Dr. PRYOR.- But there is such a law and anybody who wanted to enforce it could make trouble. Mr. KELLER.- It is observed as far as possible, but it is not the spirit of the law and it is not to the benefit of the consumptives. Dr. N. R. NORTON, of Seton Hospital. I want to put in a word in connection with Dr. Meyer's strong plea for a municipal institution. I will tell you of what has been done at Seton Hospital, which is situated at Spuyten Duyvil, where we have to take all classes of patients. Those poor incipients who cannot go elsewhere, we have to take with the advanced cases. During the last year we have treated 675 cases; we have about 175 in the institution all the time; and the great disadvantage of having the incipients with the advanced cases has been brought out there. Patients are committed there and die, sometimes, the day they arrive. It spoils the morale of the institution; it makes it very much more difficult to take care of the rest to have the advanced cases about. Under the circumstances it is impossible to segregate the incipients and keep them separate from those advanced cases. It will thus be seen that there is work going on even now within the city limits where a hospital takes care of 600 or 700 patients of all stages a year. Dr. Lee K. Frankel, Manager of the United Hebrew Charities, New York, read a paper on "Coöperation and Health Insurance for Consumptives." COOPERATION AND HEALTH INSURANCE FOR CON SUMPTIVES. In a paper read before the British Congress on tuberculosis in July last, Mr. Frederick L. Hoffman, Statistician of the Prudential Insurance Company of America, made the statement that it would be financially impossible, as it would be otherwise inexpedient, for industrial insurance com panies to contribute to the erection and maintenance of sanatoria for the treatment of tuberculosis. He further stated that it does not fall within the range of remote possibility that industrial insurance companies are likely to become interested in the sanatoria treatment for their consumptive policyholders. At the same meeting, Sir John Burdon Sanderson, on the topic, "Sanatoria for Working Men and Women," stated that it might be assumed that a system such as exists in Germany could not be established in England and America, and recommended that some voluntary insurance against tuberculosis must be regarded as the best substitute for the compulsory system. The question of the possibility of instituting a method of insurance similar to the one at present carried on under the German Insurance Law will be discussed at the latter end of this paper. In order, however, to approach this question with any degree of intelligence, it will be necessary for us to discuss and to consider the history of what is known in Germany as the Invalidity Insurance Law, under which over one-half million persons are at present receiving invalidity or old-age pensions, at a cost per annum to the insurance companies of between sixty and seventy million marks. As Germany is practically the only country in the world that has evolved a governmental plan for the care of its sick and consumptive workmen, we can limit the consideration of the subject, as given in the title, to the discussion of the work at present being done and the work that has been done during the last ten years throughout the German Empire. The German politico-social law, under which the system of paying old age and invalidity pensions developed, and through these the care of the sick, had its origin in an act passed in the reign of Emperor William I, on November 17, 1881. Prior to that time, the general subject of the care of invalided workmen had been discussed in the Reichstag, and in fact a law was in existence prior to that date for the protection of workers on railways, in quarries, mines, etc. The law of 1881, however, is the first attempt on the part of the State to express its obligation to its subjects in case of sickness or of old age. The basis of the law is compulsion. Every laborer who belongs to one of the classes specified in the act must become insured. The law includes practically all classes of laboring men and women engaged in handicrafts, factory work, housework, and in fact all positions and occupations where the wage-earner is engaged by the day or week, and where he depends entirely upon the results of manual labor to earn his livelihood. The law likewise offers opportunity for others not included in these classes, voluntarily to become insured. Under the law, the employer, either alone, as in accident insurance, or in connection with the employe, as in sickness insurance, or in connection with the State and employe, as in the Invalidity Law, must contribute toward the payment of the insurance premiums. This is the state of affairs in the present evolution of the law. The first law that was passed, after the original act in the reign of Emperor William I, was that of insurance against sickness, passed June 15, 1883. It was applied to persons working on wages or salaries in mines, factories, foundries, railroads, ship wharves, buildings, and any workshops where steam, etc., was used, and for all officials and employes who did not earn over 6 2-3 marks daily. This law was followed by that of the Accident Insurance Law of July 6, 1884, which included the category of laborers, etc., mentioned above, and was enlarged through an act of May 28, 1885, to include many other branches of industry. Through the law of May 5, 1886, sickness as well as accident insurance was extended to tillers of the soil, agriculturalists, etc. On the 1st of July, 1887, the Building Accident Law was passed for those engaged in the various building trades. On the 22d of June, 1889, the Invalidity and Old Age Insurance Law was inaugurated. Already, as early as the 17th of November, 1887, six years after William's act, the Department of the Interior presented the "plans for an Old Age and Invalidity Law." These plans proposed that for old age and invalidity, as well as for accident, a uniform pension should be paid,- in other words, that all insured persons should have equal right to pension, and that the means to pay same should be paid one-third by the employer, one-third by the laborer, and one-third by the State. Eventually a bill was introduced into the Bundesrath, under which territorial organizations were planned, i. e., geographically limited insurance societies, which should include either various communities or an entire Bundesstaat or several Bundesstaats. The law of 1889 introduced a graded wage system. Under this act, four grades of beneficiaries were created, the premiums to be paid, and the old age and invalidity pensions allowed, being proportioned to the respective earnings, the insurance premiums being paid half by the employer and half by the employe. In case of invalidity, the State paid to all classes alike a uniform pension of 50 marks per annum. This law went into effect on January 1, 1891. In the course of a few years, it developed that, while certain societies, like the "Hansestatte," accumulated large surpluses, others, like "Ostpreusen" and "Niederbayern," did not collect sufficient revenues to comply with the law; in fact, did not permit the payment of pensions from the proceeds of the capital in hand. This led to a revision of the law, which terminated in the law of July 13, 1899. No change was made in fundamentals; only, instead of having four grades of beneficiaries, a fifth was added for workmen earning higher wages than the other four classes. To overcome the difficulty of insufficient revenues, the societies work in unison. After January 1, 1900, each society had to have a joint and a special fund, the first to be used to pay old age, invalidity pensions, etc. It is hoped that, through this means, the above state of affairs will be done away with. It is impossible here to discuss the Invalidity Law in detail. Of interest, however, particularly in view of the possibility of introducing a similar system in the United States, are the premiums which must be paid by the various classes of insured, and the invalidity and old age pensions which are paid to each class. Invalidity pension is paid without regard to the age of the applicant, if permanently incapacitated for work; old age pension to any one who has reached his seventieth year. By incapacity is understood the inability to earn one-third as much as any other individual can earn under similar conditions in the same place, and at the same trade. No one, however, is entitled to an invalidity pension who has not paid at least 100 weekly premiums, and who has not waited 200 premium weeks. When the payment is less than above, applicant must wait 500 premium weeks. For old age pension, 1,200 premium weeks must have passed. The premium payments are as follows: Class 1, 14 pf. weekly. Class 2, 20 pf. weekly. Class 3, 24 pf. weekly. Class 4, 30 pf. weekly. Class 5, 36 pf. weekly. The various classes are as follows: Class 1, earning up to 350 marks per annum. |