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:ZR1919H B

:'1921 c.3

REPORT OF THE ROYAL COMMISSION

ON HEALTH INSURANCE

March 18th, 1921

LEeT S!.J \?l TJ )J:'E:nI..RY \jIC1·(:!~.l"\~ ~~.Ca

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!~lll~liili'l!il~~'lll~\m~i 33298003740918

Vancouver, B. Co,

The Lieutenant-Governor in Council,

VICTORIA, BoCo

Sir:-

March 18th, 1921.

The Health Insurance Commission appointed by Y0ll:

on November 19th, 19l9,uncler the "Pu.blio Inquiries Act",

begs leave-to submit the following report~

Your Commission was issued to E.SoR~ Winn, of

Vancouver, as Chairman, Mrso- C •. Spofford, of Viotoria, Dro

To B. Green, of New Westminster, and. D. McCal.1um of Viatoria, . . . . . ~- . - . . ..

appointing them . tobs Commissioners "to enquire. as to .the laws

relating to the subJe<rts of Mothers'PenslonS, . Maternity -InsUr­

ance. RealthJ;:nsiirancaamPn.blio Hea.lth Nursing-, wbi'ah are in

foroe in other ·oountries; to colleot faots as to the aotual

operation of those laws and·as to how far they a.re found satis­

faotorY; to enquire as to whether an.dto wh,at extent the publio

interest requires the introduotion of such laws into the Prov­

inoe of Bri ti shColumbia·; .. amd generally to ·enCJ,.uire into all

matters a~feoting the sai~ sul;>Jaots res'peotively"~ . your.Com­

missioners were furthei- direoted to report in writing the

- faots found and ~the opinions formed by them in relation to··· . .

the matters being investigated, toge~her with their recommen-.,' -:

dations in respeot of same o

On Maroh 22nd, 19·20, your ·Commissioners filed with

you their re.PO~t on one.of the-subJeots being investigated.

viz; Mothers' Pensionso

. The Commissi.oners early. oame to the conclusion

that the range of enquiry opened to them was a particularly

wide oneo They.realized that it woUld be impossible ...

-"to· cover the ·entire field without the. eXpendi ture of·· a .

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great deal of time and money. They felt too that this course was inadv"isable inasmuoh as trained investigator~ had spent years in researoh on these subjeots, and the results of whi~h were available. The Commission, therefore, confined its efforts to a study of the vast quanti~ of literature from other oountries on the SQbjeots before them, to an investigation of our needs, and to a study of the extent to whiCh the e~erience of these other oountries in suoh legislation was applioallle to Bri tish Columbia';'

The oo-operation and assistanoe of many investiga­tors was willingly and enthusiastically given the Commissiono To the" "following ,in partiCu.1ar the Commission is ,indebted, for muoh valuable help:- Dr. John B. Andrews of New York", Seoretary, Amerioan Assooiation for"Labor Legislation; Alfred Cox, OoBeE., MoBo, Medioal Seoretary , British Medioal. Association; John A. Lapp, Managing Editor, Modern Medicine, Chicago; Olga So Halsey, Special Investigator for the American Association for Labor Legislation, New York; ~ir Robert Morant, Chairman of the English Health Insuranoe' Commission; Will Ho French of the California Industrial Aocident Commission; Mrs. Barbara Mo Grimes of the Faoulty , of the University of California, and to Professor Ro H~ MUllin of the University of British Columbia ani D~eotor of Laboratory at the Vanoouver General. Hospital, ani cT.D. MoNiven, Deputy Minister of Labor for British Columbia. Thanks is also due to He Go Garrett, Superintendent of In- , surance for British Columbia; the state Secretaries and state Librarians o~ Massachusetts, New J.er~ey, Illinois, OhiO, Penns~lvania, Wisconsin and Conneatiout; the Depart -menta of Insurance at Ottawa and Victoria; the Provincial, Librarian; the SUperintendent of the Health Department of the British Columbia Government; D. A. MUnro, PreSident, ~d" A. MoInnes, -Seare'tar.i;" of the C.Po'Ro Employees' Medical. Assoaiation of British Columbia; jo A. Corey, SecretaJ;'Y

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1 of the CoNoRo Employees· Medical Association of British Columbia, to R. Wo Lane, B.Ao, LoL.B., who was a»pointed Se'oretary am Speoial Investigator for the Commission; to the Medical Associations of Vancouver, Victoria and the Fraser Valley; the Women-fs Organizations; the Great Via,)! Veterans' Assooiation; the LaborUnions~ the Fraternal Orders, and to the many publio spirited citizens who ~pplied the Commission with much ~aluable data and assist­ance in- connection with the health needs of the Provinoe~--

In studying the health needs of the ,Provinoe, the Commdssioners endeavoured to seoure the viewpoint o~ as m~ differantorganizations and private citizens -as possibleo PQblio hearings were held in tha,followtng ci ties and towns:- Princeton, Fernie ~ Cranbrook, Nelson, -Rossland, Trail, Grand Forks, Prince Rupert, GOlden., Rav­elstoke, Kamloops, Vernon, Nanaimo, Victoria, New Westmin­ster, OhilliwaCk and Vancouvero Over fifteen hundred notioes of these hearings were~led to the following:-' Members of the Legislative Assembly; all -branches of all Soldiers' Organizations, inaluding their auxiliaries; Women's Organizat~onst Labor Unions, employers of labor. having over one hundred workmen; Medical Praotit~oners; Medical AsSOCiations; Hospitals; Farmers' Insti~tes; Boards of Trade, :MU.nioipal Counoils; Lodges o:f Fraternal. Sooieties, where looationand address oould be ascertained; Manufacturers' Associations; Insurance Organizations; and individuals who we were informed had some speoial knowledge of the subjeots under investigationo The general publio was notified of the Commission's itinerary through the:

. . . . medium. of nineteen newspapers oiroulating il;l the oi tie's and towns visitedo

The evidenoe taken by the Commission has been, . embodied in two_ typawri tten,_volumes oomprising 845 pages o '

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these volumes, together with a quantity of published data and literature assembled by. the C0m.mission, are be­ing filed with this reporto A summary of the s~ient faots ana prinoiples about Health Insuranoe are embodied herein, together wi th the Commission's oonolusions and re­commendations in re~pect of sameo

EARLY HISTORY OF HEALTH mSURANCE .,0"

The beginning of Siokness Insuranoe is traceable even farther back than insuranoe against industrial aooi­dents. MUtual Aid organizations of purely voluntarY.nature . . '. .'

drawing support solely from contributions by, their members are traoeable, both in this'oountry and in Europe, as far back as the beginning of the Nineteenth Cen~y_ These organizations were found to be a very convenient vehicle for carrying Sickness Insuranoe for the grou9s of workmen' who availed themselves of membership in themo In all of' the EUropean countries MUtual Aid Societies have played an important part in the history of Health Insura'noe 0 Some of, these societies in$Ured only against sickness; others in­cluded aooident, old age, unemployment and insuranoe against invalid 1 t,y_ Among the more prominent of these early bene--fit societies were the Miners' Fu.ndso The miners wera u.sa.aJ.l..y

-the pioneers in adopting voluntary in~anceaga1ns~ slakness. In Belgium as early as 1812 temporary funds were

established in some distriots. and by 1839 permanent funds were well established in nearly all the large labor centres. It was in the latter year that over 20 mining companies at

, ' the City of Liege united in one oommon fund. for' the b~nefi1i of the ir employees. By 1850, a general ~:oheme 'of voluntary insUranoe was in operation throughout all mi~ing distriots otBelgium.- In 1851 a law, was ~assed reoognizing bY,offlcial

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supervision such MUtual Benefit Societies as complied with standard regulations laid down by the State.·

Sickness Insurance in Austria had a very similar history to that of Belgium. The purpose of workmen's in­surance there was also to provide workmen with ·an inoome during periods of disabilityo

In Denmark tne demand among workmen ~or social betterment became manifest to a very marked·degree by·1860 0

. The Governmentappolnted four sucoessfvt}- commissions in the years 1861, i866, 1875 and. 1885 to investigate condi- . .-tions and report their reoommendationso The' result was.'

. .' _. , that the voluntary benefit sooieties operating. at· that time

we~e_subsequentlY' uS,ed asa. ~ou.¢ati6n-fo.r. t1).e nation8.l. ,. institution ofHeaJ. th Insuranoe. There were in -all, . near-

.1Y- a thousand- sooieties ·operating by 1885, and with. a ve'ry, rapidly increasing membershipo These societies went under Government supervision in 1.892, and thereafter received· pUblic aid, and were therefore obliged to con:eorm to the Government regulations.

Germany, like Belgium, had a Guild Organization operating at the beginning of the Nineteenth Centuryo With industrial development in Germany following the Na-

. poleonio Wars ,factory-gutldswere organized-Tn nearly" all ., the· important industrial centres, one o~ thefr ohief pur-· .

poses being the relief of sick workmen engaged in .industry. These guilds were in most cases sUpported entirely by the workmeno Insurance against sickness or temporarydisaQiiity formed the important feat~e of the earliest forms of work-' man's insuranoe. This purely voluntary insurance offered ·by Guilds and Mutual Benefit organizat·ions developed y~ar

. by ·year :toward compulsory Sickness· Insur8lice controlled arid . strictly _regulated, and in many cases aSSisted, by the

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state. The old 1~tual Aid so~ieties were found for many reasons to be the most oonvenientorganlzations

" " " for aooomplisnlng the purposes of the State in health legislation.

Siokness Insuranoe went through the following

evolution:-

(I) Voluntary and free MUtual Sooieties entirely free

of the Sta te.'

(2) Sooieties under State regulation olassified as re­

~ognized or unreoognizedo

(3) State regulation with state subsidies for oompul~or~ Sickness Insuranoe.

(4) Compulsory Health and Accident Insuranoe.·

Germany was the first country to. adopt Compulsory Health and Acoident Insuranoe for workmen on a national scale as a part of their national industrial polioy, Prussia h~d been connected with various oompulsory in~ stitutions in industries and trades, but one of the earliest general laws regarding Compulsory Siokness Insuranoe is that contained in the Prussian Industrial Code January 17th, 18450 This code permitted local distriots to make

o regulations to oompel apprentices and workmen to affiliate wi th regular sick,relief· organizations". Four years later, employers in c.er·tain industries were compe lled to create funds· for the relief of ne.edy workmen i~ their employo In 1854 local Governments were authorized to re~ate oom­pulsory membership in guild tundsoA measure of freedom was given by permitting the workmen so deSiring to join other funds than thosespeoified at first, but Compulsory Insurance against sickness was still.insisted upon. and the. workmen il,l. many -cases organizedvoluntary-siok'funds known as MUtual Aid or Free Sooieties. " These were further encouraged by ststutes passed in 1876. It was not until

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1883 that Compulsory Health and Aooident Insuranoe on a

national scale was an aooomplis~ed faot. o

GREAT BRITAIN

The British system of Health Insurance was in­

troduoed into Parliament by the Right.Honourable David..

Lloyd George in 1911, in the. form of the National Insur­

anoe Aoto After a bitter fight it went into operation

JUly 12th; 1912, and with the exoeption of some minor

amendments the prinoiples ~f the original Act remain Un-, "

ohanged. Lloyd George studied the German system of Kealth'

, Insura.noe, but' he oarmot be aooused of bringing baok a

"made in Germany" Insurance Acto It would appear'that he

had studied the German system not for example, but rather

to ,gain knowledge of what to avoid. The British soheme

differs so materially from the German system that these

two main types of Health Insuranoe - the British and 'the

German - are fre~uently contrastedo The then Premier

As~uith onoe said in the House,- "The German system could

not be translated here 0 ••• 0 You cannot if you WOUld, set

up and work here the complicated and irritating maohinery

by which in Germany the neoessary funds for a ,provision

against siokness 00 ••• are extraoted from the profits of ,-

.. both .employer and, employed". The English 'system Was,

therefore, evolved along much more demonratlo'and generous

lines than the German. It is more generous ,beoause t~e

State oontributes part of the oost and makes special pro­

visions for the low wage-earner, and it is much mQre de­

mocratioin administration. From the German system the

British Aot adopted the prinoiple of contribution by em-/ " '

ployer, and from the Danish ani Norwegian system the

prinoiple of oontribution from the State.

SCOPE OF THE ACT.

Health Insurance is compulsory upon all persons ;

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in the British I~les between the ages of 16 and ~O who are employed at manual labor, and also for those who are not

, employed at manual labor and whose remuneration is ·less than £250. ($1,216 0 66) per yearo There are certain exemp­tions for persons covered by other schemes of siokness benefit, and provision is made for persons not otherwise covered by the Act to come under its provisions voluntar­ily. In all 13,759,400 persons were insured in February 1914,'of which number 9 t 682,300 ,were males and 4,077,100 females, or 57 percent· of the adUlt male population and 22 percent of the adult female population. Later figures available are abnormal on acoount of war oondi tionso·

INSURANCE SYST~I IS CONTRIBUTORY.

The British system is contributory. Towards the fund for the insurance of· the male members protected, the State oontributes two-ninths, the employer three-ninths and the men themselves four-ninths. In the case of women the State contributes one-fourth of the fund and thebalano& is provided equally by the women-workers and the employers. The contri bu tions . actuaJ.ly amount 'to 4d per week from the employed workman, 3d from the employed woman, 3d from the employer in either case, and 2d from the State in either case9 The employer must pay a 'contribution even for em­ployees who are themselves exempted fi-om contribution. That is provided so that exempted employees will not be given preference in employmento Certain small groups of workers earning extremely low wage (i.e~' below 2s/6d (.60~ per day) are charged lower rates or exempted entirely from contributiono'

HOW C otL8C TED.

For eaoh employee a oard is issued. On eaoh oard the employer attaohes a stamp, whioh may be purohased

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at the Post Offioe, oovering the employer's as well as the employee's oontribution, the l~tter of whioh is (leduoted from the wageso The post Master General turns over all sums so oolleoted to the Ministry of Heal th~ . The oards are turned in quarterly to the approved Sooieties affeoted, and the Societies oolleot their pro rata from the Insur­anoe Commi ss ion.

BENEFITS

The;)benefits provided are grouped 9.S.:-

MSdioal benefits, inoluding drugs and applianoesj sanatorium benefits for those suffering from tuberculosis; siokness benefi ts in the form of weekly oash allowanoe amounting to lOs ($2.43) for men and 7s/6d ($1.83) for women; disable­ment benefits of 5a ($1.22) per week after· the siokness benefits are disoontinued, whioh is at the end of twenty- . six oonseoutive weeks of siokness, and maternity benefIts of 30s{$7020) in oase of the oonfinement.of the wife of" an insured person, or of a woman who is herself ihsured. If the husband and wife are both insured the wife is entitled to 60s ($14040) in allo

ADMIN IS TlLd..T IOH

Slokness, disablement and maternity benefits are administered· through 23,500 independ_ent. "ap~roved sooieties" suoh as friendly sooieties, trade unions,. industrial. 1n-· suranoe oompanies and employers t provident fundso. Looal administration is entrusted to looaL insuranoe oommittees in the matter of medioal beneti ts and sanatoria·, and the furnishing of reports to the National Insurance Commission­erso These Looal County Comm1tteesadminister as well all. oases of "depOSit contri~tors", these being the people who do not belong to any of the "approved sooieti,eaft o ..

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THE PANEL SYSTEM

Every Local County Committee is required to pre­pare, and to publish, a list of duly quali~ied Medioal Practitioners who have agreed to attend and treat insured persons. This list is known as the Panel. Every d~~ qualified Medical Practi,tionerh8.s the right to have his name plaoed on this Panel, and every insured person is given a free ahoioe o~ :Medioal Practitioner, subject to the oonsentof the Practitioner seleoted.' In all, over 14,000 MSd10al Practitioners have oaused their names 'to be placed on the Panel as being willing to aooept panel worko Be~ore Aot was passed the average annual remuneration to doctors per oapita of population in the ~ive important towns in which all Mediaal Praotitioners' books were aUdit­ed 4s/5d ($l.OG). The Aot provides GsjOd ($1.56) annually per oapita whioh does not inolude "speoialists" serviges or drugs; 2s (~48¢') in addition is provided for drugS', medicine and applianoes. The average Medioal Praatit1'oner had 750 panel patients whioh net him for panel work,alone $1,170.00 annually. Ten percent of the dootors in 1913 had over 1,500 insured persons, four percent had over 2,000 insured persons, while fifty peroent of the,dootors had less than five hundred insured persons. 'Many dootors are not in a position to aocept more than this number on ao­count of having large private praotioes to attend too It will be noted ,that Medioal Praotitioners are permitted to retain their private praotices as well as aoting on a panelo

THE, BRITISH ACT IS A SUCCESS

The British Medioal Association whioh SO bitterly opposed the'Aot at its inoeption,'and. in ~aot threatened to strike or refuse to work under it, has ohanged its opinion

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and gone on record as approving in the main the Act as now

operating. Alfred Cox, O.B~E.) M.B. Medical Secretary of

the British Medical Association, in reply to a recent en­

quiry states -:- "The great majority of those members of our

profession who are working the system would, I am sure,

resist any attempt to repeal the Health Insurance Act.

It may not be -·it is not -an ideal system, but most of

the 14,000 doctors who now give services under it believe

that they are better ott, and that their patients are .

better off, medically speaking, since the Act than before .

it It • S. Finney, M.P., Member of the Execut i ve Board or the Miners' Federation of Great Britain and Fraternal

Delegate fran the British Trad.es Union Congress to the

. June 1919 Convention of .American Federation of Labor, said,

"Fears sometimes expressed in advance of the adoption ot

compulsory Health In~urance, that this legislation might

in some way interfere unpleasantly with the personal li­

berties of the wage-earners, have proven in practive not

well foundedo A vast deal of distress among wage-earners

can be prevented in no otber way". Mr. Charles Duncan,

Secretary of the Workers' Union of Great Britain, who

represented the Burrow Constituency in .the British House

of Commons for a number of years, speaking upon Health In­

surance in reply to a suggestion that the English Act be

repealed, said, - ttRepeal the Health Insurance Aot? Eng-.

land is not wasting time discussing absurdities. To re- .

peal the Health Insurance Act would cause a social re­

volution.in England tomorrow~ R.J. Caldwell, President

of the R.J. Caldwell Compaxw, Cotton Manufacturers, and

member of the· Employers t Industrial Commiss ion of Uni ted

States, which went to England in 1919 to investigate con­

ditions there, says' "The public should be on guard against

attempts ot interested opponents of workmen's Health In-

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surance to discredit this en1ighted proposal by unfavor­

able re~erences to British experience. Honorable J.H.

Thomas, p.e., M.P., ••••• has personally informed me that al­

though considerable opposition was shown to the Health

Insurance Act when it was ~lrst introduced, there is no

opposition today; on the contrary, employers, labor leaders

and physicians, as well as every public spirited man, bear

testimony to the great benefits in health, comrort and

general well-being of the population since compulsory Health

Insurance was introduced; and a~er seven yearst,exper­

ience everyone recognized the necessity of extending and

perfecting the Act~. Hundreds of like testimonials by

leading British public men with an intimate knowledge of

the workings of this system have given expression to like

views, and could be quoted if necessary. It would appear

from these many public utterances that there is not the

slightestpossibl1ity of its repeal. From year to year

improvements are being made. We consider the chief re­

maining weaknesses of the Act to be, -

(1) That medical treatment is limited to that pro­

vided by the general practitioner. No provision

is made for expert diagnosis by speCialists', nurs­

ing attendance, dentistry, operations, or hospital

care ( except sanatorium care for tuberculosi,s),'

transportation or artificial appliances.

(2)

(3)

(4 )

The provision of drugs and more expensive appli-

ances is inadequate.

No ~eral benefits are provided.

The maternity benefit provided amounts to only

$7020, or wh.ere husband ani wife are both insured

then to $14.40. It is payable to an insured woman

or the wife of an insured man. No medical care

is ,provided in maternity cases.

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{5} Health Insurance administered by the approved

societies with nstate sections tt has revolutioniz;ed

the purpose and practices of these societies.

(6) Soma of the approved societies operating under

the British Act are controlled by industrial life

insurance companies.

MissMargaret"Bondfield, First Woman Fraternal

Dele~tefrom Great Britain to the American Federation of

Labor, in 1919, says, - "The greatest single misfortune in

connection with the British Health Insurance law was the

compromise which permits commercial insurance companies to

serve in the capacity of approved societies. Health In­

surance for wage-earners should not be commercialized".

Any new legislation in this Province on the sub­

ject of Health Insurance, should carefully guard against the

pit falls which have to a limited degree curtailed the full

beneficial results possible from Health Insurance legisla­

tion.

GERMANY.

The German system developed until now it embraces

the following classes for insurancej-)

(1) Workmen, as~istants, journeymen, apprentices and

servants.

(2) Re-established offiCials, foremen and other employees,

in similar positions~

{5} Clerks and apprentices.

(4) Members of theatrical companies and orchestras.

(5) Teachers and tutors.

(6) Home workers.

(?) Crews on sea-going vessels and inla~ transportation.

The purpose of the Act as administered at present

is to include in the compulsory scheme all small salaried

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employees and all manual laborers so . far as they" can be·

conveniently reached for contribution through their employers.

The Privilege of voluntary insurance is permitted to cer­

tain employees not oompulsorarily covered, if they are earn­

ing annually less than 2,500 marks (normally $595000), to

'small employers having not over two employees, and to mem­

bers of employer's family working for him without salaryo

It utilized existing institutions such as mutual aid and

friendly SOCieties, and industrial fund organizations, for

the purposes ot administration. Medical Aid, a money benef! t,

maternity benefit and funeral and other benefits· are pro­

vided for. The cost of medical aid is borne one-third by

the employer and two thirds by the employees. The Imperial

state and commercial authorities bear a part of the cost of

the system by paying for supervision and by giving treat­

mantin certain hospitals at special rates. The cash bene­

fits vary according to the local fUnd or organization ad-·.·

ministering them. The mutual aid funds are provided en­

tirely by the workmen. The administration of each local

fund is by a general cominittee composed one-third of re­

presentatives of employers and two-third employees and an

administrative board elected by the two groups in the sama

proportions. The cost of-administration to benefits paid

in 1911 was 701 per cent, in 1912 it was 6 per cent, and

in 1913 it was 6.6 per cent. The average cost of the whole

system per member in dues in 1913 was $7.97. The average

cost of sickness per case was $17060 or eighty-seven cents

per day of sickness. In 1913 there were 6,630,840 cases

of sickness, ~ i.e. 45.1 per cent of all members, and the

average length of sickness of each case was nine days.

When Compulsory Health Insurance came into force

nearly forty years ago, 20 per cent of. the workers insured

themselves under mutual aid and state mutual aid fund· ar-

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rangements. The facilities provided by these funds being

similar to that of the British friendly societies. This

form of insurance carrier has since slowly lost favor in

Germany. By 1910 the number of workmen insured with them

had fallen to ?o4 per cent of the total. Establishment and

factory funds held their proportion of the insuring work-

men. The big increase in favor came to the local funds

provided under the 1883 Act. The .percentage of insured

steadily rose fram 35.? at the outset until it had reaohed

5? per cent in 1913. The. latest amending legislation.has

further tended to encourage the two most popular carriers;

viz; the local and establishment funds.

The success of the German system is unquestioned

in Germany. Even Frederick L. Hoffman, the .American Health

Insurance critio so frequentlY'quoted by American Com- .

mercial Insuranoe interests, after personally investigating­

the German system, stated in a public statement before the

~mssachusetts Commission on Old Age Pensions that;

There is no dissenting opinion, even on the part of life insuranoe managers, that Government insurance has resulted in far reaching reforms; that it has been of vast benefit to the people, and to the Nation at large, and that it has came to stay ••• The interests of 'capital and labor have certainly been harmqnized remarkably in Germany, and, speak­ing from personal observation extending over a gen- . eration,the contrast of today with the past is truly marvellous. How -far --Governmen t Insuranc e has had a share in this progress it is, of course, impossible to say; but all with whom I have discussed the subject are of one mind, -- that the effect, on the whole, has been decidedly for good.

Dro Zacher, reputed to be the most eminent Health

Insurance authority in the world, states that twelve years'

has been added to the life span of the worker during thirty

years of compulsory Health Insurance in Germany. This

statement is borne out by Investigations made by the ttNa­

tional Conservation Commissionlt on the questiono Its find­

ings are summed up in the following table:-

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RATE OF LENGTHENING LIFE, IN YEARS PER CENTURY~

COUNTRY PERIOD. MAI.E FEMAU!

England 1871 - 1881 to 1891 - 1900 or twenty years 14 16

France 1817 - 1831 to 1898 - 1903 or seventy-six years 10 II

Prussia 1867 ~ 1877 to 1891.- 1900 or twenty-three years 25 29

Denmark 1835 - 1844 to 1891 - 1900 or fifty-seven years. 13 15

Sweden 1816 - 1840 to 1891. - 1900 or sixty-seven years 17 15

William Harbutt Dawson, the authority on Health

Insurance in England, in his book "Social Insurance in Ger­

many" (1912),' expresses similar sentiments as to the bene­

fits of obligatory insurance as practiced in Germany.'

NORWAY

Norway has a very much smaller population than

the majority of European countries in which compulsory Health

Insurance has been successfully establisAed. Yet a compul-

sory general scheme of' insurance has been adapted to her

needs. With a population of only about four or five times

that of British Columbia, and Widely scattered over twenty

countries, their scheme of compulsory Health Insurance is

operated satisfactorily.

The Norwegian scheme from its inception in 1909·

included all industrial workers over fourteen years of age,

and was the pioneer in that regard. Voluntary insurance

is' made available to those not .included compulsorily, pro-'

vided that their. incomes are below eight hundred Kronen

(approximately $200.00), if residing in the, country, or one

thousand Kronen (approximately $250~00), ii':'residents of

towns or cities. The insurance is not available to a man

living in town, \vhose property, including that of his wife, ,

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is ofa greater value than ten thousand Kronen (approximately

$2,700.00) or seven thousand Kronen (approximately $1,900.00)

if living in the country.

Surgical treatment, drugs, and medical aid, are

fUrnished to the assured and to members of his ramilyo Cash

compensation is paid dur ing sickness, and it equals sixty

per cent of the workman's wageso Not more than twenty-six

weeks compensation can be paid to any workman in any one

year. Cash maternity benefits are paid for six weeks.

Funeral benefits equal a sum not greater than twenty-five

times the daily basic rate of pay.

The cost of insurance is borne in the following

manner; ~ Sixty percent by the insured; ten percent by the

employer; ten percent by the camnunej and twenty percent by

the State. The carrier is the district fund, Which is

managed by the contributors to same, and supervised by the

State.

A definite classification of the insured is made

according t·o the estimated annual wages earned. Assess­

ments and benefits are computed for an insured person on

the basis for the group in which he appears.

Special provision is made for those establish­

ment associations and benefit societies which have a member­

ship o·f over two hundred, so that they may carry their om'

insurance. They are required to furnish benefits equal to

those furnished under the Act •

HOLLAND.

The Netherlands adopted compulsory Health In­

surance in 1913. The cost of same is borne equally by

workers and employers. The ~d is managed by nistriot

organization committees of employers and workmen, presided

over by a GoverlJIIlent appointee. On account, of the extent

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to whioh medioal insuranoe was voluntarily oarried at the

time of passing the Aot, it was deoided not to include

medio~ or funeral benefits thereunder. The municipalities

were at that time making generous grants to those in need

of medioal aid.

The Health Insurance soheme in Holland more

nearly approaches state Insurance than does any of the o~her'

European systems. The Aot has not been in'operation long

enough for one to be able to judge as to the wisdom of the

elimination of medical aid and funeral benefits.

Praotioally all workman are inoluded in the,

benefits. Those speoially exoluded are public employees,

sea-going mariners, soldiers, casual laborers (where the

oontract is for less than four days work), teaohers,persons

who pay, or whose wives pay, property tax or" income tax,

persons whose wages are over a certain maximum which varies \

according to the distriot, and a few other groupso (The

population of Holland is about ten times that of British

Columbia) •

The Aot provides cash, benefits varying from.'

fifty peroent to ninety peroent of the daily wageo No

benefits are paid for the first two days, and not more than

twenty-six weeks benefits ~e payable in anyone year.

Distriot organizations bave the authority to in­

crease their own sick benefits up as high asninety'peroent

with the permission of the Government, and make ot her lo­

cal regulations in keeping with the general scheme of in-'

suranoeo

The Government also approves of special insur­

anoe fUnds democratically managed without profit, and puts

them under Government supervision and control as part of

the system. Medical aid fUnds are likewise fostered.

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ROUMANIA

Guild organizations and ·other approved benevo­

lent societies, and agencies administer the insurance laws

of Roumania under supervision of the Central Office. Their

Health Insurance is part of an elaborate scheme which em­

braces aocident, 'invalidity, old age,' maternity and health.

The total cost of the insuranoe is borne by the

workmen. Cash benefits are not paid for more than six­

teen weeks in any year. They equal fifty percent of the

wages where there are dependents, and thirty-five percent

where there are no dependents.

Medical aid, drugs and funeral. expenses are paid,

and six weeks maternity benefit is paid if the insured

avails himself of this optional insurance. Where hospital

treatment is given a workman, his cash benef~ts are re-

duced by twenty-five per cent of his wages.

Workmen are grouped according to the rate of

wages they earn. The lower paid workmen pay 83 per cent

of their v;ages to the fund. The rates of the groups vary

so that the highest paid workmen pay as high as 2022 per

cent of their wages to the fund. So that the higher paid

workmen are paying a large share of the insurance of the·

more poorly paid workers. The average rate of contribution

is 2012. per cent of \mges.

AUSTRIA.

Compulsory Health Insurance laws .were enacted

in Austria in 1888. All wage-earners are inoluded except.

those engaged in agrioulture, forestry, navigation, fish1ng,

domest1c service, or persons engaged as out-workers. The

Act includes administrative officials r~~eiving less than

$487.20 per year. Workers pay two-thirds of the cost of

the in~rance while employers pay the balance. The carrier' . . . .

system was adopted from Germany.

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District Funds, establishment funds, guild funds,

registered aid funds and other funds serving the 'workers

at the time the Act was passed were continued under the su-

pervision of the local and provincial officials. Those

workers not members of other funds, automatically came

under one of the local district funds. District funds,

while decreasing slightly in number, are increasing in

membership to the loss of the mutual SOCiety funds carry­

ing insurance. There are now over 2,600 funds, of which

545 are distriot funds. These district funds carry forty-

three per oent of the total number insured •

Medical treatment is provided with free ohoioe

of doctors under contract. Medicines, hospital oar~ and

medical appliances are provided. Cash benefits equal \J

sixty per cent of the workers loss of wages and are payable

far a maximum of twenty weeks in any year. Funeral benefits

equal twenty days pay. Maternity benefits are paid for

, four weeks.

The cost of the insurance is not per.mitted to

exceed three per cent of the wages, except under very re-

stricting canditionso

EUROPEAN COMPULSORY HEALTH JNSURANCE SYSTEMS CO:MPARED.

The table which follows shows the main features'

of each of the various enumerated systems of Health Insur-

ance in force in Eurppe.

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TABULAR Su-MMARY.

HEALTH INSURANCE LEGISLATION.

In some European Countries.

This table presents only the main features of leading health insurance laws, omitting numerous minor. qualifications. Most of the European countries mentioned have, in addition to worlanen's compensation for accidents, and health insurance provisions for the contingencies of invalidity, old age, . and unemployment.

Scope of pulsory ance '

GREAT BRITAIN (Adopted 1911; in effect

1912)

Com- 1. All manual em-Insur- ployees between

16 and 70 2. All other employ-

ees between 16 andf 70 receiving less than $768 yearly,

GERMANY (Adopted 1883; in ef­fect 1884; recodified 1911.)

1. All manual employees

2. Other syecified em-ployees foremen,of-ficials, clerks, tea-chers,actors, musio-

and nearly all less than $1216.

ians) receiving less than $1190 yearly •.

AUSTRIA (Adopted 1888; .in effect 1888)

1. All wage-earners (agriculture, for-estry, and home ... work excepted,

2. All administrat1ve officials receiv-ing less than $487. yearly.

Disabilities Covered

1. All sickness and 1. accidents not 2. covered by workmen's compensation or . common law.

All sickness First 13 weeks of dustrial acoident ability.

1. in- 2. d is-

All siomess. First 4 weeks of industrial acoi­dent disability.

Waiting Period 1. Foroash b~nefit; up to 3 days

I, For. oash benefit; up to 3 days.

2. For medical benefit:2. For medioal benefit: none. none.

1.For oash benefit: none, if illness lasts more than 3 days'.

2.For medioal benefit: none

NETHERLANDS (Adopted 1913.)

All employees receiving less than $300-$600 yearly acoord­ing to locality (domesticser­vants, certain oasual employees, and oertain tax­payers exoepted).

NORWAY (Adopted 1909; in effect 1911)

All employees over 14 receiving less than $324-378 yearly accord­ing to locality ( certa in casua 1

employees . exoepted) •

All sickness 1. All sickness. 2. First 4 weeks of

industrial ac­oident disabil­ity.

l,For cash benefit:l. For oash benefit: up to 4 days. 3 days.

2.Medioal benefit 2. For medical bene­not o ompulsory • . fi. t: none.

'.

l!aximum Time Reo~ivable

Cash Benefit

GREAT BRITAIN

1. Cashbenefit:26 weeks in any 1 yea:r.

20 Medioal benefit throughout life.

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GERMANY

10 Cash benefit: 260052 weeks for the same illness.

2. lliredi oaJ. benefit: (1) Until expiration of oash benefit. (2) Additional 52 weeks of oonvalesoent oare optional.

Minimum: 50-75% of wages Men: $2.40 weekly i Women: $1.80 weekly •.

AUSTRIA

For the same illness, 20 ... 52 weeks.

60% of wages

NETHERLANDS

26-52 weeks in any 1 year, but not more than 13 weeks in a Year for an illness for whioh benefit has been drawn more than 26 weeks in the previous year.

70% of wages o'

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NORWAY

1. Cash benefit: for the same ill­ness, 26 weeks in any 1 year but not more than 39 weeks in any 2 consecut­ive years.

2. Medioal benefit: until expiration of oash benefit.

60% of wage s.

Medioal Benefit 1.Medioal treatment. loMedioaJ. and nursing 1.Medioal. treatment. Medioal treatment 2.Medioines and limit- assistanoe and treat-2.Medioines and ther-and medioines pro-

1. Medioal and surg­ioal treatment.

edlist of thera~eu- mento tic applianoes. 2oMedioines and thera-

30Sanatorium benefit peutio applianoeso for all forms of 30Ho~ital oare, tuberaulosis. 0 ·4.Medioal treatment to

4. Medioal treatment dependents optional. to dependents op-tional.

50 Dental oare optional.

apeutic applianQes a.Hospital oare. 4.Medioal treatment

to Qependents op­tion~19

vided by voluntary 20 Therapeutic ap-siok olubs •. MUst be open to any insured person. Cash benefit 3~ not paid until arrange-ments for medioal 4. treatment rumd medi­oines are made 0

plianoes; medioines optional, Ho api tal and asylum oare. Medioal and surgiaal treatment to de-pendents; Medioines optional.

50 Dental oare optionalo

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GREAT BRITAIN GERMlillY AUSTRIA.

Maternity fit

Bene-l.Insured women (1) $7.20

1. Insured women: Insured women:

Arrangements for Medioal Servioe

Funeral Bene­fit.

(2) $14,40 if wives of in~ured men.

2.Wives of insured men: $7020. .

(1) Cash benefit 2.weeks before and 6 weeks after de­livery; or (2) Home nursing assistanoe or hos­pital oare with half oash benefit. (3) Obstetrioal, pregnaoy and nurs-

,ing benefit optional. 2. Wives of insured men:

optional.

1.Free ohoioe among 1. panel· or physioians whose pay is arranged by insuranoe Commit­tees aooording to'of­fioial regulations.

2,Other arrangements 2. permitted if numbers on panel are insuf­fioient.

Free ohoioe at least b~tween 2 physioians under written contracts with funds, if oost is not excessively in­oreasedo Insur.ed may be paid oost of medical ser­vioe if reasonable oontraots with sut- . fioient physioian~ oannot be made.

20-50 times average None. daily wage. Minimum of $12 may be fixed.

(1) Obstetrioal care (2) Cash benet it tor at least 6 weeks af­ter delivery.

Free choice among physi-cians under con­tract with funds who may be paid: (1) Fixed salaries;

Capitation; or By the visit

At least 30 times average daily wage. Minimum $12018.

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NETHERLANDS

. Insured women: (1) Cash benefit up to full wage~ during inoap~oity due to delivery. . (2) Usual oash bene­fit during incapaoity due to pregnancy.

Free choice between at least 2 physioians under contract with sick clubs.

~one.

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NORWAY

Insured women: (1) Cash benefit for 6 f/eeks. (2) Medical treatmen t.

Contraots with physicians by funds.

25 times aver­~ge daily wage. Maxi­mum, $13.50. '

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GREAT BRITAIN AUSTRIA NETHERLANDS

Contributors Flat rate of 4d weekly from men, 3d from women,

Employer one­third; employee two-thirds with some. exoeptions.

Peroentage. of wages from employer and employee.

Employer one-half; employee one-half.

Insuranoe Carrier.

3d from employer, and 2d from the State. Contribu­tions of employer and state propor­tionately inoreas­ed for exoeption­ally 10,w-paid workers 0

1. Cash benefit: (1) "Allproved 800ie­tiesnllabor unions, friendly sooieties, etoo) mut be oon~ trolled by members and not operated for profit. (2) "Deposit oontri­butors" fUnd for those outside sooieties.

2. Medioal and sanatorium benefit: representat­ive Insuranoe Commit­tee in eaoh oounty~'

1.Distriot funds. 1.Distriot Funds •. 1. 2.0ther mutual so-2.0ther mutual so- 2.

oieties not op- oieties not op­erated for pro- erated for pro-fit (establish- fit may be re-ment funds; ~n- oognized (estab­erst funds \ guild liehment funds, funds,eto.) registe~ed aid

funds t guild . funds, eto.)

Distri ot funds. Othermutua1 so­cieties not oper­ated for profit may be reoognized (local funds,etc.)

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NORWAY

From employer 10%; employee 60%;. oommune 10% and s ta te" 20%.

1. Distriot funds. 2. Other mutual societies

not operated for pro­fit may be reoognized (shop olubs oommunal siok funds, et~.)

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. !' Control of Car­

rier

,. Government i Suparvision.

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GREAT BRITAIN

1. "Approved Socie­ties" by members.

2. "Deposit oontrib~­tors"fund by Insur­anoe Commissioners.

3. Insurance Comm.i"ttees by insured, physioians, looal administration and Insuranoe Com­missioners.

GERMANY

Employers and employees; re­presentation 2/3 and 1/3 re­speotively.

Insurance Commissioners. Local,state, superior and :l,mperial in­surance of­fices •

•

AUSTRIA

... Employers and em­ployees; representa­tion 2/3 and 1/3 re­speotively.

Local and pr 0-vincial and officials under Minister ot Interior.

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NETHERLANDS •

Employe rs and em­ployees (representa­tion equal) ,and im­partial chairman ap­pointed by Crown.

Insurance Committee.

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NORWAY.

Employers, em­ployees, and commune; re- . presentation 2/9, 5/9, and 2/9 respectively.

State Insurance Institution.

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SUBSIDIZED VOLUNTARY INSURANCE

Denmark provides generous subsidies to mutual

aid sooieties operating under Government supervisiono To

be reoognized by the Government, the membership of a sooiety

must be drawn from workers and persons of small inoo~eo

These State grants equa~ now nearly one-third of the total

cost of the insuranoe providedo ,Iceland ~as a somewha~

similar subsidized voluntary system of Health In~ranQe.·

Switze~land offers splendid induoements to volun~

tary subsidized insuranoe. Grants are. made to suoh mutual

benef.i t sooieties as are not operated for profi to. They

must offer to the in~d at least twenty-six weaks oash

benefits in any year of at least a franc a day, and a

standard of medioal servioe., inoluding maternity insuranoe

and nursingo Four cantons have now made Health Insuranoe

compulsoryo

France makes small subsidy grants to mu.tual... bene­

fit societies toward sickness insuranoe, funeral benefits,

and to widows, orphans, invalids and for aSSisting the aged.

The experienoe of the French system has been that only

about five per cent of the population has been reoeiving

State assistanoe toward Health Insurance.

HEALTH INSURANCE nr AMERICA.

The development and suooess of' compulsory'Health 4 Insurance in Europe has for some years occupied the atten-

tion of students of sooial problems in this continent~

One of the early results of the oompulsory Health Insurance

movement in Amerioa was the oalling to~ether of an Amerioan

Coilference on Sooial Insuranoe in Chioago in 1913 •

. • ~ .. " __ c off. ., .... ~-' ....... .t .... c. , .• , ~.'" ..... ~ ...... _ .... ,.. ,_

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Following that date the Amerioan Publio Health Assooiation,

the Amerioan Aoademy of Medioine 'and the Amerioan Medioal

Assooiation did much researoh.work on the subJeot. MUon propaganda was spread by the interests in this oountry whioh

might be affeoted by ~ legislation providing Government

insuranoe for siokness~ E~even Amerioan States appointed

Commissions for the purpose of studying the whole snbJeot~ , .

A great deal of disaussion has been the result and the snb-.

Jeot is fast beooming understood by a large ~eotion of the'

people. The path that oompulsory Health Insuranoe is beating

is bristling with the same obstaoles whioh marked the. oourse' ,

of WorklIi.en' s Compensation for industrial aooidents a deoade -

ago. The obstacles to Workmen's Compensation have been

surmounted, and in less than ten years six Provinoes. forty.,

five States, three Terr~tories, and the Federal Government.

of United States, have adopted Workmen's Compensation laws

administered by a Commission. The obstruotions plaoed in the

way of Health Insuranoe by its opponents are fast being re-h .

moved by investigators. Seve.n state Commissions, Ma.ssaohus­etts (~9~7) f~rst report), California (1917), New Jersey .

(1918), Ohio (1919), California (1919), Penns¥~vania (1919)

and. New York (Reoonstruotion Commission 1919), reported

that there was a need for Health Insuranoe Legislation in

their respeotive Stateso FOur Commissiohs, Conneotiaut

(1919), Wisoonsin (1919), Illinois (1919) and Massaohusetts , . -

(1918) (seoond report), ~eolaredagainst it~ The pennsylvania

Commission, after reporting on the extent of the, siokness

burden, pOints out that some reme~'was neoessary to meet

the situation and asked for a further oommission to oon~

sider legislation to that endo Some ve~y valuable

work was done by the california, Pennsylvania, Ohio and

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illinois Commissions. The oonolusions drawn by the

Illinois Commission are·not in o~ opinion deduoable from

the data presented in their report. Their data would in­

dicate that there is a genuine need for compulsory Health

Insura.o:.ce.

CALIFORNIA

The California Commission (19l7),atter sixteen

months continuous work, unanimously conoluded in substance

that - "Social Insurance represents an effective means of

counteracting some of the harmful effects of sickness un­

der existing· condition; Social Insurance is almost world

wide in its application; Imlch has been accomplished in

the prevention of poverty by suoh insurBllce; the prevention

of sickness goes hand in hand with such insuranoej siok­

ness insurance next to accident insuranoe is the best

developed form of social insuranoe; the workers reoognize

the importance of insurance; workers in California do not

suffer, however, aSImlch from sickness as do workers in

. other States, but medical care is costlier in California

than elsewhere; private hos,pital facilities are beyond the

reach of the working mwm, and the conditions have resulted

in the development of free clinios, dispensaries and lodge

practioe". In 1919 the Commission again reported as

follows:

(1)0 COMPULSORY •. Insuranoe Imlst be both volun­

tary and oompu1sory, but as to at least a very large part

of the insnred it Imlst be compulsory. Experience in

other oountries had demonstrated the necessity for this 0

A purely voluntary system does not re~oh those who most

ne.ed it; its oTerhead charges are necessarily larger;

compulsory contributions from employe~, (to a voluntary

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system), are ImpractiQable; and it does not admit of free

choice of doctors, nor of exemption from medical examination.

(2). CARRIERS. In England the "friendly so­

cieties", trade unions and similar voluntary co-operati va

bodies, are practically the sole carriers of insuranceo In

Germany the carriers are 'private organizations, industrial

groups, and the State~ The Commission conCluded, in the

light of exp;erience of these countries am. of the oi vic

habits and traditions of our people, that the'sole oarrier

of the medical benefits should be the State, but that the

cash or wages benefits should be oarried either by the,

State or by a fraternal union, at the option of the insured,

but not by private commeroial oompanies operated for profit.,

(3). ' BENEFITS. The Commission agreed that the

soale of benefits ought, if pOSSible, to equal that now

granted by California in case of industrial aooidents, name­

ly, full medical. and. hospital care and two-thirds of wages.

For the sale of simplicity of administration, however, it

would be admissible to divide wage-earners into groups, eaoh

with a standard medium of basic wage, and to compute the

payment of premiums and of benefits on this basic wage,

rather than making them an exaot peroentage of the individual

wage.

(4) 0 BENEFICIARIES. The medi cal benefit should

include not merely the insured workman himself,. but his

dependent family (wife and ohildren).

(5). PAYMENTS. The insurance fund as suoh

should be self-supporting and shOUld be maintained by pre~

iums paid by the insured employees and ,their employers.

The Commission thinks that these payments shoul.d be equal

in amount, except in'certain exoeptional oases. Self em­

ployed persons, being their own employers, if, insured. \

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should obviously pay both premiums. The State's contri~

bution sho~d go to the administration of the Aot it­

self (not the fund), as in Workmen's Compensation, and

to equipping additional hospital faoilities and medioal

administration. This pa,.vment by the State should:,. if

pOSSible, amount to one million dollars per annum, but by

decreasing or delaying ho~ital equipment it oan be done

temporarily for less;,

(6). CHOICE OF PHYSICLUr 0 Every insured pe,rson

should have the right of choosing any doctor praotioing

under the Aot, and every phYSician and surgeon lioensed

under the laws of the State of California (as they now are t

or as they may hereafter be amended) should be permitted

to praotioe under the Act.

(7). PADJENT OF PHYSICIANS. Physioians

praotioing under the Act should, normally~ be paid by the

"panel" or per oapita system; that is, eaoh physician

should reoeive a fixed amouht per year, for eaoh person

(inoluding eaoh depenQent) registered as chossing him as

praotitioner. Different arrangements oould be authorized

for speoialists, for organized groups, and for isolated

oommunitieso

(8). ADMINISTRATION. The Act should be adminis­

tered by the Industrial Aooident Commission. There should.

be under that Commission a State and Distriot Medioal

administrationo

NEW JERSEY.

The New Jersey Commission unanimously reported

as follows:-

"The Commission is of the opinion that Health

Insuranoe is a measure whiCh gives great promise for reliev­

ing eoonomio distress due to siokness and stimulating pre-

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ventive aotion. To seourethese ends suoh a measure

adapted to New Jersey's needs should be based upon the

following fundamental prinoiples. Existing Health In­

surance agenoies that are conducted on an adequate basis

and at aotual cost should with mntuaL management be util­

ized in the further development of a compu1sory Health

Insuranoe system.. In order that the later effectiveness

and eoonoIn3' of a universal system may be enJoyed, Heuth

Insuranoe should be made to oover all regularly employed

. wage earners.' InS\lranoe should provide med! oal oare and·

health instruotions in Order that its work may be· both.

curative and preventive •. To minimize the finanoial dis­

tress attending sickness, the system should provide a oash

benefit during temporary inoapaoity from work. It should

also provide maternity oare to meet the special needs of

the working mothersoHealth Insurance should be demoorat­

iCally supported· and managed by those directly oonoerned,

the state bearing its share of cost and administration

as it does under Workmen's Compensation •. The system

should be under the supervision of a speoial bureau of the

Department of Labor with oompetent medioal direotors, and

in olose co-operation with existing publio health agenoies

in order to place added emphasis upon the extremely im~

portant problem of sickness preventionlt •

MASSACHUSETTS.

The speoial Commission on Social. Insuranoe ap­

pOinted by the State of Massaohusetts in 1916, reported

in favor of compulsory Health Legislation in February 1917.

It found the voluntary Health Insur~ce had never reaohed

all the people. Those who needed it the most failed to .

take·it~ The cost of oompulsory Health Insuranoe. they

~ound, OQuld reasonably be borne two-~i~ths by the employer, .

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two-fifths by the worker and one-fi:fth by the State. Looal MUtual Associations or employers and workmen could be used as carrierso Sick benefits amounting to two-thirds o:f wage loss was reoommended in addition to medioal benefits •

. Ma terni ty benefi ts to the wives of insured men, and fo.neral benefits were advised. Reasomably free choioe of medioal praotitioners was thought advisable, a~ medioal benef1ts should extend. to members of the worker's family'.

Aseoond speoial oommittee was appointed in 1917 and reported. in 1918.: The seoond Massaohusetts Commission appears to have considered its task to be that of discover­ing how the various groups to be affeoted by Health In­surance would take to a Health Insurance soheme 0 The ,opi.nion of empioyers, employees, insurance companies and drug dealers take a prominent plaoe in the report instead of data on the situation. This Commission reported in favor of encouraging the extension of voluntary insura~oe to cover sickness, and devoted muoh space to an endeavour to prove that the state did not want compulsory insuranae.,

WISCONsm

The Wisconsin Commission, without the assistance .. of any spec'ial investigators, presented in its report the well known arguments for and against Health Insurance. Some local data of value was gathered, but was not apparent­ly used in preparing the 'Commission's conclusionB,which were to the effeot that there was no great demand for Health Insurance. The majority report in short deoided that siokness of wage earners should be provided against by reducing sickness; preventive methods should be enoouragedj,' oontributions from State funds would not be C'onstitutionalj .. '

and oocupational diseases should be compensated for like oocupational aooidentso This Commission stated - nThat prevention rather ,than indemnifioation is ,a better solution

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of the problem. we see no reason why sickness of the wage earner cannot be ful~ met by diminishing illness with­out attaohing at the same time to this effort a compliQated plan of insurance as contemplated by the proposed Health Insurance Legislation" •

. CONNECTICUT

The Conneoticut Commission's conolusions "in part were as ~ollows,-

"We mu.st grant that some of the arguments pre­sented to us in favor of oompulsory Health Insurance appeal strongly to human s:entiment, and. are convinoing to the ex~ tent that more should be done by the S~ate to ~p~ove l1v-· ing conditions-and prevent disease; but they have not brought conviotion to our minds that any of the measures heretofore presented shoUld be enaoted in Conneotiout. Upon the eviden~e which has be·en presented to us and after a oareful study of investigations made elsewhere, we feel that our State should not be the first in the United States to experiment with a plan or system whioh has not operated effeotively and satisfactorily in other oountries, and which must of neoessity involve the e~enditure of·a large amount of money -- too large a burden to be imposed at the present time. It may well be that this State;should now improve and extend the oode under whioh the Department of Health and Safety operates, so that health and sanitation may be more effioiently safeguardedo So may the oompensation law be amended to ooveroccupat1onal disease and thus aid in

. reducing the loss resulting from Sickness. These changes can be made in harmony with our prino~:ples of government, and the correctional and curative features pf the sooial insurance soheme may be inoorporated in our laws without placing the State in any way in the field of social in-

.. . ~.-, ~ . . __ .. ___ .•• ~. '" '4_'~~""'~""'~''--'-_''''_ • ____ . __ .;,_. __ ...:::. __ "_.'!......., ... __ .I.-..::...:-r~~,

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suranceo It may also be. tha'!i the same plan oan be devised by which the insuranoe features, of the sooial insuranoe soheme, whioh after all are only palliative, may be eoonom­ically administered under rigid State supervision and con­trol. In our opinion this time has not arrived, and for the reasons hereinbefore given, the General Assemb~ may, with entire propriety postpone further legislative consid­eration of this phase of sooial insuranoe until the. ohanges in our National, State aDd personal relatiOns resulting from the war have been f'U.ll.y readJusted" 0'

OHIO

Expert investigations oarried on by the Ohio Commission makes its report one of the most thorough on the subjeot. This Commission reported,-

(1). The prinoiple of Health Insuranoe is approved as a means of distributing the cost of siokness.

( 2) 0 Heal th Insurance should be re qui red fo r all employees to be paid for by employers and employees in equal proportion. The State should pay all cost of State administration as in the case of the Workmen's Com­pensation Act, and all cost of supervision of insuranoe. oarrierso

(3J. The benefits to workers under Health In­suranoe should consist of (a)oash payment of a part of the wages of workers disabled by sickness; (b) oomplete medioal care for the worker, including hospital and home care and all surgioal attendanoe and the cost of allmed­iCines and applianoes; (0) adequate provision for re­habilitation both physieal and vooational in oo-operation. with existing public departments and institutions; (d) dental oare; (e) medical oare for the wives and dependants of the workers, if the same oan be doZ?-e oons ti tutionally ,. and a burial benefit for the worker. ,

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(~) (> (a) The exact form of organization of the medioal servioe, including "hospital and dental servioe, should be left largely to the State Health Insuranoe Com­mission which administers the Act to develop plans to meet oonditions in different parts of the State. Minimum stand­ards should, however, b~ established to insure that suoh servioe shall be adequate.

,( b) It should be clearly established that medioal, hospital and dental oare shall be adequately compensated. '

(5). The insurance should be carried in es-tablishment funds mutuallY managed and in publio mutual associations. Companies or assooiations writing insurance for profit should not be permitted to be carriers of suoh insuranoe.

(6)0 The system should be administered by a State Health Insurance Commdssion of four members. The, State Commission may fix such administrativedistriots as may be necessary and shall co-ordinate their work as far as possible with the local Health authorities.

(7) 0 There should be a reasonable waiting per1od, not less than six days, before cash benefits are paid. Medical benefits should be given during the entire time of disability. Benefit payments should be contiIItled as long as disability lasts, but not ex~eeding three yearso

NEW YORK

The Reoonstruction Commission of the State of New York, held meetings at which evidence was taken from re­presentatives of various interested organizations in the State, and reported itself in acoord "with the prinoiple that Health Insurance should be oompulsory"o

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ILLmors

Although the majority of thiS Commission reported

against the necessity of compulsory Health Insurance Leg­

islation, the investigators engaged by the Commission com­

piled some very valuable data which argues strongly that

there is a real need t:or compulsory Health Insurance. The

Commission's majority findings are summed up as 1'0110ws:-,

(1) That somewhat. less than two per cent are,

disabled by sickness or accident at a given time.

(2) That the peroentage not disabled, but

who have serious afflictions which may oall for medioal

care 1s distinctly larger.

(3) That approxilnately two-thirds of the wage "

,earning families.'will have one or more cases ot:, serious'

sickness or'non-industrial accident in the course ot: the

year.

(4) That in something more than half ot: these

t:amilies the illness will inc~ude that. of wage earners.

(5) That something more than a quarter of the

wage earners will be sic'k or sustain non-industrial acci­

dent in the course of the year, and that about a fifth of

the entire number will lose a week or more of the employ­

ment because of the disability caused thereby.

( 6 ) That the 10 ss 0 l' time by wage earner swill

average between eight and nine days per year f'or eaoh wage

earner in the entire group.

(7) That the losses due to sickness and non-

industrial accident are very unevenly distributed among

the wage-earning l'amilies.

(8) That the average loss i~ wages and medical

bill connected with sickness am accident:' will approach

$75.00 pe'r year par t"amily, when spread over the entire

group, amounting to 5i per cent or more' of the average

l'am1ly income. \

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(9) That the money cost ·ofsickness and non-

industrial accident borne by the wag~ earners of Illinois

is probably between $80,000,000.00 and $86,000,000.00 per

year.

(10) That sickness and non~industrial accidents

are frequently accompanied by more or less important changes

in the standard of living.

(11.) That they give rise to deficits in a

substantial number of cases.

(12) That in Chicago sickness and non-industrial

accident would appear to be responsible for 25.3 per cent

of the oases of poverty found in our investigations~

(13) That sickness and non-industrial accidents

are fOQnd as a cause or as an accompanying condition of de­

pendency in from a third to half of the-c.ases of dependency.

not giving rise to institution care.

(14) That tuberculosis and other chronic di­

seases are each found in from 20 to 25 per cent of the cases

where sickness is a cause or condition of dependency.

The Commission's reoommendations are as follows:­

(1) That the authority and powers of the state

Department of Public Health be enlarged in such manner as

to give this Department the direction and control. over

public health administration in the State, including the

administration by the local public health bodies as n~w con­

stituted, required for a proper coordination, direction and

control of matters pertaining to the public health.

(2) That the County Tuberculosis Act be amended

so as to provide for payments to wage-earners under treat­

ment in the County Tuberculosis Sanatoria.·

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'(3) That the Legislature appropriate the sum

of $60,000.00 for the control of venereal disease in ac­

cordance with the program therefor 'ini tiated by the, Federal

Government. A like amount will thus be available from the

appropriation by Congress for this purpose. The importance

of this subject is such as t~ indicate· the desirability of

the Legisiature's appropriating this amount which is the

max~um to Which the State of Illinois could be entitled

fram the Federal appropriation. The amount of the Federal

appropriation available for Illinois will be limited by the

amount which Illinois appropriates.

(4) That a Commission be created to study the

problem of Occupational Diseases and the methods for the

payment of compensation for losses occasioned thereby.

(5) That a Commission be created to study and

investigate the mortality of women in childbirth and of

infants in the State; facilities for obstetrical service;

and such other matters relating to pre-natal, obstetrical

and post-natal care as affect the health and well-being of

mothers and infants.

(6) That such legislation be enacted as may

be required for the establishment of a county hospital in

each county of the State, and for the proVision and main­

tenance of disgnostic facilities therein by the State.

(?) That such steps be taken as may be necessary

to provide public health nursing service in each county of

the State.

MINORITY REPORT

The minority report points out that the data

gathered bears out the urgency for legislation. The find­

ings of t he minor i ty may be stllIIDlari zed as 'follows;-

(1) Sickness is a serious problem. The ,chances

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are two to one that a family will have one or more of its

members seriously sick in a given year. The time 19S5 is

a serious thing economically and socially.

(2) Sickness calls far insurance principles.

(3) That sickness is an insurable risk is gen-

erally recognized.

(4), The great majority of wage-earners carry

no Health Insurance. Less than one-third of them carry

any.

(5) Available Health Insurance is inadequate

and costly •

. (6) Most available Health Insurance provide~

partial indemnity for lost wages only •

. (7) There is a distinct need for better or-

ganization of medical service for wage'-earners.

(8) If the application of the Health Insur-

ance principle to the problem of sickness among wage­

earners and their dependents is to be most effective it

must be universal and compulsory.

PENNSYLVANIA •

For lack of time this Commission was unable to

add much to the wealth-of ~fo~tion already 'compiled on

the subject of Health Insurance, but after making its studies

in Pennsylvania it decides that; - ttthere is a large amount

of sickness among employees; that the losses to employers,

employees and the public are enormous; and that the facil­

ities for caring for the sick, and for meeting the losses

of sickness are inadequate."

BRITISH COLUMBIA •.

In o~der to ascertain whether or not there was

a need for a system of s.tate Health Insurance in this Pro-·

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vince the Commission made a general study of;-

(I) Average wages paid in the more important

industries, as well as the average weekly wage covering all

industries.

(2) The extent and nature of physical defects

among the men of the country.

(3) The extent of premature death in the Pro-

vince •

(4) The ext en t and nature of preventable di-

sease.

(5) The extent and nature of sickness and the

economic loss due to it.

(6) The relation of sickness to poverty.

(7) The cost of medical attention and hospital

care in relation to the wage earning capacity of the aver­

age workman.

(8) The facilities now available to wage-

earners for insuring against sickness.

(9) The cost of commercial Health Insurance.

(10) The extent to which workmen are insured

against sickness through fraternal orders, trade unions and

commercial insurance comp~~ies.

WAGES PAID IN BRITISH COLUMBIA.

The fo110wing table shows the average daily

.' wage paid in certain industries within the scope of the

Workmen's Compensation Act in 1919;-

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nmUSTRIES.

Wooden shipbuilding Canning and packing fish Building construction Coal mining Lumbering, logging, booming, etc. Steel shipbuilding Metal mining Shingle milling, etc. Stevedoring C.P. Rly. Co. Construction and Operation C.N. Rly. Co. Construction and Operation Saw milling yards and delivery

NO. OF MEN INJURED IN EMPLOYMENT

709 101 101 840

1314 620 638 304 252 305 108

1088·

It will be seen trom these figures that in

AVERAGE DAILY WAGE.

$5.57 5.52 5.43 5.22 5.19

·5.05 4.89 4.70 4.65 4.58 4.32 3.92·

6,380 cases which came before the Workmen's Compensation

Board during 1919 in the industries enumerated above, the

average dally wage at the day of the a.ccident~ per indus­

try, was $4.92, and these industries include those which

are the most hazardous and consequently are highest in the

scale of wages. These twelve industries include all the

industries in which there were over one hundred accidents

during 1919. For all industries coming within the scope

of the Act for 1919, the average daily wage as of the day

of the aCCident, as shown by 9,242 Cases in which records

were made, was$4.68.

Many of the. occupa~ions in this Province are of

a seasonal nature, like fishing, or of a casual nature like

stevedoring, and building trades. In others, like lumber­

ing or coal mining, the steadiness of employment is depend- .

ent on the c cxmn.ercial demand for the product. Still ot hers,

~ike shipbuilding, are more or less precarious. In same

occupations, according to the evidence given before the

Commission, the loss of time runs as high as three to four·

months of the year. Considering the constant changing

fram one employment to another, due partly to readjustment

of industrial demands and partly to climatic and, economic

conditions, it may be fairly said that the average worker

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loses from eight to ten weeks annually through unemployment. , , This is also the conclusion arrive~ at by the United States

Department of Labor, Bureau of Labor Statistics as to, the United States. The 1920 Annual Report of the Workmen's Compensation Board for this Province shows that the average weekly wage for 1919 was $22.16, or less than $96.00 per month. The inadequancy of this wage to meet the present cost

I,

of food, clothing, shelter and the bare neoessities of life, is a II the more apparent and startling when it is cons idered that over fifty percent of 'all cases cOming before the Work-men's Compensation Board during the year, were cases of married men.

The tabulated statements based on returns from 174 employers, giving the weekly wage paid 2,043 women en­gaged in the mercantile industry in British Columbia in 1919" showed that 1,080 of the women were drawing $11,.00 per week or less. A similar statement based on returns from seventeen employers giving the weekly wage of 476 women engaged in the laundry industry in the same year, showed that 264 of the women were drawing $11.00 per week or 1 esse

The Minimum Wage Act, While it haS partly reme­died the evils of the lowest wages, has tended to have the effect of setting a maximum wage in many of the occupations.

THE EXTENT OF OUR PHYSICAL DEFECTS.

The physical condition of any country ar dis­trict cannot be accurately ascertained without a general medical examination of all the people, and since this coUn­try has never had a survey made of its health conditions, data on the subject is not available. The:' Commissioners did not deem it necessary nor advisable at this time to put the Province to the expense of a general survey of health

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conditionso The members of the Commission making. this re­

port, by reason of their past activities in social welfare,

fraternal. and labor work, are fairly well informed of such

conditions.

A glance at the physical examination records

made of our soldiers brings ,to light the startling physi-'

cal condition of our men. Canada recruited 566,956 men'for

the army. Under the Military Service Act 401,882 more were

registered, making a total of 968,838 men of approximately.

military age, ·of whom records were made as to physical con-

dition. Of this number 69,194 or 7.2 percent were killed

in action, died of wc:unds, disease or as prisoners of war,

or have been presumed dead 'by military aut:q.ori'ties. The

total casualty list, including the dead, reached 225,087,

which is 30 percent of the total number of recruits and

men made available for serVice, or 23.3 percent of the

total number of men of whom medical records were made.

Of the 401,882 men examined under the Military Service Act, ,

only 179,933 were made available for firing line service,

leaving 221,949 or 55.2 percent in the lower medical categories.

That is to say that of 968,838 Canadian men at their best

age physically, 69,194 have died, 155,893 'have been seriously

enough incapacitated as to appear in the casualty lists, and

221,949 others have failed to measure up to the active service

standard of health. That is to say, that 447,036 out of

968,838 of Canadats men have appeared on the casualty lists or

have been found unfit for active combatant service.

The above figures are from the 1919 report made

under the Military Service Act, and convey some idea of

the physical condition of the men of this country. It·

should be pointed out, however, that the casualty figures

include same of those men whose names were more than once

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on the casualty lists, which, however, does not reduce the

sum total of physical incapacity resulting from the war •

. No figures are available to show what extent the general

health of Canada's soldiers has been effected by .pa~tici­

pation in the war, but it is true that ·the hardships and

exposure endured will result,in an annual toll of' rheu-

matism. and kindred ailments for many years to cane.

Of the 18,169 men who were registered in British,

Columbia under the Military Service Act, only 9,609 were

found to be in suf'ficiently good physical condit~n for ser­

vice in the, firing line, arid. 4,075 were .found to be unf'it

for military service of any kind.

Vlliile figures are not available to show the

number of' BritiSh Columbia's young men who died overseas

or who appeared on the casualty lists as wounded, it may , \

be fairly estimated, of the voluntarily enlisted men and·

those registered under the :Military Service Act, that 6,000

made the supreme sacrifice and close to 16,000 others were

wounded. in action. By adding to these f'igures the 8,560

men of the Province who were found to be of low medical

category, it will be seen that'near1y half of' the' young

men of this Province have been in the casualty lists or .

in the lower physical c~tegories.

The following tables which are from the Report

of' the Director of military Service of Canada, 1919, show

the number of physically def'ective men of military age

in Canada by p,:'ov inces, and the curtailment in our man

power by the recent war.

Of

, ,

--PROVINCE.

Category A

U

B

0

D

E

TOTAL

NOTE:"

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TABLE SHOVlING FINAL -MEDICAL CATEGORIES AND

Men made available

SASKo ALTA. N.S o MAN. N.B. P.E.I.

48,615 22,024 15,191 10,959 7,656 8,359 7,880 6,965 1,325

21,492 54,172 20,089 8,850 8,559 5,826 1,729 3,696 1,989

14,049 8,952 2,~87 2,025 2,145 2,882 _ 2".528 ~,356 268

17,139 13,422 1~453 2,220 1',905 2,856 1,845 1,570 171

961 954 I 65 _ 61 455 377 112 177 17

22,709 16;078 5.751 3,961 4,896 2,215 4,075 3,138 731

124,965 115,602 45,536 28,076 25,616 22,515 18,169 16,902- 4,501

Category A refers to men available for service in the firing line; _ U is .the category designating .the men who were not examined, but were preSQrned to be In good health. B men were available for non-combatant Overseas servioe. C men for servioe in Canada only. D men were temporarily unfit, but who might later be graded A; E men were unfit.

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TABLE SHOWING PERC~'NTAGE -OF REGISTRANTS UNDER THE MILITARY SERVICE ACT

made available for servioe. > , . I ,

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" I FROVINCE ONT. QUE. SASK. ALTA. N.S. tUN. B.C. N.B. P.E.I. TOTAL. I J

I ~ f:~

~ ': : Registrations 124,965 115,602 45,536 28,076 25,616 22,515 18,169 16,902 4,501 401,882

': "

. Net total madle available 52,010

J .. 37,920 14,349 9,589 9,911 12,281 9,304 8,699 . 1,731 155,794

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!: Peroentage of I registrants

made avail-able 41 33 32 34 39 55 51 51 38 39

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TABLE SHOWING CANADIAN

CASUALTIES DURING RECENT W .. l\R.

Killed in action

Died of wounds

Died of disease

Wounded

Prisoners of war

Presumed dead

Missing

TOTAL . . . . . . . . . . . . . .

35,684

12,437

4,397

155,839

3,049

4,682

9,165

225,25~

still further inroads were made on publio health

by the "nurt epidemio of 1918-1919, during whioh period no . . .

less than 2,734 people died from influenza and pneumonia

following. influenza, in this Province alone, and the health . .

of thousands of·?thers was undermined leaving the victims .

more than ever susoeptible to disease.

At no time in the history of this o ountryhas its

man power been at a lower ebb, and this was brought about

largely by a oombination of nation-wide misfortunes for whioh

the individual was not responsible nor could he have esoaped

the results to any material extant by any efforts. of his

own 0 Therefore, the physical condition of the people is now

more than ever before, a matter for serious (l:onsiderati-on by

the Government, and on the oompletene~s with whioh the Govern­

ment solves the problem of a steady man power depends muoh

of the future prosperity of this 90untryo

In faot of Canada's geographioal prox1m1 ty to the

United states maJces it all the more imperative that we en­

deavour to maintain its produotive power .at a degree of

effioienoy whioh will enable it to sucoessful~ complete in

productivity with the Republic to the South.

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This can only be accomplished by an immediate improvement

in health conditions. The wastage of our. Canadian man

power during the war equalled that of the United States of

America with fourteen times our population, and practically

equalled that of Belgium the TTMartyr of Nations", with

nearly our own population. Physicaily the people of the

United States of America .are, in normal times, no better

off than we. The United States Provost Marshall General's

Report for 1918 states that 33.2 percent of all men examined

were reJeoted on acoount of physioal defeots, by 100al

boards and oamp surgeons. The handicap which our oOQntry

must overcome is the handioap brought by a casualty rate

fourteen times as heavy per capita as that of our nearest

industrial competitor.

The Extent of Premature Death

A study of the ages at which the people of British

Columbia die is of value in determining the responsibility

for premature-deaths, the extent to Whioh the physical.

defects causing these deaths can be remedied, the extent to .

which time loss sicknesses can be prevented, and the extent

to which proper medical treatment supplied in time might

have prevented deaths. -

The following information is given as acomparat1ve

statement re the ages of decedents. for the Y\3ars 1917, 1918

(six months), 1918-19, and 1919-20:-

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Percent of Deaths of

.Ages 1917 1918 (6 mos.)

1918-19 1919-20 1919-20:

Under 1 year 587 260 590 623 13.49 .1 to 2 years 82 45 126 77' 1.66

2 to 5 years 107 58 191 124 2068 5 to 10 years 76 44 135 106 2029 10 to 20 years 154 93 364 213 4 0 61 20 to 30 years 329 161 1,160 423 9.15 30 to 40 years 473 244 1,505 650 14007 40 to 50 years 451 248 777 621. 13.44 50 to 60 years ' 450 259 548 550 11.90 60 to 70 years' 461 244 486 509 11002 70 to 80 years 341 181 364 427 9~24 80 to 90 years 158 97 155 214 4.63

.90 years and up 18 11 24 ·32 0.69 Age and sex not given 28 9 83 49 1.06

TOTALS 1,721 1,954 6,508 4,618 .. 99 0 93

lnthe above figures still-born are not inoluded with

deaths under one year. There were 175 still-births ,in 1917,

92 for the first six months of 1918, 188 for 1918-19 and. 270

for 1919-20. These are from the twenty-fourth report of De­

partment of Health 1920 0

The Extent and Nature of Preventable Diseases •.

The responsibility for deaths from preventable diseases

must be shared by the individual, who will not oare for his own,

health, by the aomuronity. which, permits inteot~on or aon~aglon

to be possible, and by the industries in whioh the worker oon­

traots these diseases. While it is agreed that a large peroent­

age of diseases cannot be traoed to any single definite souroe,

still a study of the kinds of diseases oausing our heaviest

death lists is of valueo The following tables are taken from

the twenty-fourth Annual Report o~ the Provino~al .Board of

Healtho

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DISEASE 1911 1912

Typhoid Fever 92 99

Smallpox 0 0

Measles 11 13

Soar1et Fever 31 12

Wh<?oping Cough 23 15

Diphtheria 68 36

Tuberoulosis 316 368 (all forms)'

TOTAL 541 543 :

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SO:rvU!; PREVENTABLE DISEASES

RESULTING IN DEATH FOR PAST TEN YEARS IN

BRITISH· COLUMBIA

'.

1913 .. , 1914 1915 1916 1917 1918 (6 mos. )

85 42 .32 23 24 5

0 0 0 0 :; 0

11 1 14 12 6 17

18 3 0 1 7 2

27 23 9 37 21 14

35 11 11 18 19 7

422 403 425 367 413 236

598 483 491 458 . 493 281

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1918-19 1919-20 TOTAL

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13 9 424

2 0 5

4 9 98

·1 5 80

19 16 204

16 40 261

. 431 443 3824

486 522 4896

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2~

3.

4.

5.

6 •.

7 •

8.

9.

10.

11.

.120

130

14.

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CLASSIFIED LlST OF ALL RECORDED DEATHS

IN BRITISH COLtmffiIA FOR YEARS 1913 TO JUNE 30TH, 1920

(not inoluding Indians)

1913 1914 1915 1916 '-a

General Diseases 997 856 895 936

Diseases of Nervous system and organs of speoial sense 404 358 336 389

Diseases of Circulatory system 501 403 479 456

Di seases of Respiratory system 458 345 340 494

'Diseases of Digestive system 300 329 260 224 I

Non-venereal diseases of the Genito-urinary system and annexa 238 207 163 206

. The puerpetal state 53 65 50 50

Diseases of skin and oellular tissue 12 13 7 15

Diseases of the bones and organs of looomotion 1 3

Malformations 9 42 51 55

Diseases of early infanoy 765 579 526 438

Old age 68 66 70 80

Affeotions produoed by external oauses 717 642 583 473

Illdefined, in'oluding exeoutions 97 . 72 71 68

TOTAL 4,619 . 3,977 3t~32 3,887

1917 1918 (6 mo s.)

965 .523

380 220

540 293

439 278

268 109

204 102

59 17

23 8

3 1

51 24

405 186

54 37

.' .4;;5 225

50 23

3,896 2.046

1918-19

1,242

449

528

2,944

189

216

40

18

6

42

447

76

414

85

6 a 696

. .

1919-20

1,140

445

611

818

259

223

47

17

12

45

591

90

543

47

4ft888

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Extent of Sickness and EconomiQ Loss due to Sickness.

Sickness varies in extent with the seasons of the year and a sickness survey made at any given time could not be relied upon to present aocurately the extent of sickness for the whole year. With this fact in mind several, surveys made at different seasons of the year and. made by the Metropolitan Life Insurance Company in the states of New York, New Jersey, North carolina, Massachusetts, Pennsylvania, West Virginia and Montana, have be en snmmari zed wi th the result that it is established that 2.'02 peroent, of the population is sick at any one time and that 1.83 peroent of the population is suffic:iently siok to be anable' to work. That is to say, there is an average loss of time per person during the year of 5.68 days. F. Davey, for 35 years Grand Seoretary of the Grand Lodge of the Inde­pendent Oraer of Oddfellows of British Colurabia, (the largest Order in the Province), stated before the Commission, "I find the average man's siokness has been nearly five' days in twenty yearS average for the members of the Order"o

Data gathered in California indicates that an average of six days was lost per worker from illness in each year for that State. The Illinois Commission found that the average in Illinois was slightly under nine d~s. The Massaohusetts Commission in 1915 reported that 6.6 days disability from work would ba a fair average, while the Ohio Commission fixed it at nine days~

After oareful survey made in Penns.tl vania, the Realth Insuranoe Commission decided that six days a year would be a low average period of sickness for the workmen of that State.

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The New Jersey Commission fixed the average figure' at 702 days for all workers over fifteen years of

age.

The Commission on'Industrial Relations for the united states of Amerioa, found that "eaoh of the thirty~ odd million wage-earners in the United states, loses an average of nine days a year through siokness.,n

Estimating the average time loss at seven days', , . . ",

.,;.

a year, and the number of wage earning men and women of' this Provinoe at 170.000, and taking the average wage at $3.50 per' day, the eoonomio loss in wages alone in a year is $4,165,000. To find the total oost of siokness there . should be added to this amount the oost ofal! medioal and hospital oare given in the Provinoe. The, total wages lost through acoidents in industry in British Columbia during 1920 was $1,545,956.66 in claims finally disposed ofo The , ,

loss in produotion through siokness is, therefore, about three times as great as it is through aooidento~

This annual period of sickness would not in' 1 tsel:t be such a burden for workmen if it were equalized among them annually. But sickness does not equalize itself as conveniently as that. The more fortunate among us esoape sickness entirely, while others are inoapaoitated for months at a time with oonsequent disastrous results. Com­pulsory Health Insuranoe would equalize the burden, and tide the siok over the period of disability when they are least prepared to bear it~,

The Relation 'of Sickness to Poverty.

~iokness plays a most disturbing' part in the life of most families in whioh there is a limited inaome and a narrow margin of finanoial reserve to meet emergenoies.

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~enditures on food, olothing, heat, housing and dental

care, have to be curtailed to such an extent that the heaJ~th

of members of the sick man's family fre~uently beoomes per~

manently impaired. In order to ascertain the relation.

of sickness to the process of economio degeneration, ~.

investigation carried on. in a working man r S ~ection .c.t

Chioago, determined the normal eoonomio status of 608

charity families by using as a basis the family inoome aug~

mented by the wages los~ through siokness~ It was found

that only sixty-eight of these families had normally enjoyed

mlbderatE3 incomes, '139 had had meagra inoomes anD. 401 had, .: ...

deficient inoomesc. The deduction. drawn is that "the effeot

of sickness, as a factor making for.dependency p. varies irl~

versely with the level of normal economia status of the

familyTl 0 Siokness reduced the earning oapaoi ti of thos&

families studied to 35~9 per cent of what the earnings would

have been had it not been for illness"

THE COST OF 1IEDICAL AND HOSPITAL ATTENTION.

Medical Practitioners are forced. to oharge fairly

substantial fees to cover the cost of living. equipment~

office rents t attendants, libraries and other overhead ex'­

penses. A glanoe at the schedule of fees adopted by the

Vancouver Medical Association will show that surgioal atten­

tion and treatment by specialists quickly runs into very.'

large sums of money, equal in some oases. to the aooumuJ.ated.

savings of most thriftyworkmene Below are given some general

items from the soale of fees approved by the Vancouver Medioal

Assooiation, and which are similar to those in force through­

out the Provinoeo

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House and Office Practice.

Office consultation

Single visit, 8 A.M. to 8 P.M.

Single visit, 8 P.M. to 8 A.M.

Visit to' count~, per mile (one way) in . addition to ordinary fee

Consultation with another Physician

MEDICAL FEES -

Highly infectious diseases, e.g. Small~ox, per visit

MINOR OPERATIONS-

Wounds requiring stitches

Dressings

Incision of absess

Varicocele

Circumcision

Haemorrhoids and Fissures

Fistula in ano

HEAD A..T\JD NECK-

Thyroid

Epithelioma of Lip, simple excision

Epithelioma of Lip, dissection

Tubercular Glands

THORAX AND SPlllE

Empyema

ABDOMEN-

Hernia (Radical cure)

Hernia (Double)

Dilatation and Curettage

BONES AND JOIHTS-

Fractures -

Ribs, Fingers, Toes

- .'

$2.50

3.00 to 5.00

5.00

1.00 It 2.00

5.00 " 25.00

5.00 ".10.00

5.00 upwards

2.50 " 5.00 "

50.00 " 50.00 It

25.00 It

50.00

. 150.00

25.00 upwards

100. 00 upwards .

100.00 "

50.00 n

100.00. "

l50 .• 00 ,.

35.00 n

10.00 to $50 .. 00

".

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Clavicle

Arm, Forearm, Leg, Jaw

Femur

ElbOiV

Compound or severely comminuted

Open Reduction of Fractures

Open Resetting of Fractures

DISLOCATIONS

Small bones

Large bones

AMPUTATIONS - .

Fingers·or Toes

Leg or Arm

OSTEOTOMY -

Genu Valgum.

Skin Grafting

Varicose Veins

Suturing of Tendons

Suturing of Nerves

NORMAL CONFDmlENT-

Haemorrhage

Instrumental Labour

Miscarriage

EYE -SPECIALISTS.

Office Consultation (first)

(subsequent)

House Visit

Consultation with Physician

Congenital Cataract

$40.00 to 100.00

50.00

75 0 00

75.00

50.00 to 500&00

150.00 upwards

150.00 n

5.00 to 25.00·

25 0 00 to 200.00

10.00 to 50.00

100.00 upwards

lOO.OO It

25.00 to 150.00

75.00

10.00 to 100.00

50.00

35.00 upwards

50.00 tt

45.00

35.00 n

5 0 00 upwards

2.50 " n

10.00 n

:"100 0 00 "

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Senile Cataract

Enucleation (removal of eye)

NOSE p~ TlmOAT -

Adenoids

Tonsils

Adenoids and Tonsils

Inferior Turbintomy

Middle Turbinotomy

SUbBUCOUS Resection

GENITO-URlli.A..."IT FEES -.

Varicocele

Lithotomy (stone in bladder)

Bladder tumour s

Nephrotomy (stone in Kidney)

~ffiDICO-LEGAL FEES -

Examination and Opinion

Expert Testimony (1st day)

Vfhen detained from day to day per diem

$ 125.00 upwards

100000

25.00 . " 25.00 " 35.00 " 25.00 " 35 0 00 . " 75.00 "

50.00 to 200 .. 00

100.00 to 1000.00

100.00 to 5000.00

100.00 to 1000.00

50.00 to 500.00

25.00 to 500.00

50.00 to 1000.00

Added to this, the patient is:f:'aced· with a hospital

bill and heavy loss in time during his sickness. The prospect

of the majority of workmen with families meeting such amounts

at one time is very remote. The result is that in a very large

percentage of cases the attending phYSician and the Government,

Municipalities and other contributors to the hospital funds

have to bear the burden. The Medical Superintendent of the

Vancouver General Hospital stated before the Commission that

fifty per cent of the public ward patients treated at the

Vancouver General Hospital had to be treated as charity patients,

and that another ten per cent got away free ,y,ho should pay. This

hospital treated 14,735 patients last year •. It is clear that at

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the present time the burden of sickness is to a very large

extent shifted, partly by necessity and partly by dis-

honesty, unto the shoulders of others than those who re-

ceive the treatment. A system of Health Insurance ad-

ministered under Government control would spread the

cost of sickness fairly over those who should pay and

would secure a just contribut:ion from many vvho now spend

all their earnings as they go along, and make no provi-

sion for a rainy day. These contributions would not be

burdensome to any class, collection being made during

the period of health, employment and prosperity. During

1920 the cost of operating and maintaining the Vancwver

General Hospital was borne in the following way:-

Provincial Government Ci ty of' Vanc ouver Other Municipalities General ward & other patients Federal G01Ternment patients Subscriptions for maintenance and operation and from other sources (including unpaid borrowings at bank)

$ 158,120.60 159,305.40

27,203 .. 90 346',167.92 160,716.30

185,593.10 18c1 /0

$1,037,107.22 . 100%

It will be seen fram these figures that last year

only about one-third of the funds for this Institution.

were supplied by the patients themselves. The hospital

reached its maximum number of patients 1,168 at one time

in February 1920. British Columbia has hospital accommoda­

tion for 3,500 bed patients at one time, not counting mental

hospitals, s9 it will be seen that the Vancouver General

Hospital carried on just one-third of the hospital work of

this Prov ince at a cost per case per day for 1920 of $3.12.

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AVAILABLE METHODS OF SICI0T.ESS INSUPJu"1CE

Commercial Insurance Companies and Sickness

Insurance Companies are not sufficiently meeting the

needs of the people of this Province. The public is

availing itself of their policies only to a very limited

extent, partly due·to the fact that their premiums are

high as compared with the losses paid, with a very,

limited coverage and partly because the average citizen

will take a chance .on remaining well rather than insure.

, A study of the figures given below will show that the

cost of administration in Health Insurance through pri­

vate companies is higher th~ the majority of people

would care to pay_

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t.

I,

..

(x)

(y)

(x)

(.1 )

Premiums

Al1ianoe $94,485 Nationale

Anoient Or- 24,559 der of For-esters

Artisans Can- 157,496 adi en-Franoa-is

Cat;ho1io Mu.- 13,780 tual Benefit Assn.

Independent ' 257,214 Order of Foresters

Royal Guar-. 2,525 dians

Woodmen of the World 1°2 624

~ 560 z683

. , ! ..

SIClomss INSUruu~CE IN CltNADA

Premiums reoeived and Claims paid by Fraternal Sooieties operating under Dominion Lioense, for Siokness Business.

1914 1915 1916 Claims Premiums Claims Premiums Claims Premiums

$82,742' $99,483 $102,031 $103,466 $115,592 $101,209

25,404 23,607 24,399 22,073 30,429 21,965

142,425 160,576 151,336 165,659 -156,773 170,267

10,035 9,550 10,044 7,969 7,724 7,247

225,125 234,914 ~13,037 212,307 196,904 205,639

1,454 2,150 817 2,460 1,099 2,702

8 1488 6.715 41717 5 1 860 4.849 5 1379

$495!673' '~5361995 ~5061381 - ~519! 794 i 513!370 ~5141408

(x) Premiums inolude aooident a.ssessments and olaims inolllde aooident olaims, (y) Premiums inolude funeral fees and olaimsino1ude funeral olaims.

..

--1917 1918

Claims Premiums Claims

$138,781 $93,193 $119,495

38,762 41,326 39,970

149,965 171,444 156,711

6,651 6,602 6,839

177,527 197,837 209,365

1,482 2,751 1,848 -

4 1838 5 2383 5.063

~5l81006 ~5l81536 ~5391291

NOTE:- . Fi~res for the Allianoe Nationale for the years 19l4i

1915 and 1916 were taken from the Quebeo Reports and ino1ude business outside of Canada. All figures for he Artisans Oanadien-Franoois ino1ude business outside of Canada, but the business of both oompanies is largely in Canada-. The above figures are supplied by the Department of Insuranoe at Ottawao

.'

1914

1915

1916

1917

1918

;1,.919

PIiEIVITIThIfS COLLECTED FROM INSURED

$157,000.

139,000.

126,000. I

197,000.

221,000.

249,000.

TOTAL $1,089,000.

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SUNMPl1Y OF ACCIDENT UmURANCE.

HI BRITISH COLlnVlBIA.

for six years (1914-1919)

LOSSES PAID TO INSURED

71,000.

'62,000.

47,000.

111,000.

78,000.

113,000.

$482,000.

PERCENTAGE OF .AIvIOUNTS COLLECTED HETURlillD TO INSURED.

45.3

44.6

37 0 :,3

56.3

35,5

45.4

44.3

,.

COST OF OPERATION, PROli'I'I'S, . ETC. IN PI!RCENTAGE.

54.7

55.4

62.7

43.7

64~5

5 l1.6

55.7

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Year

1916 1915 1914 1913 1912

'" 1911 ' .. 1910

1909 .... ,

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TABLE Snm'JING PHEMItHiB AND LOSSES IN HEALTH INSlJR8.NCE IN U. S. A.

FROM 1906 1916.

'Percentage of Cost of Premiums re- operation

Premiums Losses turned to in- profits, etc sured in losses in "Oercent.

$9,292,065 $4,501,239 48.4 51.06 7,891,030 3,705,713 46.9 53.1 7,594,840 3,53:3,656 46.5 53.5 6,928,735 3,256,227 47.0 53 6,339,406 3,126,160 49.0 51 7,101,666 3,314,301 46.6 53.4 6,451,028 2,770,744 42.9 57.1 5,714,579 2,173,386 , 38 1lO 62

, The above i"igures' are taken fram. the Insurance

Year Book and are given also in the American Year Book, 1917.

EXPERIENCE IN HEALTH INSORANCEIN BRITISH COLUMBIA.

Realizing the necessity of some more adequate i"orm

of Health Insurance measure, certain bodies of indUstrial

workers have established i"or themselves systems by which med­

ical attention is supplied them in return for monthly contri-

bution into a fund for that purpose. Among the most success­

ful organizations of this kind is the "Canadian Pacific Rail-

way Employees' Medical Association of British ' Columbian.

It was formed in May 1914, ~nd embraces all employees of

the Canadian Pacific Railway Company from Vancouver to Stephen

on the Main Line and Kootenay Lines,and B.C. Lak,e and River

Service. At first the insurance was voluntary but ninety­

five percent of the employees joined the Association, and

now it is compulsory. The fees charged to commence with

were $1.25 per month for married men and $1.00 per month for

single men. Subsequently in June 1917, they were increased

to $1.50 for married men, and $1.25 for single men. At these

rates a surplus of $27,000. has been built up in the past

four years. The Association provides medical and surgical

treatment, including services of an eye, ear, nose and'

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throa-t specialist, hospital care and medicine for members

and dependent members of their fa.rnilies; in fact, everything

that a sick person needs in the way of care, except tubercu-

losis and confinement cases. For confinement cases an al-

lowance of one-half the Doctor's fee is made. On the

present basis of charge the single man is bearing part of

the married man's burden because it has been found by the

Association tbat it costs aa cents to care for a single

man· for a lllonth aDd $1.94 per month to· supply medical

attention to the average married man and his family and_

dependent relatives living with him. Inasmuch as this·.

Association has an average of approximately 6,000 employ­

ees for the year round, scattered widely throughout the

Province, it gives us a fair example of what can be dbn~

in Health Insurance and ths cost of supplying same. De­

pendents of the insured are covered which brings the total

number receiving benefits to 15,000. lUre D.A. Munro,

President of the Association, in giving evidence before

the COEIDlission, said, "We find there is not much differ-

ence between the Health Insurance and Compensation; it

is only a step ~rom Compensation to. Health Insurance. I

think there should be no cash compensation benefits paid".

The Canadian Northern Railway Employees' As­

sociation have a similar association with similar by-

laws, covering all. Their ASSOCiation is meeting with

like success. Both of these Associations limit their

membership to employees of the respective companies with

which they are engaged.

A digest of several forms of sickness insurance

successfully operated by employees in certain industrial

concerns in British Columbia is given as fol1ows:-

\ \

.-_...!.. ." _____ L.:-..:.....:. __ • -'--;:~-------- -

Name of.Employer Nature Medical & Looation of of' and

Industry. Industry Surgical Servioe.

B.C.Southern Ry.- Transpor- All Cranbrook, tation. Fernie.

,

Canadian Collieries Coal All -Cumberland Mining

/'

Canadian Collie~ies, Coal All Ladysmith Mining

Canadian Copper Co. Metal All Princeton. Mining

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A SUMlvIARY OF BEALTH INSUR.AJ.'JCE AS OPERATED

Drugs Dressings

and X-Ray,

All -

All

All

All

IN CERTAIN INDUSTRIAL CONCERNS

IN BRITISH COLUN~IA.

Hospital Limitations Approximate Service. ani Population

Exceptions. Served..

Partial No hospital servioe for Dependants Maternity, Cases $15-.00

,

Partial Hospital 3000. Servioe for worlonen only

Partial Hospital for 2000. family six months in any one year. No hospital for " maternity oases. Infeotious and vener~al diseases excluded.

Partial Hospital servioe for workman only Veneral diseases & ¥9sults of intoxica-

i rm Ayn' nn An.

,

No.of' Cost Dootors Per Engaged. Month

$1.50

2 '$1.50

2 $2.25

$1,.00

Thi s temporar-ily broke the "FLU"

Time loss thro ugh accident allowed at $1.00 per day first six months,50¢ second six months. Permanent Total

- Disability, ac-cident $500.00 Death accident $300.00

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2.

Canadian National Transpor- All· All Partial Hospital servioe Married Employers supply '. Railways tation for disease may be ~l.50 transportation under

limited to 3 months. ingle this arrangement. Maternity Cases $1,25 $12,50. Venereal disease exoluded.

Canadian Paoifio Transpor- All All Partial Hospi tal serviae 5'000 Married Transportation to Railway tation for illness may be workmen $1,50 workman and physician

, limited to 3 months, and Single supplied by employero ~ - but has not been so their $1,25 f: ;

limited. families. ~;

V Canadian western Saw- All All Partial Hospital service i:·· Lumber Co. milling to workmen only 1 $1.25 :; ~: Sapperton. ~ .

i~' Consolidated M & S. Metal All All Partial Maternity and "Hos- Married

Rossland. mining pital for family ~~2. 00 exoluded. . Single

~l.50

Corbin Coal and Coal All All All Unlimited in every This association (joke Co. mining respe at exc ept as 1 $2,00 Provide.s full ser-Corbin. to venereal diseases. viae to dependants

of workmen killed.

Eastern B.C. Ry. Transpor- All All All Venereal disease 1 $2.00 tation exoepted

r " !~ .

r". I -j

r

. ' , . , . . . . " : ~

30

~ ~squimalt & Nanaimo Transpor .. All All Pal"tlal. No Hospital for Married

, . , Railway tation family, Mat.erni ty $1,25 ~.

attendanoe half Single rates. $1.00

Inland Coal & Coke Coal All All - Partial $12.00 for Maternity 1 $1,50 .. Co. , mining Cases if' patient goes 1

i' Merritt. to the hospital. No

: hospital servioe for < "ohronio" diseases. /.

i. 'r:'! ':;:

Kettle Valley Transpor- To Workmen Only Treatment of family 4 $1050' J,,'

" r ,:, ' Railway. tation at 25% below usual '", .~

;' ra test ' , " , ;

~

~., l?aoifio Coast Coal All All Partial Aooident work handled 400 2 $1.25 ~: .... Coal Mines. ' Mining by W.C.B. I~':;(

SQuth Wellington

Prinoeton Coal & Land Coal All All Partial Aooident work handled 1 $1.25 Co II , Princeton. mining by W.C.B'

Paoifi 0 Mills, ': Paper All All All $1.50 ~is assooiation Ooean Falls making gives full servioe

to family at Eresent fee.

Viotoria Lbr. & Logging and All All Partial Maternity oases not $1.50 Mfg. Co. sawmilling. inoluded.

\.

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~ f-, .. I-

f'.;, t I,,: I

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t ,.'

Western Fuel CO~t Banaimo.

W1nderme»e Branoh C.P~R.

Coal mining

All

Transpor.. All tation

~ . .

All Partial

All Partial

Aocident work handled byW.C.B.

No Hospital for dependants. Ma­ternity cases $15.00. extra.

: :;.

.'

$1.00

1 $1.50

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SICKNESS BErTEFITS IN FRIENDLY SOCIETIES.

Fraternal Sooieties oarry on a very important work along Health Insuranoe, lines in this Province at the present time. There are two main types of fraternal so~ cieties - those that are purely social, and those that pay fraternal benefitso In the former, unstated benefits are frequently voted to needy members of the fraternity, but the sick benefit idea. is discouraged.o In the latter, sick bene­fits form an important part of, the work of the lodges.. ,Rules and regulations govern the payment of siok benefits, and the Real th Insurance phase of these fraternities i's' generally their chief attraction to new members.

Membership qualifications vary widely in kind. in. different Orders, but usually restrict the joining age some-, where between 18 and 50. Nationality, religion, physiQ~l ii tness and oharaoter may also be a bar to membershipo Men suffering from certain specifio diseases, suoh as tuberculos­is, venereal or chronic trouble are usually ineligible. The result is that the fraternal orders have as their membership a group of "selected'risksff.

Monthly lodge dues ,are usually paid by the members, 'and the funds go to the rent and maintenanee of the local

~ lodge, to the funeral a~A sick benefit accounts, and to the Grand Lodge or Supreme Lodge 0' A. Sick member to be' eligible, for sick benefits must be in good standing in his lodge, not in arrears in his dues, and have been a member the pre-, scribed probation period. These sick benefits are usually cash or medical or botho Nearly all lodges have cash bene­fits onlyo These usually do not rQn more than $5~OO to $10.00 a week for thirteen weeks in any given yearo The wait­ing period is usually one weekO' Where "lodge doctors" are pro­vided, the doctor's services are usually paid for on a per capita basis, and he 1s responsible for the oare of all

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illnesses except operations, maternity cases and the more

"serious diseases".

Fraternal benefit societies, while carrying on

very important work in many parts of the Province, reaoh,

after all, only a oomparatively small percentage of the total

population. In many cases the local lodges are given wide

administrative powers whioh may not be used with the best

of judgment. Certain of them have a membership largely

of men of advanced years, while others are "~aQng men"

lodges •. With a laek of centralized control, a looal lodge

of elderly men in declining physioal oondition oan readily

beoome·unsound finanoiallYo Some of these sooieties have

undert~~en to supply more benefits than they oan afford to .

pay with the dues oolleoted, as oan be seen from the follow­

ing tabla:-

-. YEAR ,

f

,; I ' c· r 1914 t .

1915 . '

1916 t ' r'

. 1917 r' ~.

1918

1919

TOTAL

. "

~. ' .. - .

0' . . . .

~~UillY OF SICIDNESS nmURANCE.

PR~IImvB COLLECTED FROM INSURED

$ 68,000.

68,000.

100,000,

50,000.

73)000.

. 106,000.

465,000,

IN BRITISH COLIDiIBIA.

for six years (1914-1919.)

LOSSES PAID TO INSURED

20,000,

32,000.

43',000,

21,000,

41',000.

65,000~

202,000, '

'PERCENTAGE OF AMOIDrrS COLLECTED RETURNED TO INSURED.

29.5

' 47.1

43

42

56.7

61.3

47.7

o· . .

COS'll 0]' OPl::F:ATION PROFITS, E11C. HI PERCENTAGE

70.5

52.9

57.

58 •

43.3

38.7

'52.3

'.

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- 71 -

Only 5.3 percent of. all workmen injured in industries

in British Columbia last year, were shown to be in receipt of

financ ial benefits from Health or Accident Insuranoe,. or fra- '

ternal or trade union benefits of any kind other than that

provided by the Worman's Compensation Board. It may readily

. be seen that a very large ~ercentage of the workmen in this

Province, even those in the oomparatively well paid oocrapations,

must live with a very narrow margin between their inoomes and

the oost of living. The faot is that they have a "hand.. to

mouth" existenoe, and only about one in fourteen carries alJ.y

form of Benefit Insuranoe at the present time. Consequently,

when the burden of siokness falls on a workman ,or his family"

he is ill-prepared and, general~ unable to bear ito

PUBLIC .ATTITUDE AS EXPRESSED BEFORE COMMISSION.

There is a genuine demand throughout the Province

for some kind of Health Insuranoe. In the evidence submitted

to the Commission the prinoiple of Health Insuranoe was en-

dorsed by fifty-two women's organizations, twenty-seven fra­

ternal sooieties with the limitation in some cases that they

should be permitted to carryon as do the approved societies in

Great Britain, forty labor organizations of various kinds,

and thirty-nine individuals speaking on the'ir behalf. It was

opposed by the Insurance Federation of British Columbia, four

insurance agents on their own behalf,one duly qualified.medical

practitioner who disliked the administration of the English

Act, one optometrist, one Rate-payers Association. which feared

the cost, and two other individuals. The MedioalAssocia-,

tions of Victoria, Vancouver and the Fraser Valley, while all

represented before the Commission, did not oppose the pr1n~iple

of Health Insuranoe.

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THE ATTITUDE OF THE 1~DICAL PROFBSSION.

The report of the joint oommittees - Finance and

State Medicine - of the Vancouver l1edical Association formu-

latedthe following i'u..ndamental principles for any proposed

legislation on Health Insurance':-

1. There must be actual necessity for such Legislation.

2. If any system of state Control of medicine is introduoed only those departments affecting the health and effio­iency of the community should at first be included, viz~ PUblic Health, Epidemic and Infeotious disease, inol~d­ing Tuberaulosis, and also Venereal disease and School Inspection.

3. As regards administration, your Committee is strongly of the opinion that centralization of control should be, avoided as much as possible. We believe that the admin­istration should be extra-politioal, by means of a Com-' mis si on, similar to that administ eri~ the Worlonen' s , Compensation Act.

4. As regards paymento Your Committee feels very strongly that a system of salaried medical men'would be a very bad one and believes that payment should be pro rata for work done, along the lines of the Workmen's Compen­sation Act.

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5. We believe that work should be open to all who are quali­fied to do it. That the qualifications of any mam for'speoial

work should be decided upon by the administering Board, advi,sed by the medical profession in the Province, through their Associations.

At a meeting of the Fraser Valley Medical Assooia­

tion called to consider the matters before the Health Insur-

ance Commission, the follow ing resolutions were passed:-

1. That this association endorses the enlarging of the Workmen's Compensation Act, to include sickness or disabili ty, to all to whom the Act ~t present applie's, on condition that the patient be granted the privilege, of ohoice of his own physician.

2. That whereas this Assooiation foresees great diffioulties, in the working out of this seotion, of the Aot, owing to the tendenoy to malinger, therefore, we woul~ consider it advisable to appoint 'a physioian as arbitrator, to deoide on all oases of suspected malingering. ,

3. Tha t whereas the quarantine of Intections and Contagious, Diseases is for the protection of :'the publio, rather than, the individual quarantined, be it resolved that this Assooiation reoommend that ,the expenses, other than Medical, ,~f all quarantinable cases~ bea oharge on the oommunity ~n whioh they oocur. '

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That this Association would suggest the establishment of State Laboratories for x-ray and Laboratory Diagnosis.

That this Association, while not opposed to the bonus ing of child-birth, considers yhat the expenses inaurred at the time of child-birth are not so deterring an influence to child bearing as the expenses incurred in the·rearing of the children, therefore we would suggest that any bonus given, be in the form of an annual grant for the rearing of children.

That this Associa~ion would advise that no Legislation in connection with state medicine be undertaken without the most serious deliberation, that the matter has not had sufficient consideration, and any Legislation at the pres-ent time would be prema turao .

The Commissioners making this report do not herein'

recommend either state Control of medicine or state ·~dioine.

Dr. George Hall giving evidenoe before your Commission.

on behalf of the. Viotoria Medioal Sooiety said:-

"The Committee was formed from the Mediaal. Sooiety

to report on State Health Insuranoe and this is approxima~ely

the report which we submitted and which was accepted and was

agreeable to the Medical Sooiety~ After oonsidering the Legis­

lation in the older countries, in England and Germany, and also

aonsidering some of the proposed Legislation in the 'various ~

States, am1 the reports vrhi oh have been made, we came to the

conolusion that while we could favor Health Insurance, we did.

not feel there was any Act either in operation or in prinoiple

which was entirelY suitable - we felt that the legislation of .

the older oountries would not be acceptable ·either to the in­

sured or to the medioaJ.profession - some of the Aots. whioh

are proposed in the various states are more aoceptable, .but. the

need for suoh legislation is not as great in British Columbia.,

for instanoe as it is in the more congested and poorer distriots

in Eastern Camada and in the Eastern states, andfor.that reason

we do not think the Provinoe would be justified at the present

time in enacting any experimental legislation, ~t that . the ..

development along the lines of State Health Insuranoe in

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Eastern Camada and the states should be watched with a view of profiting by their experience indioated. In the rnaantime we felt there was a need in British Columbia for assistanoe to the laboratories - many of the poorer people find great difficulty in paying laborator,y fees, which are necessary to­day to practice scientifio medioine, and we feel the Prov1nce could very well extenit assi'stanoe to these laboratories. .T"Aat also applies to the X-Ray and radium specialties. We also felt· there was need for assista.nce in conneotion with infeot1ous diseases, suoh as scarlet fever, smallpox, et.a.,- the expens& in suoh infeotious diseases becomes excessive when a burdan on the individual, and the state should give some assistanoe in infeotious diseases. There is also inoreased assistanoe needed for ho~ita.ls and sanitarium.- I expect other bodies have. presented their views along that line and it is not necessary for us to do so. Then we feel also that some assistanoe might be extended in the treatment of. gonorrhea and syphilis owing to the fact that many people have not ths means and they are negleoting the treatment of these diseaseso If some assistance were given through the state it would be possible to oarry out more effective treatment and perhaps oompletelY cure many oases which at the p~esent time are only partially oured and no doubt oommunicated. That generally covers th~ lines along which we think assistance should be given, while. we wait further experienoe with the legislation along the lines' of State Health In sur an 0 e rf

0 "Academioally we favor. ittr.

THE POSITION. OF FRATERNAL SOCIETIES.

The ~ollowing endorsement of Health In.surance was filed wi th the Commission by the "Fra ternal Societies Welfare' Assooiation, "compo sed of:-

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Court Mountain View No.369, Canadian Order of Foresters.

Kitsilano Loyal Orange Lodge No. 2195.

Vancouver Loyal Order of Moose No.888.

Council of Chosen Friends No. 311.

Council of Chosen Friends No. 3840

:Manchester Unity I.O.O.F. Loyal Alexander No. 7843.

British Columbia District Independent Order of Reohabites No.110

Sons of England, Wilberforce Lodge No.'7'7.·

Daughters of England, ~ueen of the .West No. 33.

Benevolent and Proteotive Order of Elks.

"The Fraternal Societies Welfare Assooiation .

of British Columbiau endorsed the objeots of Compulsory

lnsurance as proposed by the Prov LTlC ial -Government,. pro­

vided they are administered ,in a ,proper manner.

It is considered howev~r;

That, of the several forms of Insurance proposed

under the Health Insurance Commission, viz;

1. Mothers' Pensions. 2. Ivlaternity Benefits. 3. Health (Sickness and Death) Insurance. 4. Public Health Nursing.

The second (2nd) and third (3rd) items can be

most properly and.. sympathetically administered through

approved Fraternal Societies who already have the neces-.'

sary facilities and experience to carry out the \-'lark.

That to attel1I9t to do otherwise would prove more

costly, less prompt and efficacious and in general not so

satisfactoryo

That 'should the Govern.l'nent fail to utilize the

said Fraternal SOCieties, the effect would be to jeopar­

dize their existence, from the fact they would either have

to eliminate contributions for benefits :.from their objects

of Associat ion, or their members 'would be compelled' to

carryon double Insurance. Considering that these,Societies'

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are mainly organized to carry out the second. and third

objects previously' stated, and that: such a large propor-

tion of the General Public are members of such bodies, ad-

verse action.by the Government would not fail to meet with

disapproval.

Tb.erefore it is re,comrnended:

10 That where possible, the Government arrange

for the administration through approved Fraternal Societies

of:

(1) Maternity Benefits. (2) Health (Sickness and Death) Insurance.

2. That in unorganized Districts, t ruit is, vlhere

there are no approved Fraternal Socieites,insurance shall

be handled by the nearest ,Government Agent, provided, however,

when any inhabitants are already paying through an approved

Society elsewhere, said form of payment shall be recognized,.

and further, should any approved Society open a Lodge or

Branch in the District, those inhabitants who have hitherto

been administered by the Government Agent, shall have the

option of notifying the Government that, on and after a

certain date, they wish to transfer fram the Govermnent Agent

to such Lodge or Branch.

3. That the Government shall recognize the Tables

for contribution in force in approved Societies, provided

said amount of benefit is equivalent to the Government scale.

As for instance, supposing a person is assured in an approved

Society, vihich he joined in his youth, whereby his contribu­

tions are less than the scale demanded by the Government,

but yet assured him of Government scale of Benefits, such

assurance shall hold good (example -the Gover~~ent scale

is ~loOO contributions for ~lOoOO benefitsr.' whereas the

assured has only been paying 751 for 10.00 or over).

40 That all persons covered by the Act, irres-

. pective of the incQQe they receive, shall pay the same almunt

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of contributions for equal benefits.

The Grand Lodge of the Knights of Pythias of

British CohLrn.bia in Convention on 1Iay 14th, 1919, at Vancou-

ver unanimously went on record for Health Insurance in the

follow ing terms:-

VrnEREAS the recent war has proved that military success depends upon industrial efficiency and this efficiency is D~inly the result of the nental and physi­cal condition of the individual worker:

VIBERBA.S a lowerl.ng of the physical, efficiency) moral force and standards of citizenship results fram the hardships visited on large numbers of those around through sickness and. premature death of the bread winner:

AND WBZREAS it is one of the principles of this Fraternity that every effort be used to aid suffering humanity ar~ to promote the highest degree of public 'well-being and unselfish citizenship:

THEREFORE, be it resolved, that this Grand Lodge of the Order of the Knights of Pythias' of the Grand Domain of British Columbia place itself on record as favoring the enactment of such a measure of Health In-­surance as will guarantee to every deserving person immunity from want at a time when life's burden is al­ready heavy:

.AND BE IT FUR'rHER RESOLvlID that the individual members of this Grand Lodge pledge themselves to us,e every effort towards securing such a legislative en­actment and that a copy of this resolution be forward­ed to the Ministers of the Provincial Government.

OPPOSITION FROl-I COliEERCIA.L n;rSUR1.J.\w E C GrLlP l-;l'JlliS-.

The evidence of Mr. \lj.lliam Thompson, President

of the Insurance Federation of British Columbia, read be-

fore the Commission is slliuraed up by him as follows:-

1. That there is no legitimate demand, or

necessity for Compulsory Health Insurance in the Prowince

of British Columbiao

20 That there is no comparison between conditions

in Eur9pe, or in Great Britain, and conditions obtaining in

British Columbia.

3 0 Legislation of a sir.lilar natul"e no;y in force

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in other countries has not proved so successful, as to

warrant its 'adoption by this Provinpe, even if conuitions

call for same meaSLU~e of relief.

4. The principle of Compulsion is absolutely

abhorrent to liberty loving people, in a democratic country.

It should be noted that l'Ir. Thompson, the Presi­

dent of the Insurance Federation of British Columbia, took

the extraordinary and surprising attitude of refusi,ng to be

examined by the members of the Co~ission, on the subject

matter of his evidence which he read before them.

During the hearing throughout the Province, it

was apparent that individuals engaged in the commercial

sickness al~accident insurance business were bending

their efforts toward defeating the introduction of Health

Insurance Legislation iIi this Province.

In the issue of the "Cranbrook Herald t1 , of .Jan-

uary 15th, 1920, an advertisement fifteen inches by eleven

inches appeared 'With black border, and reading as follows:-

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rrGOOD AND S"lJFFICIEi:IT RElil101JS -.THY STATE llJSliR10TCE SHOULD FAILY'.

It covers only a portion of the 'wage earners.

2. A plan TIorked out by politicians to create work for themselves •.

3. A step towards-autocrasy~

4. An attempt to enslave the plain people.

5. Jill Act to prove workingmen as incompetent citizens.

6. A plan to force state medical attention upon per­sons "17110 do not Ylan t it.

7. A plan to have job-holding politicians inspect your hODle.

8. ~~ insinuation that a wage-earner is a commercial corr.nlOdi ty •

9. A plan to make outcasts of members of your family.

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10. Class legislation.

11. A plan to protect the regular' employees only.

12. A plan to waste funds so as to create a political monoply.

13. A plan to befog Fraternal men by statistics.

14. A plan to increase the state tax.

15. A plan to destroy beneficial Fraternal Insurance Societies.

16. A plan to prevent Fraternal men from enjoying the benefits of their volunta~J efforts.

1 7· .. , 11 plan to $tifle the beautiful custom of Fraternal Sick Benefits and burying of their dead.

18. A :plan to place the doll~ above justice, norality and brotherly love.

19. A plan to make a selfish creature ~ith no concern for his distressed brother.

20. An att~mpt to treat the people of British Columbia the SaF.J.8 as those in Eurppe, 'where condi thms are vastly different"

21. An attempt to create classes, thereby hlliililiating the small, wage-earner.

22. A plan diametrically opposed to the spirit of the Anglo Saxon race, which hates compulsion.

23. No protect ion afforded to wage-earners leav ing British Columpia.

240 Compulsory insurance means slavery.

25. Sounding the death-knell of all Beneficial Fraternal Insurance Societies. -

26. Because in every place where Health Insurance has been proposed in United States, it has been rejected.

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27. Because it interferes with Provincial professional methods and religious beliefs.

28. Because the unemployed and small business men will not be protected ..

29. Because it is un-British.

30. Because it TIould create pauperism.

31. Because it is prompted by theorists and politicians.

32. Because you could never prevent poverty by placing the workers in bondage.

33. Because there is an entirely different principle involved than in the Workmen's Compensation Act.

34. Because farmers and other uninterested. 00 rsons nill have to share the huge cost of increased taxation.

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35. And lastly, because 'we, ac:3ritichColw:1bians do not 1,7is11 to be placed in a .state of s8rvility to be over-burdened with taxes, and to lose ou~c civil and social rights.

PROTEST n;::lEDIATELY AGAErsr rrE3 PAS31·l.GE 0:2' rillE PRO­POSED AC'J: TIr Tm B. C. :LEG ISL..t,,11.)?3.

This advertisement 'V7as clearly an effort to intentionally

mislead a.'t1d misrepresent the general effect of Health In-

surance •

Ur. Thompson's evidence which has been circulated

in pamphlet form, is in SJI:le instances taken verbat ill,

from the pamphlet entitled tfA refutation of False State-

ments in Propaganda for Compulsory Health Insurance",

published in ·October 1919 by the National Civic Federa­

tion, (a body of interests opposed to Health 'Insurance,

and with headquarters in Hew York City). The citations

to Brend' s book, !1'1he Health and t he Staten, are not to

the original book, but to the reprint of cha~ter seven

which is being distributed by the Prudential Insurance

Company of Newark.

The pau~phlet a~~its the desirability o~ extending

nursing care and of providing medical and hospital care

for maternity cases. It is this same form of n~ternity

care, 17hich the pamphlet PQint,p out has been so success-

ful in reducing infant mortality in NeVI Zealand, \7hich is

recoThuended by your Commissioners as a part of a

Health Insurance measure for this country.

The pamphlet contends that Health Insurance ~il1

not improve public health. This statement is an erron-

eous conclusion drawn frarJ1 the fact that in Germany

the average days per sick insured person have increased

from 5.9 in 1885 to 8.5 days a year in 1912. But during

this interval the period during which cash benefits were

payable has been increased from thirteen to twentY-SiX

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weeks and certain diseases previously excluded, have been

included.

On the other hand,the German mortality rate,

unaffected by artificial definitions, has steadily de-

creased, showing an improvement in national health. On

this point Louis I. Dublin, the statistician of the Me­

tropolitan Lite Insurance Company, (in "Social Bearings

of Workingmen t s Insuranc'e Economic World", 17th February,

1917, page 239) says:-

"Side by side with the development of the sick­ness law, there has been a considerable and significant reduction in the mortality of the Empire. The figures do not apply to the nation as a whole, exclusive of the working people', as is shown by the corresponding figures for the larger sickness SOCieties, where, if anything, the differences in mortality between earlier and later. periods are even greater than for the nation as a whole. It may be argued that mortality rates are not to be confused with sickness rates. There is a measure of truth in this; but it must be pOinted out that mor­tality is an index which represents a natural phenomenon, whereas the insurance statistics of compensated sickness are largely affected by administrative rulings ap~ do not always. give a true picture of the conditions with which they deal. We are, therefore, compelled in a measure to use the facts of death as an index of the facts of sick­ness!! •

The effect of Health Insurance in preventing

sickness can scarcely be mBasured by comparing the ef-

forts of one country with another, - too rr.Jany other

factors should be taken into account. Of the new in-

terest aroused in prevention measures brou&~t about by

compulsory Health Insurance; th~ British Ministry of

reconstruction Reports (1919), states:-

. "The practical administration of this novel pro­vision immediately threw into strong belier the somewhat dehurranized characte~cistics or the public health system, toe:;ether wi th the narrovmess or its limitations and the inad~quancy of it s acLrn.inistra t i ve provision. In 1914: !.ir. Lloyd George pOinted out that lithe Insurance Act had done more than ru~y number of Commissions, to locate, to define, and to classi~y the problems of public health. I Ylill not say it was revealed, but it nas Given proDin­ence to one very striking fact -- that an imrllense number of men al1..d YlOmel1, througn that lack of vi tali ty am sta.-r:l­ina which comes frO!!l unhealthy conditions and surround­ings,. live lives that are :prolonged struggi'es against

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debility and disease. I! The attention thus dra ... ·m to these conditions not only stimulates provision for the direct alleviation of e:.dsting sufferin:::, but ,:llso encouraged the rediscovery, as it TIere, following the course of revolution of medical science, of a hUL'llaner principle of 9revention, as the l11eans by which the sufferings of tile individual could best be relieved or averted".

In another general respect the Insurance Act entirely altered the previous position. It created a new body of'organized public opinion, with a financial interest in the improvement of the national health".

The Insu:::'ance Fede,ration I s pamphlet furt her

states that there is no direct relation between'sickness

and poverty and mentions incidentally on the following

page that the British Royal Commission on the Poor Laws "called

attention to the Association of poverty 'with sickness".

American data proves conclusively this association, which

has long been apparent to fraternal and welfare workers.

The Illinois Health Insurance Commission in a study of

4,474 wage-earners found that the aruount of sickness in-

creased with the decrease in income. In the most favored

income group, 26.9 percent of the TIage-earners were sick

in the co~rse of a year; in the least favored g~oup, 37.3

percent TIere il~. In a study of 31,481 charity cases, ,the

United States TIa~igration Commission of 1909, found that

sickness was a factor in 38.3 percent of the number, -

the single largest factor.

The statements regarding the British Act are

misleading. The figures portraying the slight develop-

Dlent of voluntary insurance under the Act compared with

the original estimated, do not give any idea of the tre-

mendous increases in membership which the friendly societies

recorded after the passing of the Insurance Act. Naturally

these accessions absorbed w~ny who might qnder other cir­

c~tances have come in under the Government's voluntary

scheme o Moreover, the Government's voluntary system main­

tained no agents, a condition which does not conduce to ex-

tensive development.

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The statements as to the large number of tuber-

cular non-insured patients overlook the fact that' the bene-

fits of the British Act are limited to wage-earners; 'there

is no provision for children cmd wives (other than maternity

benefits of the British Act are limited to wage-earners;

'there is no provision for children and wives (other than

maternity benefits).

Dr. Friedenburg is cited as opposing the German

"system". This citation is to the pamphlet "Practical

Result of Workingman's Insurance in Germany" listed as the

close. This deals entirely with Workmen's Compensation.

Health Insurance is scarcely'mentionedo Waile Dr. Fried-

enburg may be correct in his estimate of the malingering

tendencies among Germans, under their Workmen's Compen-

sation Legislation, suchan estimate is not true of the

workers of British Columbia. The Workmen's Compensation

Board of this Province reports tl~t they have not found

ten genuine malingerers during the four years of the

operation of the, legislation here •

Dr. C.A. March~ :U.D., of the University of Lon­

don, Member of the Royal College of Surgeon and House Sur-

geon and House Physician at Poplar Hospital, states in re-

ferring to the compUlS01Y insurance as operating in Great

Britain, says, ItI can not 'remember a single case of real

ID~lingering in the last six monthso A~nost always the pa-

tients who want to stay on longer exaggerate their condi-

tion to themselves."

Dr. John Devine, M.D., of the University of

Glasgow, President of Hull Medical Society, and 'who cares

for 1, 000 patients on panel, states, "I d,o not think there

is any mal~ngering to speak of. It is very rare, and I

have not much faith in the claim that over-insurance induces

malingeringu •

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The quotation in the Insurance Fedorationts

pamphlet giving :;)1'. Eoffn:a.n!s opinion. io entil'elyat

variance i-lith the opinion [;;i ven by. the saTJ.e Dr. Hoffuan

on his return from GerlliB.ny after an exhaustive investiga­

tion of the subject there. The evidence given by him be­

fore the Hassachusetts C~mmission on Old Age Pensions in

1910, uas as follows:-

ffBut there is no dissenting opinion, even on the

part of life insurance managers that GoverIlIlEnt insurance

has resulted in far reaching reforms, that it has been

of vast benefit to the people and to the nation at large,

and that is has came to stay.

The interests of capital and labor have' certain­

l¥ been harmonized remarkably in Germany, amd speaking

from personal observation extending over a generation, the

contrast of today with the past is marvelous. How far Go­

vernment insurance has had a share in this prqgress, it is,

of course, impossible to say; but all with whom.I have dis­

cussed the subject are but of one mind, - that the effect

on the 'whole has been decidedly for good" •

The Insurance Federation in its pamphlet says,

"It would not materially affect the insurance men who are

now writing this class of business, except in a very few

cases and excepting so far as it might curtail possible

expansion of the business along the line indicated". If

this be correct, are we to assume that their efforts are

actuated by purely unselfish motives .... '1hen they oppose what

is believed in Great Britain and other European countries

to be a solution of sickness problem. As is shown in the

proceeding pages of this report, all of the progressive

industrial European countries have SQme form of health in­

surance, tl~ same being more highly specialized in the more

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fully developed industrial countries, viz:- England and

Germany.

The Insurance Federation Pamphlet says, "We state

emphatically that there is no legitimate demand or necessity

for compulsory health insurance in the Province of British

Columbian. The answer to this is found in the evidence

given by the welfare orga~zations formed specially for the

alleviation of sickness and. distress, by sooial welfare

vlorkers, and by our lahor organizations. A further answer

is that praotically the only objeotion raised to the move­

ment is that of those health insurance companies whose pro­

fi ts are made from the sickness and distress of the 1nsured~.

Inasmuch as health is a basi~ asset of the nation,

it should not be used as a commodity for the making: of pro-

fits by so-called sickness.insurance companies. No more

should sicknes? bea profit-making business than the policing

of our Province. The maintenance of health s.hould be a

function of good Government. If it is a function o~ good'

Government, it should not be a legitimate field for a profit­V

making business. This vie\~oint has no1 been aoceptedby

. six out of the nine Canadian Provinces, in the case of ~n-

dustrial accidentso It shOuld even to a greater extent be

accepted in the case of-sickness,

The Insu~ance Federation pamphlet further says,

"We state emphatically that there is no comparison between

conditions in Europe or in Great Britain and conditions ob-

taining in British Columbian~

Health conditions are not now as serious in this

new country as they are in Great Britain, but will they not

necessarily become so as population increases, if general

health conditions are not properly organized and remain

neglected? It is advisable at this time- to see to it that

neither the conditions existing in Great Britain or in \.

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Europe generally be permitted to develophere o

The Insurance Federation's pamphlet further says,

Tlrie state emphatically tha t legislation of a similar na~.lre now

ill foroe in other oountries has not proved so suocessfUl as to

warrant its adoption by this Province, even if conditions call

.for some measure of reliefno

There is clearly an admission in this statement that

an unfortunate health condition does exist here, and that the

conditions oall for' some measure of relief~ . The proof that

the British and other European health legislation is meeting

Y~lith general satisfaotion is that neither employers, employees,

medioal men, nor other organized bodies, have at any time sought

to have this health legislation repealed~ . On the other hand,

the evidenoe is olear that these different types of legislation

in Britain and in Europe generally are being amended from time

to time by having additional features provided for the care of

the siok.

The Insurano e Federa ti on's pamphlet 0 on t inues t "We

emphatioally state that the prinoiple of ,oompulsion is absolute­

ly abhorrent to liberty-Iovi~~ people in a demooratio oountry" •

In other wordS, they say that that form of compulsory health

legislation "'lhi ch is recognized as a product of British fair

play by the "mother of nations" herself oeases ,to. have the same

beneficial effeot when applied-to Canada~

When we are dissatisfied with a law, an!1 are una.ble to

asoribe any particular reason for our objeotion, the tendency

has been to refer to it as "aompulsoryTl legislation, and,

therefore, repugnant to .the demooratio viel1.1point. One should

not be afraid of the word "compulsion". Law is compulSion,

and, after all, compulsory laws are no thing more nor le.ss th~

an expression of judgment of our legislato'rs stated in aon- '

venient form and placed on our statate books. In a great m~

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things Vie have cheerfully aocepted compulsory laws , whi en.

really compel us to do something or prevent us from ~oing other

things we formerly did, e.g., in school attendance, in sani­

tary laws, in traffic laws and in health regulations •. In

compulsory health ins'uranoe we have nothing more than the

ordinary compulsion of a tax. The profit of which is refleat­

ed entirel~to the benefit of the tax-p~er, even to a muoh

greater extent than the tax itself amountsto~' '

A oareful reading of the Insurance Federation's

pamphlet is· all that is necessar,y to oonvinoe. one that there:

is a la~ger' measure of truth in the soheme of compulsory

health insuranoe so violently denounoed than there is in ..

the attempted refu ta tion •.

The. recent war has proved that military suoo ess

depends upon industrial effioienoy. This effioiency is- mainly

the result of mental and physical oondi tion of the individual

worker.

It is true that the prosperity and progress of the

oommunity depends and depends vitally upon'that community's

health standard. Just as a man with sickness· i~ his family

experiences difficulty in paying his billsp so does the

oommunity find that preventable disease acts as a brake upon

the progress of the business in that cOmnnL~ity. Health can

be truly said to be the essential factor in the productiveness,

prospe+,ity and happiness of a community, and henoe in the

advanoe of civilization •

To be thoroughly equipped to faoe any emergena~ of

either peace or war, the State must take a more constant

and intelligent interest in the health and fitness of its

peopleo Many of the large plants on the. Atlantio Coast re­

cognizing the influenoe of health and ho'me oondi tions on

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the effioienoy of their workmen have established a health de­

partment in oharge of oompetent physioians to oare for the re­

~uirements of the workmen and their families. The faot that

the tenden~y in this direotion'is rapidly extending, and in

this age when competition is at its peak, is the best llossible

evideno e that from a financial standpoint the servi ce is ·justi­

fied •

A workman is at his maximum of effi~ienoy when in .

good health; and when not depressed by affairs ariSing from

home conditions that he is unable to oope with. Too great a

value cannot be placed on this faotor,yet it is safe to assume

tha t under good health oonditions,o errors of judgment that: lead

to waste in time and material, and frequently injury to work­

man himself, are at a minimum •

. One of the greatest items of waste in modern so­

ciety is the time lost by the reduction in physical st~dard

caused by disease that oould either have been prevented or

at least limited by effioient medioal service o Another faotor

is the loss sustained by a family when its support' is either

withdrawn by death or a long siege of illness •

. If our reasoning is oorreot, are we not foroed to

the oonclusion that the health of' the workman and his family,

as well as his ability to meet the financial requirem~ts of

the home, are matters of publio conoern? .

Speaking aoademically. the-essential .charaoteris­

tios of the wage worker's economio position is tha~ his'in­

oome depends upon oontinuous effort. No work no llay: no work

no incomeo Yet in the very nature of things continuou~ effort 0

is almost.impossible. It must be oocasionally interrUp~ed for

a variety of oauses,of whlohsiokness is:·one.This, .ther.efor.e, ..

means interruption of . income, but his expendi turesmust

necessar~ly be a continuous one if life is to go on~

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One might compare the situation to the problem of

water supply, whioh is obtained f~om rain fall. The demand of

. society for water is praotioally oontinuous, but it does not

follow therefrom that we must Qepend upon continuous rain fall.

Instead we build reservoirs, not private cisterns mind you,

but publio, or, if you will, social reservoirs. To meet

the continuous demand fo·r income when wages for any rea.son

stop, we must build a reservoir in the form of insurance.·

AS. far as the health insurance sold by oommercial. com­

panies is concerned, the solution of the problem for siokness .

evidently cannot be found in a machinery whose loss of , energy

is so great acoording to experienoe in this Province as shown

by the Government reports referred t~ herein, and covering the

years 1914-19, that out of $100. collected, -it takes $52".30

for "management expenses and only returns $47070 to the insured!

The purchasing value of the average wage has actually been

decreasing by the additional pressure exerted towards the

tendency of a higher standard of lifeo The surplus in the

Vlorkman's budgets is far less common now than it probably was.·

15 years ago, and a protracted il~ess neoessarily represents

a muoh more serious problem..;'

Health Insurance ma~ be defined as a method by Which

the economio loss ocoasioned by illness is .distributed among

a group of persons, periodical payments being made by the

diffe.rent members of the groupo The'need is two-fold. Ther.e

is that of indemnification against loss, and the need of

dimishing the loss itsel~. Indemnifioation is the essence

of the insuranoe prinoipleo' It spreads the loss of eaoh

person in a group over them allo' Insurance aims to reduae

fluotuations, to make the income stream ~ore steady. We.

believe it is more advisable to pay premiums year by year for

'fire insurance than to suffara big fire loss when fire oomes~

The financia~ able have protected themselves in fire

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insurance, marine insurance, life insurance,fidelity insurance,

plate-glass insurance, steam boiler insurance, and to a limited

extent accident and health insurance •. They have, therefore,

long endeavoured to eliminate" or at least to reduce. every

determinable risk. But the curious and disheartehing faot

is that outside of Workmen's Compensation, the workers in this

Provinoe have received as yet very little benefits from the

applica tion of the insuranee principle. Yet it is the wo rker

whose need of health insurance is greatest, and for two impor­

tant reasons. One is that the workman is more likely to lose

his health than the finaneially able, for it is w~ll known

from numerous lines of research that the death rate, std, there~

fore, the,siokness rate prevailing among the wage-earnars is

two to three times that prevailing among the well-to-do. The

other reason is that any loss from siokness is a far more

vital matter to the poor than to the rieh. The workmaa who

loses his health loses his. ehief asset. It is well known

that the aVierage worman seldom insures against illness be-

cause he is financially unable to do so~

From the estimates.made by Dr. Rubinow, one of the

most celebrated statistic-ians and authorities on health insur ..

ance in Amerioa, it would appear that only about five peroent

of the w.orkmen in America needing insuranoe aotual~.have it.

In this Provinoe it has been shown by the Workmen's Compen·.­

sation statistios that only 5.3peroent of inJ~ed workmen'

receive benefits from ei ther aooiden.t insurance oompanies,

trade unions or fraternal sooieties •. That being so, thera·

are millions of Vlorkmen in Amerioa who oannot at present a.vail

t~emselves of necessary medioal, surgical and nursing aid. for

~Aen they most need it, they oamnot pay/ito

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As important as is indemnification, it is far less I . I imuortant'than prevention. The introduction. of Health ns:ur-. ,

ancs into this Province, would necessarily add the prevention

of loss to that of indemnifying against loss. It is well

known that fire insurance has led to the use of slow.-burning

construction and other safe-guards agalnst destruation by ~ira.

Prevention

It is well known that the Workmen's Compensation

Legislation has had the ef~ect of greatly stimulating industrial

methods in accident prevention. Out of Workman's Compansation

came the popularizing of the rrSafety-First" slogan and. the

public movement which it represents. It has been truly said

that accident prevention measures in all Provinoes and states

prior to Workmen's Compensation Legislation was wholly in­

efficient and unsuccessful until the Workmen's Compensation

Legislation became effective. In the same way it is believa¢

that sick~ess prevention will not be ef~icient until the work

is ?onducted ~rom some clearhouse, suoh clearing house being

authorized to enforce regulations, and being in control of a

body untrammeled by politics. It is believed too that the

sickness prevention movement oan be far more potent than the

safety movement because sickness is more prevalent and more

preventable. than accidents o Pasteur, the 'celebrated Frenoh

Scientist, convinced us that "It is within the.power of man

to rid himself of every parasitic disease"o

The idea of "preventingrr disease as contrasted with

"ouringTf it has long had the attention of students of social

ills. The thought of averting·disease rather than ouring it

has led to our laws on sanitation and vacoination, our'

quarantine orders, anti-spi tting regula~ions and countless

similar enactments. Much sickness has been prevented

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by anticipator,y action, but disease has not been eliminated. We have still much of it with 'us. The best results of pre-

, vention cannot be suocessfully attained u..l1.til further devel­oped and' incorporated in a general soheme of health insur­ance. The promotion of sooial well-being is one of ~da­mental importanto Instead of directing our whole attention

'to formulating a series of lId.onTts" in hea.1.th matters, some construotive program of health promotion should go hand in hand with prevention. An ed.ucational campaign on the im­portanoe of fresh air, exercise, proper food.,clothing and

..,housing is equally importanto With health promotion am ,sickness prevention operating in oonjunotion as insepar-

. able parts of a properly arranged. health 'insuranoe program, the volume of siokness would be materially reduoed.

Curative medioine must have its place in any health insuranoe progr~ in order to meet the oases of sickness which will continue to develop in spite of all the prevention and health eduoation which oan,be assimilated by the people.

TUberculosis sanatoria were built to oure viotims and prevent the spread o~ the disease o Besides accomplish­ingin part these tvJO objects:, a very important work has in addition been achieved in inoreasing publio understanding of it, and of the necessity_9f proper living in order to pro­mote health.

Sickness prevention, health. promotj,on ,~d curative medicine must be combined in one heal th insur~nc,e sohema in order to get the best results o

Opponents to oompulsory Health Insuramce mainly contend that Health Insuranoe is not neoessary"and that pre­ventive medioine would solve oompletely our health problems.

Health Insurance ,will afford a very powerful stimulant to employers, employees ancl.,public men to take

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fuller and speedier advantage of possible health-saving devioes. Just as employers have installed safe-guards for dangerous machinery in order to reduce. the cost. of Work­ments Compensation, so in order to reduce the oost of Irealth Insuranoe will ,they supply,for instance, better sanitation, ventilation, and lighting, better' hours of labor and more consideration for the special needs of the employed men, women and children. The employee will be more ready to ap­ply to his own physiaal maohinery a principle, long since applied by his employer to inanimate machinery. ,

After Real th' Insurance has been adopted. slight ' impairments to health will be remedied before they become s,erious. One important effect of suoh attention to the health of the workman will be the prolongation of his life and espeoially its earning peri~. Fewer workman, will be thrown on the sorap heap in their early forties with all ,the tragic consequences involved to their families as well as to themselves ~'

Again, under compulsory Health Insurance, both the employer and employee will co-operate with the general public in seauring better publio, water supply, better sew­erage system, better milk, meat and food laws, better school hygiene, more playgrounds and parks, and proper regulation of liquor and other health-~estroying businesses. Health Insuran.oe will, operate as ' it did in Europe in stimu.lating the general soientifio study of disease prevention.

In Great Britain, the Health Insuranoe Aot has led to eduoation on the prevention and treatment of tuber­oulosis, m811Y of the health oommittees having arranged for leotures, moving pioture shows, and other means of eduoat­ing the publio. It will direotlY and powerfully tend to reduoe povertyo

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Without Health Insuranoe a vast number sooner or la tar ex."Yiaust whatever finanoial margin they have, and sink into poverty. A workman without Health Insuranoe is gambling with his livelihood, and in.many cases is sure to be thrown out of the game. It is definitely knovm that siokness oauses the grea t·.bulk of :desti tution.. Vii th the removal of

. siokness, a great part of the present-day distress would be withdrawn.

It is agreed that the world of today is seething with unrest. Old World radiealism with its propaganda. is sinuously foroingits way into every oommunity. A large number deplore I.W.Vi. ism, Bolshevism, disregard for law:;' and opposition to the State. The bolsheviks of today are

. mainly the negleoted .ohildren of yesterday. . The big major­ity of .them sprang from the homes of the poor, the handioapped the sick and the scantily educated.

The manufacturer or merchant who sells his goods. skilfully, but who neglects to keep his stock in order or to order a new stock, finds some day that he has nothing more to sell. The farmer who carefUlly tends his horses and oattle but neglects his colts a.nd calves awakes' some. day to f"ind he has no good live stock. The publio that ooncerns i.tself today with neither the welfare of its adults nor its children will find some day that those children. have grown up orippled in body and mind. The child who is not given his ohance today, who is neglected by sooiety and so feels forced to fight sooiety, will becoma a menaoe to that sooiety that your child will have to reckon with. It is not enough that your own child be healthy, well nurtured and trained; the other fellow's child. must have his:.ehanoe,. muS4 .be healthy, properly developed and trained, or your.boy when he reaches maturity and seeks to take his father's plaoe in the world's \'1ork will find that the 0 ther fellow's boy has. \ also reaohed the state of manhood a radioal, who refuses to

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father's place in the TIorld's work·TIill find that the other

fellow's boy has also reached the state of manhood a rad-

ical, VIllo refuses to allovl your son to nork. If you will

not aSSU1!le responsibility for the health of the other fellow

,and his children, then you must do so for the sake of your-

self and your own.

On the 28th June, ,1919, the report of the Royal

'Commission', cOIDIlonly known as the "Iy~others t 'Co:mmission",

appointed by the Dominion Government to enq.Lire into indus-

trial relations in Canada was filed at Ottawa. 'That report

reco~nizes that one of the causes of the unrest in Canada

nas due to sickness.

'r:l:.eir first re cOI!I.t:J.endat ion, and it is necessarily

assumed the most important, reads as follows:-

"We recommend irnn.edia te enquiry by expert boards

into the follorling subjects: - \7i th a vie\"! to early legis-

lation, - A State Insurance aga inst unemployment, sickness"

invalidity and old age".

In Septemb er 1919, the Nat ional Industrial Con-

ference of Dor::J.inion an,d Provine ial GoverllJ.!lent representat ives

and representatives employers and labor men met at Ottawao

This conference unanimously endorsed the recoIDlllendat ion of

the l:Iothers' COIllmission as outlined in the preceding para-

graph, and urged the appointment of a Board or Boards to

enquire into the subjects of State Insurance against unem­

ployment, Sickness, invalidity and old age. The Dominion

Government, has not as yet c amplied with the rec ommendations

of either the Mothers' Co:m:nission or the National Industrial

Conference.

It is particularly noticeable that on our statute

books there are a great many laws relative to ,pigs, sheep,

cattle and horses with very little legislation for humans.

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If it is so essential to protect the dOI1l.estic animals, why

should it not be equally essential to protect llumans? The

very fact, however, that our health laws are being gradually

extended is an ev idence that our Government s are becoming

more humanized, and by being humanized·they are naturally

reaching out to assist and p~otect the sick of the com-

munity.

We have made compulsory educational laws, but have.

neglected to see to it that all children were sufficiently

healthy or phySically fit to assimilate the teachings.

As a rule, a normal person has five· senses. All

knowledge is obtained through them. Our compulsory educa-

tional law says to the parent or guardian of a child, Itl

der!1.and your offspring be given to me for education from the

time he is six until he is fourteen. years of age. He must

get Imowledge from me through hisfi 'Ie senses. I haveT!la,ped

out a :program for hiE to tal<;:e through these five senses.

I pay a teacher to carry out that program. That program

is all rignt for those 'whohave prop sr health to take ad- .

vantage of it, but to the sick, weak, neglected ar..d poorly- .

fed child it provides nothing but a species of punishment.

It is suggested that the State owes a duty to that Child,

to see to it that before compulsion is uSE}d that the child

is made healthy and physically fit, thereby placing the un-

fortunate on an even basis "Viith those more fortunate. All .

children should have an equal chance.

The evidence of the necessity of improved health .

conditions is clearly demonstrated by the large nQ~ber of

witnesses who gave evidence before' this Commission. The

evidence of the Welfare Organizations and' Labor Unions uas

most convincing. The \7orkmen themselves realize more than

anyone else F.hat the present-day health .conditions are in

their respective communities. The formation of the numer-.,

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ous welfare organizations is a:zain a fUl't:'1er convincing

proof, that they look upon the health of the community as

being inadequately provided for.

There is seldom an issue of the daily papers that

do-as not contain scne item ShOVl:bg necessity for inproved

health conditions. In the "Daily Province" of March 14th,

1921, ap:gears the folloTIing: -

"Wanted - A Helping hand".

If To live in two small, insanitary rooms, with . the only communication to the outside world coming by means of a skylight, must be most discruraging.­But to be lying ,in one of these rooms very ill, am knowing that two of your three children are in the isolation wa~d of the hospital with scarlet fever, and that your husband is seeking work every day, all in vain, then one has no ambition to live and get well ..

It' is with these facts on hand that the social service department of the Vancouver General Hospital is making an earnest appeal to the citizens of Van­couver to lend their assistance in TIhatever way poss­ible".

Dr. M.T. MacEachern, ex-Presid.ent of the British

Columbia Hospital Association, and Superintendent of the

Va:rlc.:ouver General Hospital, lihich provides hospital accoIn.-

modation for more than one-third of the hospital treatment

of the Province, on January 29th, 1920, in addressing the

Victorian Order of Nurses said, nOur hospitals TIould not be

crowqed to the doors as they are today if more preventive

\'lork such as is being carri-ed-0ut by the Victorian Order of

Nurses TI'as done. Every day the fact is brought to us at

the Vancouver General Hospital, and we are shocked at the

great econoaic losses the Province is sustaininG. We re-

ceive cases in which the patients have reached a desperate

stage. L?uc 11 care and expense is involved in treat!'llent, and

the work is perhaps futile in the end. Could preventive

m.easures have been given before the cases ~ad became ser­

ious, many lives could have been saved and' much expense.

The more TIe spend in the interest of public health, the less

we 'will need to spend in charities and correctionlt•

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Then a;,;a i..Yl, He tno';! of tile establisl1I:Kmt of the

:rtotary Tuberculosis Clinic in Vancouvor, Cllildren' s Clinics

in a nUI.lbe:'" of our larger cities, the st,:::.rtling infor.u1ation

disclosed by the El.edical ills:pection of the school children,

tIle establishnent of the school nurse,. of the health nurse,

,the constant demands m.ade on our Provincial Health Depart-

meut for further extension, the police statistics sho~ing

the growth of tl1e drug habit, the condition of the children

left at the Creche while their mothers go out to work, the

tuberculosis sanitoria, the organization of wb.rkmen's med-

ical associations whel"'eby the worlanen band ther::!.selves to-

gether in a body to spread the cost '01' the individual mem-

ber's illness over their Hhole nembership. Surely those

with a k-nowledge of these conditions 1,-:;110 are constantly

working in their midst should be in a better position to

say what the needs are than those who very rarely, if ever, .

go near the ~70rlG.'],en's 11ones o

One member of this Commission alone has investi-

gated over 200 cases of i70rknen rlhere they have been unable'

to meet the cost of sickness conditions, and 'where siel:: con-

ditions were being neglected by reason of that cost. I

Lilr. A.M. Innes, Secretary of the Canadian Pacific

Employees' l'.'Iedical Associat-ion, says as follows:ttI~ is,

however, in the care of children that I consider we are

performing a great benefit to the Province in having phys i­

cal defects cured \'luere otherwise the children would have

to be allowed to grow up defective. .As for instEL71Ce, we

have a boy in the hospital at the present time who lost the

power of his ankles through SOI!le trouble in childhood al1.d

ViaS unable to v~alk. Our Doctor has straiglJ:l;ened one leg

and is now working on the other, so that he will walk with

only a slight limp instead of being helpless. The father,

before com.ing to vrork with the Railway COEpany, had a good

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deal of sickness in his faElily, and could not afford to lJay

for any further medical treatr:1ent. -.Ie have spent over

;)700. for hospital treatment for this fanily in 1919, but

Viill have the satisfaction of knm'ling that \7e have Given

the boy a chance to become a producer instead of an object

of charity. I cculd enttmerate dozens of cases of a less

serious nature that our doctors have successfully treated

'."/hich would not otherwise have got proper care,. as their

parents could not afford to PaY for the treatment n •

Dr. Alfred Cox, Secretary of the British Medical

Association,. in giving evidence before the committee of

Sickness Benefit claims in 1914 under the National Insur-,

ance Act of England 1911, states, "I never VIas so struck

b:r anything in my life as I l1aye been at the 'way that the

profession h~s been surprised at the undiscovered &uount

of sickness which was e;oing untreated beforehand, and

which is nOVI getting attended. toll.

Dr. John Devine, M.D., University of Glasgm'l,

President 0 f the Hall l.:edical Society, having 1000 patients

on panel, beinG I!lainly clerks, engineers and \iorl'~ers in

oil and floUl" ,';}ills, in Gi iring evidence before the' saLle

CO::':'ILnission says, ;lr feel that the conditions al';e very much

better than in the days 0] private practice. The insured

p :3rsons v[ho consul ted r..e do not do so unnecessarily. I

think they should come to me with minor ailm.ents as it

saves the~l beins serious ailment s TIhicn :put s them on sic k-

ness benef it. Since the method 0 f :payment is capitation,

the doctor finds it to his advantage to study his lJatient's

case carefully and. get rid. of him by curing him. as quic1\:-

ly as possible".

Dr. R.J. Farnam,:i:.I.D., Univers:ity.of London, haV'-

ing from 1300 to 1350 on his panel, in giving evidence be-

fore ·the same COL!ill.ission, says, "11y :pat ient s who are the

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up:;?er Y!Or~cillg class and \'1ho 'Were rJostly my pri vate- patient s

before the Act, have come to me for trivial things as I

told then they should come in order, that I may tre2.t them

and prevent trivial conplaints developing into serious

ailments. When they had to pay before the Act, they ~ould

not do this, and, further, since a large ·group.of people

having no adequate medical attendance prior to the Insur­

ance Act,. there is naturally, of course, considerable·

"arrears of sickness" during. the first period of the Act.

If I might. elaborate for the purpo se of illustrat ion, the

great number of anaemic girls who suffer from indigestion

are in that state', in many cases because of bad teeth.

Their mouths being cleaned, the focus of trouble being

removed, and we are not having those people ill in the same

. way in the future. Things are quiet ing dovm already, and

we are seeing a'narked falling off in the claims for medi-

cal benefit".

Dr • .A. Turner Belding, member of the Royal College

of Surgeons' Insurance Cormnittee for the County of Norfolk,

Local hledical Committee and Panel Committee, practicing in

East Dereham liith 500 on panel, says, in giving evidence

before the same Commission, "During the first year the Act

was in effect, we 'were dealing "lith a large number of per-

. sons who previously had never had any. adequate medical treat-

ment, but in the sec ond year this number VI.as reduced consider-

ably".

Dr. J.A. Harrison, M.C.C.M., Glasgow, 2589 on the

list, says, in giving evidence before the SaBe COIlJIllission,

IIFrom a medical point of view I can. report that in my dis-

trict there 'VIaS only a private 'practice VIOl"};: done before t:Q.e

Act. I have practiced there for yGars, and this \"linter I

have seen less pneul110nia than ever before.' I attrioute this

to treatL~g the colds earlier. Since patients do not have

to pay for individual ailments,they cane more readily,' and

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it is possible to practice :preiJ8n:tiv~ T.lerlieine. I 11,3.ve·

not had as hard i-jork s jllce the Act. I do not l1ave as ileavy

visiti:c.g and I attribute this to the fact timt the:l come Yih9n

they first feel sick and get their :::~13dicj.ne i7hich lasts them.

Tney do not ca~e to see ne as often as they did before. I

am getting fewer chronic abdominal troubles than I had. It

is true that I get the cases nO:-1 at an earlier stage'!.

After investigating the subject o~·Eealth Insur-

ance for themselves, the Special Committee. of the American

Eedical Association reported in p§,rt as follows:- ~However

one may criticise the details, the Insurance Act has unques­

tionably irilproved the conditions of the working c:J.:"asses

which have come under the law. This is a very noticeable

feature in England".

Hundreds of .like statements could be incorporated

in this report if necessary_

The average worker ca~~ot afford to pay the items

outlined in the ordinary medical tariff. The result is that

in· fear of the expense that might be. incurred in going to

a medical man, he either neglects himself or goes to a

druggist, and without a proper knowledge of his condit ion

purchases a patent medicine, the contents and effect of

which he knows but little. Evidence of the spread of this

patent medicine tr~ffic is sho~vn by the large display adver­

tisements constantly appearing in our press.

Private medical practitioners have to render a

large proportion of their services on a charity basis; a

further percentage of services are charged for but the

accounts are not paid. Medical practitioners should not be

made public philanthropists or explOited in this manner,

nor should the uorkers be pauperized for :.lack. of a general

scheme whereby they can make contributions to a medical

aid fund so as to pay their way during periods of sickness •

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It1s not infref;tuent to find. the present day worker bi tter­

ly resenting an appeal to charity either for himself or

his family_ Rather than have such an appeal made, he and

his family are often found to be suffering in silence. The

result is that he naturally becomes antagonist1a to soci ety.

which represents to him an unequal distribution of wealth.

From such antagonism it is but a short step to Bolshevism.

Distribution of Sickness Burden

Sickness is traceable to three sources:-

(1) to the individual on account of his carelessness I

a.l'1d recklessness in his daily condu·ct, ·to the use of intoxi-

cants, naraotics and drugs, to personal vice and to intemper­

ance in eating and drinking.·

(2) to the health conditions in the industry in

which the individual is engaged, i.eo as to dust, dirt, heat,

bad air, fatigue, poisons, infections, bad light, dampness

and weather exposure •

(3) to the health conditions of the community,

which, if ·neglected, breed and spread communicable diseases

such as tuberculosis and typhoid fever. These diseases can·

only be checked by community action, by educating the child-

ran on health matters, and by enforcing proper standards of (

housing and living •

The loss accompanying sickness in turn falls upon:­

(1) the individual.

(a) in loss of earnings, (b) in medical care expenditure, (a) in impaired earning power.

(2) the industry, by interruptions in production,

by inconvenience in replacing and retra-ining new men. These

interruptions due to sickness of employees cause a loss to

industry in the same way as do breaks to pieces of maohiner.v~

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If the cause of any particular case of sickness could be

definitely assigned to some condition in the industrial

plant itself, the 1;'1orkman should have as much right of re­

course against his employer as he would in the case of dis­

ability resulting from aocident in that industrial plant •

. In taking away the right to legal action resulting from .

certain industrial diseases, e.g., lead-poisoning, Govarn-

men~s have already recognized the responsibility of industry

for such sickness, and have substituted instead a statutory

right to aompensation under Workmen's Compensation laws.

The funds for such co~pensation are entirely met by industry

itself. Employers pay assessments for such purposes' and

in turn shift the burden, when pOSSible, onto the pub11Q

by adding its cost to prioe of the commodity~ The result

of such Workmen's Compensation laws has been followed by

diligent and conscientious effort on the part of employers

to eliminate the cause of industrial diseases. Suoh a re-

sult might naturally be expected to follow a general Kealth

Insurance law to 'which employers contributed.

(3} tfie commLL~ity, by reduced production and con-

sequent reduced prosperity •. Dben the cost of sickness is

not me t by the individual, it has. to be met by voluntary

contribution from the puolig. or by taxes.

The benefits to be derived from a Health Insurance

measure in turn would accrue:-

(l) to the individual, (2) to the industry, and ( ~) to. t~e "t t 1 v _~ Co~~UL~~ y a arge.

It is consequently reasonable to say that the cost

of such Health Insurance should be borne by these three

interested groups proportionately as they would be affeoted

by same o The benefit to the individual:'would be great.

His wage loss, the cost of medical attention he pays, and the

monetary value of impaired physioal condition as a result

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of not having adequate and timely medical treatment can only

be estimated. The benefit to industry in having healthy

and contented industrial v/orkers is eq,ually great.::. By

improved working conditions and improved melioal service, and

the systema.tio practice of preventive medicine, there would

be a very material decrease in the labor turn-over and in

labor absenoes, and a very material increase in production.

Industries are fast realizing the cost of loss of the ser-

vioes of their employees on account of sioknesso .At least

3000 wage-earners are off duty, on .anaverage, every day .

of the year in this PrOVince. Many others by neoessity of

ciraumstancesappear at work in a partially disabled cqn­

dition, which leaves many of them permanently impaired for

productive work. In some industries it costs $30 to $50.

to hire and initiate a new unskilled employee and in the

oase of a skilled mechanio, the oost runs as high as $300

per case. Preventive medicine practiced among workers,

and paid for in part by the industry, is not charity. It

pays dividends to the industryo }:rore and more are industrial

leaders realizing that the health of the vlorker is an a.sset

of the industry, and should be as carefully guarded as are

the other assets of the industry.

The benefit to -the-State from compulsory Heal th

Insurance Vlould also be oonsiderable. It would eliminate

to a grea t extent the system of tag-day Hdri ves n and hos;pi tal

ndri ves", as well as the constant demands on the .Government

by the ho spi tals to mal~e up defioi ts 0 It would mean the

payment of hospital ward expense, two-thirds of the costs

of which are not now being paid by the patients. The pre-

vention of muoh pauperism, vioe and crime would follow.

Society would tend to be stabilized and prosperity and well­

being would be encouragedo

The cost of supplying medical servioe to the in-

.jured among those 113,000 industrial workers covered by the

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jured among those 113~000 industrial workers covered by the workmen's Compansation Act in this Province last yea:r was $397,450.94, or $3 0 51 per person covered. Sickness causes approximately three times as nro.ch loss of time from work as do accidents. It would take_an estimated cost of $1,192,353. to cover medical treatment for sickness of the workmen now covered by the Workmen's Compensation AClt. There are ap-_ proximately 170,000 wage-earners,' male and femala, in the Province whose incomes are under $3000 per year. To pro-vide them and 170,000 dependants (which is a fair estimate of dependents of married and single men) with mediaa1 treat­ment would cost approximately $3,580,2000 On the basis that such cost be borne, two-fifths- by the insured, two-. fifths by the industry and one-fifth by the Government, the cost to the insured wou1d be $1,432,080 to industry $1,432,080, and to the Government would be $716.,.040.

The services recommended by this Commission in their reports on Public ITealth Nursing and Maternity Benef1ts p

as well as the cost thereof, wbuld nacessa:rily become a part of the oompu1sory Health Insuranoe recommended -her-ain.

'. The following table compiled by the Department of Health shows the Provincial Government expenditures on health during the past six yearso

1915-16 1916-17 1917-18 1918-19 Through Health Dept. $ 44,860 $49,860 $50,708 $47,382

Care of De­feotives

Hospital per capita al­lowance

ITospital bldg.grant Ru.r al. Do ctors

280,207 286,455

247,129 280,985 - 15,500 149,650

9,698 7,112

327 , 318 - 441, 713

307,969 448,358 44,635 - 45,000

6,246 7,175

1919-20 _ 1920-21

$46,774 $ 67,030

530,518

500,000 25,000 11,050

627,616 _

450,000 35,000 10,000

TOTAL $597,394 774,072 736,875 989,628 1,113;'342 1,189,646

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It will be seen from the a.bove that the Government

is now spending an average of over a million dollars annually

on health in one form or another. Over half a million was

spent last year in the field which would be covered to a very

large extent by a scheme of compulsory Health Insurance and

Public Health Nursing. ,

1i."iJ.nicipalities and. private subsoribers are also bear--­

ing a heavy po~tion of the cost of siokness. The Provinoial

Government last year paid 15 percent of the cost of operat­

ing the Vancouver General Hospital, and the City of Vanoouver

paid 15 per cent. :Patients paid only 33 percent of the t:otal

cost of operating that institution. This hospital took oare

of about one-third of British Columbia's hospital cases o

There are so many public welfare organizations,

different kinds of clinics and nursing organizations, each

operating in its own way and making calls on the Governmant

~~d on the oitizens for support, that the best re~ts are _

not being obtained from the monies spent~ A general system

of health legislation would take the major portion -of the

cost of sickness ~~d distribute it equitably over those affect-

ed, Such a scheme would permit a large section of the citizens

of this Province not now contributi!1..g, to do so in asystemat-

ic way_ At present this --1s -impossible, owing to the lack

of co-ordination among the organizations interested in siok-

ness problems.

Prior to the present system of Workmen's Compansation:~

it was urged by the insurance and other interests that if it

were made Dominion wide and thus administered by one central

body, instead of by a number as at presen.t, it would be- more

economical and the uniformity gained -- thereby Vlould. area te .

better results, and would not be a nandicap on provincial

industry. - This argument, Il:0wever, ViaS easily disposed of , -

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and the justification for the present system has been

definitely and clearly proven. Today we have Workmen's

Comgensation Boards in six of our Provinces, while in the

United States they have WorkmenTs Compensation Boards in

forty-five States and three territories. The same argument

as outlined above is now being urged by the same interests

against a Provincial Health InsuranoQ, measure. The answer

given to the opponents of Provinc-ial Workmen's Compensation

Aots is equal,ly applioable today to a Health Insuranoe

measure.

Health begets happiness, happiness prosperity. and

with happiness and prosperity, our country oannot help but

reaoh the height of suooess in the oo~reial world.

Finally, we may expeot Health Insurauoe to help

forward industrial peace, for it will provide maohiner~

for oontinual conferenoe between employer and employee~,

It is believed that Health Insurance is needed in British

Columbia in order to tide the workman over the grave amer-"

genoy inoidental to illness, as well as in order to reduoe'

illness itself~ lengthen life, abate poverty, improve

working and earning; power, and diminish the cause of in­

dustrial discontent. There is no other measure now before

the publia which equals the power of Health Insurance toward

social betterment.

Reoommendations:-

(1) That a provinoial-wide oompulsory Health Insur­

anoe measure be enaoted and made applioable to all wage­

earners under' the age of 65 years who have been bona fide

residents of British Columbia for at least 18 months, and

whose inoomes are not in exoess of $300,O~ per year, suoh

insurano~ to inolude the families and other dependents of

the insured.

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{2} That volumtary health insurance be provided for all wage-earners in exoess of· $3000. and for all others irrespective of the amount of their incomes.

(3) That such legislation provide ade~uate medioal, surgioal, specialist, dental and hospital treatment, tr~s­portation, nursing, medicines, crutches and apparatus in­cluding such artificial members as ma.y,- be deemed necessary. to cura and relieve from the effects of disability whether it be by accident or by siokness.

(4) That in the case of wage-earners, compensation be paid for time loss after the f.irst thr.eedayso

(5) That the legislation provide a funeral benefit of at least·1100~

." '(6) That there be free ohoice of physioian and

tha. t his remuneration be on an approved fee sohedul.e basis 0

(7) That existing fraternities, employees.med.ioal assooiations and other siokness benefit .assooiationg be . permitted to be oarriers under the Aetas long as they comply with the requirement of the Aoto

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(8) That such legislation be administered by a Commis sion.

(9) That-wo-fifths of the benefits be paid for· by the insured, two-fifth~ by the employer.and one-fifth by. the State.'

"---(10) That before set tling' on the details of. any'

Health Insuranoe·measure, a tentative bill b~ prepared and

cirett.lated widely among those inter'ested in the subjeot throughout the Province.

Dro ToBo Green, one of the members of this CommiSSion was unable to agree wi th the recommendat:ions made herein.

Respeotfully submitted.,

"EoSoHoWinnrt

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