[Discussion on Dickinson, Pike, Ketchum, and Williamson]Author(s): Frank LangSource: Journal of the American Association of University Teachers of Insurance, Vol. 15, No.1, Proceedings of the Twelfth Annual Meeting (Mar., 1948), pp. 66-69Published by: American Risk and Insurance AssociationStable URL: http://www.jstor.org/stable/249913 .

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Discussion

By Frank Lang, Manager, Department of Research, Associa?

tion of Casualty & Surety Companies

As I sat here listening to my four colleagues giving an account of the present state of affairs in the field of medical care insurance, I couldn't help but wonder what sort of report they would submit were

they addressing this group ten years hence?December 1957 instead of December 1947.

I think we are all agreed, but I will say it once again, though with full awareness of the fact that in so doing I lay myself open to the charge of tedious repetition of an old refrain, that "Today, health insurance is at the erossroads." Tomorrow it will have moved on?and by 1957 it will be still further along the road. We hope it will be along the Highway of Voluntary Health Insurance, and not the

Byway of Compulsory Government Insurance. I use the word "by- way" advisedly?in the sense of a secondary or detour route, which will be necessary only if the main route becomes impassable for lack of proper maintenance.

Our speakers have reported on the present state of repair of three of the lanes in the Highway of Voluntary Insurance:

Frank Dickinson has told about consumer expenditures for medi? cal care and the relatively small portion going to medical care cost.

Al Pike has described what private group insurance has ac?

complished. He reports growth in all three divisions?hospital ex?

pense, surgical expense, and general medical expense insurancs?10- % million individuals being covered under group hospital, 8 million under

group surgical, and % million under group medical.

Mr. Ketchum has given a picture of the job that is being done

through medical society and hospital-sponsored plans. Twenty-eight mil? lion hospital subscribers is a large number in any man's language. A few years ago it would have been thought fantastic. Such an achieve- ment points an encouraging pattern for the future.

And finally Bill Williamson has shown wherein lie the strengths and limitations of voluntary plans.

In addition to the three types of medical care protection that we

have heard discussed this afternoon, namely coverage through com? mercial group insurance and through medical society and hospital-spon? sored plans, there are a number of other voluntary methods for securing this type of protection. Lack of time prohibits a detailed discussion of

each, but for the sake of completeness I think it might be well in

passing to list them. They include (1) individual insurance which is purchased by the individual from the commercial insurance company; ((2) a variety of plans best grouped under the common heading, prepay? ment medical care organization?among them private group clinic or

physician-managed plans, industrial employer-employee plans, govern-

(66)

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Discussion 67

mental plans established by the various government agencies, consumer-

sponsored plans which have grown out of the desire of a group of

persons to budget the cost of illness, the FHA plan, and the bituminous

mine industry plan; and (3) a final category designated as university health plans. An estimate made within the past month by the Research

Subcommittee of the Conference Committee on Health Insurance of

which I happen to be a member, gives the following totals for the

number of persons covered under the various voluntary medical care

plans: Hospital expense 41,323,000; surgical expense 17,530,000; medical

expense 6,465,000.

We must not forget either that entirely apart from these medical

care plans, there is the older type of indemnity protection against loss

of income in case of accident or sickness. This, after all, is the basic

protection provided by insurance. All the other coverages discussed this afternoon are an outgrowth of this fundamental type. Under this heading there are six generally recognized covers: (1) group insurance, (2) individual insurance, (3) fraternal benefit societies, (4) paid sick

leave, (5) employ mutual benefit associations, and (6) union plans. The total number of persons protected through these channels is esti? mated at 26,823,000.

We know what is avaiiabie. Do we know, though, what is wanted?

Specifically, what does public sentiment demand? During the past few

years the average American has become an extremely health-conscious individual. He has learned that on an average day 7,000,000 persons in the United States are disabled by sickness or injury so that they are un- able to go about their ordinary business?school, work at home, or work on the job. He has learned too that this disability has re? sulted in an annual earnings loss for the nation of some 3-4 billion? to say nothing of 1.5-3.3 million man-years of working time lost in an

ordinary year.

Through the use of public opinion polls, attempts have been made to find out just how the average American wishes to take care of this

problem. Today, there is hardly a polling organization in the country? either national, regional, or local?that has not at some time or other un- dertaken the task of determining public opinion with regards to medical care. Findings show a surprising degree of consistency regarding the answers to some of the questions, but marked variation in answers to others. All polls agree that a large majority of the American public feels that most people do not get enough medical care and that some? thing should be done to improve the situation. As early as July, 1943, only a month after the appearance of the Wagner-Murray-Dingell bill, the Opinion Research Center of Princeton, New Jersey asked the ques? tion, "Do you think anything might be done to make it easier for people to pay doctors' or hospital bills?" The reply was an emphatic affirmative as shown by the following percentages: 63% yes, 11% no, 26% no opinion. The same question asked during 1945 brought very similar results. A year later the National Opinion Research Center of Denver found an even larger proportion of people?

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68 The American Association of University Teachers of Insurance

82%?feeling that "something should be done to make it easier for

people to secure medical care when they need it."

Another issue oh which there is apparent agreement coneerns

methods of payment. Here findings reveal a marked preference for

prepayment. In answer to their question as to whether the public

preferred a pay-in-advance or pay-when-you-are-sick plan the same

three polls referred to above found between 45% and 64% of those

queried favoring the prepayment method.

No such unanimity of sentiment, however, exists among respondents with regard to the medium through which this care should be provided or

the ageney through which it should be administered. Three of the major national polls report extremely diverse findings as to the proportion fav?

oring federal or state administration as opposed to administration by

doctors, private agencies, or local organizations. When asked about the

choice of plans, the percentage of people claiming to favor an ex?

tension of social security to include health insurance varied from as

much as 37% to 70%. In addition to polls by these three national polling organizations, the question of medical care has been explored, as far as

I am aware, by regional surveys in Washington, Iowa, California, and

Michigan; by three in Minnesota; and two in Pennsylvania. All of these

have tried to measure public opinion with regard to a government- operated medical care program and all have shown wide variation

ranging from 38% to 83% in favor of such a plan. This divergence of

opinion apparently is not due to incorrect sampling but rather may be

traced to differences in the wording of questions used by the different

pollers. These studies, incidentally, provide an excellent example of the

difficulties that may arise and of the necessity for formulating ques? tions with extreme care. For example, findings show that more opposi? tion is expressed when a government-sponsored plan is described as

"socialized medicine", "government-controlled medicine", "compulsory health insurance" or "a new tax for paying people's doctor bills". On

the other hand, more approval is indicated when the same plan is repre?

sented as "insurance for which the worker helps pay", " a means of

providing low cost medical care", "a plan supported by the president" or

"a method similar to systems already in operation".

The importance to this audience here is that there exists a fluidity

of public opinion as related to a national program of health insurance

which in turn is caused by the fact that people have not yet made up

their minds on the issue and are easily swayed by the many verbal

stereotypes which usually accompany any discussion of this controversial

issue.

Small wonder the average American is confused. On one side he

finds himself confronted with a multiplicity of proposals, each claiming

to offer the solution to his problem by providing complete health in?

surance and medical care. On the other side he finds himself only too of?

ten misled and unable to obtain the protection to which he believes him?

self entitled. This is a situation that needs correction and one that

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Discussion 69

everyone in any way connected with insurance should feel an obliga? tion to rectify. This is particularly true for those among us connected with insurance education. For it needs a public relations program on a broad educational level designed to show the man in the street just what is available under the various plans?a program which admits frankly the strength and limitations of each. Only an honest public relations campaign, based upon indisputable data can accomplish the purpose.

There may be differences in opinion as to method, but they are insignificant in the face of the overwhelming mandate from the public of this country to go ahead and to do something about medical care.

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