Ii FOR INDUSTRY-

Needed: Broader & Higher Health Benefits

IN 1953, the most prosperous year in U.S. history, some 3,500,000 families found themselves in serious finan cial straits. The cause was the high cost of sickness, which for those American families ran between 20% and more than 100% of their annual income. For industry, sickness is also costly. Some 500 million man-days are lost each year because of injuries and illnesses. The total loss in wages: $9 billion.

On top of that, efficiency and morale of workers are often low because of their worry over how they will pay doctor and hospital bills. Says Eastman Kodak's Industrial Relations Director Craig Cochrane, whose company has one of industry's most complete health insurance plans: "Broadly speaking, in addition to the human considerations, we feel that people do their work more effectively when they are relieved of worry and anxiety. Medical care may be delayed if they haven't the money to pay for it. But with prompt medical care they will recover more quickly, lose less time."

Many companies already have preventive programs that call for periodic examinations, and over the past 15 years, much has been accomplished in the way of voluntary insurance plans, paid for by the company alone or with the help of employees. In 1939, only a handful of Americans in industry were covered by medical insurance v. some 32 million today. But many companies still think of health insurance plans as mere fringe benefits and necessary evils, do not institute them until forced by the unions. About a fourth of U.S. industrial workers are still un covered, and even those who are insured often get inadequate protection. Health insurance payments last year covered only 17% of the medical bills paid by all U.S. families--$1.5 billion out of a total of $8.6 billion. One problem is that many companies are too small to take out group policies. This difficulty is being solved in some cases by bunching together the employees of an entire industry, or a section of it. In New York, for example, some 7,000 members of the painters' union are covered by group policies financed by 600 painting contractors.

Even among such well-established plans as the nonprofit Blue Cross and Blue Shield, there are shortcomings. Most group policies do not cover dependents over 18. Many do not provide benefits high enough to compensate for the soaring costs of hospitalization, and most do not provide long-term care for such diseases as polio, TB and cancer. Another frequent weakness: if an illness runs longer than a specified time (seldom more than 120 days), benefits stop and the patient has to wait sometimes for months before they start up again. Meanwhile, he has to pay all expenses himself, just when he can least afford to.

While few people think that every family's health could or should be totally insured down to the price of the last aspirin tablet, there is still a big job to be done by industry. One of industry's most ambitious insurance plans is California's Kaiser Foundation Health Plan. Started by Henry J. Kaiser eight years ago to cover 40,000 employees, it has spread far beyond his own companies; the plan now covers more than 400,000 subscribers, and its fourteenth hospital, a $3,000,000 glass structure, has recently opened in San Francisco. Under the Kaiser plan, an individual subscriber pays as little as $4.30 a month (the same subscriber pays up to $9.50 with two or more dependents). Except for such illnesses as alcoholism and mental disorders, this entitles him to free treatment (by specified doctors) in 35 institutions, including 14 hospitals. For each illness suffered, he is entitled to 111 days of hospital care in a year, including all extras.

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Since it is in the major medical expenses that health insurance really counts--and where it now most often fails to pay the bill--this is the area that many companies are now concentrating on. Led by General Electric, more than 150 companies have installed "major medical" or "catastrophe" plans to cover such diseases as cancer, TB and other long illnesses. These plans are usually integrated with regular group medical insurance, which pays the first part of the bill. The employee pays the next $100 to $600, in somewhat the same way as he would pay for minor auto damage under a deductible policy. Anything over that (up to as much as $10.000) is paid by the insurance company. Premiums need not be prohibitive under such deductible schemes. At Sears Roebuck, dependents are excluded from the major medical plan to keep costs down, and the premium runs to only 40-c- a month.

In such ways, industry can broaden the coverage, improve the health insurance of its employees and increase its efficiency by cutting down on many preventable illnesses. Unless companies broaden the medical coverage of their employees, the Fair Deal cry is sure to arise again for a Government-run compulsory plan for all.

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