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The Social Security Act
DENTAL ECONOMICS T H E SO CIAL SECU RITY A C T
By E. E. VOYLES, D.D.S., Indianapolis, Ind.
the act are based on dollar m atching, w ith the governm ent dictating the terms.
engage in any other occupation. T h e present members are: John G . W in a n t, chairm an, A rth u r J . A ltm ey er and V in cent M . M iles. Frank Bane is executive director, and the present staff consists o f about 100 persons. T h e board is given rather broad pow ers fo r m aking inter pretations and establishing rules and reg ulations to carry out the purposes o f the act. In addition to administration, the board is delegated the duties o f “ studying and m aking recom m endations as to the m ost effective methods o f providin g eco nom ic security through social insurance and as to legislation and matters o f ad m inistrative policy concern in g old age pensions, unem ploym ent compensations, accident compensations and related sub jects.” T h is quotation is the m ost signifi cant phrase in the entire la w and may mean m uch to both the m edical and the dental profession. It is clearly evident that the la w w as prom oted by a socialistically inclined group w h o are stron g advocates o f insurance.
CENTRAL ADMINISTRATION
STATE CONFORMITY
T h e m a jor provisions o f the act are u nder the con trol o f the D epartm ent o f L a b o r and are administered through the Social Security Board and the C h ild ren ’s Bureau.
T h e la w is so hazy as to defy efforts tow ard a clear understanding o f its m any provisions. States attem pting to revise their law s in con form ity to the federal act must rely on the Social Security B oard fo r its meaning. Politicians and social w orkers are quick to find in these
H E E con om ic or Social Security A c t has becom e an outstanding topic o f discussion throughout the land. It is regarded as the most far-reaching legis lation ever passed by the Congress. It contains revolutionary provisions in volv in g the intim ate life and w ell-b ein g o f every citizen and reversing the age-old philosophy o f personal responsibility, th rift, frugality and self-reliance. T h e act substitutes long-distance cen tral con trol fo r local determ ination o f m any w elfare problem s. U n d er this act, it becomes necessary fo r all states to set up law s, make plans and provide state funds in order to share in the distribution o f federal subsidies. T h is is accom plished by means o f federal taxation. In the case o f unem ploym ent compensations, these taxes w o u ld penalize any state that fails to adopt em ploym ent insurance. A l l these state law s must be acceptable at W a s h in gton. W it h m inor exception, this act offers no federal gifts, but all titles under
T
T h e board consists o f three mem bers appointed by the President. Each receives a salary o f $1 0,00 0 a year and m ust not /our. A .D .A ., Vol. 23, M ay, 1936
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acts the basis fo r a huge bureaucracy o f
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The Journal of the American Dental Association
p u blic w elfare w orkers. U nsu pported claim s are therefore being m ade by this group as to the qualification requirem ents o f the administrative personnel o f the states and counties. C on tradictory to the selfish aims at prom oting the socially trained groups, significant interpretations w ere given verbally by M r . Frank Bane, executive director, o f the Social Security B oard, in response to inquiries by interested citizens dispatched to W ash in g ton to ascertain the facts. T h e y are as follo w s : In order to meet the requirements o f the Social Security Board, it is not necessary (1 ) that the state board approve of the county board members and employes; (2 ) that the board members o f the county have definite qualifications fixed by the state boards; (3 ) that the state board have power o f removal o f county board members or its employes, nor (4 ) that the county board members or employes have com pleted a definite course of instruction in social welfare. T h ere is nothing in the Social Security A ct which prescribes any specific method of administration in political subdivisions o f the state. T h e state is required to provide a plan which shall be mandatory upon all political subdivisions of the state if administered by them and a plan which shall provide for efficient operation in the political subdi visions o f the state. T h e matters relating to selection, tenure of office and compensa tion of personnel are reserved to the state. T h ere is nothing in the act having to do with the administration of hospitals fo r the insane, penal institutions, reformatories or county infirmaries. SPOILS SYSTEM OR MERIT SYSTEM
T h e Social Security A c t has no p rovi sion w hereby civil service rules shall g ov ern appointments fo r positions u nder the act. T h is opens up another large field w here the “ ins” and the “ outs” m ay bat tle fo r the plunder o f the pu blic payroll.
T h e states m ay establish law s that w ill load the payrolls w ith political w orkers or they m ay provide a m erit system, w hich w ill brin g into the w elfa re depart m ent persons o f special attainm ents and experience. T h e im portance o f this choice cannot be overestim ated. T h e choice w ill affect the state boards and the various county boards and hundreds o f employes w hose duty it w ill be to investigate ap plications fo r aid, keep in touch w ith those to w h om aid is granted, see that funds are collected and paid out, and in vestigate questions o f fraud, racketeering and political favoritism . Shall the appointees w h o are to adm in ister this huge undertaking be chosen be cause they are “ righ t” p olitically and have som e skill in connecting aid w ith votes, or w ill they be selected on a com petitive basis as to ability and h old their positions as lon g as they do their w o r k right and abstain from partisan political activity? “ P olitical clearance,” o r a certificate of party regularity, may u n fortu n a tely play a part in the adm inistration o f aid to the unfortunate. Responsibility in this m at ter rests heavily on the legislatures o f the various states. Som e legislatures have had the foreth ought to provide in their law s that the state and coun ty adminis trative boards shall be com posed o f rep resentative citizens, w h o shall receive their appointm ent through cou rt ju d g e ships and w h o serve w ith ou t pay. T h is is intended to a fford som e meas ures o f protection against political p il lage. SUPPLANTING LOCAL CONTROL
T h is far-flu ng program o f social secur ity w ill inevitably supplant com m unity efforts and sound the death knell o f local autonom y. M a n y com m unities have lon gestablished w elfa re agencies that are ad ministered loca lly and in a large measure gratuitously by public-spirited citizens
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Dental Economics w hose names read like a page from “ W h o ’ s W h o . ” Such persons contend that “ blue-print patterns” are n ot tai lored to local needs, that volum inous in structions, intricate record systems and meaningless red tape hinder rather than help. U n dou bted ly, such interference by paid social agents w ill drive out gratu itous efforts. T im e alone w ill reveal w hether econom ic security centralized in W a sh in g ton w ill prom ote hum an w elfare and happiness commensurate w ith the burdens it entails and the expectations this act has aroused. T h e measure o f security in certain provisions o f the act m ay be disappointing to those w h o have been taught to lean heavily on the arm o f paternalism . Long-distance planners often reveal a w o fu l lack o f inform ation regarding the needs o f backw ard communities. F o r exam ple, B row n C ou n ty, Indiana, is kn ow n nationally as the m ost backw ard coun ty in the state. It is there that the governm ent has concentrated its u p liftin g activities. A n d this county has only about 8 per cent on relief, w h ile M a r io n C ou n ty , in cluding Indianapolis, has 18 per cent, and M o n r o e C ou n ty, seat o f Indiana U niversity, has about 33^ per cent on relief. C rim e is practically un k n ow n in B row n C ou n ty. Contentm ent, happiness and independence often lu rk in places accessible on ly w ith a “ horse and bu g gy ,” w hich is perhaps unbelievable to the m etropolitan m ind. T h e land o f these natives m ay be “ subm arginal,” but not their managem ent. T h e entire act is com pulsory in char acter and the tendency is to make large groups o f citizens creatures o f the state. Especially under the titles relating to dependent children and child w elfare, the gate is th row n open w id e fo r the propaga tion o f any “ ism” w hich m ay be the w him o f the m om ent or w hich may fit any ex pediency.
SECURITY AND CHARACTER
M a n ’s insecurity has ever been the m o tivating influence back o f the develop m ent o f such sterling qualities o f char acter as th rift, industry and frugality. T h e fear o f dependency in o ld age has always driven men to give o f their best. W i l l the standing assurance o f econom ic security affect adversely national th rift en masse? T h is question intrudes itself into any analysis o f the security act. W i l l a measure o f security in everything essen tial fro m birth to death encourage par asitism ? W i l l ou r national citizenship as a w h ole lose some o f the qualities that have m ade us a great n ation ? “ W h y w ork w hen the governm ent w ill supply all ou r essential needs?” says a rapidly increasing group. “ W h y w ork , w hen 35 per cent o f ou r earnings are required to pay the cost o f govern m en t?” says an other group. Beaum er states that it took thirty years under the G erm an system of social insurance to underm ine the honesty o f the rank and file o f the people. W il l A m erica, steeped in a system o f political chicanery, make m ore rapid progress in insurance evasion, chiseling, gra ft and racketeering? A virgin field for many form s o f trickery is opened under this act. Som e years m ay be required to sup ply the answer to these questions. CONSTITUTIONALITY
T h e constitutionality o f this act has been seriously questioned. In fact, the unem ploym ent com pensation feature o f the act w as recently tested in the N e w Y o r k Supreme C o u rt and an adverse decision w as rendered. In another court in the same state, a favorable decision w as given. Several states have passed laws con form in g, at least in part, to the federal act and others have the m atter under con sideration. T h e question arises as to w here these states w ill stand if the law
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The Journal of the American Dental Association
in w h ole or in part is declared unconsti tutional. It is estimated that Indiana w ill pay into the governm ent $ 4 0 ,0 0 0 ,0 0 0 a year in n ew payroll taxes and the sum fo r N e w Y o r k is estimated at $ 9 0 ,0 0 0 ,000 fo r 1938. W h a t w ill be the situa tion in the states if the federal la w does not stand the test o f the cou rts? W i l l a sim ilar confusion result as in the case o f the A A A decision? T h e la w w ill prob ably com e up fo r am endm ent many times during the com in g years. THE COST
T h e r e is no predicting w hat the total tax cost o f this program w ill am ount to in the w h ole coun try. It w ill be huge to begin w ith and, if it fo llo w s precedent, it w ill rapidly g ro w larger. In G erm any, unem ploym ent insurance w ent into effect in 1927, w ith 3 per cent levied on pay rolls. By January, 1930, it w as raised to 3| per cent. In Ju ly, it w as raised to per cent, w hen it became necessary fo r the governm ent to subsidize it to the extent o f $ 1 73 ,6 00 ,0 00 in that year. In O h io, a w ork m en ’s com pensation la w w as enacted in 1912. D u r in g the first three years, the average cost o f operation w as $ 1 ,1 8 5 ,8 1 4 . Since that time, there has been an increase o f 1,220 per cent. T h e last three years, the cost averaged $ 1 5 ,47 2,07 9. T h e r e has been an increase o f about 4 0 0 per cent in taxes in this cou n try during the last tw enty years, w hich undou btedly w ill receive a trem endous increase as a result o f social insurance. O n the basis o f “ pay as you g o ,” the en tire governm ental tax bill in this coun try today w o u ld am ount to about 25 per cent o f the entire national incom e. T h e financial plight o f the principal central governm ents o f E u rope has been ascribed, in large measure, to the drain o f social insurance. In A m erica, the g ov ernm ental w aste that is com m on in most federal, state, country and city units
hardly lends encouragem ent to the hope that this act w ill be administered eco nom ically. U n d er the act, a n ew layer o f governm ent is set up in each state, requiring hundreds o f n ew state office holders and employes. A recent survey in Indianapolis show ed that U . S. A g e n cies occupy 10,430 m ore square feet of floor space than the entire state capitol, in cluding the attic. Social Insurance is so com plicated as to require an elaborate system o f expensive accounting, checking and actuarial com putation, besides elab orate m achinery fo r con trollin g the costs and the prevention o f frau d. T h e outlay fo r social insurance w ill inevitably be com e a m ajor item in all state and federal budgets. DIVISIONS OF THE ACT
T h e federal act is divided into eleven titles or separate laws. T itle 1 : O ld A g e Assistance.— T h is means m oney payments to needy old per sons and carries an appropriation o f $4 9,750,000 for the current fiscal year and a sum sufficient annually th ereafter; also, an appropriation o f $ 2 5 0 ,0 0 0 fo r adm in istrative expenses o f the Social Security B oard under this title. Paym ent to states: 1. A l l states must have plan approved by the Social Security B oard. I f requirements are not carried out by the state, federal payments w ill stop. 2. State contributions up to but not exceeding $15 per m onth are matched. 3. T h e state plan is m andatory in all counties. Q ualifications to receive assistance: 1. T h e age must not be over 65 years after 1940. A g e 70 may be required previous to that date. 2. T h e recipient m ust not be an inmate o f a pu blic institution. T itle 2 : Federal O ld A g e Benefits .— In addition to old age assistance, the act provides fo r old age annuities to be paid from the “ Federal O ld A g e A c co u n t”
Dental Economics created in the U . S. T reasu ry and based on the principle o f actuarial com putation. T h ese payments do not begin until Jan. 1, 1942, and the beneficiary must have attained the age o f 65 and not be em ployed by another person in a gain ful occupation. T h e am ount o f the annuity depends on the duration o f the period over w h ich an individual has paid payroll incom e taxes and his average m onthly wages after D ec. 31, 1936. Funds to support this account are presumably taken from payroll taxes and appropriated on recom m endation o f the Secretary o f the T rea su ry to the Bureau o f the B u dget. O th e r persons not subject to state taxes and n ot otherwise com ing under the p ro visions fo r old age benefits may volun ta rily purchase annuities in lim ited amounts and under specified conditions.
T itle 3 : Unemployment Compensa tion.— Com pensations under this title cover persons on ly w h o have been em ployed and have lost their positions tem porarily. Persons perm anently unem ployed are not covered. T h is is a distinctly labor section and contains reservations protectin g some o f the principles advo cated by union labor. T h e plan is to im pose a federal tax on all employers o f eight o r m ore as a means o f forcin g states to adopt compensation laws, the adoption o f w h ich w ill exem pt the employers in the state from payment o f 90 per cent o f the federal tax, thus keeping the m oney paid by employers in the state to be used fo r the benefit o f local w orkm en. T h e excise tax on payrolls became e f fective Jan. 1, 1936, and is increased from 1 to 3 per cent over the period up to 1938. A n incom e tax identical w ith the em p loyer’s excise tax is levied on the incom e o f the employes, and must be c o l lected by the em ployer under penalty. A n em ployer is defined as one w h o on each o f tw en ty days in different weeks o f the
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taxable year em ploys eight o r m ore per sons. E m ploym ent exceptions are: farm labor, dom estic service, crew o f vessels, relatives, governm ent em ployes and em ployes o f n onprofit institutions. It is ad ministered under the Social Security B oard. A n appropriation o f not to ex ceed $ 4 ,0 0 0 ,0 0 0 is provided fo r the fiscal year and an appropriation o f $ 4 9,00 0,00 0 annually thereafter.
T itle 4 : A id to Dependent Children. — T h is title means m oney payments to dependent children, w h o are defined as under 16 years o f age and deprived o f parental support or care, and w h o are livin g w ith relatives in residence m ain tained by them as his o r their ow n hom e. Paym ents are lim ited to $ 1 8 a m onth fo r one child, w ith $12 fo r each addi tional child. T h is subsidy also is con d i tioned on acceptable state plans and is under con trol o f the Social Security B oard. T h e governm ent provides one third o f the total sum expended in carry in g out the state plan. T h is calls fo r an appropriation o f $ 2 4 ,7 5 0 ,0 0 0 for the fiscal year and a sufficient sum thereafter. It also appropriates $ 2 5 0 ,0 0 0 for the fiscal year fo r administration.
T itle 5 : M aternal and Child W elfare. — T h is title covers maternal and child health service, services fo r crippled chil dren, child w elfare services and v oca tional rehabilitation. T h e first three are administered by the C h ild ren ’s Bureau in the D epartm ent o f L ab or and the last through the U . S. D epartm ent o f E duca tion. M a tern al and child health service has fo r its object prom oting the health o f m others and children. It carries an allot ment o f $ 2 0,00 0 to each state and a part o f $1 ,8 0 0 ,0 0 0 based on the num ber o f live births in a state, during the last cal endar year. T h is also is conditioned on a state plan and financial participation acceptable to the Social Security Board.
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The Journal of the American Dental Association
Service for crippled children calls fo r an appropriation o f $2 ,8 5 0 ,0 0 0 annually. A n allotm ent o f $ 2 0 ,0 0 0 is m ade to each state, w ith additional sums according to need. It is conditioned on state plans and financial participation. F ederal funds are to be w ith draw n if the state fails to carry out the requirements. Plans must be approved by the C h ief o f the C h il dren’s Bureau. C h ild w elfare service calls fo r an ap propriation o f $1 ,5 0 0 ,0 0 0 fo r the fiscal year, w ith an allocation o f $ 1 0 ,0 0 0 to each state offerin g approved plans. T h is service is aimed at strengthening public w elfare services, especially in rural areas, and the protection and care o f homeless, dependent and neglected children. V ocation al rehabilitation calls fo r an appropriation o f $ 8 4 1 ,0 0 0 fo r each o f the fiscal years 1936 and 1937 and $ 1 ,9 3 8 ,000 fo r each year thereafter. A fu rther authorization o f $ 4 2 5 ,0 0 0 is m ade fo r the fiscal year to the C h ild ren ’s Bureau for expenses. A ll these im portant w elfa re activities are centered in the D epartm ent o f L ab or. T itle 6 : Public H ealth W o r k . — U n der this title, provisions are made to as sist states and other political divisions in establishing and m aintaining adequate public health service, in cluding the train ing o f personnel. T h is calls fo r an annual appropriation o f $8 ,000 ,0 00 . A further appropriation o f $2 ,0 0 0 ,0 0 0 annually is authorized fo r the expenditure o f the P ublic H ealth Service fo r investigation o f disease, sanitation, etc. I t covers pay allow ance and traveling expenses o f the P u blic H ealth Service in the additional duties im posed by this title. T h is operates under the Surgeon G eneral, w ith the ap proval o f the Secretary o f the T r e a s ury. T h is also is contingent on the states’ setting up program s acceptable to the D e partm ent o f P u b lic H ea lth and providin g
state funds to be augm ented by federal dollars. A ll plans must be presented by the health departm ent o f each state and approved by the Surgeon G en eral o f the P u blic H ealth Service. It is specified that allotm ents to the states from this appro priation shall be determ ined on the basis o f population, special health problem s and the financial needs o f the several states. In addition to strengthening the serv ice divisions o f the state health depart ments and their political subdivision, provision is m ade fo r the training o f health personnel. Several m edical centers throughout the cou n try have adequate facilities fo r training m edical personnel fo r public health w o rk . A s soon as facil ities are available, it is understood that the governm ent w ill finance the training o f a selected group o f dentists fo r public health w ork . T h e y w ill receive some pay during the period o f training. A t a m eeting o f the A m erican P u blic H ealth Association last M a y , recom m endations w ere made as to qualifications for health officers and health personnel. T h e qualifications recom m ended included a degree o f d octor o f m edicine, at least one year’s hospital experience, w ith spe cial experience in pediatrics and infectious diseases, and som e experience in general practice ; the candidate to be n ot m ore than 35 years old w hen first specializing in pu blic health w ork , w ith n ot less than three months o f special training in public health and in addition some field experi ence. H ig h er qualifications fo r staff posi tions included training in biostatistics, bacteriology, im m unology, w ater purifica tion, sew age disposal, fo o d pu rity and principles o f nutrition, venereal diseases, tuberculosis and other com m unicable dis eases, and fam iliarity w ith epidemics. T h e foregoin g gives an idea o f the scope o f training that, w ith som e m od i fications, m ay be required o f those den
Current Literature tists w h o hope to en ter the field o f public health service. A fe w states n o w have fu ll-tim e dental representation in the departments o f health. T h e opportu n ity is presented under this act fo r organized dentistry to assume leadership in securing dental rep resentation on all state boards o f health and the establishm ent o f dentistry in the broader field o f general public health.
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In order that dentistry may participate in the activities under this title, it is nec essary that a program be form ulated and endorsed by the State H ealth D epart m ent and be accepted by the Surgeon G en era l o f the U . S. P u blic H ealth Serv ice. T h is is a challenge to the leadership o f organized dentistry in every state. 808 O dd Fellow Building.
C U R R E N T LIT E R A T U R E Treatment of M elanom a: Report of Four Hundred Cases (Frank E. Adair, Surg. Gynec. & Obst., 62:406 [Feb. 75] 1936) : T h e nomenclature o f the malignant pigmented tumors has always been confus ing. A genetic term fo r the entire group is melanoblastoma, which is subdivided into tw o classes: (1 ) melanosarcoma and (2) melanocarcinoma, the appellation de pending on the preponderance o f epithelioid or spindle cells in the tumor. Melanoma is one of the most malignant of all tu mors. A fair proportion of five-year cures can be obtained. T h e five-year results in operable cases are 33 per cent for the pri mary and 27 per cent for the recurring lesion. T h e great m ajority are advanced and no therapy w ill produce a cure. Thirty-eight cases o f five-year survivals of melanoma are reported. T h e best results in treatment are seen when the melanoma is situated in the eye or beneath toe nails. T h e w orst results are associated with dis ease in the vulva o r the rectum or within the mouth. J. F rank H a ll.
Fractures of Jaw and Allied Traumatic Lesions of Facial Structures (H . H . Weisengreen and W . N . Levin, Ann. Surg., 103:428 [M arch] 1936): Several tables are presented which show that the largest number of fractures occu r in the mandible. O f sixty cases, fifteen were in the region Jour. A .D .A ., Vol. 23, M a y , 1936
of the angle and twenty in the mandibular molar region, particularly the third molar. T h e second table points out the fact that the highest percentage occur in the earlier years, 90 per cent being before 49 years of age and the highest percentage group being 36.7, from 20 to 29 years. The cause in most of these cases w as automobile acci dents and fights. Some o f the points stressed in the management of fractures were early reduction, prevention of infec tion, adequate dietary measures and a post operative examination and check-up. T h e authors found local anesthesia to be very satisfactory. Physiotherapy was found to be valuable in several cases. M . W . M c C rea.
Trigeminal Neuralgia in Multiple Sclerosis (M . M . Meredith and G. H orrax, J. Nerv. & M ent. Dis., 82:497 [2Vow.] 1935): T h e authors report two cases: 1. A case of bilateral trigeminal neuralgia, complicated by multiple sclero sis. T h e tw o sides were treated separately. A t the first operation, the sensory root was avulsed as w ell as the motor root. T h e second operation was performed at a later date and care was manifested to pre serve the motor root. T h e authors state that numbness and paraesthesia are com mon, while pain is rare in multiple scler osis. 2. T h e trigeminal neuralgia in this case preceded the multiple sclerosis by
By E. E. VOYLES, D.D.S., Indianapolis, Ind.
the act are based on dollar m atching, w ith the governm ent dictating the terms.
engage in any other occupation. T h e present members are: John G . W in a n t, chairm an, A rth u r J . A ltm ey er and V in cent M . M iles. Frank Bane is executive director, and the present staff consists o f about 100 persons. T h e board is given rather broad pow ers fo r m aking inter pretations and establishing rules and reg ulations to carry out the purposes o f the act. In addition to administration, the board is delegated the duties o f “ studying and m aking recom m endations as to the m ost effective methods o f providin g eco nom ic security through social insurance and as to legislation and matters o f ad m inistrative policy concern in g old age pensions, unem ploym ent compensations, accident compensations and related sub jects.” T h is quotation is the m ost signifi cant phrase in the entire la w and may mean m uch to both the m edical and the dental profession. It is clearly evident that the la w w as prom oted by a socialistically inclined group w h o are stron g advocates o f insurance.
CENTRAL ADMINISTRATION
STATE CONFORMITY
T h e m a jor provisions o f the act are u nder the con trol o f the D epartm ent o f L a b o r and are administered through the Social Security Board and the C h ild ren ’s Bureau.
T h e la w is so hazy as to defy efforts tow ard a clear understanding o f its m any provisions. States attem pting to revise their law s in con form ity to the federal act must rely on the Social Security B oard fo r its meaning. Politicians and social w orkers are quick to find in these
H E E con om ic or Social Security A c t has becom e an outstanding topic o f discussion throughout the land. It is regarded as the most far-reaching legis lation ever passed by the Congress. It contains revolutionary provisions in volv in g the intim ate life and w ell-b ein g o f every citizen and reversing the age-old philosophy o f personal responsibility, th rift, frugality and self-reliance. T h e act substitutes long-distance cen tral con trol fo r local determ ination o f m any w elfare problem s. U n d er this act, it becomes necessary fo r all states to set up law s, make plans and provide state funds in order to share in the distribution o f federal subsidies. T h is is accom plished by means o f federal taxation. In the case o f unem ploym ent compensations, these taxes w o u ld penalize any state that fails to adopt em ploym ent insurance. A l l these state law s must be acceptable at W a s h in gton. W it h m inor exception, this act offers no federal gifts, but all titles under
T
T h e board consists o f three mem bers appointed by the President. Each receives a salary o f $1 0,00 0 a year and m ust not /our. A .D .A ., Vol. 23, M ay, 1936
917
acts the basis fo r a huge bureaucracy o f
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The Journal of the American Dental Association
p u blic w elfare w orkers. U nsu pported claim s are therefore being m ade by this group as to the qualification requirem ents o f the administrative personnel o f the states and counties. C on tradictory to the selfish aims at prom oting the socially trained groups, significant interpretations w ere given verbally by M r . Frank Bane, executive director, o f the Social Security B oard, in response to inquiries by interested citizens dispatched to W ash in g ton to ascertain the facts. T h e y are as follo w s : In order to meet the requirements o f the Social Security Board, it is not necessary (1 ) that the state board approve of the county board members and employes; (2 ) that the board members o f the county have definite qualifications fixed by the state boards; (3 ) that the state board have power o f removal o f county board members or its employes, nor (4 ) that the county board members or employes have com pleted a definite course of instruction in social welfare. T h ere is nothing in the Social Security A ct which prescribes any specific method of administration in political subdivisions o f the state. T h e state is required to provide a plan which shall be mandatory upon all political subdivisions of the state if administered by them and a plan which shall provide for efficient operation in the political subdi visions o f the state. T h e matters relating to selection, tenure of office and compensa tion of personnel are reserved to the state. T h ere is nothing in the act having to do with the administration of hospitals fo r the insane, penal institutions, reformatories or county infirmaries. SPOILS SYSTEM OR MERIT SYSTEM
T h e Social Security A c t has no p rovi sion w hereby civil service rules shall g ov ern appointments fo r positions u nder the act. T h is opens up another large field w here the “ ins” and the “ outs” m ay bat tle fo r the plunder o f the pu blic payroll.
T h e states m ay establish law s that w ill load the payrolls w ith political w orkers or they m ay provide a m erit system, w hich w ill brin g into the w elfa re depart m ent persons o f special attainm ents and experience. T h e im portance o f this choice cannot be overestim ated. T h e choice w ill affect the state boards and the various county boards and hundreds o f employes w hose duty it w ill be to investigate ap plications fo r aid, keep in touch w ith those to w h om aid is granted, see that funds are collected and paid out, and in vestigate questions o f fraud, racketeering and political favoritism . Shall the appointees w h o are to adm in ister this huge undertaking be chosen be cause they are “ righ t” p olitically and have som e skill in connecting aid w ith votes, or w ill they be selected on a com petitive basis as to ability and h old their positions as lon g as they do their w o r k right and abstain from partisan political activity? “ P olitical clearance,” o r a certificate of party regularity, may u n fortu n a tely play a part in the adm inistration o f aid to the unfortunate. Responsibility in this m at ter rests heavily on the legislatures o f the various states. Som e legislatures have had the foreth ought to provide in their law s that the state and coun ty adminis trative boards shall be com posed o f rep resentative citizens, w h o shall receive their appointm ent through cou rt ju d g e ships and w h o serve w ith ou t pay. T h is is intended to a fford som e meas ures o f protection against political p il lage. SUPPLANTING LOCAL CONTROL
T h is far-flu ng program o f social secur ity w ill inevitably supplant com m unity efforts and sound the death knell o f local autonom y. M a n y com m unities have lon gestablished w elfa re agencies that are ad ministered loca lly and in a large measure gratuitously by public-spirited citizens
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Dental Economics w hose names read like a page from “ W h o ’ s W h o . ” Such persons contend that “ blue-print patterns” are n ot tai lored to local needs, that volum inous in structions, intricate record systems and meaningless red tape hinder rather than help. U n dou bted ly, such interference by paid social agents w ill drive out gratu itous efforts. T im e alone w ill reveal w hether econom ic security centralized in W a sh in g ton w ill prom ote hum an w elfare and happiness commensurate w ith the burdens it entails and the expectations this act has aroused. T h e measure o f security in certain provisions o f the act m ay be disappointing to those w h o have been taught to lean heavily on the arm o f paternalism . Long-distance planners often reveal a w o fu l lack o f inform ation regarding the needs o f backw ard communities. F o r exam ple, B row n C ou n ty, Indiana, is kn ow n nationally as the m ost backw ard coun ty in the state. It is there that the governm ent has concentrated its u p liftin g activities. A n d this county has only about 8 per cent on relief, w h ile M a r io n C ou n ty , in cluding Indianapolis, has 18 per cent, and M o n r o e C ou n ty, seat o f Indiana U niversity, has about 33^ per cent on relief. C rim e is practically un k n ow n in B row n C ou n ty. Contentm ent, happiness and independence often lu rk in places accessible on ly w ith a “ horse and bu g gy ,” w hich is perhaps unbelievable to the m etropolitan m ind. T h e land o f these natives m ay be “ subm arginal,” but not their managem ent. T h e entire act is com pulsory in char acter and the tendency is to make large groups o f citizens creatures o f the state. Especially under the titles relating to dependent children and child w elfare, the gate is th row n open w id e fo r the propaga tion o f any “ ism” w hich m ay be the w him o f the m om ent or w hich may fit any ex pediency.
SECURITY AND CHARACTER
M a n ’s insecurity has ever been the m o tivating influence back o f the develop m ent o f such sterling qualities o f char acter as th rift, industry and frugality. T h e fear o f dependency in o ld age has always driven men to give o f their best. W i l l the standing assurance o f econom ic security affect adversely national th rift en masse? T h is question intrudes itself into any analysis o f the security act. W i l l a measure o f security in everything essen tial fro m birth to death encourage par asitism ? W i l l ou r national citizenship as a w h ole lose some o f the qualities that have m ade us a great n ation ? “ W h y w ork w hen the governm ent w ill supply all ou r essential needs?” says a rapidly increasing group. “ W h y w ork , w hen 35 per cent o f ou r earnings are required to pay the cost o f govern m en t?” says an other group. Beaum er states that it took thirty years under the G erm an system of social insurance to underm ine the honesty o f the rank and file o f the people. W il l A m erica, steeped in a system o f political chicanery, make m ore rapid progress in insurance evasion, chiseling, gra ft and racketeering? A virgin field for many form s o f trickery is opened under this act. Som e years m ay be required to sup ply the answer to these questions. CONSTITUTIONALITY
T h e constitutionality o f this act has been seriously questioned. In fact, the unem ploym ent com pensation feature o f the act w as recently tested in the N e w Y o r k Supreme C o u rt and an adverse decision w as rendered. In another court in the same state, a favorable decision w as given. Several states have passed laws con form in g, at least in part, to the federal act and others have the m atter under con sideration. T h e question arises as to w here these states w ill stand if the law
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The Journal of the American Dental Association
in w h ole or in part is declared unconsti tutional. It is estimated that Indiana w ill pay into the governm ent $ 4 0 ,0 0 0 ,0 0 0 a year in n ew payroll taxes and the sum fo r N e w Y o r k is estimated at $ 9 0 ,0 0 0 ,000 fo r 1938. W h a t w ill be the situa tion in the states if the federal la w does not stand the test o f the cou rts? W i l l a sim ilar confusion result as in the case o f the A A A decision? T h e la w w ill prob ably com e up fo r am endm ent many times during the com in g years. THE COST
T h e r e is no predicting w hat the total tax cost o f this program w ill am ount to in the w h ole coun try. It w ill be huge to begin w ith and, if it fo llo w s precedent, it w ill rapidly g ro w larger. In G erm any, unem ploym ent insurance w ent into effect in 1927, w ith 3 per cent levied on pay rolls. By January, 1930, it w as raised to 3| per cent. In Ju ly, it w as raised to per cent, w hen it became necessary fo r the governm ent to subsidize it to the extent o f $ 1 73 ,6 00 ,0 00 in that year. In O h io, a w ork m en ’s com pensation la w w as enacted in 1912. D u r in g the first three years, the average cost o f operation w as $ 1 ,1 8 5 ,8 1 4 . Since that time, there has been an increase o f 1,220 per cent. T h e last three years, the cost averaged $ 1 5 ,47 2,07 9. T h e r e has been an increase o f about 4 0 0 per cent in taxes in this cou n try during the last tw enty years, w hich undou btedly w ill receive a trem endous increase as a result o f social insurance. O n the basis o f “ pay as you g o ,” the en tire governm ental tax bill in this coun try today w o u ld am ount to about 25 per cent o f the entire national incom e. T h e financial plight o f the principal central governm ents o f E u rope has been ascribed, in large measure, to the drain o f social insurance. In A m erica, the g ov ernm ental w aste that is com m on in most federal, state, country and city units
hardly lends encouragem ent to the hope that this act w ill be administered eco nom ically. U n d er the act, a n ew layer o f governm ent is set up in each state, requiring hundreds o f n ew state office holders and employes. A recent survey in Indianapolis show ed that U . S. A g e n cies occupy 10,430 m ore square feet of floor space than the entire state capitol, in cluding the attic. Social Insurance is so com plicated as to require an elaborate system o f expensive accounting, checking and actuarial com putation, besides elab orate m achinery fo r con trollin g the costs and the prevention o f frau d. T h e outlay fo r social insurance w ill inevitably be com e a m ajor item in all state and federal budgets. DIVISIONS OF THE ACT
T h e federal act is divided into eleven titles or separate laws. T itle 1 : O ld A g e Assistance.— T h is means m oney payments to needy old per sons and carries an appropriation o f $4 9,750,000 for the current fiscal year and a sum sufficient annually th ereafter; also, an appropriation o f $ 2 5 0 ,0 0 0 fo r adm in istrative expenses o f the Social Security B oard under this title. Paym ent to states: 1. A l l states must have plan approved by the Social Security B oard. I f requirements are not carried out by the state, federal payments w ill stop. 2. State contributions up to but not exceeding $15 per m onth are matched. 3. T h e state plan is m andatory in all counties. Q ualifications to receive assistance: 1. T h e age must not be over 65 years after 1940. A g e 70 may be required previous to that date. 2. T h e recipient m ust not be an inmate o f a pu blic institution. T itle 2 : Federal O ld A g e Benefits .— In addition to old age assistance, the act provides fo r old age annuities to be paid from the “ Federal O ld A g e A c co u n t”
Dental Economics created in the U . S. T reasu ry and based on the principle o f actuarial com putation. T h ese payments do not begin until Jan. 1, 1942, and the beneficiary must have attained the age o f 65 and not be em ployed by another person in a gain ful occupation. T h e am ount o f the annuity depends on the duration o f the period over w h ich an individual has paid payroll incom e taxes and his average m onthly wages after D ec. 31, 1936. Funds to support this account are presumably taken from payroll taxes and appropriated on recom m endation o f the Secretary o f the T rea su ry to the Bureau o f the B u dget. O th e r persons not subject to state taxes and n ot otherwise com ing under the p ro visions fo r old age benefits may volun ta rily purchase annuities in lim ited amounts and under specified conditions.
T itle 3 : Unemployment Compensa tion.— Com pensations under this title cover persons on ly w h o have been em ployed and have lost their positions tem porarily. Persons perm anently unem ployed are not covered. T h is is a distinctly labor section and contains reservations protectin g some o f the principles advo cated by union labor. T h e plan is to im pose a federal tax on all employers o f eight o r m ore as a means o f forcin g states to adopt compensation laws, the adoption o f w h ich w ill exem pt the employers in the state from payment o f 90 per cent o f the federal tax, thus keeping the m oney paid by employers in the state to be used fo r the benefit o f local w orkm en. T h e excise tax on payrolls became e f fective Jan. 1, 1936, and is increased from 1 to 3 per cent over the period up to 1938. A n incom e tax identical w ith the em p loyer’s excise tax is levied on the incom e o f the employes, and must be c o l lected by the em ployer under penalty. A n em ployer is defined as one w h o on each o f tw en ty days in different weeks o f the
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taxable year em ploys eight o r m ore per sons. E m ploym ent exceptions are: farm labor, dom estic service, crew o f vessels, relatives, governm ent em ployes and em ployes o f n onprofit institutions. It is ad ministered under the Social Security B oard. A n appropriation o f not to ex ceed $ 4 ,0 0 0 ,0 0 0 is provided fo r the fiscal year and an appropriation o f $ 4 9,00 0,00 0 annually thereafter.
T itle 4 : A id to Dependent Children. — T h is title means m oney payments to dependent children, w h o are defined as under 16 years o f age and deprived o f parental support or care, and w h o are livin g w ith relatives in residence m ain tained by them as his o r their ow n hom e. Paym ents are lim ited to $ 1 8 a m onth fo r one child, w ith $12 fo r each addi tional child. T h is subsidy also is con d i tioned on acceptable state plans and is under con trol o f the Social Security B oard. T h e governm ent provides one third o f the total sum expended in carry in g out the state plan. T h is calls fo r an appropriation o f $ 2 4 ,7 5 0 ,0 0 0 for the fiscal year and a sufficient sum thereafter. It also appropriates $ 2 5 0 ,0 0 0 for the fiscal year fo r administration.
T itle 5 : M aternal and Child W elfare. — T h is title covers maternal and child health service, services fo r crippled chil dren, child w elfare services and v oca tional rehabilitation. T h e first three are administered by the C h ild ren ’s Bureau in the D epartm ent o f L ab or and the last through the U . S. D epartm ent o f E duca tion. M a tern al and child health service has fo r its object prom oting the health o f m others and children. It carries an allot ment o f $ 2 0,00 0 to each state and a part o f $1 ,8 0 0 ,0 0 0 based on the num ber o f live births in a state, during the last cal endar year. T h is also is conditioned on a state plan and financial participation acceptable to the Social Security Board.
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The Journal of the American Dental Association
Service for crippled children calls fo r an appropriation o f $2 ,8 5 0 ,0 0 0 annually. A n allotm ent o f $ 2 0 ,0 0 0 is m ade to each state, w ith additional sums according to need. It is conditioned on state plans and financial participation. F ederal funds are to be w ith draw n if the state fails to carry out the requirements. Plans must be approved by the C h ief o f the C h il dren’s Bureau. C h ild w elfare service calls fo r an ap propriation o f $1 ,5 0 0 ,0 0 0 fo r the fiscal year, w ith an allocation o f $ 1 0 ,0 0 0 to each state offerin g approved plans. T h is service is aimed at strengthening public w elfare services, especially in rural areas, and the protection and care o f homeless, dependent and neglected children. V ocation al rehabilitation calls fo r an appropriation o f $ 8 4 1 ,0 0 0 fo r each o f the fiscal years 1936 and 1937 and $ 1 ,9 3 8 ,000 fo r each year thereafter. A fu rther authorization o f $ 4 2 5 ,0 0 0 is m ade fo r the fiscal year to the C h ild ren ’s Bureau for expenses. A ll these im portant w elfa re activities are centered in the D epartm ent o f L ab or. T itle 6 : Public H ealth W o r k . — U n der this title, provisions are made to as sist states and other political divisions in establishing and m aintaining adequate public health service, in cluding the train ing o f personnel. T h is calls fo r an annual appropriation o f $8 ,000 ,0 00 . A further appropriation o f $2 ,0 0 0 ,0 0 0 annually is authorized fo r the expenditure o f the P ublic H ealth Service fo r investigation o f disease, sanitation, etc. I t covers pay allow ance and traveling expenses o f the P u blic H ealth Service in the additional duties im posed by this title. T h is operates under the Surgeon G eneral, w ith the ap proval o f the Secretary o f the T r e a s ury. T h is also is contingent on the states’ setting up program s acceptable to the D e partm ent o f P u b lic H ea lth and providin g
state funds to be augm ented by federal dollars. A ll plans must be presented by the health departm ent o f each state and approved by the Surgeon G en eral o f the P u blic H ealth Service. It is specified that allotm ents to the states from this appro priation shall be determ ined on the basis o f population, special health problem s and the financial needs o f the several states. In addition to strengthening the serv ice divisions o f the state health depart ments and their political subdivision, provision is m ade fo r the training o f health personnel. Several m edical centers throughout the cou n try have adequate facilities fo r training m edical personnel fo r public health w o rk . A s soon as facil ities are available, it is understood that the governm ent w ill finance the training o f a selected group o f dentists fo r public health w ork . T h e y w ill receive some pay during the period o f training. A t a m eeting o f the A m erican P u blic H ealth Association last M a y , recom m endations w ere made as to qualifications for health officers and health personnel. T h e qualifications recom m ended included a degree o f d octor o f m edicine, at least one year’s hospital experience, w ith spe cial experience in pediatrics and infectious diseases, and som e experience in general practice ; the candidate to be n ot m ore than 35 years old w hen first specializing in pu blic health w ork , w ith n ot less than three months o f special training in public health and in addition some field experi ence. H ig h er qualifications fo r staff posi tions included training in biostatistics, bacteriology, im m unology, w ater purifica tion, sew age disposal, fo o d pu rity and principles o f nutrition, venereal diseases, tuberculosis and other com m unicable dis eases, and fam iliarity w ith epidemics. T h e foregoin g gives an idea o f the scope o f training that, w ith som e m od i fications, m ay be required o f those den
Current Literature tists w h o hope to en ter the field o f public health service. A fe w states n o w have fu ll-tim e dental representation in the departments o f health. T h e opportu n ity is presented under this act fo r organized dentistry to assume leadership in securing dental rep resentation on all state boards o f health and the establishm ent o f dentistry in the broader field o f general public health.
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In order that dentistry may participate in the activities under this title, it is nec essary that a program be form ulated and endorsed by the State H ealth D epart m ent and be accepted by the Surgeon G en era l o f the U . S. P u blic H ealth Serv ice. T h is is a challenge to the leadership o f organized dentistry in every state. 808 O dd Fellow Building.
C U R R E N T LIT E R A T U R E Treatment of M elanom a: Report of Four Hundred Cases (Frank E. Adair, Surg. Gynec. & Obst., 62:406 [Feb. 75] 1936) : T h e nomenclature o f the malignant pigmented tumors has always been confus ing. A genetic term fo r the entire group is melanoblastoma, which is subdivided into tw o classes: (1 ) melanosarcoma and (2) melanocarcinoma, the appellation de pending on the preponderance o f epithelioid or spindle cells in the tumor. Melanoma is one of the most malignant of all tu mors. A fair proportion of five-year cures can be obtained. T h e five-year results in operable cases are 33 per cent for the pri mary and 27 per cent for the recurring lesion. T h e great m ajority are advanced and no therapy w ill produce a cure. Thirty-eight cases o f five-year survivals of melanoma are reported. T h e best results in treatment are seen when the melanoma is situated in the eye or beneath toe nails. T h e w orst results are associated with dis ease in the vulva o r the rectum or within the mouth. J. F rank H a ll.
Fractures of Jaw and Allied Traumatic Lesions of Facial Structures (H . H . Weisengreen and W . N . Levin, Ann. Surg., 103:428 [M arch] 1936): Several tables are presented which show that the largest number of fractures occu r in the mandible. O f sixty cases, fifteen were in the region Jour. A .D .A ., Vol. 23, M a y , 1936
of the angle and twenty in the mandibular molar region, particularly the third molar. T h e second table points out the fact that the highest percentage occur in the earlier years, 90 per cent being before 49 years of age and the highest percentage group being 36.7, from 20 to 29 years. The cause in most of these cases w as automobile acci dents and fights. Some o f the points stressed in the management of fractures were early reduction, prevention of infec tion, adequate dietary measures and a post operative examination and check-up. T h e authors found local anesthesia to be very satisfactory. Physiotherapy was found to be valuable in several cases. M . W . M c C rea.
Trigeminal Neuralgia in Multiple Sclerosis (M . M . Meredith and G. H orrax, J. Nerv. & M ent. Dis., 82:497 [2Vow.] 1935): T h e authors report two cases: 1. A case of bilateral trigeminal neuralgia, complicated by multiple sclero sis. T h e tw o sides were treated separately. A t the first operation, the sensory root was avulsed as w ell as the motor root. T h e second operation was performed at a later date and care was manifested to pre serve the motor root. T h e authors state that numbness and paraesthesia are com mon, while pain is rare in multiple scler osis. 2. T h e trigeminal neuralgia in this case preceded the multiple sclerosis by