Senator Pepper applied this question specifically to title I. part B. which deals with maternal and child-health services. We woul apply this question also to title I, part A, dealing with "Grants t States for public health services," and to title I, part C, dealing wr.. "Grants to States for medical care of needy persons." Our concern, we repeat, is that all Americans be covered, and w hope to see the elimination of all loopholes by which the universality of coverage could be thwarted and by which the residents of sou States could be denied the important benefits provided under title I. Above all, we urge that S. 1606, strengthened by these neede amendments, be passed-and passed at the earliest possible date. Senator DONNELL. Reverend McMichael, when was held the mos recent general conference of the Methodist Church? Reverend MCMICHAEL. 1944. Senator DONNELL. 1944. Did that conference express itself on the subject of compulsory health insurance? Reverend McMICHAEL. No. Senator DONNELL. Has it ever expressed itself on that subject? Reverend McMICHAEL. Not that I know of; no. It has expressi itself officially on the subject of medical care for all. Senator DONNELL. But not on the matter of compulsory heal. insurance, is that right? Reverend MCMICHAEL. That is right, as far as I know. Senator DONNELL. You mentioned on page 12 of your statemen and I quote: "He can also abandon that doctor if his work become unsatisfactory." I call your attention to this situation: Take a community in whic there has been adopted the per capita plan under the bill, and suppo that you should have selected Dr. Jones, and Dr. Jones should prose unsatisfactory to you, and you have the right to abandon Dr. Jone Suppose, however, in the community there are three other doctors, and the panel of each of those is filled. Is there any right that you know of by which you can select one of those doctors regardless of how mu you want his services? Reverend MCMICHAEL. Well, I do not know of any way that ca be handled, except that there are, as I understand it, local cor tees which will be consulted on these ...tors, advisory committees. and advisory councils of various kinds, and it would seem to me might be handled in this way: If I were sick, judging from the exper ence I have had with my own father as a doctor, and I could not g adequate attention from the doctor I had, and I went to another doct he would take care of me, if there were an immediate emergency s uation requiring medical care. Senator DONNELL. I was not talking about an emergency situatio Suppose you have selected Dr. Jones? Reverend McMICHAEL. Yes. Senator DONNELL. Thereafter, because of his record or for son personal reason, you did not consider him proper, and you decid you did not want him. You certainly have the right, as you hav indicated, to abandon that doctor. Reverend McMICHAEL. I believe that the right works both wayI think that the doctor also has some choice in the matter of t patient, so that if there were another one of these three doctors wi wanted me as a patient, I believe that he would have the right to choose me as one of his patients. Senator DONNELL. I am not certain as to that. Senator DONNELL. But I do call your attention to the section mentioned rather frequently in the testimony giving the Surgeon General the right to prescribe maximum limits to the number of potential beneficiaries for whom a practitioner may undertake to furnish general medical or general dentai benefit. Had you considered that?" Reverend McMICHAEL. Yes. My understanding of that, Senator, is that this will only be done if the majority of the doctors in the area involved choose that particular plan of receiving payment. Senator DONNELL. That is correct. That is the reason that I qualified my question. Reverend McMICHAEL. I believe there is also a provision that allows the doctors who did not approve that decision reached by the majority, or, that there is a possibility that those representing the minority may choose some other than the per capita basis. I think there is a possibility, at least, that the doctors in the community could be receiving their pay on some other basis than that of the per capita, even if they live in the community which has decided on the per capita basis. Senator DONNELL. I was speaking of the community in which the per capita basis was adopted and the quotas have been filled and you have abandoned your doctor. Then it would seem to be there would be a restriction on your part with respect to someone else to choose the doctor. Reverend McMICHAEL. I think there is a restriction of choice in the present situation. If we look at the present situation, where in my own home county doctors have declined in number, and far more people with a great deal of illness than there are doctors to take care of them, they are very restricted in the choice of doctors, because the doctor is not available. And I do think it is sound, if we are going to have high-quality medical care, for there to be some limit to the load of a particular doctor. I mention my own father. He had far too many patients, and it seems to me we must be concerned to take care that there is highquality medical care. I believe in the so-called voluntary plans there are often limits put to the number a doctor may handle. It seems to me physically impossible for a doctor to handle too many. There is no specified number within a particular community that a doctor may have, 2,000 or 1,000 or whatever the number is; but it seems to me that the doctors in a particular community, if they want to have the load limited, should have the choice to vote on that question, and if they prefer another method they do have that opportunity. You do not only have to consider the patient, but you have to consider the doctor. If I go to a doctor now he can refuse to treat me, if he considers his load too heavy. I think when we look at the present situation in which so many of the areas of the country have freedom restricted because of the absence of doctors, these doctors do not go to the low-income areas because they will not be paid adequately on the treatment basis, and I think there will be more doctors going to such areas as the county from which I come, which will give not less but far more freedom of choice to the people in those communities. Senator DONNELL. It is still true, is it not, Reverend McMichael, that today if you desire to separate yourself from your existing physiciar. that if another physician desires to take you as a patient he has that privilege? Reverend McMICHAEL. That is true. Senator DONNELL. Whereas under this law, as I understand it, in a community in which the practitioner has reached his maximum quota and in which the per capita basis has been adopted, he would not be at liberty to decide for himself whether his case load is as grea as he can handle, but that would be left to the Surgeon General rather than the physician himself? Reverend McMICHAEL. My impression is that the doctor woul There is some misunderstanding between us about the bill. My pression is that the doctor would have the freedom to choose me as a patient if he preferred me to someone on the group on his list. I' other words, if a doctor wanted to put me on his list and he had 1.0. people on his list, and he preferred me, that he would have that choic under the bill. Senator DONNELL. By eliminating someone on the list? Reverend McMICHAEL. By eliminating some one of the thousan The person eliminated might like the other doctor very well. Senator DONNELL. Or he might like the one from which he was eliminated. Reverend MCMICHAEL. But the doctor has that choice of eliminating, whether he has his quota filled or not. Senator DONNELL. He certainly has that right under existing li Do you mean under the bill? Reverend McMICHAEL. Yes. My impression is that the doctor do have a choice, and he could eliminate a person whether his quota wa filled or not. Senator DONNELL. Reverend McMichael, are there any further observations you desire to make at this time to the committee other tha your statement? Reverend McMICHAEL. No. I think I have covered the major points in the statements here. Senator DONNELL. I am sure I express on behalf of the members of the committee here our appreciation for this very thoughtful azi most interesting observation that you have given to us. It evidenos much work and thorough preparation. Reverend McMICHAEL. Thank you very much, Senator. Senator DONNELL. The committee will be in recess until 10 o'clock on the morning of Tuesday next, to meet at a place subsequently to b announced. (Whereupon, at 1:35 p. m., Thursday, April 11, 1946, the commit tee adjourned to meet again at 10 a. m., Tuesday, April 16. 1946.) NATIONAL HEALTH PROGRAM TUESDAY, APRIL 16, 1946 UNITED STATES SENATE, COMMITTEE ON EDUCATION AND LABOR, Washington, D. C. The committee met at 10 a. m., pursuant to adjournment, the Honorable James E. Murray (chairman) presiding. Present: Senators Murray, Pepper, Ellender, Morse, Donnell, and Aiken. The CHAIRMAN. Gentlemen, the meeting will come to order. Other members of the committee are on the way here, but we have a big schedule and I think we should open the hearing immediately. Mr. William Green is the first witness here this morning. Mr. Green, you may proceed with your statement. STATEMENT OF WILLIAM GREEN, PRESIDENT, AMERICAN FEDERATION OF LABOR, ACCOMPANIED BY NELSON H. CRUIKSHANK, DIRECTOR, SOCIAL INSURANCE ACTIVITIES, AMERICAN FEDERATION OF LABOR Mr. GREEN. Thank you, sir. Mr. Chairman and members of the Committee on Education and Labor, I appreciate the opportunity to present to you the position of the American Federation of Labor with respect to the proposals for the establishment of a national health program as they are set forth in the legislation you are considering, Senate bill 1606. AFL PROGRAM FOR SOCIAL SECURITY This subject is not new to us. The American Federation of Labor has been working for the past several years to develop a program for extending our social security system in a manner designed to enable our people to bear the unpredictable hazards of our modern industrial society. Our committee on social security, of which Mr. Matthew Woll is chairman, has been now for several years engaged in a study of the inadequacies of our present social security program and has, with the assistance of experts in this field, drawn up a comprehensive plan for the development of a well-rounded, national social security system. The experts they have consulted include men of acknowledged attainment in Government service, in the universities, in the professions, and in business. The program we have developed includes, in addition to provisions for extending the facilities needed for health services and provisions for grants to States for public health services and maternal and child health and welfare services and for public assistance, proposals for the establishment of a national system of public employment offices and of a national social insurance system. This last item includes proposals for the development of insurance against temporary and extended disability, for the extension and improvement of our oldage and survivors insurance system, for the special protection needed by veterans, for a genuine and practical unemployment insurance program and for a national system of health insurance. This program also includes well-considered methods for meeting its entire cost. A number of these provisions are now being given separate consid eration. For example, the program for the construction of health facilities is largely incorporated in Senate bill 191, to which with strengthening amendments, the American Federation of Labor has given its wholehearted support. Likewise, the Committee on Way and Means in the House of Representatives is now reviewing the oldage and survivors insurance program. We have presented to this committee with all the emphasis at our command, our proposals for strengthening this portion of the social security program. Our entire program for the development of a unified, comprehensive social security program worthy of a great nation in a position of world leadership, is contained in Senate bill 1050, introduced in the Senate nearly a year ago by Senator Robert F. Wagner and his colleague, the distinguished chairman of this committee, and simultaneously in the House of Representatives by Congressman John D. Dingell. The proposal you have before you in the Senate bill 1606, therefore. represents but another part of an over-all program. Though in our opinion the need is for the immediate adoption of an inclusive and comprehensive program, we support this proposal to privide for a national health program because it represents to us a worthy step in the right direction. ENDORSEMENT OF NATIONAL HEALTH INSURANCE The significance of the support given the bill by the American Federation of Labor does not lie wholly in the vast membershipnow nearly 7,000,000 individuals-of our affiliated unions. I submit that there is great significance in the fact that our organization has not always held this position. In fact, 30 years ago we were definitely against the establishment of a health insurance program. But our great, democratic labor organizations, in response to the expressed needs and wishes of the membership, have steadily swurz over to the support of this program, to the point where, in the lat national convention of the American Federation of Labor, which was held in New Orleans in 1944, it was adopted unanimously. Some of the enemies of this program have attempted to taunt u by quoting my predecessor, Samuel Gompers, in opposition to health insurance. They have even gone to the expense of printing large posters, which they offer free and on which they have reproduced s picture of this great leader and quoted his words of 30 years ago. I think I knew Samuel Gompers as well as the people who are paying for the printing of these posters. I know also, that some of the same i terests who are now so willing to pay money to induce workers to follow Samuel Gompers' leadership were willing, when those words of h were uttered, to pay money to get workers to forsake his leadership |