progressive country in the discovery and application of scientific medicine."51 Thus compulsory health insurance not only meets the urgent need of the wage-earner for medical care and for financial assistance during illness, but, of the various possible methods of insuring, it alone promises to distribute the cost fairly and wisely between employers, 50 The German Workmen's Insurance as a Social Institution, Compiled by order of the Imperial Insurance Office for the St. Louis Exposition, Part IV, p. 24. 51 National Conservation Commission, Report on National Vitality: Its Wastes and Conservation, p. 102. "Through the establishment of health insurance, campaigns for "Health First" will spring up, as did those for "Safety First."—New York Tribune, March 14, 1916. employees and the state, while it also offers peculiar administrative advantages and can be counted on to give a powerful stimulus to the prevention of sickness. Compulsory health insurance is at once an economical method of providing for the needs of the wage worker and a mighty force for the inauguration of a comprehensive campaign for health conservation. "Undoubtedly some such arrangement for the protection of workmen and their families against the sufferings consequent to illness and accident must come as a development of the present social trend. Already some dozen of countries in Europe have successfully instituted and maintained such health insurance without in a single instance a confession of failure or abandonment of the effort to solve this serious problem."-New York Herald, February 9, 1916. HEALTH INSURANCE STANDARDS 1. To be effective health insurance should be compulsory, on the basis of joint contributions of employer, employee and the state. 2. The compulsory insurance should include all wage workers earning less than a given annual sum, where employed with sufficient regularity to make it practicable to compute and collect assessments. Casual and home workers should, as far as practicable, be inIcluded within the plan and scope of a compulsory system. 3. There should be a voluntary supplementary system for groups of persons (wage workers or others) who for practical reasons are kept out of the compulsory system. 4. Health insurance should provide for a specified period only, provisionally set at twentysix weeks (one-half year), but a system of invalidity insurance should be combined with health insurance so that all disability due to disease will be taken care of in one law, although the funds should be separate. 5. Health insurance on the compulsory plan should be carried by mutual local funds jointly managed by employers and employees under public supervision. In large cities such locals may be organized by trades with a federated bureau for the medical relief. Establishment funds and existing mutual sick funds may be permitted to carry the insurance where their existence does not injure the local funds, but they must be under strict government supervision. 6. Invalidity insurance should be carried by funds covering a larger geographical area comprising the districts of a number of local health insurance funds. The administration of the invalidity fund should be intimately associated with that of the local health funds and on a representative basis. 7. Both health and invalidity insurance should include medical service, supplies, necessary nursing and hospital care. Such provision should be thoroughly adequate, but its organization may be left to the local societies under strict governmental control. 8. Cash benefits should be provided by both invalidity and health insurance for the insured or his dependents during such disability. 9. It is highly desirable that prevention be emphasized so that the introduction of a compulsory health and invalidity insurance system shall lead to a campaign of health conservation similar to the safety movement resulting from workmen's compensation. HEALTH INSURANCE TENTATIVE DRAFT OF AN ACT Submitted for Criticism and Discussion by the COMMITTEE ON SOCIAL INSURANCE OF THE AMERICAN ASSOCIATION FOR LABOR LEGISLATION The British title, "Health Insurance," is used instead of the German "Sickness Insurance," because it calls attention to the main object of the act, the conservation of health, that is, the prevention and treatment of sickness, as well as provision of financial benefits. Section 1. TITLE. This chapter shall be known as the Health Insurance Act. Section 2. DEFINITIONS. When used in this act: "Commission" means the Social Insurance Commission; "Fund" means a local or trade fund, as the case may be; "Society" means an approved society; "Carrier" means the society or fund which carries the insurance; "Insurance" means health insurance under this act; "Disability" means inability to pursue the usual gainful occupation. PERSONS INSURED The principle of compulsion has been adopted because authorities are pretty generally agreed that this is the only method to reach the poorest paid and the most improvident workers, who obviously most need the benefits offered by an insurance scheme. Thus in Great Britain, where voluntary sickness |