France-Continued

(27) Ministère de la Santé Publique et de la Population: Application de l'ordo nance du 2 Novembre 1945. No. 36. Paris (February 9, 1946).

(28) Ministère de la Santé Publique, Direction de l'Hygiène Sociale: Applicati de l'ordonnance du 2 Novembre 1945. Circulaire No. 148 (June 6, 1946 (29) Ministère du Travail et de la Sécurité Sociale, Direction Générale de Sécurité Sociale, Sème Bureau: Circulaire No. I. S. S., 1946. Paris (Jan ary 3, 1946).

(30)

(31)

(32)

(33)

(34)

L'Organisation de la sécurité sociale. Revue Françai du Travail, 1: 43–46 (April 1946).

-: Loi No. 46-1146 du 22 Mai 1946,, portant généralisatio de la sécurité sociale.

: Décret du 8 Juin 1946. Paris.

La généralisation de la sécurité sociale. Revue Fra çaise du Travail, 1: 230–232 (June 1946).

- Les tarifs médicaux en matière d'assurances sociale Revue Fraçaise du Travail, 1: 477-481 (August-September 1946). (35) Secrétariat d'Ftat à la Présidence du Conseil et à l'Information, Directio de la Documentation: Généralisation de la Sécurité Sociale et de la R traite des Vieux. Conférence de Presse de M. Ambroise Croizat, Ministr du Travail et de la Sécurité Sociale. Hors série No. 99 (May 2, 1946). (36) United States Department of Labor: Sickness and maternity insurance i France. oMnthly Labor Review, 46: 622-637 (March 1948).

Belgium

(37) Fuss, Henri: Social security in Belgium. Annals of the American Academ of Political and Social Science, 247: 117-124 (September 1946). (38) International Labour Office: Legislative Series 1944. Belgium 2, Legislativ Order: Social Security. Mercantile Printing, Ltd., Montreal (1945). Legislative Series 1945. Belgium 3, Legislative Orders Miners; Belgium 4, Orders: Sickness and Invalidity Insurance; Belgium 10 Order: Social Security (Seamen). Mercantile Printing, Ltd., Montreal (1946).

(39)

(40) Ministère du Travail et de la Prévoyance Sociale: Bulletin d'Information du Fonds National d'Assurance Maladie-Invalidité. Special No. March 25 and May 20, 1946. Brussels (1946).

(41) L'Institut National de Statistique: Bulletin de Statistique, 32: 649 (August 1946).

(42) Sand, René: Les effets de la guerre sur la santé de la population belge. Archives Belges de Médecine Sociale et d'Hygiène et Revue de Pathologie et de Physiologie du Travail, 4: 7-25 (March 1946).

:

(43)

Health problems. Annals of American Academy of Political and Social Science, 247: 92-97 (September 1946).

(44)

: Un Programme du la Santé pour la Belgique. Actualités

Sociales No. 12. J. LeBègue & Cie., Brussels (1945). (45) Special Committee (Canada) on Social Security: Health Insurance; Report of the Advisory Committee on Health Insurance Appointed by Order in Council P. C. 836 Dated February 5, 1942.

Sweden

(46) Act: Lag om folkpensionering (1946, nr. 431-433). Svensk Författningssamling.

(47) American-Swedish News Exchange, Inc. News from Sweden, Release No. 265. New York (January 2, 1946).

(48) Bill: Kungl. Maj:ts proposition nr. 312 till riksdagen med förslag till lag om allmän sjukförsäkring, m. m. given Stockholms slott den 27 September 1946.

(49) Broberg, Rolf: Huvuddragen av den nya folkpensioneringen. Folkpensioneringen, No. 6: 136-146 (1946).

(50) Hohman, Helen Fisher: Old Age in Sweden; A Program of Social Security. Federal Security Agency, Social Security Board. Washington (1940). (51) International Labour Office: Sweden 6. Legislative Series 1931.

Orders

and Notification: Sick Funds, Maternity Benefit. E. Birkhaeuser & Co., Basle.

Sweden-Continued

(52) Kungl. Medicinalstyrelsen: Allmän Hälso-och Sjukvård År 1943. Norstedt and Söner, Stockholm (1945).

(53) Kungl. Pensionsstyrelsen: Erkända Sjukkasor År 1943, gämte Specialutredning för Ar 1944. K. L. Beckman, Stockholm (1946).

(54) Royal Social Board: Social Work and Legislation in Sweden. Tryckeriaktiebolaget Tiden, Stockholm (1938).

(55) Statistiska Centralbyrån: Statistask för Sverige Trettiotredje Årgangen 1946. P. A. Norstedt and Söner, Stockholm (1946).

(56) Stockholms Erkända Centralsjukkasse: Taxa (fee schedule) 1946-47).

Denmark

(57) Aarhus Amts Middelstands Sygekasse: Vedtaegt for Sygeforsikringsforeningen. Aarhus (1946).

(58) Armstrong, Barbara: The Health Insurance Doctor. Princeton University Press, Princeton (1939).

(59) Centralforeningen af Sygekasser i Odense Amt: Overenskomst mellem Centralforeningerne af Sygekasser i Odense og Svendborg Amter og Fyns Stifts Laegekredsforening. Hagen & Sorensen, Odense (1934).

(60) Commissioner of Recognized Sickness Funds: The National Sickness, Invalidity and Funeral Insurance in Denmark. Copenhagen (1932). (61) Danish Foreign Office Journal: Social insurance and public assistance in Denmark. Reprint No. 221 (June 1939).

(62) Direktøratet for Sygekassevaesenet: Beretning fra Direktøren for Sygekassevaesenet i Aaret 1944. Krohn, Copenhagen (1946).

(63) International Labour Office: Denmark 4. Legislative Series 1937. E. Birkhaeuser & Co., Basle (1936).

(64)

: Denmark 5. Legislative Series 1940. Mercantile Painting. Ltd., Montreal (1940).

(65) Politikens Forlag: Facts about Denmark. Copenhagen (1946). (66) Socialt Tidsskrift: Social Denmark. A Survey of the Danish Social Legislation. Krohn, Copenhagen (1945).

(67) Svgekassen "Aarhus": Vedtaegt. Aarhus (1946).

(68) United States Department of Labor: Sickness insurance in Denmark. Monthly Labor Review, 46: 364–370 (February 1938).

(69) Wechselmann, Sigurd: The Danish National Insurance Act. J. N. Schultz, Ltd., Copenhagen (1936).

The Netherlands

(70) Jansen, G. (Managing Director, Netherlands State Insurance Bank): Talk on the organization of the health insurance system in the Netherlands. (Processed.) (71) Luikinga, A. J.: De Verplichte Ziekenfondsenverzekering. EconomischStatistische Berichten. July 10, 1946. Reprint, No. 1522.

(72) Rapport van de Commissie, ingesteld bij Beschikking van den Minister van Sociale Zaken van 26 Maart 1943 toekomstige ontwikkeling der

sociale verzekering in Nederland. 3 vols. and app. 'sGravenhage, Algemeene Landsdrukkerij (1945).

(73) Verslag over het jaar 1943 van den Geneeskundigen Hoofdinspecteur van de Volksgezondheid: Verslagen en Mededeelingen betreffende de Volksgezondheid (September 1946). Reprint.. (74) Verslag van den stand der Ziekteverzekering . . . door het bestuur der Riiksverzekeringsbank . . . 'sGravenhage, Algemeene Landsdrukkerij

(1946).

(75) Winkler Prins: Algemeene Encyclopaedie. N. V. Uitgevers Mij. "Elsevier," Amsterdam (1933).

(76) United States Department of Labor: Sickness insurance in the Netherlands. Monthly Labor Review, 45: 1945–1354 (December 1937).

(77) Verordeningenblad voor het bezette Nederlandsche Gebied, No. 160 (August 1. 1946), No. 201 (October 16, 1941); Ziekenfondsenbesluit.

Dr. DAVIS. I want now to come back to our own land and to conclude with some remarks about costs. The medical propaganda machine-I'm sorry to refer to it as such.

Senator SMITH. I'm sorry to have you refer to it in that manner, too.

Senator MURRAY. That's bad publicity to use in discussions of t problem.

Dr. DAVIS. The medical propaganda machine has tried to throw lot of scare into people about costs, particularly by talking as national health insurance payments would be a new tax out of people pockets. Actually, the majority of Americans are now spendi an average of 3 percent of their income annually for the physician and hospital services which would be available under the bill S. 132 The health-insurance payments of these people would be a substitu for, not an addition to, these present expenditures.

Let me call attention to two charts which have been clipped fro the May 1947 issue of Fortune magazine. I have a few copies o them and if you care to have them I will give them to you. Th charts I refer to are these two-the blue and the green. The a companying text clearly explains their significance, and the chart follow a long article in Fortune representing a general economi study of conditions, of which the medical part is merely a small frac tion. These are rather beautiful charts, and they present a graphi picture.

Senator MURRAY. Are you offering those charts for the record?

Dr. DAVIS. If it is feasible to reproduce those two charts and not the whole document, it would be advantageous to have them incorporated in the record so that they would be available to anyone reading it, although I have tried to word my testimony so that it is self-explanatory without the visual aid of the charts.

Senator SMITH. You mean the charts under the heading, "What they spend to stay alive"?

Dr. DAVIS. Yes, sir; those two charts.

The blue chart, which is the second one, shows the total percentage of family income. That is the chart with the blue bars on it. It shows the percentage of family income spent for medical care by American families of different levels. The lower the income, the higher the percentage. The higher the income, the less the percentage spent for medical care. This seems unfair, but unhappily it is true. In actual figures the families with incomes under $1.000 a year—and they constituted about 20 percent of the people in 1945-spent from 5 percent to 8 percent of their income for medical care. The big middle-income group, which constituted about 70 percent of the population in the same year, spend about 4 percent of their income for medical care. Medical care here means all forms of medical care, including dentistry, as well as drugs, hospitals, and physician's care. The top 10 percent of the people spend only 2 to 3 percent for care.

Now the charges levied under the national health insurance bill would be a percentage of earnings, 3 percent, in fact, calculated up to earnings of $3,600 a year. This 3 percent would be paid in full by selfemployed persons, or 12 percent by employed persons for whom the employer pays the other half. Even the low-income people who paid 3 percent would be better off than they are now, and the middle group would be paying about the same, even if they paid the whole 3 percent. Senator MURRAY. Do you want to offer these charts for the record at this time?

Dr. DAVIS. Yes; I think it would be a good idea to have them in the record.

(The charts referred to follow :)

Medical expenditures in relation to family income...

0-5 5-1 1-1.5 1.5-2 2-2.5 2.5-3 3-4 4-5 5-7.5 7.5-10 10+ INCOME IN THOUSANDS OF DOLLARS

... And as a percentage of total family income

7

INCOME IN THOUSANDS OF DOLLARS

Dr. DAVIS. Contrast this situation with the voluntary insuran plans which always charge a flat rate, not varied with income. T charges of the medical society plans and their affiliated hospitalizatio plans that means many of them are affiliated with the Blue Cro plan-run from $50 to $60 per year per family, and these plans usual cover only care in hospitalized illness, which average only about ha the total costs of medical care to a family.

A $1,000-a-year family which joined one of these plans would ha to double its average yearly expenses for medical care. A $2,000-. year family would have to add 50 percent to its medical expenditur if it joined. Half of the our population earns less than $2,000 a yea even in this time of full employment.

Instead of these voluntary plans being cheap, they are expensiv I would like to add there that I mean expensive in relation to the pay ing power of a considerable part of our population. They are so e pensive in proportion to the incomes and spending habits of man people that their sponsors now want Government subsidy for then The Taft-Smith-Ball-Donnell bill makes a pass at offering a subsidy By "making a pass" is explained in the language that follows. Bi look at these charts and think about these figures. You will then com to the conclusion that the subsidies would have to mount up to some thing like $2,000,000,000 a year before most of the American peopl would be served; that is, this would be the case if Americans woul accept the charity label which this bill would plaster on their faces and if the difficult administrative problems of running such subsidie could be worked out.

In fact, S. 545 is essentially a bill starting a system of State medi cine, the cost of which would fall mostly on the income-tax payers o this country, and therefore especially on the high-income-tax payers The national health insurance bill, S. 1320, by contrast, would enable the mass of the people to pay according to their ability into the national health fund, and the supplementary amounts required from general taxation would be relatively small.

All voluntary plans are not expensive. There are plans controlled by the people who pay the bills, in cooperation with an organized staff of doctors, which offer comprehensive medical and hospital serv-. ices at much lower cost. Some of these plans provide complete medical services at a cost of $20 to $25 per capita, or $60 to $80 per family per year. That is complete medical service. The reason is that they have an efficient form of professional organization-that is, group practice-and a form of administrative organization which gives incentive to disease prevention and to financial economy.

These plans are precisely the type which organized medicine has most strongly opposed. This type of plan might be wiped out by the medically controlled administrations which S. 545 would set up and by this bill's failure to include any antimonopoly provisions. Certainly further development of this type of plan would be stopped by S. 545. Under S. 1320, on the other hand, existing plans of this type would be protected and new ones could be started by either laymen or physicians, or by a body including both.

That concludes my testimony. The remainder of my statement is merely a summary of the points. I don't think you want me to read those into the record. They are already in the record as part of my complete statement, and there is no point in taking up your time.