For the Nation's Health

Ever since the first medicine men started to live high off the boar by ordering their patients to bring them the choicest cuts, ailing mankind has been worrying about how to pay the doctor. In the U.S. recently, attention has been concentrated on two rival methods (TIME, Feb. 20, 1950): compulsory national health insurance (favored by President Truman and Federal Security Administrator Oscar Ewing, "socialized medicine," to its opponents) and the present system of private payment to the doctor for each separate service he gives, with a limited exception for prepayment through voluntary insurance (favored by the A.M.A.).

Last week the U.S. was offered a middle way. The President's Commission on the Health Needs of the Nation recommended that the U.S.: 1) put the Truman-Ewing plan on ice, 2) go all out to extend voluntary insurance plans to tens of millions not now covered, 3) let federal and state governments pay the premiums for those who cannot afford to pay them, 4) dot the nation with up-to-date medical centers where doctors would practice in groups. The commission's plans would cost the Federal Government an estimated $1 billion a year, on top of the $1 billion it now spends for health.

To head the commission a year ago, Harry Truman got a topflight surgeon and medical administrator (in the VA), Chicago's Paul Budd Magnuson, who says: "I'm a Republican myself and always have been." The President let Magnuson pick the rest of the commission—14 representatives of medicine, dentistry, nursing, farmers, labor and consumers. And Magnuson now swears that nobody in the Administration "exerted the slightest bit of pressure on the commission."

Payments. The traditional system of paying the doctor and the hospital is breaking down, said the commission, because the costs and complexities of medical care are increasing all the time. The solution proposed: prepayment through voluntary insurance plans. Many of those now operating are all right as far as they go, the commission believes, but they cover only about 15% of bills for medical care. They must, it believes, be extended to cover doctors' services both at home and in the office, and to cover some nursing services, dentistry for children, and costly drugs and appliances.

One trouble now, says the commission, is that doctors themselves have blocked some all-inclusive insurance plans that consumers want. And in several states there is a ban on plans sponsored by consumers. . But the biggest obstacle to the growth of insurance plans is inability to pay. The main groups which the commission lists as unable to buy prepaid medical care are: those on relief, the blind, the aged, dependent children, the growing numbers now living largely on social security benefits, and those eking out a marginal living on small incomes. To provide for all these, the commission proposes:

¶ A cooperative federal-state program, each state to set up a single health authority responsible for developing health services, both public and private, and making them available to all.

¶ Use of social security funds to pay insurance premiums for those drawing old-age and survivors' benefits.

¶Joint federal and state payments to meet premiums for those on relief or otherwise unable to pay their own way.