American Journal of Public Health
January 2003
Medical Care for All the People
By Henry E. Sigerist
The idea of social insurance is by no means new but has a history of over sixty years. It is not a revolutionary but, on the contrary, a basically conservative issue. It does not tend to overthrow the existing economic order but provides a corrective mechanism that mitigates its hardships.
The provision of medical services to the population has two aspects, one economic and one medical. Both must be considered and studied together because they are inseparable. Indeed the best economic plan defeats its own purpose if the money is used to finance a poor type of medical service, and on the other hand the best medical plan must collapse if it is not properly financed. Illness is an unpredictable risk for the individual family, but we know fairly accurately how much illness a large group of people will have, how much medical care they will require, and how many days they will have to spend in hospitals. In other words, we cannot budget the cost of illness for the individual family but we can budget it for the nation. The principle must be to spread the risk among as many people as possible and to pool the resources of as many people as possible. In other words, we must apply the principle of insurance, with which everybody in America is familiar. . . .
The experience of the last fifteen years in the United States has, in my opinion, demonstrated that voluntary health insurance does not solve the problem of the nation. It reaches only certain groups and is always at the mercy of economic fluctuations. . . . . Hence, if we decide to finance medical services through insurance, the insurance system must be compulsory.
http://www.ajph.org/cgi/content/full/93/1/57
Comment: Henry E. Sigerist was the director of the Johns Hopkins University Institute of the History of Medicine. His comments above are excerpted from an article published in the Canadian Journal of Public Health in 1944. The Canadians understood what he had to say. Will we ever understand?