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PROGRAM PRINCIPLES

The Principles of National Health Insurance

Today and for the Future

While not directly involved with environmental health
services, the Committee for National Health Insurance
is acutely aware of the effect of the quality of the en-
vironment on health and believes that development of
personal health services must be paralleled by concerted
efforts to improve the human environment.

The American people have a right to good health
care. The Committee for National Health Insurance
believes that fulfillment of that right requires the enact-
ment of national health insurance.

We acknowledge and take pride in the past history
of progress and great achievement of our medical sci-
ence and technology. We believe, however, that now
and for the future American medicine should be judged,
first and foremost, by its performance in meeting the
public needs and by its contributions to improved
health and well-being for the men, women and children
of the population.

We believe our health services must now be revital-
ized to overcome serious deficiencies in organization.
Only a program of national health insurance can pro-
vide the supports required to bring about the changes
that are needed.

The nation is indebted to the private health insurance
industry for education of the public that the costs of
medical care services are insurable, for the extent to
which they have actually insured some of the costs of
personal health care, and for the development of a net-
work of experienced organizations. This reserve of
knowledge, skill and organization will prove invaluable
as we move forward with new programs. However,
private insurance, despite its massive growth over the
past 30 years, today still does not cover on the average,
more than one-third of the consumers' health care ex-
penditures. For many segments of the population pri-
vate insurance is not obtainable in a form which is ade-
quate and at a price which they can afford. And it is
mainly sickness insurance, not health insurance.

With personal health services falling behind the
capacity of modern medicine, and the needs of many
people largely unmet, most Americans cannot budget
and self-finance their full personal health needs through
the existing private payment systems. We believe a new
health insurance plana national program is essen-
tial. It is the best hope for coping with the critical
problems and deficiencies that beset the health care
field. It offers a new opportunity to eradicate the fi-
nancial barriers to good health care and thus to reduce
illness, disability and suffering.

1. All persons resident in the United States should
have available, as a matter of right, comprehensive per
sonal health care services, with equal opportunity of
access to the available services throughout the country,

2. Personal health care services should be provided
under arrangements that, to the maximum extent prac-
ticable and within a framework of improved provisions
for service, make full use of existing personnel and
facilities and are acceptable to the people to be served
and to those who provide the services.

3. The availability of personal health services should
be assured through a national health insurance program.

4. The national health insurance program should be
an integral part of the national social insurance system.
The program should be financed by contributions from
employers, employees, self-employed persons-preserv-
ing present provisions which permit employer assumption
of all or part of employee contributions and from Fed-
eral general tax revenues.

5. The benefits of the program should extend to the
entire range of services required for the maintenance of
personal health, including services for the prevention
and early detection of disease, for the care and treatment
of illness, and for medical rehabilitation when needed.

6. Payments for the services provided as benefits of
the program should assure full financial protection for
the consumers and should be fair to the providers of the
services.

7. The national health insurance program should in-
clude provisions designed to contribute toward safe-
guarding the quantity, quality, effectiveness, continuity
and economy of the family health care services it finances,

8. The administrative arrangements and the finances
of the national health insurance program should be de
signed so as to encourage the organization of profes-
sional, technical and supporting personnel into health
teams and groups capable of providing comprehensive
health care for families and individuals efficiently and
effectively, with compensation through comprehensive
per capita payments as an alternative to the prevailing
fee-for-service method of payment.

9. There should be public control of the basic policies
governing the program, and full public accountability
for its financial and operational activities.

(over)

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THE "QUALITY" OF PRIVATE

HEALTH INSURANCE
The "have-nots"-people who do NOT have volun-
tary health insurance The population under age 65
amounted to 175,880,000 people on January 1, 1967.

(The population aged 65 and over equalled 18,670,-
000 at that time.)

15.5%-27,291,000 people—under age 65 had no
hospital insurance.

22%-38,432,000 people—under age 65 had no
surgical insurance,

37% 65,146,000—had no in-the-hospital medical
expense insurance.

49% 86,130,000—had no insurance to cover X-
ray and laboratory examinations when not in the hos-
pital.

60%-104,887,000—had no insurance for visits to
doctors' offices or doctor visits to their homes.

64% -112,035,000had no insurance against the
cost of prescribed drugs.

97% -171,737,000 had no insurance against den-
tal expenses.

Persons suffering from a disability are almost by
definition users of hospital and physician care. The
disability which lasts six months or more is considered
more or less permanent, Health insurance may not be
available to such disabled people or it may limit the
insurance company's liability for "a pre-existing condi-
tion."

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DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE,

SOCIAL SECURITY ADMINISTRATION,
OFFICE OF RESEARCH AND STATISTICS,

Washington, D.C., April 1, 1970.
Hon. PHILIP A. HABT,
U.S. Senate,
Washington, D.O.

DEAR SENATOR HABT: In response to your letter, dated February 19, I am enclosing the report that Mrs. Cooper of my staff and I prepared on “The Cost of Accidents.” Included are data on the direct and indirect costs resulting from motor vehicle, work, home, and other types of accidents.

I hope the enclosed study will be helpful in preparing your report on automobile insurance. Sincerely yours,

DOROTHY P. RICE,

Chief, Health Insurance Research Branch. Enclosure.

THE COST OF ACCIDENTS* In 1968 more than 111,00 persons died from accidents (table 1). Another 49 million persons, or about one-fourth of the total population, suffered injuries in accidents (table 2). The pain and grief resulting from these accidents cannot be measured. The losses from destruction of personal property-homes, automobiles, personal and economic valuables-are not known but can be readily imagined.

The economic cost of accidents in terms of disability and premature death can be measured. In 1968, this cost amounted to between $13 and $14 billion (table 3).

The $13-$14 billion cost of accidents represents the direct costs of diagnosis, treatment, and rehabilitation of accident victims and the indirect costs associated with loss of earnings due to disability and premature death.

Direct expenditures for hospital and nursing home care, physicians' services, drugs and other medical services for accident victims amounted to about $4 billion in 1968.

These accident victims spent more than 28,000 days in the hospital and accounted for about 7.4 percent of all physician visits. One out of 12 dollars spent for personal health care in the Nation was spent for the care of persons in accidents.

The direct costs are only the beginning. Those who are disabled by accidents add another burden to the economy through their loss of output. One out of every 3 men in the productive age group 17-44 years was injured in accidents. Taking into account members of the labor force and housewives, a total of 134 million work days were lost in 1968. These are equivalent to 507,000 man years, amounting to $3.6 billion in lost output.

Other losses result from premature death. If the 111,460 persons killed in accidents in 1968 had not died, many of them would have continued to be productive for a number of years. The present value of these future losses cost the Nation $5.4-6.8 billion in 1968, depending on the discount rate.

Accidents are commonly classified into four major groups : motor vehicle; work; home; and other. Motor Vehicle

Motor vehicle accidents cost the Nation $5–$6 billion in 1968. About 3.4 million persons, or 7 percent of the total, were injured in this class of accident. The direct costs for the care of such injured persons as well as those killed in these accidents are by far the costliest, representing more than one-third of the total and amounting to $1.4 billion.

The productivity losses of employed persons unable to work, or housewives unable to keep house because of motor vehicle accidents represented one-fifth of the total for all accidents. Lost man-years for persons in motor vehicle accidents amounted to 115,000 and their lost earnings in 1968 reached $769 million.

* Prepared by Dorothy P. Rice and Barbara S. Cooper, Office of Research and Statistics, Social Security Administration.

About one-half of all the deaths from accidents occurred in motor vehicle accidents. Since many of these deaths occur in the most productive years (age 20-44), the present value of the future losses for all persons who died in motor vehicle accidents represented three-fifths of the total accident mortality losses. Work

In 1968, 9 million persons were injured at work. Costs for the medical care and treatment of persons injured or killed in work accidents totaled almost $650 million.

Productivity losses for this class of accident were the largest. About 213,000 man-years, or more than two-fifths of the man-years lost, and about $1.6 billion, more than two-fifths of the total lost earnings, resulted from work accidents in 1968.

It is estimated that 14,300 persons died in work accidents, representing the smallest proportion of all deaths due to accidents. The present value of future losses for these deaths, however, is high since everyone killed had been working and productive. These losses totaled $1.1 billion (at a 6 percent discount rate) or an average $78,434 per death. For all accidents, the average per death was about $61,123.

Direct costs, productivity losses, and mortality losses combined bring the total cost of work accidents to more than $3 billion. Home

Accidents in the home are responsible for the greatest number of injured persons. More than 20 million persons, or about 1 out of 10 persons, were injured at home in 1968. Of this total, nearly 5 million were under age 6. The medical costs of all the persons injured and those killed in accidents at home reached $1.3 billion.

Disability resulting from these accidents was responsible for a loss of 121,000 nan-years and $641 million in earnings.

Another $1 billion (at a 6 percent discount rate) were lost due to the 25,550 deaths from accidents at home bringing the total morbidity and mortality loss to almost $3 billion. Other

Other accidents such as airplane or railroad accidents, drowning, falls or fires in public places, etc., cost the Nation almost $2 billion in 1968.

More than 17 million persons were injured and 17,700 killed in these "other" accidents. Direct costs for care and treatment of these people amounted to $668 million.

This class of accident had the lowest productivity losses-107,500 man-years and $622 million in lost earnings and the lowest economic loss due to premature death-about $700 million (at a 6 percent discount rate).

TABLE 1.-ESTIMATED NUMBER OF DEATHS DUE TO ACCIDENTS BY AGE, SEX, AND CLASS OF ACCIDENTS, 1968

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1 Includes deaths with age unknown.

TABLE 2.—TOTAL NUMBER OF PERSONS INJURED AND RATES PER 100 PERSONS, BY AGE, SEX AND CLASS OF

ACCIDENT, 1968
Iin thousands)

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All persons......... Under 6.. 6 to 16..... 17 to 44.... 45 to 64... 65 and over.

Men.... Under 6.. 6 to 16.. 17 to 44... 45 to 64. 65 and over...

Women.. Under 6.. 6 to 16.... 17 to 44.. 45 to 64.... 65 and over..

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Source: National Center for Health Statistics "Estimates: 1968" (in process).

TABLE 3.—TOTAL ECONOMIC COST: ESTIMATED DIRECT EXPENDITURES, INDIRECT COSTS OF MORBIDITY, AND PRESENT VALUE OF LIFETIME EARNINGS DISCOUNTED AT 6 AND 8 PERCENT, BY CLASS OF ACCIDENT, 1968

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About one-half of all the deaths from accidents occurred in motor vehicle accidents. Since many of these deaths occur in the most productive years (age 20-44), the present value of the future losses for all persons who died in motor vehicle accidents represented three-fifths of the total accident mortality losses. Work

In 1968, 9 million persons were injured at work. Costs for the medical care and treatment of persons injured or killed in work accidents totaled almost $650 million.

Productivity losses for this class of accident were the largest. About 213,000 man-years, or more than two-fifths of the man-years lost, and about $1.6 billion, more than two-fifths of the total lost earnings, resulted from work accidents in 1968.

It is estimated that 14,300 persons died in work accidents, representing the smallest proportion of all deaths due to accidents. The present value of future losses for these deaths, however, is high since everyone killed had been working and productive. These losses totaled $1.1 billion (at a 6 percent discount rate) or an average $78,434 per death. For all accidents, the average per death was about $61,123.

Direct costs, productivity losses, and mortality losses combined bring the total cost of work accidents to more than $3 billion. Home

Accidents in the home are responsible for the greatest number of injured persons. More than 20 million persons, or about 1 out of 10 persons, were injured at home in 1968. Of this total, nearly 5 million were under age 6. The medical costs of all the persons injured and those killed in accidents at home reached $1.3 billion.

Disability resulting from these accidents was responsible for a loss of 121,000 nan-years and $641 million in earnings.

Another $1 billion (at a 6 percent discount rate) were lost due to the 25,550 deaths from accidents at home bringing the total morbidity and mortality loss to almost $3 billion. Other

Other accidents such as airplane or railroad accidents, drowning, falls or fires in public places, etc., cost the Nation almost $2 billion in 1968.

More than 17 million persons were injured and 17,700 killed in these "other" accidents. Direct costs for care and treatment of these people amounted to $668 million.

This class of accident had the lowest productivity losses—107,500 man-years and $622 million in lost earnings—and the lowest economic loss due to premature death-about $700 million (at a 6 percent discount rate).

TABLE 1.-ESTIMATED NUMBER OF DEATHS DUE TO ACCIDENTS BY AGE, SEX, AND CLASS OF ACCIDENTS, 1968

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