st what program are you referring to in that sentence? Mr. LOUCHHEIM. The program that supports national health inrance. You will find that very clearly stated on page 2:

It supports a national health program consisting of national health insurance d Federal aid to States for public health, maternal and child services, medical earch and education, medical care for the indigent, and construction of hosals and health centers. It opposes medical charity for the self-supporting, and strictive laws preventing consumers, farmers, workers, and others from organizhealth insurance plans—

d so forth.

Senator DONNELL. That is the balance of that page?

Mr. LOUCHHEIM. That's right, sir. In other words, in order to beme a member, a person must not only support the program but must so make a contribution, either large or small.

Senator DONNELL. That is, you do not accept anybody as a member your committee unless he first indicates adherence to these prinples which you have set forth; is that correct? Mr. LOUCHHEIM. That is correct, sir.

Senator DONNELL. All right.
Senator SMITH. Is that all?

Mr. LOUCHHEIM. Yes, sir.

Senator SMITH. Dr. Michael M. Davis.

Senator DONNELL. Mr. Chairman, at this point I would like to resent for the record, with the request that it be incorporated and ›t out in full, a resolution on S. 1320 presented to the house of deleates of the Association of American Physicians and Surgeons and nanimously adopted by the delegates at their meeting in Chicago, une 28, 1947.

Senator SMITH. If there is no objection, it will be copied into the ecord.

(The matter referred to is as follows:)

Whereas a new version of the Wagner-Murray-Dingell bill was introduced into ongress on May 20, 1947; and

Whereas this legislation proposes compulsory sickness insurance for all emloyed persons; and

Whereas enactment of the legislation would tend to regiment all patients and hysicians and thus foster governmental paternalism with its degrading and weakening influences; and

Whereas the proposed law gives no assurance of greater quantity of medical are, since it is reasonable to presume that most doctors would not participate n such a scheme, because to do so would be contrary to the public interest; and Whereas the bill would lower the quality of medical care; decrease the quality and caliber of persons attracted into medicine; and hamper medical advances; and

Whereas the measure proposes to create a vast administrative political bureaucracy and place control of the Nation's health activities in the Federal Security Administration, which is neither qualified with professional personnel nor experience to administer medical care but whose past record is characterized by blundering ineptitude, waste, and unauthorized propaganda; and

Whereas enactment of the Wagner-Murray-Dingell bill would increase very substantially the costs of medical care and thus add greatly to the enormous ax burden already carried by American taxpayers; and

Whereas the bill would remove the patient's right to choose his own doctor, since all doctors would not enter into the scheme and thus eliminate the important, intimate, and confidential personal relationships existing between patients and physicians; and

Whereas no real need has ever been shown for a system of compulsory sickness insurance which would force all persons into the scheme whether or not they desired to participate; and

Whereas voluntary sickness-insurance plans are rapidly gaining increasi acceptance by both physicians and potential patients and if extended and giv either State or Federal financial aid and encouragement for persons of income, where needed and properly and safely administered, will soon adequate meet the medical care needs of the Nation; and

Whereas the extension of any form of governmental compulsion into the sonal affairs of the people is not in the American tradition and decidedly agait the public interest; and

Whereas the AAPS is dedicated by the provisions of its organization to preser and extend for all the people of America the superb record of medical care in United States and to countenance only those changes which are in the pub interest: Therefore be it

Resolved, That the house of delegates of the Association of American P sicians and Surgeons at its interim meeting held in Chicago, Ill., June 27 and 2 1947, go on record as strongly disapproving the Wagner-Murray-Dingell bill an copies of this resolution be sent to members of the Senate Committee on Labṛ. and Public Welfare, now holding hearings on the bill; and officers of the associ tion be instructed to oppose vigorously the legislation by enlightening Member of Congress and the American public of the bill's many objectionable provision HOUSE OF DELEGATES OF THE ASSOCIATION

OF AMERICAN PHYSICIANS AND SURGEONS, H. W. DETRICK, M. D., Speaker.

Dr. DAVIS. Mr. Chairman and Senators, Mr. Louchheim has re quested that the testimony which I have prepared and is now in you hands in the form of mimeographed copies, in accordance with the regulations, be copied into the record, instead of my reading it inte the record, in the interest of saving time. I presume you have had an opportunity to study it, and I will summarize it and comment on it in order to expedite matters, if that is agreeable to you. Will it be satis factory for me to proceed in that way?

Senator SMITH. I have no objection, Dr. Davis, but I have not had time to read it yet. I had another committee meeting, so I didn't have time to read your statement. Is there any objection to proceeding in that manner?

Senator DONNELL. No objection.

Senator MURRAY. In summarizing it, you will cover all the important parts of the statement, I presume. Is that correct?

Dr. DAVIS. I had in mind covering the most important parts in my

summary.

Senator SMITH. Go ahead. Your brief will be incorporated in the record, to follow your testimony.

STATEMENT OF MICHAEL M. DAVIS, PH. D., CHAIRMAN, COMMITTEE FOR THE NATION'S HEALTH

Dr. DAVIS. May I identify myself for the record as Michael M. Davis, a native of New York. I received a bachelor's and a doctor of philosophy degree from Columbia University and have been concerned throughout my professional life with the administration of hospital. clinic, and other health services and as a consultant concerning their economic and public relations. I appear here today as chairman of the executive committee of the Committee for the Nation's Health.

Senator SMITH. That is the same committee that the previous witness referred to?

Dr. DAVIS. Yes. Mr. Louchheim is executive director of the committee.

Mr. Louchheim has already made clear the general position of the committee, namely, that we favor the National Health Insurance and

Public Health Act, S. 1320, and that we oppose the proposed S. 545. Too often both friends and critics of the National Health Insurince and Public Health Act talk about the provisions of the bill from the top down. It's much easier to understand them from the ground up.

In order to consider how the bill would work for a patient and a loctor in any community of the United States, in giving an illustration as to how the bill would work, I picked the town of Roanoke Rapids, N. C., to show the typical actual relationship between a patient and a doctor, a general practitioner or specialist, and I have shown how the obtaining of hospital care would not involve any contact between the doctor, the patient, or the hospital outside of the relationship to the State health agency of North Carolina, and in most instances really nothing outside of Halifax County or the service area, which might not be contiguous with the county. That is the main point I have endeavored to bring out in showing how this plan would work. I cannot lay too much stress upon the point that in the operation of a bill of this kind we are concerned with services which involve a very large proportion of all the people in the country in the course. of a year or two when sickness occurs to them, and most of the doctors of the country and the hospitals

Senator DONNELL. Pardon me. I have some difficulty in following your illustration. I can't read at the same time you speak. I wonder if you couldn't tell us what this illustration is.

Dr. DAVIS. Tom Jones, the textile worker; is that what you're talking about?

Senator DONNELL. That's the illustration you are referring to, is it not?

Dr. DAVIS. Yes.

Senator DONNELL. I can't follow it and get your analysis at the same time. Can you tell us what the illustration is?

Dr. DAVIS. Perhaps I had better summarize that in some detail to make it clearer.

I asked the question: How would the bill work for Mr. Thomas Jones, a textile-mill worker, who lives with his family in the town. of Roanoke Rapids, N. C.? He becomes sick, and he and his wife think he ought to have a doctor. The health insurance law is in operation. Tom Jones earns $36 a week. He pays 54 cents a week, which is 112 percent of his earnings, into the national health insurance fund, and his employer pays an equal amount.

Now that Tom Jones is sick, how does he get a doctor? Does he have to write to Washington or ask a local official? No. Tom Jones calls the doctor he had had before the law went into effect. Dr. Brown comes to see him, just as he would have come before the law was passed, but with two important differences. In the first place, Tom Jones won't get any bill from Dr. Brown. In the second place, Dr. Brown can prescribe what Tom needs and not just what Tom can afford-laboratory tests, for instance, or a specialist if Tom's illness proves obscure or takes a bad turn. Dr. Brown will be paid by the health insurance official of the area that covers Roanoke Rapids and Halifax County in which this town is located.

Where does the Federal Government come into all this? Not at all. The National Health Insurance Board would have paid North

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Carolina its quota from the national health insurance fund. North Carolina would have allotted the Halifax County health service area its quota.

Suppose Dr. Brown thought Tom Jones had pneumonia, that he had a poor heart and might be in danger. Tom Jones or his wife, if they were anxious, or Dr. Brown, if he thought it necessary, could call in a specialist, Dr. George Johnson, the one internist within reach Either of these doctors might decide to ship Tom at once to the Roan oke Rapids Hospital, where he could get better care than Mrs. Jones could give him at home. The local health insurance fund would pay. this hospital the costs of its services to Tom Jones.

In all this, neither Tom Jones, nor Dr. Brown, nor Dr. Johnson, nor the Roanoke Rapids Hospital would have anything to do with any official or board outside of Halifax County.

I think that summarizes the point pretty well. I then go on to explain how the relationship would be in case they called in a special ist, and how the qualifications of a specialist would be determined, and his right to receive payment at the higher rates which would be paid a specialist, as compared to a general practitioner.

Senator DONNELL. Who would determine whether he is entitled to be considered a specialist?

Dr. DAVIS. The State agency administering the health insurance law would determine the lists of specialists-those in different branches who would be made eligible to receive payment as specialists. The national body-that is, the Board, the Federal Security Administrator, and the Federal Government, with the Advisory Council-would lay down the very general policy, such as, for instance, they would, as the law indicates, be required to recognize the standards set by the appropriate professional bodies.

Senator DONNELL. Pardon me a minute, if you don't mind. Who would determine whether or not he is entitled to have a specialist? Dr. DAVIS. Dr. Brown would determine whether or not he should call in a specialist.

Senator DONNELL. Suppose Dr. Brown and the patient differ in their feeling as to whether or not a specialist should be called in? The patient thought it necessary; Dr. Brown thought it was not. Who would determine that?

Dr. DAVIS. Under those circumstances, the patient has a right to go to the nearest medical administrative officer available in that local service area, or in a neighboring one, and request, over the head of Dr. Brown, that he be allowed to have a specialist.

Senator DONNELL. How large are these areas?

Dr. DAVIS. Under the law the States are required to make the necessary surveys and divide the State up into local health-service areas. The procedure there follows rather closely what is already in operation now under the Hospital Survey and Construction Act, which of course sets up, as you gentlemen know, a procedure for making such service areas and dividing the State up into those service areas.

Senator DONNELL. I don't want to interrupt you, but I want to get these facts perfectly clear in my own mind. As I understood it, you said that if he and his physician, Dr. Brown, disagree as to whether Jones needs a specialist, Jones has the right then to go to an administrative officer; is that right?

Dr. DAVIS. A medical administrative officer.

Senator DONNELL. A medical administrative officer, either in that rea or in an adjoining area?

Dr. DAVIS. Yes.

Senator DONNELL. Might that adjoining area be over in some neary county?

Dr. DAVIS. In sparsely settled areas the State health insurance gency might not find it necessary, on account of the limited number f people and doctors, to have a full-time medical administrative fficer in every service area. They might solve that problem by havng a medical administrative officer who would cover more than one rea, or they might employ a doctor in each area on part time if the mount of work required did not require full time.

Senator DONNELL. Of course, if a patient who considers that he leeds immediate attention by a specialist finds it inconvenient to To over to some other area some miles away and have the specialist nake this investigation, he just goes without a specialist-is that right-if there is disagreement between him and the doctor?

Dr. DAVIS. One can conceive of such a situation, but may I say this: Dr. Brown-that is the general family practitioner who is treating him—if the patient wants a specialist, and he for some reason or other doesn't think it necessary or doesn't want him to go to one for some reason or other, then Dr. Brown faces the risk, since Jones has free choice-if Dr. Brown doesn't do what Jones wants him to do then Jones can change to another doctor, which he has the right to do.

Senator DONNELL. And then if there is a disagreement between Dr. Brown and the patient, and that disagreement should arise, we'll say, over alleged disagreeable conduct on the part of the doctor toward the patient, then the patient can go to a local officer or committee, have a hearing and take an appeal; is that correct? What happens if the patient dies while all this appeal business is going on? Does the appeal lapse, or is there some provision for the heirs, successors, and assigns to carry on the appeal?

Dr. DAVIS. In the case of a complaint, Senator-I take it you are not referring now to the question of the specialist?

Senator DONNELL. No.

Dr. DAVIS. You are referring in general to the matter of complaints? Senator DONNELL. Yes.

Dr. DAVIS. If Mr. and Mrs. Jones feel that Dr. Brown was negligent-he didn't come for 24 hours, and they waited and waited, and then when he finally did come he was hasty and disagreeable-they may enter a complaint about him. He may continue to treat them or they may change their doctor. But they might go to the local health service organization, which is described in the bill, and complain that Dr. Brown was a very disagreeable person and they wanted the health service organization to know that and they wanted to enter a charge against him. The nature of the charge might be so serious that it might even involve legal matters if it was a question of malpractice. It would be a legal case then, under general laws. Or it might be just a complaint.

The provision in the law, as you remember, is that the local health center would have to take one of two alternative forms, according to how the State may decide. I won't go into detail on that unless you