In recent years newspaper comment on the subject has been frequent. At times it has been plainly stated that the making of appropriations has involved political support. *27 In 1905 the Board of Public Charities, in advocating a uniform system for determining the amount of the appropriations, stated that the application of a rigid rule "... would do away with what is now a crying evil, an institution of great influence being able, under the present system, to secure a much larger appropriation than is possible to a similar institution doing the same service, but not possessing the same influence. " *28

27 See Philadelphia Public Ledger, 19 January, 1910; 29 December, 1910; 9 May, 1913; and 7 April, 1913; also Press, 18 January, 1910, and 21 May, 1913 for comments on the wastefulness of appropriations. See also Record, 20 January, 1910; Inquirer, 18 January, 1910; Public Ledger, 9 May, 1912.

28 Report (1905), p. 4. Italics are the author's.

Instances of careless extravagance are sometimes discovered. In 1899 the legislature appropriated $175,000 annually for the Soldiers' and Sailors' Home at Erie. The governor reduced this to $100,000, because only that amount had been used annually by the home during the previous two years, although $175,000 had been appropriated. *29 In 1913, the Charleroi-Monessen Hospital, in Washington County, asked the Board of Public Charities for $10,000 for the two years ending May 31, 1915.30 The board approved $5,000. *31 When the bill making the appropriation came up for final passage in the House it carried $20,000. *32 In the same year the Punxsutawney Hospital Association applied for $28,000, which the board reduced in its recommendation to $19,200, or $9,600 annually. The report reads, "If need is the test, the recommendation should be $9,600. *33 The committee on appropriations, whose chairman represented the district in which the hospital was located, reported an appropriation of $53,000 for two years. *34 Commenting on the subventions to private hospitals in Pennsylvania, Mr. Abraham Flexner says, "That this policy is thoroughly objectionable and demoralizing is beyond dispute. The state has neither right nor business to make presents to private corporations that it can neither regulate nor control. And the level of civic life in Pennsylvania has been greatly lowered by the log-rolling and favoritism that the possibilities of 'pull' have created. *35

In brief, the appropriations have grown because the party leaders have found in them a convenient means for securing the adherence of influential citizens and for coercing members of the legislature. Subventions are more effective for accomplishing these ends than are appropriations to state institutions, since no locality takes as much interest in a state hospital or orphanage as it does in one that is controlled, managed and supported, in part, by the leaders in town or city life.

Before the subventions could have been converted into a political tool, however, they must have been approved by a large portion of the voters within the state. It would be absurd to suppose that so large a proportion of the state funds as is now paid to privately managed charities could continue to be so disbursed if the voters of the state were opposed to the policy. A threat from the party leaders that the appropriations for institutions in his district will be reduced can be effective in coercing a legislator only if his constituents expect him to secure those appropriations. A fundamental reason for the existence, persistence, and growth of the subventions is the fact that the people of Pennsylvania demand them.

29 P.L. (1889), p. 345. This is a state institution.

30 Board of Public Charities, Preliminary Report (1913), p. 44.

31 Ibid.

32 Legislative Journal, p. 3661, col. 1.

33 Preliminary Report (1913), p. 77. Italics are the author's.

34 Legislative Journal, p. 4214.

35 Medical Education in the United States and Canada, p. 299. The entire context is given but the last sentence is the significant one for this discussion.

But this demand is not necessarily the product of a reasoned conclusion that the subvention system is the best that can be devised. It is more the result of local enterprise, local civic pride, and a strong competitive spirit. If one town in a county receives a subvention that enables it to maintain a first-class hospital, other towns of equal importance very naturally seek to establish hospitals by the same means. Moreover, the rivalry is not confined to cities. Charitable organizations, churches that control eleemosynary institutions, and even groups of physicians seek to obtain grants to build up hospitals, homes, and other institutions. Once a few subventions have been made, the demand is sure to grow as the unaided organizations perceive how much easier it is to secure funds from the legislature than from individual contributors.

That the hospitals and homes in many communities could not be maintained without state aid is conceded by practically everybody. That the work they do is mostly meritorious and generally undertaken by their trustees and stockholders for humanitarian pruposes and with the highest ideals is also conceded. Because these institutions are operated for such laudable purposes it is difficult for the people in the communities in which they are located to understand why the state should not aid them liberally. One who questions the wisdom of the grants is everywhere met with the reply that hospitals and orphanages are philanthropic enterprises, that their sole function is to relieve human suffering and to alleviate misfortune, and that no worthier object of public expenditure can be named. In this manner, expansion of the appropriations is usually justified alike by physicians, by trustees, and by the general public. *36

36 See statement by Dr. Horace G. McCormick, Advantages of the Pennsylvania System, Pennsylvania Medical Journal, Vol. XIII, pp. 265-267.