- Email: [email protected]
Fact and Fallacy
FA CT A N D FALLACY
An analysis of compulsory health insurance
Allen 0. Gruebbel SO M U C H P R O P A G A N D A H A S B E E N P U B L I S H E D A B O U T C O M P U L S O R Y H EALTH
IN S U R A N C E T H A T
SO M E P E R S O N S B E L IE V E T H A T T H E
SYS
T E M M A Y H A V E M E R IT . T H I S A R T IC L E E X P L A IN S W H A T W I L L H A P P E N TO T H E P A T IE N T A N D T H E
D E N T IST W H E N
TH EY
BECOM E, R ESPEC
T IV E L Y , W AR D AN D A G E N T OF T H E ST A T E .
advocates of compulsory health in surance have gone to great pains to paint an appealing picture for the public, but they have gone to even greater pains to distort its main purpose and meaning. Since a national health service under government control and based on a com pulsory health insurance scheme has many serious flaws and dangerous possi bilities for the future, it would seem that everyone, including government officials, would want the public to know the facts before such a far reaching and serious move is attempted. The reports of some government officials and of agents of some unofficial organizations have been more of the nature of propaganda litera ture than of objective analyses of all pos sibilities for improving the health of the American people. The withholding of important facts and the distortion of per tinent information obviously are premedi tated, and designed to hide the unfavor able aspects of the federalized health care scheme. For more than a decade the proponents of compulsory health insurance have at
T
h e
498
tempted to convince the people of this country that the present method of dis tributing health care does not meet ex isting needs and therefore is not in the best interests of the public. They have claimed that a regimenting system would serve the public better. The health profes sions also are convinced that a federal sys tem of medicine, dentistry and nursing under a national compulsory health insur ance plan would degrade personal health care and the professions that render the service and that it would regiment the professions and the public into a social system that inevitably would result in a loss of freedom and initiative. The health professions are convinced also that the public will be opposed to the plan when it knows how compulsory health insur ance would operate, how the services of dentists and physicians would be impeded by governmental regulations, how health services would be distributed by orders from government instead of by require-
Executive secretary, Council American Dental Association.
on
Dental
Health,
J.A.D.A., Vol. 38, April
Gruebbel
ments of science and how much the na tionwide plan would cost in terms of in creased taxes. False Assumptions Agencies of the federal government have published voluminous documents describing the health needs of the Ameri can people. A study of these reports re veals the clear fact that the data were presented and interpreted for the specific purpose of influencing the enactment of compulsory health insurance legislation. In other words, the pattern was cut to fit the cloth. The reports are a contradiction. They contain some well established data but also some assumptions, many of them false. In many instances no attempt has been made to document the statements on which conclusions were based or to separate opinions from facts. Thus, the obvious conclusion is that the reports were written to influence the public’s thinking and its actions. In 1946, a 185 page report1 was pre sented to Congress by one of its commit tees in an attempt to prove that compul sory health insurance should be adopted because people need the services of phy sicians, dentists, hospitals and nurses and also medicines and appliances. The re port stated that national health insurance is the only practical way to supply these services for all the people, which, of course, is not true. Thus far, no one has presented evidence which justifies the conclusion that we must have federalized health insurance or the public will be without the health care it needs. The health professions believe there are better, more effective and less dangerous meth ods for reaching the desired health goals. Federal Security Administrator Oscar R. Ewing’s report2 to President Truman followed the same pattern. Mr. Ewing claimed that “ every year 325,000 people die whom we have the knowledge and skills to save.” No documentary evidence was given to support this statement. He
1949 . . . 499
also cited losses to individuals and indus tries as a result of bad health and the high rate of rejection in Selective Service examinations. Granting, for the sake of argument, that Mr. Ewing’s data were accurate, there is no evidence in this country or abroad that compulsory health insurance would save more lives than are now being saved, that it would reduce the prevalence and duration of illness or that more illness would be prevented or cured. Death rates and prevalence of illness or physical defects are lowered by pre ventive measures and early and sound treatment. These goals can be reached without a national system of compulsory insurance. In fact, experiences in foreign countries indicate they can be accom plished more easily by the methods em ployed in this country than by a system of national compulsory health insurance. The propaganda of unofficial organi zations that support a national health in surance plan also is largely fallacious. For example, the booklet distributed by the Committee for the Nation’s Health, Inc.,3 is completely nonobjective and is designed to mislead the reader. It stated in part: M ore Americans w ill die needlessly this year than were lost in the last war. . . . 97 million Americans, cannot afford adequate m edical care. . . . Can you afford a five dollar bill every time you feel an ache or pain? W hat if that sniffle becomes pneumonia, that cough becomes tuberculosis, that lump be comes cancer and then that five dollar bill becomes a 500 dollar b ill? . . . Y ou could afford [health services] through national health insurance. . . . Y o u w ill have a good chance fo r a long life and a m erry one.
A federalized system of compulsory in surance will not result in a saving of lives i. Bureau of Research and Statistics, Social Security Board, Medical Care Insurance: A Social Insurance Program for Personal Health Services. Senate Com mittee Print No. 5, 79th Congress, 2d Session. Wash ington, D. C .: U .S. Government Printing Office* 1946. q. Ewing, Oscar R ., The Nation’s Health, A Ten Year Program: A Report to the President. Washington, D . C .: U . S. Government Printing Office, 1948. 3. This Will K ill You. New York: Committee for the Nation’s Health, Inc.
500
The Journal o f the American* Dental Association
and a reduction of the cost of health care for the majority of families. On the con trary, governmental restrictions, controls and interferences between practitioner and patient will lower the standards of medical, dental and nursing care, and un questionably will result in an increased death rate and prolonged illness for many persons. Advocates of national health insurance have attempted to convince the public that the scheme in no way would interfere with the practice of dentistry, medicine or nursing. This effort to reassure the public and the professions would be com mendable if it were based on fact. Actu ally the opposite is true. Although the proponents of the com pulsory health insurance scheme have not revealed how all aspects of the plan would operate, one fact is known above all others, which is that the plan must be administered by governmental regula tions. These regulations would place re strictions on certain types of services and, in some instances, would specify the con ditions under which they could be ren dered. The present Wagner-Murray-Dingell Bill, for example, would give almost unlimited powers to the Federal Security Administrator, under whose direction the National Health Insurance Board and the state administrators would supervise the actions of practitioners and would authorize citizens to receive health care. The practice of medicine and dentistry cannot be performed properly unless the practitioner assumes full responsibility for the treatment he gives and unless the physician or dentist is permitted to pro vide services that are dictated by the re quirements of each individual case and not by political or administrative expe diency. Insurance, Prepayment or Taxation Proponents of national compulsory health insurance claim that the nation can solve its health problems by taking advantage of the insurance principle.
which has been effective in many com mercial and voluntary plans. There can be no question, philosophically, of the value of insurance to the individual and to society if the insurance plan is actuarially sound and if the plan does not endanger the rights, privileges and well being of individuals and society. Insur ance as a single entity is desirable. But insurance resulting in the adoption of dangerous social philosophies, excessive costs and lowered standards of health service is undesirable. The proposals contained in the Wagner-Murray-Dingell Bill cannot be car ried out as sound insurance practice. Insurance is a method for providing pro tection against loss or a damaging event by spreading risks among a large number of potential claimants. The funds col lected from insured persons are used to pay insurance claims, administrative cost and, in the case of commercial agencies, dividends. In other words, a financially sound insurance plan is based on known actuarial experience; it is self supporting through the collection of premiums, and it guarantees stipulated benefits. The proposed federalized health care scheme must be financed, in part, by ap propriations from the general revenue fund, in addition to payroll deductions or income taxes. The scheme would not be self supporting, nor would it assure the provision of benefits to all persons cov ered under the plan. Thus, the scheme is not insurance, but actually is only a method for collecting additional taxes. On numerous occasions supporters of compulsory health insurance have de scribed the proposal as a “ prepayment plan.” President Truman used the term in his message to Congress. In a strict sense, prepayment is considered to mean payment in advance of the receipt of service. The question of whether a system of national compulsory health insurance can be classified as prepayment perhaps is only an academic one. Nevertheless, the fact remains that the federalized health
J.A.D.A., Vol. 38, A p ril 1949 . . . 501
Gruebbel
plan must be subsidized by congressional appropriations and that the income tax payments alone will not pay the billions of dollars in costs. Cost The people in this country are paying about $6,500,000,000 a year for health care. This figure does not include approxi mately $2,000,000,000 annually for pub lic health services. The advocates of a federal health insurance plan theorize that the expenditures for health care could be used to a better advantage if the payments were made to the federal government and if the government in turn would place the members of the health professions on its payroll. The public is being led to believe that it would receive the same or better health care than it now receives at no added cost. The proponents of the scheme have taken great pains to hide the fact that individuals, as taxpay ers, would have to assume the added bur den of administrative costs. Governmental agencies are reluctant to release data of this nature, but a conservative estimate, based on available information, indicates that administrative costs in public aid programs amount to at least i o per cent. Thus, the public would be required to pay at least $650,000,000 annually as a service charge. The people of the United States no doubt would appreciate a reduction in their present tax load instead of an in crease in taxes for the employment of thousands of additional persons to admin ister a plan which would not justify its high cost. The Basic Issues In spite of all that has been written and said about the need for a more effec tive health plan, the improvement of health service and its extension to more persons are not the chief cause of conflict between the opposing groups. The health professions always have led in furthering these aims. The basic issues are: (1) the
interference of a third party in the health affairs between a citizen and his physi cian or dentist and (2.) the universal socialization of the health services. There is no more justification for requir ing physicians, dentists and nurses to serve under a national socialized system than there is for requiring attorneys, bankers or business executives to do so. The patient also would be regimented. He would be required to fill out govern ment forms. He would receive only such services as were allowed under the regu lations. If he needed services that were not authorized under the regulations, he would be required to pay for them in addition to the payment he made to the government. Also if his physician or den tist were not enrolled in the plan, he would have to pay twice for the treat ment. If he needed the services of a specialist, generally he would have to be referred by a general practitioner. The selection of the specialist might be made for him by a government agent. His phy sician or dentist, if he found it necessary to provide treatment that was not in ac cord with governmental regulations, might be released from the program as no longer “ qualified.” Or if the dentist or physician of his choice had enrolled un der his care the maximum number of patients permitted under the regulations, he would have to seek the services of an other practitioner. Every wage earner, including the self employed, would be compelled to pay a tax for personal health services regard less of whether he wanted the service and regardless of whether it was available to him. He would pay a tax for a hospital bed, but the hospital might not be able to accept him and he might be forced to remain at home. He would pay a tax for the services of a physician, but the physician of his choice might not be en rolled in the plan and he would have to pay both the tax and his practitioner’s fee. He would pay a tax for dental servvices, but the dental benefits might be
502
The Journal of the Am erican Dental Association
limited to children or to special types of dental services, and he would be required to pay a fee to the dentist for service in addition to the tax to the government. The proposed bill is ambiguous, and many of its provisions are vaguely defined. Consequently it is impossible to deter mine how it would operate. The benefits to which the taxpayer would be entitled and the regulations under which the practitioner would be compelled to per form his services would be determined after the bill becomes law. The public and the health professions have the right to know in advance what will happen to them when they become, respectively, wards and agents of the state. When the people of this country know these facts, an overwhelming majority, no doubt, will join with the health profes sions in opposing federalized health care. Preserving Fundamental Concepts The level of health in this country can and should be raised. The need for addi tional resources and for sound planning cannot be questioned. The health profes sions want the highest possible standard of health that can be achieved. They want to improve and expand research, facili ties for prevention and treatment and community public health programs. The method for providing health serv ices in this country admittedly can and should be improved. But even with its faults, no one has produced acceptable evidence that the system used in some other country is better. It would seem proper and consistent with our form of government that local communities continue to have the right to choose the kind of public health pro
gram they want and need. The principle of state’s rights has been one of the bul warks and safeguards that has made our form of government the best in the world. The federalized system of health care un der the proposed Wagner-Murray-Dingell Bill would rob the states and communities of the right of self determination through the provision that the federal government will notify the governor of the state that the plan will be administered by the federal agency until a state plan is sub mitted and approved. A federalized system of health care would affect the life of every citizen of this country. It would affect his initiative and his sense of responsibility to himself, his family, his community and his govern ment. It would affect the health service he would receive from his dentist, physi cian and nurse. It would affect the ad vancement of the health sciences. And finally, but by no means least, it would affect our social structure by greatly in creasing the power of the central govern ment. These are the risks that must be weighed carefully by every citizen who has a stake in the welfare of this and succeeding generations. These are the risks that form the core of the issue. Better physical, mental and emotional health are goals toward which all the health professions are working. It is the considered opinion of the vast majority of the members of the health professions that a federalized health insurance scheme would be a serious handicap in achieving these aims. Compulsory health insurance under control of government would be excessively expensive and po litically, sociologically and ideologically undesirable.
An analysis of compulsory health insurance
Allen 0. Gruebbel SO M U C H P R O P A G A N D A H A S B E E N P U B L I S H E D A B O U T C O M P U L S O R Y H EALTH
IN S U R A N C E T H A T
SO M E P E R S O N S B E L IE V E T H A T T H E
SYS
T E M M A Y H A V E M E R IT . T H I S A R T IC L E E X P L A IN S W H A T W I L L H A P P E N TO T H E P A T IE N T A N D T H E
D E N T IST W H E N
TH EY
BECOM E, R ESPEC
T IV E L Y , W AR D AN D A G E N T OF T H E ST A T E .
advocates of compulsory health in surance have gone to great pains to paint an appealing picture for the public, but they have gone to even greater pains to distort its main purpose and meaning. Since a national health service under government control and based on a com pulsory health insurance scheme has many serious flaws and dangerous possi bilities for the future, it would seem that everyone, including government officials, would want the public to know the facts before such a far reaching and serious move is attempted. The reports of some government officials and of agents of some unofficial organizations have been more of the nature of propaganda litera ture than of objective analyses of all pos sibilities for improving the health of the American people. The withholding of important facts and the distortion of per tinent information obviously are premedi tated, and designed to hide the unfavor able aspects of the federalized health care scheme. For more than a decade the proponents of compulsory health insurance have at
T
h e
498
tempted to convince the people of this country that the present method of dis tributing health care does not meet ex isting needs and therefore is not in the best interests of the public. They have claimed that a regimenting system would serve the public better. The health profes sions also are convinced that a federal sys tem of medicine, dentistry and nursing under a national compulsory health insur ance plan would degrade personal health care and the professions that render the service and that it would regiment the professions and the public into a social system that inevitably would result in a loss of freedom and initiative. The health professions are convinced also that the public will be opposed to the plan when it knows how compulsory health insur ance would operate, how the services of dentists and physicians would be impeded by governmental regulations, how health services would be distributed by orders from government instead of by require-
Executive secretary, Council American Dental Association.
on
Dental
Health,
J.A.D.A., Vol. 38, April
Gruebbel
ments of science and how much the na tionwide plan would cost in terms of in creased taxes. False Assumptions Agencies of the federal government have published voluminous documents describing the health needs of the Ameri can people. A study of these reports re veals the clear fact that the data were presented and interpreted for the specific purpose of influencing the enactment of compulsory health insurance legislation. In other words, the pattern was cut to fit the cloth. The reports are a contradiction. They contain some well established data but also some assumptions, many of them false. In many instances no attempt has been made to document the statements on which conclusions were based or to separate opinions from facts. Thus, the obvious conclusion is that the reports were written to influence the public’s thinking and its actions. In 1946, a 185 page report1 was pre sented to Congress by one of its commit tees in an attempt to prove that compul sory health insurance should be adopted because people need the services of phy sicians, dentists, hospitals and nurses and also medicines and appliances. The re port stated that national health insurance is the only practical way to supply these services for all the people, which, of course, is not true. Thus far, no one has presented evidence which justifies the conclusion that we must have federalized health insurance or the public will be without the health care it needs. The health professions believe there are better, more effective and less dangerous meth ods for reaching the desired health goals. Federal Security Administrator Oscar R. Ewing’s report2 to President Truman followed the same pattern. Mr. Ewing claimed that “ every year 325,000 people die whom we have the knowledge and skills to save.” No documentary evidence was given to support this statement. He
1949 . . . 499
also cited losses to individuals and indus tries as a result of bad health and the high rate of rejection in Selective Service examinations. Granting, for the sake of argument, that Mr. Ewing’s data were accurate, there is no evidence in this country or abroad that compulsory health insurance would save more lives than are now being saved, that it would reduce the prevalence and duration of illness or that more illness would be prevented or cured. Death rates and prevalence of illness or physical defects are lowered by pre ventive measures and early and sound treatment. These goals can be reached without a national system of compulsory insurance. In fact, experiences in foreign countries indicate they can be accom plished more easily by the methods em ployed in this country than by a system of national compulsory health insurance. The propaganda of unofficial organi zations that support a national health in surance plan also is largely fallacious. For example, the booklet distributed by the Committee for the Nation’s Health, Inc.,3 is completely nonobjective and is designed to mislead the reader. It stated in part: M ore Americans w ill die needlessly this year than were lost in the last war. . . . 97 million Americans, cannot afford adequate m edical care. . . . Can you afford a five dollar bill every time you feel an ache or pain? W hat if that sniffle becomes pneumonia, that cough becomes tuberculosis, that lump be comes cancer and then that five dollar bill becomes a 500 dollar b ill? . . . Y ou could afford [health services] through national health insurance. . . . Y o u w ill have a good chance fo r a long life and a m erry one.
A federalized system of compulsory in surance will not result in a saving of lives i. Bureau of Research and Statistics, Social Security Board, Medical Care Insurance: A Social Insurance Program for Personal Health Services. Senate Com mittee Print No. 5, 79th Congress, 2d Session. Wash ington, D. C .: U .S. Government Printing Office* 1946. q. Ewing, Oscar R ., The Nation’s Health, A Ten Year Program: A Report to the President. Washington, D . C .: U . S. Government Printing Office, 1948. 3. This Will K ill You. New York: Committee for the Nation’s Health, Inc.
500
The Journal o f the American* Dental Association
and a reduction of the cost of health care for the majority of families. On the con trary, governmental restrictions, controls and interferences between practitioner and patient will lower the standards of medical, dental and nursing care, and un questionably will result in an increased death rate and prolonged illness for many persons. Advocates of national health insurance have attempted to convince the public that the scheme in no way would interfere with the practice of dentistry, medicine or nursing. This effort to reassure the public and the professions would be com mendable if it were based on fact. Actu ally the opposite is true. Although the proponents of the com pulsory health insurance scheme have not revealed how all aspects of the plan would operate, one fact is known above all others, which is that the plan must be administered by governmental regula tions. These regulations would place re strictions on certain types of services and, in some instances, would specify the con ditions under which they could be ren dered. The present Wagner-Murray-Dingell Bill, for example, would give almost unlimited powers to the Federal Security Administrator, under whose direction the National Health Insurance Board and the state administrators would supervise the actions of practitioners and would authorize citizens to receive health care. The practice of medicine and dentistry cannot be performed properly unless the practitioner assumes full responsibility for the treatment he gives and unless the physician or dentist is permitted to pro vide services that are dictated by the re quirements of each individual case and not by political or administrative expe diency. Insurance, Prepayment or Taxation Proponents of national compulsory health insurance claim that the nation can solve its health problems by taking advantage of the insurance principle.
which has been effective in many com mercial and voluntary plans. There can be no question, philosophically, of the value of insurance to the individual and to society if the insurance plan is actuarially sound and if the plan does not endanger the rights, privileges and well being of individuals and society. Insur ance as a single entity is desirable. But insurance resulting in the adoption of dangerous social philosophies, excessive costs and lowered standards of health service is undesirable. The proposals contained in the Wagner-Murray-Dingell Bill cannot be car ried out as sound insurance practice. Insurance is a method for providing pro tection against loss or a damaging event by spreading risks among a large number of potential claimants. The funds col lected from insured persons are used to pay insurance claims, administrative cost and, in the case of commercial agencies, dividends. In other words, a financially sound insurance plan is based on known actuarial experience; it is self supporting through the collection of premiums, and it guarantees stipulated benefits. The proposed federalized health care scheme must be financed, in part, by ap propriations from the general revenue fund, in addition to payroll deductions or income taxes. The scheme would not be self supporting, nor would it assure the provision of benefits to all persons cov ered under the plan. Thus, the scheme is not insurance, but actually is only a method for collecting additional taxes. On numerous occasions supporters of compulsory health insurance have de scribed the proposal as a “ prepayment plan.” President Truman used the term in his message to Congress. In a strict sense, prepayment is considered to mean payment in advance of the receipt of service. The question of whether a system of national compulsory health insurance can be classified as prepayment perhaps is only an academic one. Nevertheless, the fact remains that the federalized health
J.A.D.A., Vol. 38, A p ril 1949 . . . 501
Gruebbel
plan must be subsidized by congressional appropriations and that the income tax payments alone will not pay the billions of dollars in costs. Cost The people in this country are paying about $6,500,000,000 a year for health care. This figure does not include approxi mately $2,000,000,000 annually for pub lic health services. The advocates of a federal health insurance plan theorize that the expenditures for health care could be used to a better advantage if the payments were made to the federal government and if the government in turn would place the members of the health professions on its payroll. The public is being led to believe that it would receive the same or better health care than it now receives at no added cost. The proponents of the scheme have taken great pains to hide the fact that individuals, as taxpay ers, would have to assume the added bur den of administrative costs. Governmental agencies are reluctant to release data of this nature, but a conservative estimate, based on available information, indicates that administrative costs in public aid programs amount to at least i o per cent. Thus, the public would be required to pay at least $650,000,000 annually as a service charge. The people of the United States no doubt would appreciate a reduction in their present tax load instead of an in crease in taxes for the employment of thousands of additional persons to admin ister a plan which would not justify its high cost. The Basic Issues In spite of all that has been written and said about the need for a more effec tive health plan, the improvement of health service and its extension to more persons are not the chief cause of conflict between the opposing groups. The health professions always have led in furthering these aims. The basic issues are: (1) the
interference of a third party in the health affairs between a citizen and his physi cian or dentist and (2.) the universal socialization of the health services. There is no more justification for requir ing physicians, dentists and nurses to serve under a national socialized system than there is for requiring attorneys, bankers or business executives to do so. The patient also would be regimented. He would be required to fill out govern ment forms. He would receive only such services as were allowed under the regu lations. If he needed services that were not authorized under the regulations, he would be required to pay for them in addition to the payment he made to the government. Also if his physician or den tist were not enrolled in the plan, he would have to pay twice for the treat ment. If he needed the services of a specialist, generally he would have to be referred by a general practitioner. The selection of the specialist might be made for him by a government agent. His phy sician or dentist, if he found it necessary to provide treatment that was not in ac cord with governmental regulations, might be released from the program as no longer “ qualified.” Or if the dentist or physician of his choice had enrolled un der his care the maximum number of patients permitted under the regulations, he would have to seek the services of an other practitioner. Every wage earner, including the self employed, would be compelled to pay a tax for personal health services regard less of whether he wanted the service and regardless of whether it was available to him. He would pay a tax for a hospital bed, but the hospital might not be able to accept him and he might be forced to remain at home. He would pay a tax for the services of a physician, but the physician of his choice might not be en rolled in the plan and he would have to pay both the tax and his practitioner’s fee. He would pay a tax for dental servvices, but the dental benefits might be
502
The Journal of the Am erican Dental Association
limited to children or to special types of dental services, and he would be required to pay a fee to the dentist for service in addition to the tax to the government. The proposed bill is ambiguous, and many of its provisions are vaguely defined. Consequently it is impossible to deter mine how it would operate. The benefits to which the taxpayer would be entitled and the regulations under which the practitioner would be compelled to per form his services would be determined after the bill becomes law. The public and the health professions have the right to know in advance what will happen to them when they become, respectively, wards and agents of the state. When the people of this country know these facts, an overwhelming majority, no doubt, will join with the health profes sions in opposing federalized health care. Preserving Fundamental Concepts The level of health in this country can and should be raised. The need for addi tional resources and for sound planning cannot be questioned. The health profes sions want the highest possible standard of health that can be achieved. They want to improve and expand research, facili ties for prevention and treatment and community public health programs. The method for providing health serv ices in this country admittedly can and should be improved. But even with its faults, no one has produced acceptable evidence that the system used in some other country is better. It would seem proper and consistent with our form of government that local communities continue to have the right to choose the kind of public health pro
gram they want and need. The principle of state’s rights has been one of the bul warks and safeguards that has made our form of government the best in the world. The federalized system of health care un der the proposed Wagner-Murray-Dingell Bill would rob the states and communities of the right of self determination through the provision that the federal government will notify the governor of the state that the plan will be administered by the federal agency until a state plan is sub mitted and approved. A federalized system of health care would affect the life of every citizen of this country. It would affect his initiative and his sense of responsibility to himself, his family, his community and his govern ment. It would affect the health service he would receive from his dentist, physi cian and nurse. It would affect the ad vancement of the health sciences. And finally, but by no means least, it would affect our social structure by greatly in creasing the power of the central govern ment. These are the risks that must be weighed carefully by every citizen who has a stake in the welfare of this and succeeding generations. These are the risks that form the core of the issue. Better physical, mental and emotional health are goals toward which all the health professions are working. It is the considered opinion of the vast majority of the members of the health professions that a federalized health insurance scheme would be a serious handicap in achieving these aims. Compulsory health insurance under control of government would be excessively expensive and po litically, sociologically and ideologically undesirable.