Health Insurance Catalogue

Sixty-six years ago, Prince Otto von Bismarck's Germany set up the first national "Sickness Insurance" plan, covering industrial workers. Kaiser Wilhelm I had proclaimed: "The cure of social ills must be sought not exclusively in the repression of Social Democratic excesses, but simultaneously in the positive advancement of the welfare of the working classes." This state assumption of responsibility has been interpreted by some as farsighted statesmanship, by others as the embryo of the totalitarian state. In any case, it caught on. Today more have some form of public health insurance. In the catalogue:

Germany, since Bismark's day, through Hitler's regime, and under Allied Occupation, has steadily developed sickness insurance.

About 42 million, or 70% of the population, are covered.

Premiums are raised through a 6% payroll tax, shared equally by employees and employers. Austria, since 1888, has copied the German pattern. More than 6,500,000, or 90% of the population, are now health-insured. White-collar workers contribute 4.2%, and manual laborers 5 to 6.5% of their wages. Administration is in the hands of semiprivate companies supervised by the government. Sweden, since 1891, has promoted voluntary sickness and accident insurance. More than half the population, or 4,700,000, are covered. They pay varying premiums to government-approved societies. The government pays 55% of the societies' outlay.

Nearly all of Sweden's 3,359 doctors take part. A law already passed, but not effective until 1951, will make health insurance compulsory. Norway has had health insurance since 1909, compulsory for all earning less than 9,000 kroner ($1,800) yearly and voluntary for those earning more.

About 2,500,000, or 80% of the population, are covered.

Most of the country's 2,800 doctors are in the plan. A bit more than half the premiums is paid by employees, the remainder by employers and government. Denmark, beginning with health co-operatives in 1891, has had a compulsory system since 1933. Of Denmark's 4,000,000 people, all those over 15 years of age must now register with recognized health insurance cooperatives and contribute premiums equaling up to $10 yearly. But benefits depend on individual income. Those who have more than $1,700 a year after taxes are not eligible for free medical treatment.

France has had compulsory health insurance since 1928. It now covers 30 million, or 75% of the population, including the republic's President but not its lawyers, doctors and landowning farmers. Regional councils, elected by premium-paying workers and employers, manage the program.

Funds are derived from a 12% social security levy on payrolls, half contributed by employees and half by employers. Patients may choose any doctor. Doctors merely sign forms with which patients claim reimbursement from their insurance. By now an ingrained habit, the principle of health insurance is beyond political argument.

Italy has kept the national health insurance introduced by Mussolini in the '20s. Almost 15 million of a working population of 25 million participate. Premiums, contributed equally by employers and employees, amount to 3% of white collar, and 5% of manual worker salaries. The insurance organization has a salaried staff of 600 doctors who serve members, but the main medical burden is borne by 15,000 of the country's independent practitioners. Their bills are paid half by the insurance, half by the insured.

Australia's Federal Parliament last year enacted a compulsory program of free drugs, in which the government would pay pharmacists for all prescriptions. But doctors have refused to cooperate, i.e., write prescriptions on government forms; they say free medicine has led to "tonic swilling" in nearby New Zealand. Parliament is also weighing compulsory health insurance that would pay half of every citizen's doctor bills from the public treasury. Doctors don't like this scheme either; they argue it will bring "a third party into the traditional intimate and confidential relationship between doctor and patient."

New Zealand has had compulsory insurance since 1938. Costs come from a general social security levy of 7.5% on all incomes. Nearly 2,000,000 New Zealanders are entitled to free medical care except for specialist services. Most telling criticism has been that doctors are doing so well financially that they neglect research and spurn lower-paying hospital posts.

Russia, the ultimate in state control, has the ultimate in state health insurance. Medical service is free to all. Doctors and dentists are assigned and paid by the state. Benefits, however, are limited by facilities available. Relative example: Russia has one dentist for 14,000 people; Britain has one dentist for 3,271 people, the U.S. one for 1,885 people.

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