I cannot pretend to have more than touched on the fringe of the complicated subject of insurance in relation to public health. The inauguration of the act meant an enormous increase in the direct relationship of the medical profession to the state. A great stride in the socialization of medicine was taken. But it was done ill-advisedly; it continued a false and low ideal of isolated general medical practice; it has even been described as a fraud on the insured, in view of the incompleteness of the medical service provided; and it diverted into an unsatisfactory channel the energy and money which were urgently needed for the immense good obtainable by reform of poor law and public health administration, and extension of their medical services. Had the lines indicated by history and experience and by the report of a strong royal commission on the poor law—there was a majority and a minority report, but both agreed in the chief essential points—been followed, England would now possess a nearly completely unified state medical service, instead of standing at the point whence false steps need to be retraced, with a view to a coördinated and simplified medical and public health policy. With the principle of contributory insurance to secure monetary support during illness there can be no quarrel; but in the interest of national efficiency complete medical provision, preventive and curative, must be made by the state, irrespective of insurance, for all in need of it; and the medical practitioners employed in the necessary certification of such insurance work as is continued must, if the insurance is to be satisfactory, be employed under conditions which will render them independent of the favor of the insured, and will enable them to utilize their knowledge of each patient’s case for the needed preventive measures, whether these be concerned with the sanitation of home or factory or workplace, or with personal habits. _The Need of the Future_