RHODE ISLAND.

TEXAS.

VERMONT.

WASHINGTON.

WEST VIRGINIA.

WISCONSIN.

Reasonable medical and hospital service and medicines when needed provided for period of 2 weeks, but Rhode Island has no law fixing fee bills for physicians under Workmen's Compensation Act.

During first week of injury, Association shall furnish reasonable medical aid, hospital services and medicines when needed, and if it does not furnish these immediately as and when needed it shall repay all sums reasonably paid or incurred for same.

Medical, surgical and hospital services furnisht for first 14 days, not to exceed in amount $75.

None.

First aid bill will be voted on at the next general election and if bill passes a fee bill will undoubtedly be adopted.

At present no first aid or medical attention provision in the Washington Workmen's Compensation Act.

Such sums for medical, surgical and hospital treatment as may reasonably be required, in any case not to exceed $150; provided in case of permanent disability that said disability can be reduced by surgical or medical treatment, the amount expended for medical, surgical or hospital treatment shall not exceed $300.

Medical, surgical and hospital treatment, medicines, medical and surgical supplies, crutches and apparatus for period not to exceed 90 days.

HEALTH INSURANCE.

By JOHN B. Andrews, Ph.D., New York, Secretary American Association for Labor Legislation.

Medicine has progrest far since doctors taught that the inflammation from a burn could be relieved by holding the affected part near a hot fire, and that the bruised head of a viper would cure snakebite. Knowledge and technique have abundantly progrest, but the pivotal change, I take it, has been the development of the scientific spirit. When Vesalius refused to hark back to authority for his theories, but appealed directly to the facts, guesswork and traditionalism lost respectability, and genuine research took their place. In the difficult field where medicine and sociology meet, the American Academy of Medicine has well upheld this ideal.

I feel at home in meeting you for this discussion because the organization I represent also approaches its problems in a scientific spirit. We endeavor to apply scientific methods to the subject of labor organization. We endeavor to base our action on careful study of experience. The scientific attitude also implies that we must consider the welfare of the whole country, for the future as well as for the present.

Perhaps the best evidence that we have succeeded in maintaining a scientific attitude toward labor problems is that we are occasionally criticised by employers as being too friendly to trade unions and again just as roundly condemned by certain representatives of labor as being too friendly to the employers.

The subject of our discussion is Health Insurance, with special reference to the model bill prepared by the Association for Labor Legislation. Perhaps I cannot do better in the beginning than explain to you why and how we drafted this legislation.

About seven years ago, you will remember, we began to give serious attention to workmen's compensation for industrial accidents. Investigations indicated that no fewer than 25,000 human lives were sacrificed each year in American industry.

The list of serious injuries, incapacitating for a period of four weeks, or more, totalled about 700,000. Each year of productiv endeavor yielded as an incidental product some 45,000 widows and orphans. This truly was a social problem worthy of our best remedial efforts.

The coming of workmen's compensation, which in the short space of six years swept over 35 of our 50 states and territories, and over the federal government for its own employes, was revolutionary in its effects. Accident statistics suddenly became something more than a sorry joke. Information accumulated almost automatically. Millions of dollars, formerly spent in wasteful and contentious methods, were now available to care for the victims of accidents on a systematic, scientific basis. Even those who in the beginning opposed workmen's compensation as a legislativ proposal are now loyal adherents of it in practice. Both employes and employers as well as society in general have benefited. And perhaps the chief gain has been the continuous economic pressure toward accident prevention. Many employers, in coöperation with their employes and the agents of the state, are now preventing from one-half to twothirds of their accidents which six years ago they regarded as inevitable. The coming of workmen's compensation gave impetus to the great movement for "Safety First."

As early as 1912 it had become evident to many people that this social insurance method of dealing successfully with industrial accidents would be extended before many years to another and no less serious contingency in the life of the worker. At the annual meeting of the Association for Labor Legislation, held in Boston that year, a national committee was provided to investigate the subject of workingmen's sickness. The members of that committee include leading authorities of the country on statistics, medicine, nursing, and social insurance.

EXTENT AND COST OF SICKNESS.

The committee found that about 3,000,000 persons in the United States are sick at any one time, and that each of our 30,000,000 wage-earners loses an average of approximately

nine days' work from this cause yearly, while the resultant yearly wage loss totals $500,000,000 and medical treatment costs an additional $180,000,000 annually.

This estimate of nine days' illness for each wage-earner is substantiated by the recent community sickness surveys carried out by the Metropolitan Life Insurance Company in Rochester, N. Y., and Trenton, N. J., which revealed an average of 8.5 days of disability a year for men and 9.4 days for women.

The enormous expenditure of $180,000,000 a year for medical care cannot be met by our industrial sick. An analysis made by the Boston Dispensary showed that only 17 per cent. of the families with which the institution was in touch received incomes from which they should be expected to pay for medical treatment beyond that necessary in childbirth and acute illness in the home. In the Rochester survey it was found that 39 per cent. of those who were sick had no physician in attendance; of those who were ill but able to work, 54.7 per cent. had no physician. In New York State, out of 300,000 patients cared for by 185 hospitals, 46 per cent. were taken as public charges or as free patients. In New York City alone, forty-six hospitals cared in one year for 69,000 patients, or 57 per cent. of their total, who paid nothing for their treatment. Yet the United Hospital Fund states that: "At present only one in ten persons seriously ill or injured in this city now gets treated in any hospital. For lack of proper treatment thousands lose their health and efficiency and become a burden to their friends and the community." Even the dispensaries of New York, with their 4,500,000 treatments yearly, fail to reach all of those who require their services.

Wage studies, furthermore, show that the slender savings of workingmen are inadequate to meet the wage loss due to sickness. A recent investigation of 700 sick wage-earners by the Russell Sage Foundation disclosed that in addition to using up savings the deprivation of income was met (1) by relief societies, (2) by relatives and friends, who were undermining their own health and strength in order to help others; (3) by employers and trade unions, and (4) by borrowing money, taking in lodgers,

sending the wife to work, committing children to institutions, and moving to cheaper quarters all of which tend to reduce the standard of living and to multiply sickness. In 75 per cent. of the applications for aid to the New York Charity Organization Society, sickness was directly or indirectly responsible. About eight-tenths of the relief expenditure of the New York Association for Improving the Condition of the Poor is made necessary by sickness. In short, sickness was found to be a factor in seven times as much dependency as is industrial accident. The economic loss due to the impaired vitality of wage-earners, and to that of ill-nourisht and ill-cared-for children when they come to working age, cannot at present be accurately measured, but it must be considerable. Moreover, altho much of it is preventable, there are no signs that sickness in America is diminishing. On the contrary, deaths in middle life, due to degenerativ diseases, have increast in the United States 40 per cent. during the last twenty-three years. Until some means is found to prevent illness, and to distribute its cost, sickness will continue to produce destitution, dependency, inefficiency, waste, and death.

RESPONSIBILITY FOR SICKNESS.

The committee also found that responsibility for sickness may with justice be divided among three parties-the employer, the workman, and the state.

While not to the same extent as for industrial accidents, the employer is nevertheless largely responsible for the sickness which assails his workmen, and interferes with the stability of his working force. Every new man broken in, every man transferred from his regular work to take the place of a worker who is absent, represents a definit financial loss, and much of this loss is but the employer's chickens coming home to roost. Often by conditions common to his trade, such as monotony of work, speeding up, and a work-day of unhygienic length, and also by payment of wages inadequate for proper food, clothing, shelter, and recreation, he undermines the vigor and resisting powers of his workpeople, so that the omnipresent bacteria of