of the Nation's largest minority, the Negro people should be of particular cern to the entire country, be it therefore "Resolved, That we strongly urge the passage of "The National Health Ins ance and Public Health Act of 1947,' S. 1320, without discrimination as to ra creed, or color." We respectfully urge its inclusion in the record of the Senate Subcommittee Health. We wish to express our sincere appreciation for your efforts in behalf of 1 islation which will insure greater health benefits for all of the people of Nation. Respectfully yours, ALMA VESSELS, R. N., Executive Secretary Hon. H. ALEXANDER SMITH, AMERICAN MEDICAL ASSOCIATION, United States Senate Building, Washington, D. C. DEAR SENATOR SMITH: It has come to my attention that a letter from Thurm Arnold, Esq., to Dr. Channing Frothingham, chairman, Committee for the N tion's Health, Inc., 1790 Broadway, New York 19, N. Y., dated July 2, 1947, h been introduced as part of the record of the hearings on S. 545 now being he before the Subcommittee on Health of the Senate Committee on Labor and Publ Welfare. That letter undertakes to call into question the good faith of t American Medical Association in its efforts to promote the health of the peop of the United States. I respectfully request that this communication also made a part of the record. The American Medical Association, now 100 years old, was organized “to pr mote the science and art of medicine and the betterment of public health." has endeavored to do so to the best of its ability by stimulating progress medical education, by efforts to assure the purity and potency of medicin preparations and the therapeutic value of apparatus, by exposing quack remedie and charlatans, by promoting rational medical research and by many othe methods, including fostering the development of prepaid voluntary medical car plans. The intimation, implicit in Mr. Arnold's letter, that in those efforts the associ tion, or any of its constituent or component units, have been motivated by a selfis or improper interest or that they have not had as an impelling objective the bet terment of the health of the people, stems either from a lack of obtainable know! edge or from a disregard of knowledge actually possessed. Mr. Arnold is quite correct that the council on medical service of the associa tion has established “standards of acceptance for medical care plans" and tha it has granted its seal of approval to a number of such plans sponsored by medica societies that have met the standards so established. Plans developed by othe groups must meet the standards established by the council if they are to receiv its seal of approval and a study of such other plans is now under way. As to whether or not the enactment of S. 545 would tend to “increase the powers and the monopolistic control of organized medicine," which Mr. Arnold asserts it would do, the association has sufficient confidence in the integrity d the sponsors of the bill and in their sincere desire to promote the public welk being to be convinced that no such result is intended nor will any such result ensue if the bill is enacted. Mr. Arnold is simply seeing implications in the bill not warranted by its provisions, Sincerely yours, GEORGE F. LULL. Senator DONNELL. With the Senator's consent, at this point, while this citation is already in the record. I think it will be well, for convenient reference, to again insert it, with reference to the case to which Mr. Arnold refers, namely, the American Medical Association v. the United States, being (317 U. S. 319). Senator PEPPER. Yes; I think we should have it. I ask to insert in the record an article entitled, "Health Means Plans and Dollars" with he subtitle "We must find a way to meet our challenging national medical problem," in the April 1947 issue of Kiplinger's Magazine. That is put out by the well-known author of the Kiplinger letter. That contains some very interesting material on this subject, among thich is: This country had higher infant death rates than seven other countries, higher ancer, heart, nervous, and mental disease rates. The average life expectancy t birth was higher in four countries; at 20 years it was higher in each country; tage 40 in 11; and at age 60 in 12. And so on. Senator SMITH. Are you offering this entire document, this magaine? Senator PEPPER. I will offer it for the record, just a couple of pages. Senator SMITH. Very well. (The article Health Means Plans and Dollars follows:) HEALTH MEANS PLANS AND DOLLARS-WE MUST FIND A WAY TO MEET OUR CHALLENGING NATIONAL MEDICAL PROBLEM. United States medicine, which has devised brilliant treatments for many of our ls, is having a hard time prescribing for its most acute problem-how to make medical services available for all who need them. There is wide agreement on the diagnosis-our medical facilities are badly rganized and too expensive for most people. There is no general agreement on he right treatment, despite the universal interest in working out some solution. We are all potential consumers of medical services, and we are all affected by the ealth of our community. And our overburdened doctors need relief from a ystem under which they can't take care of all the sick, even with charity reatments. Although the Nation's health cannot be put on a dollars-and-cents basis, employrs should be concerned with the terrific inroads, largely preventable, which illess makes on production. Before the war between four and five hundred million work-days were lost annually from sickness-about 40 times the number lost hrough strikes. The loss of consumption power may be even greater. Here is what's wrong in the judgment of the American Medical Association, ndividual doctors, lay experts, and Government officials: The traditional fee system of payment for medical services is too costly. Most eople can afford emergency pills and treatment, but not preventive medicine or rolonged, catastrophic illness. Some estimates say that about 20 percent of the opulation can't pay even for minimum medical needs. There are not enough doctors, especially in rural regions, slums, and small comunities. Many doctors are underpaid. Few have time to keep up with evelopments. Hospitals and other facilities are too few, poorly distributed, often antiquated. Medical research is haphazard. We spend a hundred dollars for research on fantile paralysis, which afflicts relatively few, for every 25 cents spent on mental isease, which afflicts millions and fills more than half the Nation's hospital beds. Many people, particularly if they have no trouble meeting their own medical bills nd deal exclusively with comfortably established city physicians, find it hard to ccept so sweeping a diagnosis. But the clinical facts are disturbing. According to the AMA in 1940, most individuals and families with incomes nder $3,000 needed help in meeting medical bills. That amounted to well over 5 percent of the population. People who borrow from small-loan companies need he money most often to pay medical bills. For many an ailing individual the high cost of sickness poses the question of ow much medical attention he can do without, and for how long. The grim conequences of such enforced self-denial showed up in prewar medical statistics, which brutally dispose of the notion that the United States is the healthiest ation on earth. This country had higher infant death rates than seven other countries; higher ancer, heart, nervous, and mental disease rates. The average life expectancy at birth was higher in 4 countries; at 20 years it was higher in 8 countries; at age 0 in 11; and at age 60 in 12. The subsequent revelation that about 40 percent of young Americans were unfit for military service for medical reasons has hush our big talk about national health standards. It's not primarily the doctor's fault that protracted illness and preventi medicine are so expensive, although it is a fact that organized medicine, throu the American Medical Association, has demonstrated a minimum of social awar ness in facing the mounting medical crisis. But the individual practitioner usually is too busy with his never-ending respa sibilities to think about broader medical issues. He carries an appalling loạ In most cases the family doctor has fully earned the respect and affecti which millions of Americans have for him. He has a habit of quietly scaling dow bills for needy patients and carrying a load of charity cases without talkil about it. So many doctors have concentrated in the cities that demands on country at small-town doctors are proportionately higher. These small community doerą are often the ones with poorest facilities, largest practices, and lowest incomes The main effort to bridge the economic gap between patient and doctor has be through voluntary group insurance plans as a substitute for the fee system pay ment. During the last two decades many Americans have got partial coveraį against sickness through one of these plans. But they have three fatal defects: They don't offer adequate coverage: the have proved too expensive for lower-income groups; and they don't includ enough people. Like most commercial health insurance policies, group insurance plans tend restrict services and to neglect thorough treatment. Some group plans provid only hospitalization for limited periods, but over half our medical bills are fo treatment given outside of hospitals. Less than 5.4 percent of the populatio has insurance for physicians' services, and about 2.5 percent have complete hom office, and hospital coverage. Only 1 American out of 4 has any kind of healt insurance at all. Many of people who have had experience administering group health plans sa that these are only a necessary stopgap in the absence of a national health plan There are signs that the tide is setting in the direction of such a national pr gram as a logical extension of social security. Opinion polls show a majority if favor of pay-roll deductions to provide national health insurance. And in th last Congress Republicans and Democrats joined to provide Federal funds for th construction of more hospitals and clinics, and for treatment and research i mental health and other fields. Congress hasn't acted on the problem of providing medical services for thos who can't afford them. But it may do so during the present session. Senator Robert A. Taft (Republican), Ohio, has revised his health bill, and reintroduced it, with the support of the AMA. Given the Senator's influence and the Repub lican desire to win votes from those who would benefit by the measure's provisions chances for this bill look pretty good. Its main provisions: Coordination of civilian Federal health functions in a new Federal health agency. Appropriation of $200,000,000 yearly to assist States in providing medical care and hospital services for individuals and families unable to pay for them Cash contributions by States at least equal to the sum advanced from the Federal Treasury. Approval of State programs by the Surgeon General, with appeal to national health council in event of disagreement. Enactment of the bill, according to its proponents, would probably make some basic medical services available to the poorest 20 to 25 percent of the population; opponents say only 10 percent. Critics of the bill object strongly to a provision that applicants would have to prove their inability to pay. Too many States require a means test as proof of this inability to pay. This is a throw-back from the concept of social security to that of public charity. It seems needlessly humiliating, say the critics,' that sick people should have either to exhaust their savings or stigmatize themselves as paupers to obtain emergency medical care. The Taft bill also minimizes basic public interest in good health for everyone We do not maintain schools only for those who are too poor to go to private schools, nor libraries for those who are too poor to buy books. Why offer medical care to the indigent, and exclude middle-income families for whom, als medical services are too expensive? Another criticism is that the Taft bill, by providing only emergency relief forestalls any attempt to combat disease on a Nation-wide scale. Some doctors hink tuberculosis could be wiped out in the United States within a generation, philis within a shorter time. But this could be done only through a Nationide campaign, with services readily available to everybody. One major political force interested in going beyond the provisions of the Taft I is United States labor. With hopes of big wage boosts collapsing, union negoators are now going down the line for fuller health coverage as well as cash enefits paid for by employers. Management will be hard put to refuse this emand altogether. In the next few years an estimated 8,000,000 workers are likely to get new or treused health protection as a result. Senator Taft's prescription, limited coverage for bottom-income groups, differs f course from the unions' proposal-full coverage for all union labor. But by ne of the ironies of politics, both efforts may have the same long-run effect. Once you provide basic medical care for 35,000,000 citizens under the Taft bill nd for additional millions of industrial workers under union contracts, the bjection to going the whole hog diminishes. The cost would be much cheaper it were spread over the whole population. And coverage would be more comlete. The financial and administrative burden of health and welfare clauses ould be taken off private enterprises and placed on official agencies. One proposal for such a program has been embodied in the administrationponsored Wagner-Murray-Dingell bill. It is expected to be financed by a 3 ercent pay-roll levy divided between employees and employers, plus a general ppropriation for research and training. Payments from this fund would be entrusted for disbursement to the Surgeon eneral, who would also set standards. But day-to-day administration would è left to States, local communities, and existing medical groups. Doctors would ontinue, if they preferred, to practice on the present fee system, with payments de to them out of the insurance fund. Doctors who wished to practice on a all or partial salary basis could do so. Those who wished to remain completely utside the system would be free to do so. Patients could go to any general practitioner in the system. The doctor also ould be free to accept or reject patients. It's worth nothing that the British Medical Association once fought a national ealth system based on compulsory health insurance just as stubbornly as the MA does now. After a Conservative government set one up anyway, the ritish Medical Association swung to support. One reason: doctors' incomes went up. Like a number of distinguished medical men, some United States business aders have come to regard a national health program as a desirable extension f our present social-security laws. Executives like Charles Luckman, president f Lever Bros.: Gerard Swope, president of General Electric; and David Sarnoff, RCA, feel this way. Total cost of a national health program has been set at $4,000,000,000 yearly. hat's about what we pay now, in doctors' bills, taxation for public health serve, etc., for such medical care as we get. Socially and economically, it would em sensible to organize medical services for faster progress toward the goal f medical science, which is not just care in sickness, but positive health for the dividual and for the entire community. Senator PEPPER. Mr. Hansen, you do feel then, that the organizaon of this Cooperative Health Federation of America for which you peak, and the sentiments that you have here expressed by the rural eople and people who might be considered of average intelligence oes represent a growing demand on the part of the American people hat there may be some plan worked out by which adequate medical are, including all phases of medical care, may be made available and ccessible to the whole American people? Mr. HANSEN. There is no question about it. Senator SMITH. Members of the committee, before we recess, and n order to emphasize the point, which I think we are very much intersted in, that we are not discussing partisan matters now, because the o-called Taft bill, S. 545, and the so-called Wagner-Murray bill that Senator Murray introduced here, S. 1320, and Senator Murray is Democrat and Senator Taft a Republican, but I can state there ar differences of opinion in my own Republican Party on the question concerned, and I know there are in the Democratic Party, but I hav here given to me by a friend of mine a copy of a letter from Dr. R. I Robins, Camden, Ark., which he suggested that I insert in the recor to show his view at least. This letter is addressed to Mr. Gae Sullivan, executive director of the Democratic National Committe Dr. Robins is a member of the Democratic National Committee, th national committeeman from Arkansas, and he writes under date o July 2, 1947: DEAR MR. SULLIVAN I have your bulletin of June 21, 1947, in which you continue to urge the ide of compulsory health-insurance legislation. To me and the people in my sectio of the country, this is a very repulsive project of the Democratic Party. It is very well known that this is the brain-child of such radical social reformer as Michael Davis and Isidore Falk, who would like to see our democratic systeń transformed into a totalitarian system. It seems to me that it is high time for the Democratic Party to stop pushin the philosophy of bureaucracy in our country. The present program seems have as its ultimate object the destruction of the principal of self-reliance of th American citizen and making him more and more dependent upon the centra Government. This leads to the loss of freedom as it has in all of the nation which have tried it. The tax gatherer this year will take more than one-fourth of our nationa income. Yet, our party continues to try to push programs that will increas this. The national health program which you are advocating is a compulsory program. There is no choice. It would build one of the greatest bureaus in the history of the world-a multi-billion-dollar bureaucracy. I would like to see the Democratic Party get away from the philosophy d Government paternalism and get back to the basic principles that made this Nation great. I am looking forward to seeing you next Wednesday. Sincerely yours, R. B. ROBINS, M. D., National Committeeman. Senator SMITH. I am merely offering this because of the suggestion sometimes made that all the criticism of this approach comes from the Republican Party, and I just want it to appear that there is a difference of opinion among Democrats as well as Republicans, and this evidence is from a member of the Democratic National Committee, addressed to the executive director of the Democratic National Committee by Dr. R. B. Robins, Democratic national committeeman for Arkansas, Camden, Ark. So it appears that we are approaching the subject, I might say, from a bipartisan standpoint, and we are trying to solve the problem, and we have different points of view in both parties. Senator PEPPER. I guess we will probably find that a lot of Democratic doctors are against S. 1320 and a lot of Republican workers and farmers are for it. Senator SMITH. Mr. Hansen, we appreciate very much your coming and thank you again for the fair way in which you have presented the matter. Mr. HANSEN. I appreciate the attention, the courtesy, and good humor of the committee. Senator SMITH. I understand that Mr. Joseph Louchheim and Michael Davis, who were to be here today, will be here tomorrow morning. |