Evening star., 1948-07-02
On Meeting the Hospital Crisis

The Star concluded its understanding edlto-
rial on The Hospital Crisis" with the hope
that our private hospitals would go slow in
withdrawing from the Community Chest Fed
Grafton. Inflated costs and inadequate revenues
have imposed paralyzing deficits upon all our
voluntary hospitals. Unless last years made
quate contribution to our hospitals is increased
substantially financial desperation may force
them to conduct their own fund drive. This
writer agrees with The Star that such a step
should be taken only as last resort.
Were our ebt-bogged hospitals to decide
upon . separate drive for indispensable oper-
ating funds there Is little doubt Of its success
But, as The Star points out. this is treating
symptoms and ignoring the basic disease. In
solvency is the paralyzing disease currently
afiicting every essential element of our health
security.
Let us assume our hospitals withdraw from
the Community Chest Federation and conduct
successful drives for survival funds. Next year
they will be faced with the same endless, dis
couraging task In the meantime, our COM
munity will have abandoned the fruitful policy
Of o consolidated social welfare budget and
the single all-out, an-purpose drive for ade-
quate voluntary contributions In self defense
other equally worthy welfare projects would
have to abandon the Community Chest ideal.
The summation of inevitable desertions would
mean unpredictable default of community duty
to our unfortunate. The devil would take
the hindmost.
Rather than be the first to abandon the
Community Chest ideal, why not dedicate our
selves to devising ways and means to prevent
all future hospital deficits? Let us cure the
disease rather than treat the unappeasable
symptoms.
A Solvent Health Plan.
This voteless community under dictatorial
control Of our Federal Government offers ex-
ceptional opportunity for conscientious leader
ship to originate solvent health security plan.
The cynical default of the past should not
prevent change Of heart by our derelict
political masters.
All schools Of medical economics agree that
the principle of contributory health insurance
should be the basic method OF financing our
Nations health security. Instead of annual
drives to liquidate mounting deficits Of our
hospitals, why not prevent those deficits by
using sound insurance principles? In this
Nations voteless Capital every element neces-
sary to the success of such plan is available.
We lack only intelligent leadership and pur-
poseful coordination. Such plan would be in
this wise:
First, through accurate t-accounting we
would reduce the essential cost OF an adequate
patient-day of disqualification to fair minimal
figure. This should be uniform for all hospitals
providing similar services whether they be
tax-subsidized or private. All hospitals should
provide minimal standard OF adequate care
and subscribe to minimal standards Of social
and economic justice for their employees. This
means that government should not extort
bankrupting concessions from private hospitals.
There is no justification for government con-
fscating services at $3.50 q day which cost
private hospitals $14.48 to produce. Neither
is there any excuse for the 81 differential per
diem in operating costs to taxpayers between
public hospitals rendering identical services to
tax-eligibles in the same community Ge. Gal
linger and Freedmen's). Likewise, prepaid in
surance plans should be denied deficit making
discounts and concessions
Second, once the fair-cost formula for similar
services has been determined, let actuaries
calculate subscriber cost of a solvent prepayable
insurance plan available on the basis of non-
cancellable. nonselective, city-wide participa-
tion
Third offer such low-cost, prepayable, risk
sharing health security policy to the public in
lieu Of soliciting funds for inevitable health
security deficits.
Inclusion Of Tax Elgbles
Such = solvent insurance plan need not
exclude participation of tax-eligibles or those
who partially need public aid Government
simply would make its fair contribution to
the insurance fund instead of unpredictable
allocations to restricted-purpose appropria.
tions. It's social welfare actuaries would ascer-
tain the total number of families in the COM
munity entitled to public assistance. Govern
ment then would appropriate their low-cost
insurance premiums for fiscal year and make
1t dependably available to the consolidated in
surance fund.
Those able to pay only part Of the premium
costs would continue to be processed by our
Hospital Service Agency. HSA would investi-
gate applicants for partial aid and certify their
title to health security insurance at less than
average cost. Instead OF recapturing already
incurred hospital expenses from low income
groups, HSA would accomplish the same sup
portive mission by acting as insurance con-
troller for the underprivleged group. These
would divide themselves into two categories:
If the low income beneficiary had obtained
his low-rate health security policy before
actually needing its indemnity, he would
enjoy full coverage by continuing to keep his
reduced premiums current But If the low
income applicant for partial assistance i'm
providently had waited until there was actual
need of disqualification, he would be required
to pay a bonus and a whole years insurance
premium before becoming eligible for benefits.
In so penalizing improvidence and procrasti-
nation, the plan would have the healthful
effect Of encouraging dutiful prepayment In
stead of present postpayment.
This plan would leave community philan-
thropy relatively simple task. The demands
for hospital contributions would be limited to
financing the small deficit which might result
from low income groups receiving their health
security insurance at lower -than-average cost.
THOMAS E. MATTINGLY, M. D.
Nomination Impressions Compared
To the Editor OF The Star:
Two reports Of the Macarthur nomination
at the Republican Convention contain inter