Middle Way to Health

In an effort to make the average American a participant and not a statistic in a national health program, the progressive wing of the Republican party has brought up before Congress two bills, $1970 and H.R. 4919, outlining a new medical insurance plan. The pith of the bill is its emphasis on local autonomy. Its logic is that by keeping the average person in what amounts to personal contact with the health plan's administration you give him the responsibility of using the plan prudently.

In the form proposed by its sponsors, the bill states that any group of responsible citizens can set up an insurance plan adapted to the needs of a particular area; if necessary, existing organizations such as Blue Cross or the various benefit associations can serve as nuclei for the program. The payment of doctors, the maintenance of professional standards, the establishment of adequate medical services (ambulances, etc.) would all be the responsibility of this locally self-sufficient group.

To implement the autonomous nature of the plan, participation will be on a completely voluntary basis--for doctors and hospitals as well as patients. This distinguishes the newer plan from the compulsory Truman omnibus health bill introduced last year. The argument for the compulsory system is that a voluntary plan, if it is ever to gain enough participants, must have expensive sales promotion; the Blue Cross supposedly pays out one-third of its premiums in advertising. But under any government-controlled plan, the cost of administration would almost surely be greater than that of an advertising program. In any case, if there is differential in cost, it could be rationalized, in the words of the sponsors, as the "price of freedom of participation."

What has made this Republican plan most acceptable as an alternative to the Truman bill is that it has combined "free participation" with the former plan's better provisions. The Hospital Construction Act, now in force, would remain; federal financial aid would be extended to medical schools and federal scholarships to medical students. Moreover, the government would bolster the local setup by contributing a portion of the lower income members insurance. For instance, if a worker paid $10 a year in premiums, the government would make up the difference between that and $50, the established norm in the region. Eligibility for federal aid would be contingent upon a non-profit insurance organization whose membership was more than half layman.

The bulk of the plan's financing would come from a 3 percent payroll deduction which could be split between employee and employee. Like any insurance plan, the premium would be written in view of the risk and if profits accumulated the participants could get a rebate or a rate adjustment. To make up losses in a low-income region or to pay for a disaster, the federal government or the state could be called upon for aid. The individual states would be required to issue bonds to provide the initial expenses of any insurance system.

As a compromise in autonomy between the medical profession and a government bureau, the bill embraces the better portions of two extremes into a new and distinctly stronger plan. It should come near accomplishing the age-old goal of medical insurance programs--to keep medicine from being neither a luxury nor a political spoil.