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Special Message to the Congress on Health and Disability Insurance

May 19, 1947

To the Congress of the United States:

Healthy citizens constitute our greatest national resource. In time of peace, as in time of war, our ultimate strength stems from the vigor of our people. The welfare and security of our nation demand that the opportunity for good health be made available to all, regardless of residence, race or economic status.

At no time can we afford to lose the productive energies and capacities of millions of our citizens. Nor can we permit our children to grow up without a fair chance of survival and a fair chance for a healthy life. We must not permit our rural families to suffer for lack of physicians, dentists, nurses and hospitals. We must not reserve a chance for good health and a long productive life to the well-to-do alone. A great and free nation should bring good health care within the reach of all its people.

In my message to the Congress on November 19, 1945, I said that every American should have the right to adequate medical care and to adequate protection from the economic threat of sickness. To provide this care and protection is a challenging task, requiring action on a wide front.

I have previously outlined the long-range health program which I consider necessary to the national welfare and security. I say again that such a program must include:

1. Adequate public health services, including an expanded maternal and child health program.

2. Additional medical research and medical education.

3. More hospitals and more doctors--in all areas of the country where they are needed.

4. Insurance against the costs of medical care.

5. Protection against loss of earnings during illness.

I am pleased to observe that important advances were made by the last Congress toward realization of some of the goals which I set forth in my earlier message. But we must not rest until we have achieved all our objectives. I urge this Congress to enact additional legislation to authorize the program I have outlined, even though the fulfillment of some aspects of it may take time.

Our public health services--federal, state and local--provide our greatest and most successful defense against preventable diseases. But in many states, cities and counties in America, limited funds reduce the work of our public health services to a dangerously inadequate level. Public services related to maternal and child health were expanded by the 79th Congress, through amendments to the Social Security Act. This action was gratifying, but the long-range need for additional health services for children and expectant mothers, and for care of crippled or otherwise physically handicapped children, should be carefully studied by the Congress.

The Nation's medical research programs must in the future be expanded so that we can learn more about the prevention and cure of disease. The Congress has already recognized this by providing for research into the causes of cancer and mental diseases and abnormalities. Further dividends will accrue to our Nation--and to our people-if research can point the way toward combatting and overcoming such major illnesses as arthritis and rheumatic fever, and diseases of the heart, kidneys and arteries.

We still face a shortage of hospitals, physicians, dentists and nurses. Those we have are unfairly distributed. The shortage of doctors, dentists and nurses can be met only through expanded educational opportunities. The shortage of hospitals will be met in part through the action of the last Congress which provided Federal aid for the construction of hospitals.

In the last analysis the patient's ability to pay for the services of physicians or dentists, or for hospital care, determines the distribution of doctors and the location of hospitals. Few doctors can be expected to practice today in sparsely settled areas or where prospective patients are unable to pay for their services. Doctors tend to concentrate in communities where hospitals and other facilities are best and where their incomes are most secure. The unequal distribution of doctors and hospitals will plague this nation until means are found to finance modern medical care for all of our people.

National health insurance is the most effective single way to meet the Nation's health needs. Because adequate treatment of many illnesses is expensive and its cost cannot be anticipated by the individual, many persons are forced to go without needed medical attention. Children do not receive adequate medical and dental care. Symptoms which should come early to the attention of a physician are often ignored until too late. The poor are not the only ones who cannot afford adequate medical care. The truth is that all except the rich may at some time be struck by illness which requires care and services they cannot afford. Countless families who are entirely self-supporting in every other respect cannot meet the expense of serious illness.

Although the individual or even small groups of individuals cannot successfully or economically plan to meet the cost of illness, large groups of people can do so. If the financial risk of illness is spread among all our people, no one person is overburdened. More important, if the cost is spread in this manner more persons can see their doctors, and will see them earlier. This goal can be reached only through a national medical insurance program, under which all people who are covered by an insurance fund are entitled to necessary medical, hospital and related services.

A national health insurance program is a logical extension of the present social-security system which is so firmly entrenched in our American democracy. Of the four basic risks to the security of working people and their families--unemployment, old age, death and sickness--we have provided some insurance protection against three. Protection against the fourth--sickness--is the major missing element in our national social insurance program.

An insurance plan is the American way of accomplishing our objective. It is consistent with our democratic principles. It is the only plan broad enough to meet the needs of all our people. It is--in the long run--far less costly and far more effective than public charity or a medical dole.

Under the program which I have proposed patients can and will be as free to select their own doctors as they are today. Doctors and hospitals can and will be free to participate or to reject participation. And a national health insurance plan can and should provide for administration through state and local agencies, subject only to reasonable national standards.

Finally, I should like to repeat to the Congress my earlier recommendation that the people of America be protected against loss of earnings due to illness or disability not connected with their work. Protection against temporary disability is already provided by two states and is being considered in others. Comprehensive disability insurance should exist throughout the Nation. It can and should be a part of our social insurance system.

The total health program which I have proposed is crucial to our national welfare. The heart of that program is national health insurance. Until it is a part of our national fabric, we shall be wasting our most precious national resource and shall be perpetuating unnecessary misery and human suffering.

I urge the Congress to give immediate attention to the development and enactment of national health and disability insurance programs.