Senator DONNELL. Has there been a poll taken of those members? Mr. CAREY. Yes, sir.

Senator DONNELL. When was that poll taken?

Mr. CAREY. The poll was conducted in the orderly processes of our organization. I mention in my testimony, in the national convention of the CIO, and the national convention of the affiliated organizations and the State organizations and in the committee organizations and in the local union bodies and in the district council; I am trying to anticipate your question as to whether or not we sent out post cards. My answer is "No."

Senator DONNELL. In other words, there has been no poll of each of the individual 6,338,000 members of your union as to their opinion on S. 1320? That is correct, is it not?

Mr. CAREY. In our processes we consider that is the way of telling their opinion, by having it from the local union.

Senator DONNELL. I might just ask you again: Has there been anything sent directly to each of the 6,338,000 people?

Mr. CAREY. No, sir.

Senator DONNELL. That is all.

Senator SMITH. I might remind the subcommittee that this witness would like to get a certain plane, at what time?

Mr. CAREY. At 1:40.

Senator MURRAY. I would like to ask just a few questions.

Mr. CAREY. I will be delighted to return at some other time, at the need of the committee.

Senator MURRAY. We appreciate that but I hope it will not be necessary to bring you back here again.

ou feel that if this bill is put into operation there will be eventually a great improvement in the health of the American people?

Mr. CAREY. Yes, sir.

Senator MURRAY. And that, in turn, would tend to decrease the cost of the operation of the plan?

Mr. CAREY. Yes, sir.

Senator MURRAY. It would result also in a great increase in the members of the medical profession?

Mr. CAREY. It would result in an increase.

Senator MURRAY. And in nurses. So that, as a result of the combined operation of the bill, the health of the Nation would be greatly advanced, and thereby the cost of the complete operation of the bill would be greatly reduced?

Mr. CAREY. May I add on the other side, there would be a tremendous saving in what can now be considered a wasteful method of operation, measured in terms of loss of production by illness and other things.

Senator MURRAY. I put into the record here, the other day, statistics showing the great losses that this country suffers as a result of ill health. Industry, for instance, annually loses many millions of dollars as the result of ill health of its workers. Improvement in that connection would be a great advantage to business and industry in this country?

Mr. CAREY. Yes; it would.

Senator MURRAY. There being great need for a program of this kind, you feel that the working out of the provisions of the bill is

something for experts to do, not for the witnesses that come here to tell us about the actual conditions in the country with reference to the need? For instance we have had heretofore people come from way out in the agricultural sections of the Nation to tell us about the failure properly to distribute medical care in those sections of the country. The same kind of witnesses have come here from the South. You do not feel that those witnesses should be the ones to lay out a blueprint for the American people? That is something that should be done by the Congress when the problem is laid before the Congress? It is the duty of Congress to work out a bill here that will accomplish the purposes that the people of this country demand?

Mr. CAREY. Correct.

Senator MURRAY. And that is all we are trying to do here. But we have had other witnesses testifying on this line for instance, we had Dr. Parran here yesterday and he explained in some detail how this bill would be put into operation, how the different steps would be staggered so that we would finally get into complete, harmonious operation, and that is a problem, as I say, for experts. But you came here to tell us about the need from the standpoint of American workers, and you feel that the American workers are a unit on this proposition that we need some compulsion system of financing medical care in this country?

Mr. CAREY. And I say not only the workers, but I may say I have seven sisters and three brothers, all of them married, living in Senator Smith's State, and they too, as well as the members of the CIO, and their dependents as well, feel that way about it.

Senator MURRAY. S. 545 has been talked about here. It provides an appropriation of $200,000,000, to be duplicated by the States. If that sum of $200,000,000 was fully duplicated by the States, it would not go very far in meeting the needs of the country, would it?

Mr. CAREY. No, sir; and it would not be immediate. There would be some delay in the terms of the application.

Senator MURRAY. In order to get the care that that bill would undertake to provide, a person would have to sign an affidavit, or submit proof he was a pauper or was unable to pay for some reason or another? Mr. CAREY. That is as I read the bill. That is my understanding. Senator SMITH. It is not quite that. That is not provided in the bill.

Senator MURRAY. I am glad to be corrected. The bill provides that the people who are not able to pay

Mr. CAREY. In whole or in part.

Senator SMITH. You have got the two questions presented: Whether you are going to have an over-all coverage under which everybody gets free medical care, even without paying the tax, or whether to let those pay that can pay and take care of the other people that cannot. That is another approach.

Senator MURRAY. Under S. 545 the people that get medical care do not have to pay anything. It is completely a Government program. Senator SMITH. No; they have to pay-it provides that they pay part or all.

Mr. CAREY. NO; they would pay for it, but not directly.

Senator MURRAY. Well, if that bill were carried fully into effect and expanded and we should undertake to have it applied to the

country as a whole, to meet the entire problem in this country, we then would have a system of really socialized medicine, would we not? Senator DONNELL. You are not in favor of socialized medicine, I take it, Senator?

Senator MURRAY. I do not care what kind of medicine you call it. We should have medical care for all.

Mr. CAREY. I am going to answer that by stating I would not know. Senator MURRAY. You would not know what the effect of that bill would be?

Well, anyway, you think that S. 1320 more adequately meets the needs of the country than S. 545?

Mr. CAREY. Yes, sir. That is why we are so wholeheartedly in support of S. 1320.

Senator PEPPER. I am aware of your time limitation, Mr. Carey. and I am just going to ask you this: As I see it, the core of S. 1320 is simply to provide a method by which the masses of the people of this country can pay for the medical care that they need. Now, the doctors, except in the sense that they also are taxpayers are not going to be the great payers of these fees that this law will require, because there are only a couple of hundred thousand doctors in the country, but what impresses me is that Mr. Cruikshank came here, appearing for 72 million members of the A. F. of L., of the working people of this country, and you come here appearing for over 6,000,000 working people of this country. They are the ones that will be getting wages on the pay rolls of the country. They are the ones who will have to pay the tax, and you come here to say that "we, who are the ones that will bear the burden of the tax, want to pay the tax because it is the way we can budget our medical care," and you say that "the doctors, who will get the money that we pay in, have no right to block us before the American Congress from the the right to pay the taxes that will give us a way to meet the budget to pay the medical needs of the family."

Is that not about the gist of it?

Mr. CAREY. That is correct. I do not say that that is the position that will always be held by the doctors, the position of opposition. I would say that that is changing. Certainly it is not changing rapidly enough to cause the medical profession today to understand the provisions of Senate bill 1320 sufficiently to be here testifying as the champions in support of it. I do not look upon it as anything in the form of WPA for the medical profession, but I think there is a moral obligation on their part to support this bill.

Senator PEPPER. One other thing. Not only is it true that, you are going to have to pay your part of the tax as workers, but it contemplates a tax on the employer, which will add to the cost of the goods, and the workers will have to pay or bear their share of that. too. So that the principal burden of these taxes that S. 1320 contemplates will be on the working people of the country, yet you are the ones who are here asking that you be permitted to pay those taxes. Mr. CAREY. That is correct.

Senator DONNELL. The Senator does not at all contend that the pay-roll taxes will pay the whole expense of it?

Senator MURRAY. Every technician who has appeared here has certainly indicated that it would pay the majority of it.

Senator DONNELL. I say, though, the Senator does not contend that the pay-roll taxes will pay all the expenses.

Senator MURRAY. No, we do not know how much this may have to be, and we frankly confess that there may have to be an appropriation to supplement it. But that will have to be worked out in Congress, as to whether we want to raise the tax or whether we want to resort more to your method of subsidizing out of the Federal Treasury.

Senator DONNELL. That would be payment out of the Federal Treasury.

Senator MURRAY. But the principal approach to the payment of these services is through the pay-roll tax from the employer. Mr. CAREY. Yes, sir.

Senator SMITH. Thank you, Mr. Carey. We appreciate very much your coming here to testify this morning.

Senator MURRAY. I assume Mr. Potofsky's statement will be included in the record?

Senator SMITH. Mr. Potofsky's statement will be put in following Mr. Carey's testimony. Now, we will recess until 2: 30 this afternoon. (Mr. Potofsky's brief is as follows:)

STATEMENT OF JACOB S. POTOFSKY, GENERAL PRESIDENT OF THE AMALGAMATED CLOTHING WORKERS OF AMERICA AND MEMBER OF THE EXECUTIVE BOARD OF THE CONGRESS OF INDUSTRIAL ORGANIZATIONS, ON BEHALF OF THE CONGRESS OF INDUSTRIAL ORGANIZATIONS IN SUPPORT OF THE NATIONAL HEALTH INSURANCE AND PUBLIC HEALTH ACT OF 1947

I am here today to speak not only for the 325,000 members of the Amalgamated Clothing Workers of America, of which I am the general president, but also for the more than 6,000,000 members of the Congress of Industrial Organizations. The Amalgamated Clothing Workers of America is a union which was born in the sweatshops. Its members have for more than 30 years been actively improving their working and living conditions. As long ago as 1923, the Amalgamated instituted an insurance program which has since developed into an extensive system of benefits providing its members with substantial protection.

As part of the Congress of Industrial Organizations we have been in the forefront of the campaign for higher minimum wages and shorter hours and for old age, health, and other social insurance not only for our own members but for all the.American people. We have done this because we believe that the problems of economic and social security are not divisible and must be met on a national level.

The opportunity to enjoy good health and protection from the economic effects of illness is a cornerstone of the basic American rights of freedom from fear and freedom from want. The health and well-being of the people are essential to maintenance of a high level of production and full contribution to the Nation's economy.

The poor state of the Nation's health was made shockingly apparent by our wartime experience. At a time when the national defense required the greatest utilization of our manpower, the Selective Service System found a very high proportion of our young men unfit for military service. Almost 5,000,000 young men between the ages of 18 and 37–30 percent of all those examined—had been rejected for miiltary service by April 1945. Yet, despite this "weeding out," an additional 3,000,000 were discharged or treated for disabilities which had existed before their induction. These figures were tragically significant for our military mobilization. I mention them now because they are no less indicative of the inability of the American people to meet the demands of normal, peacetime living.

What are the facts about our Nation's health today? Our experts tell us that 1 out of every 20 are disabled by sickness on any average day. And these 7,000,000 who are incapacitated are by no means all suffering from minor or temporary ailments. More than half have been sick for 6 months or longer. These figures represent pain and personal suffering. And they also represent a great loss to

our productive capacity. At least half of the 7,000,000 disabled on an average day are in the labor force and would ordinarily be employed or looking for work. Illness or accident was responsible for the loss of 500,000,000 workdays or abou: 3 or 4 billion dollars in wages during 1942, when our need for war production was critical.

The simple truth is that our country's health facilities are insufficient and that those most in need of medical care are least able to afford it. Compared with other countries, our medical standards are high. But those health and medica' resources which we have are so unevenly distributed that the areas and groups in greatest need have the least service. In spite of the tremendous strides made recently by our public health and maternal and child care programs, there are still 40,000,000 Americans living in communities without full time, local publis health services. When one realizes that it would take more than 100 years to cover the whole Nation with public-health services on the present basis, the hopelessness of attempting to provide satisfactory health services without a comprehensive national health program becomes brutally clear.

Present insufficiencies of service are at least equalled by the financial inability of those families most urgently needing medical care. Illness most often strikes those least able to afford it. The medical histories of low-income families are records of premature death and longer and more frequent illness. Yet, although low-income families have greater medical needs than those with higher incomes. they actually receive far less medical attention.

Facts on our insufficient, badly distributed, and poorly organized health facil:ties and on the inability of large sections of the American people to pay for evet a minimum of medical care have been testified to in detail by medical and publichealth experts. I shall not linger over them. We believe that the Nationa Government should act to improve the situation just as it has moved ahead to help build roads, improve forestry practices, help the farmers raise healthy animals, and in many other ways develop the Nation's resources. Surely, our people are our greatest resource.

Before the war, about $4,000,000,000 a year was spent for medical care. Three-fourths of this was spent by patients and their families; one-fifth by Federal, State, and local governments; and the rest by industry and philanthropy. The costs of medical care can be fairly well predicted for large groups, and the distribution of risks and costs can, therefore, be spread to provide medical care for those least able to pay for it themselves. There is nothing new about this idea. Our educational system is based on the same principle.

To a certain extent, various insurance plans have been attempting to do this for years. The insurance program of the Amalgamated Clothing Workers of America had its origin in the establishment of an unemployment insurance fund in Chicago in 1923. After the enactment of the Social Security Act in 1935, it was converted, by agreement with the employers, into a life and health insurance plan which went into effect in 1940. The Amalgamated, which had pioneered in the field of unemployment compensation, then embarked on a program to protect its members against the financial burdens of death and disability. At the present time, almost 300,000 of the 325,000 members of the Amalgamated are entitled to benefits. These include death, accident, illness, maternity, and hospitalization benefits. And-parenthetically-I should like to remark that men's clothing workers receive, in addition, retirement benefits. That this insurance is answering a long-needed want on the part of our own members is best shown by the fact that up to March 1946, in almost half the deaths, the Amalgamated policy was the only insurance left by the member.

But, industry-supported plans cover relatively few workers. More extensive in coverage, although still not meeting actual needs, are the voluntary insurance plans, such as the Blue Cross plans. These now cover about 13,000,000 peopleless than one-tenth of the entire population. But, although the success of these plans demonstrates the possibility of insuring middle-income families against hospital expenses, their costs are so high that they cannot be extended to the low-income families most in need. And, although these plans help make existing facilities available to those who can meet the costs, they do not touch upon the vital fields of medical care other than hospital care. Even our own Amalgamated insurance program does not provide medical service as such, but helps defray the expenses of such care, and then only partially.

The essentials of a good national health program are simple to formulate. The cardinal purpose of such a program is, above all, to place satisfactory medical and hospital care within the reach of all the people. More hospitals and more doctors must be available to those groups and in those areas of the country