FROM PACT TO HEALTH
EDWARD MONTGOMERY New York, April 29th
IFHANKS to Mr. Acheson's skilful conning, the Altantic Pact and its complementary programme of military assistance , seems, for the moment anyway, to be set steady with a fair wind behind it. The public hearings of the Senate Public Relations Committee on the Pact—ritual preliminary to any important piece of legislation—began on Wednesday, April 27th, with Mr. Acheson as the first witness. According to all reports .he made an excellent impression, and combined tact with firmness -in facing the issue which has been troubling a good many of the less enthusiastic sup- porters of the Pact in the Senate, which is whether a vote for the Pact automatically implied 4 moral commitment to vote for the Adminis- tration's estimate of the financial assistance to its signatories that will be needed to give it teeth. Mr. Acheson had previously shown some signs of wanting to avoid this issue, but when it came to the point on Wednesday he grasped the nettle firmly, and several times in the course of his long statement to the Foreign Relations Committee and the questioning that followed, he reiterated his belief that to accept the Pact was necessarily to accept also, ip principle at least, the obligation of military assistance, although no one would be bound to
any particular details—as, for example, that of the cost involved. .
This candour on Mr. Acheson's part-somewhat alarmed Senators
Connolly and Vandenberg, the chief Democratic and Republican figures on the Committee, who have been trying all along to keep the debate on the Pact itself separate from the discussion of the cost of implementing it. But they appear to have been unduly nervous of the results of mixing up the debate on the two subjects, for, according to the latest reports from Washington, Mr. Acheson's frankness seemed rather to have appealed to most of the other Senators than repelled them.
. On the domestic side President Truman's " Fair. Deal " programme
is again running into rather heavier weather.. The Administration navigators in Congress are having to do a good deal of backing and filling on the labour legislation for the repeal of the Taft-Hartley law and its replacement by a modified version of the. Wagner Act. It appears almost certain that the Administration Bill will not get through the House of Representatives without several amendments designed to strengthen the Government's hand in dealing with labour disputes, in line with similar provisions in the Taft-Hartley law. But the measure which at the moment. is arousing the widest, and the wildest, controversy is President Truman's health programme which he recommended to the Congress in a message on April 22nd. This controversy has by now become almost an annual spring event in American life. Regularly every year for the four years since he became President, Mr. Truman has asked Congress for compre- hensive Federal health legislation, and regularly every year Congress has laid it away on the shelf to cool for another year.
The British have had their argument about a national health service, and Mr. Beyan- won it. Americans are just in the early stages of theirs. But whereas a year ago both British and Americans were arguing in a vacuum, this year Americans have what they have heard and read about how the British experiment is working in prac- tice to reinforce their arguments—both pro and con.' On the whole, I think, the American Press has reported the progress of the British scheme very fairly. But it was perhaps inevitable that in its earliest stages the reports should have tended to stress its shortcomings arid faults. Latterly the reports have shown a confusing tendency to go rather too far in the opposite direction* in emphasising the success of the British health service, particularly its political success in main- taining popular support for the Labour Government.
By Mr. Bevan's standards, Mr. Truman's proposals would seem modest enough _to satisfy even the most diehard member of the British Medical Association. The core of Mr. Truman's scheme is a system of compulsory health insurance. Every American now covered by Social Security—the number is estimated at present at eighty-five million, with another thirty-five million to be added if Social Security is expanded under other pending " Fair Deal " legislation—would be covered by the insurance. Every insured individual, as well as members of his immediate family, would be entitled to complete medical, surgical, dental and hospital care. Patients would be free to choose their docar, dentist or hospital, and these in turn would be free to accept or reject patients. Doctors, dentists and hospitals could choose whether to participate in the scheme full-time, part- time or not at all. Doctors and dentists would be allowed to decide locally the method of payment—whether on a salary basis, a fee basis, a flat sum per year for each patient, or some combination of methods. Hospitals Would be• paid on the basis of ,the actual cost of furnishing services, and patients would be permitted to pay for special luxuries, such •as private rooms. The ,scheme would be administered nationally, but its actual operation would be in the hands of local committees set up by the stale governments.
- The cost 'of all this, under Mr. Truman's plan, would be met by the creation of a Federal health insurance fund. This fund would be supported by a 3 per cent. pay-roll tax," . to which employers
would contribute per cent. annually of their total pay-roll, em- ployees would contribute, II per cent, of their weekly cheque or monthly salary, and the Federal Government would contribute a sum equivalent to per cent. of the total national pay-roll for the first five years and i per cent. thereafter. The payments of the individual insured person would, however, be limited to 14- per cent. on the first $4,800 of- income, so that the maximum individual pay- ment would be $72 a year. This tax is calculated to produce about $4.5 billion a year, and Federal assistance would bring the total insurance fund up to about $5.3 billion the first five years and $6 billion thereafter. Estimates of the cost of the scheme vary widely, from the Administration's '$6 billion to $7 billion a year to the American Medical Association's $18 billion.
But the ink was hardly dry on Mr. Truman's message to Congress outlining his plan before the-Ainerican Medical AssOciation roared to the attack. A quotation from the A.M.A.'s statement will show that it has nothing to learn from its British counterpart in the matter of opposition. The statement declares : " There is neither hope nor promise of progress in this system of regimented medical care. It is the discredited system of decadent nations which are now living off the bounty of the American peopleand if adopted here it would not only jeopardise the health of our people but would gravely endanger our freedom. It iL one of the final, irrevocable steps towards State Socialism—and every American should be alerted to the danger."
The A.M.A. evidently thinks that one reason why. its British colleagues failed to block the creation of the National Health Service in Britain was because their opposition was not sufficiently vigorous, The A.M.A. does not intend to repeat the B.M.A.'s mistake if it can help it. Nobody in Washington seems to think that Mr. Truman's health programme has any better chance of passage this year than it had last year or the year before that. But at any rate no one can say Mr. Truman has; ot tried.
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