STATEMENT OF ALFRED BAKER LEWIS OF GREENWICH, CONN. ON BEHALF OF THE NAACP AND THE HEALTH SECURITY COUNCIL We need free hospital and medical care for everyone through a system of government health insurance. We should have the best health care in the world because we spend more money on medical research than any other country. Probably we have the best medical and hospital care for those comparatively few who can pay for it. But too often it is not available to those who need it. An important reason for this failure to deliver the best health care for everyone is the cost to the individual person who becomes sick or injured in a non-industrial accident (industrial accidents are already covered by workmen's compensation). The cost of medical and hospital care has risen in the last few years higher and faster than other components in the increasing costs of living. Good health care should be the right of any inhabitant of our country, just as the chance as to get an education is a right. Yet they do not have such care as a right, and the care they do get is not as good as it should be. There are two proofs of that last statement. The best test of good health care is infant mortality. If we had the best medical care of any country, we would have the lowest infant mortality. We don't. We are 18th from the lowest, and nearly every country with lower infant mortality than ours has some form or other of government health insurance. This is a fact which we cannot ignore. We must face it. To ignore it, as do the opponents of government health insurance, can only be done at the expense of the nations health. The second proof is that Negroes have a substantially higher rate of infant mortality and a lower rate of longevity by 10 or 11% than do whites. This is clearly due to the lack of proper delivery of health care to those who need it. For Negroes are basically as healthy and hardy as whites if (91) not more so. If you doubt that, you have only to look at the figures for the Olympic games, and their performance in professional ball games. In the 1964 Olympics, one college, Tennessee A&M in Nashville, with 10,000 Negro students, had 7 gold metalists. No other college had more than one gold medalist except the University of California, which has some 90,000 students, over 90% of them whites; and it had two gold medalists. When 10,000 Negro students turned out 7 gold medalists and nearly 90,000 white students won 2 gold medals, no one can say that Negroes are not healthy and hardy. They are. If they don't live quite so long--and they don't--and have a higher infant mortality rate than whites--which they do-it is because of the harder economic conditions under which on an average they have to live, and part of these harder economic conditions is poorer medical care. The 1968 Olympics told the same story. The proportion of Negro to white gold medal winners on the American team was higher than their proportion to the general population. It has been argued that we should maintain our present medical system, which is mainly on a fee for service basis, because we have made progress in increasing health and longevity. That is true. We have made such progress. The countries, however, which have government health insurance have also made such progress and at a greater rate than we. We are now 18th from the lowest in infant mortality. Fifteen years ago we were 9th from the lowest. While we have made progress in reducing infant mortality and increasing longevity, the countries with government health insurance have made greater progress. The figures are given in Exhibit A. ARGUMENT ABOUT COST The big argument used by the opponents of having free hospital and medical care for everyone is the cost. The argument is fallacious. It would add to the Federal budget. But every penny added to the Federal - 3 budget would be taken off the budgets of those who now pay somehow for hospital and medical care. There is absolutely nothing in government health insurance that will increase the total social cost of health care, though it will add to the Federal budget. The inhabitants of our country already bear in full the cost of illness and non-industrial accidents. If a man becomes ill or injured in a non-industrial accident, the cost is borne by him if he can afford it. His family pays part of the cost for he may have to draw on his savings for his old age or for the higher education of his children. His employer suffers the loss of his work, and in a sense the whole community loses from the loss of his productive labor. Some of the financial cost may be borne by an insurance company, which means in the long run by the premiums of the policy holders. If he is indigent, or the illness forces him to become so, the state and local taxpayers, who pay for public welfare relief, carry the load. The cost is there. community pays it. All that health insurance does is to distribute the cost around in a more just and equitable manner. Someone in the Part of the trouble with health care is that the availability of it is very unevenly distributed. If you live in a poor community the chances are that there is not good medical care readily available even if you can afford it. Most physicians, like others, want to live and practice where the money is. So poor communities have far fewer doctors or dentists in proportion to the population than richer ones. We recognized this fact by trying to stimulate the building of hospital and health centers in places which lack them through the HillBurton Act. This has reduced somewhat but not eliminated the present maldistribution of medical care. If you are unfortunate enough to be on relief, the situation is worse. Most relief costs are paid for by local taxes, mainly real estate taxes, with some subsidies from the State governments. This means, if relief - 4. is to be adequate, that the poor would have to be taxed heavily to support the destitute living among the poor, of whom there are many; while wealthier persons living in richer communities are taxed only lightly to support the destitute living among the rich, of whom there are few. This is clearly unjust. Also, it intensifies the maldistribution of medical care because the poorer localities simply cannot pay the taxes to provide adequate relief including medical care for those who need it and cannot pay for it. It also hits all Government health insurance would transfer the cost of sickness and non-industrial accidents for persons on relief from the state and local taxpayers who now pay most of the cost of general public welfare relief to the Federal Government. This would be a gain in social justice. For the states raise most of their money by sales taxes. Sales taxes bear much more heavily in proportion on the poor than on the rich. Nearly every penny spent by a poor person is hit with a sales tax. But many expenditures typical of a rich family totally escape a state sales tax, such as expenditures for domestic service, for trips abroad, or for investments. The local government bodies raise most of their money by taxes on real estate. This hits small homeowners. tenants, because the landlords add the cost of the taxes to the rents. Taxes on real estate are not an accurate reflection of wealth, and therefore of ability to pay. For most of the wealth of rich people is held in the form of stocks and bonds, which are intangible personal property, and which the taxes relied on by local governments hardly ever reach. The Federal Government on the other hand raises most of its money from the graduated personal income tax and the corporation profits tax. Despite loopholes favoring the rich in these taxes, which your committee is now trying to reduce, the Federal Government's tax system is, roughly, taxation in proportion to ability to pay. - 5 GOVERNMENT HEALTH INSURANCE WOULD REDUCE THE COST OF HEALTH CARE There are sound reasons why the social cost of medical care would almost certainly be less under a system of government health insurance than it is now. Too many people, when they begin to get sick, put off going to the doctor because of the expense. Inevitably, when they finally do have to go, the disease is apt to have a stronger hold and the cure is likely to take longer than would have been the case had he or she sought medical care earlier. If they could get medical care by government health insurance without personally paying for it through the fee-for-service system, they would be less likely to put off going to the doctor until too late. PRESENT ACCIDENT AND HEALTH INSURANCE COSTS ARE TOO HIGH A good deal of accident and health insurance costs are now carried by private insurance companies. Most of the policies are not sufficiently comprehensive. Some are only for disaster insurance, paying the cost of hospitalization if it goes above a certain fairly high level. Nearly all the group insurance policies that I know exclude mental illness and dental care. Nearly all individual policies exclude the cost of care for illness growing out of a pre-existing physical condition. The cost of maternity coverage is very high for those in the marital and age bracket that need it most. Above all, all the policies are unnecessarily expensive because of the high acquisition costs. These acquisition costs are mainly advertising expense. They are totally unnecessary from a social point of view, and would be eliminated entirely by government health insurance. You can get some idea of the unnecessary cost of health insurance carried by private companies from the figures on the relation between premiums and benefits collected and paid by private insurance companies. |