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TITLE I OF S. 1606

Title I, part C of the bill, dealing with grants to States for medical care of needy persons, is an obvious necessity, which appears to be universally recognized, as one of the chief opponents of the bill, the American Medical Association, in its national health program of February 23, 1946, recommends that for medical care of the needy, local funds be supplemented "with the assistance of Federal funds when necessary.' ""

Title I of the bill referring to grants to States for health services and specifically to provisions for venereal diseases, tuberculosis, maternal and child welfare, and the care of the indigent, appears in all its subdivisions to cover vital areas of need for medical care in our country today. The need for the measure provided for in this title is particularly acute among our Negro citizens.

With the plans for the administration of the S. 1606, the NAACP must have certain vital concerns. About 79 percent of our Negro population are concentrated in the 17 Southern States where they comprise approximately one-fourth of the total population. Another 18 percent live in the 3 Middle Atlantic and 5 North Central States. making a total of 97 percent in these 25 States. Until very recently about 90 percent of those living in the South were rural dwellers in contrast to 80 percent of those living in the North. These facts of regional and rural and urban concentratiton would entail variations in the mechanics, but not the principles of procedure in implementing the bill as it would affect the Negro.

The NAACP is concerned that, irrespective of the means by which it would be planned to implement the bill in any locality, there should be no discrimination against any citizens because of race, creed, color, or national origin. It is concerned that in the provisions for training of the large new personnel that will be needed for State and local health work, Negroes be integrated into the program at all levels. administrative as well as professional, without respect to section of the country.

The association is further concerned that in the needs for medical care and facilities to be determined by the respective States, the same standards should be used for such determination for all political subdivisions of the States and for all citizens.

TITLE II, S. 1606

Title II of the bill, referring to prepaid personal health servic benefits, appears to have many progressive features in keeping with democratic practice. The provisions for a national advisory counc and local advisory councils on which both the professions and the public would have representation extends representation to areswhere it has not extended before, and affords an opportunity to th public and to groups of the professions, which hitherto have not had such opportunity, to work for the improvement of both the nations. health and that of their own communities. The association does no find, as has been frequently alleged, that the traditional free choice of physician by patient, and patient by physician, has been impaire by the provisions of the bill. Section 205, (A) specifically states in effect that any physician, dentist, or nurse legally qualified to prac

ice in a State shall be qualified to furnish services. Section 205, (B) tates very clearly that every person entitled to receive general medial, or general dental benefits shall be permitted to select, from among participating practitioners, those from whom he shall receive such enefit subject to the consent of the practitioner or group of practiioners selected, and every such individual and every group of such ndividuals shall be permitted to make such selection through a repesentative of his or their own choosing and to change such selections. The remaining provisions of this section all are directed at ensurng not only that achieved medical standards be maintained, but shall De advanced. It is further specifically stated that "payment shall be adequate, especially in terms of annual income or its equivalent and by reference to annual income customarily received among physicians, lentists, or nurses having regard for age, specialization, and type of community; and payment shall be commensurate with skill, experience and responsibility involved in furnishing the service." Were it not for the fact that fees can be paid in a variety of ways it would still be impossible for the association to see any way whereby medical care, even under the bill, could be extended to those particularly economically underprivileged areas where it is most sorely needed. In the past it has been impossible for physicians to remain long in either rural or urban areas where they are needed most, because of lack of facilities on the one hand and the fact that the population was too poor to afford them an adequate income on the other. The HillBurton hospital construction bill, S. 191, which has been passed by the Senate and which has received endorsement of the American Medical Association, would provide a means for the construction of lacking facilities. S. 1606 for the first time, offers a means whereby the necessary professional personnel could be paid in such areas. As has been repeatedly pointed out in earlier testimony, no form of voluntary prepayment medical insurance could be of benefit to these people, because they could not afford it. In this connection it should be emphasized that the furor over free choice of physicians can have no meaning for millions of Negroes as well as of millions of whites in poor economic circumstances, because down the years these people have been without any medical services whatever. Ofttimes when such services have been available they have been the indifferent services of physicians who do not want them as patients or similarly unsatisfactory services of crowded clinics.

ATTITUDE OF THE AMERICAN MEDICAL ASSOCIATION

Major objection to the bill from the medical profession has been voiced by the American Medical Association, consequently the counterproposals of this organization have been studied with great interest. In the considered judgment of the association these counterproposals are far inferior to the proposals of the national health bill. The American Medical Association's proposal, as stated in its Journal of February 23, 1946, recognizes apparently that some form of prepayment medical insurance is necessary, and it is the determination of the American people to obtain such insurance. There may be said, therefore, to be general agreement that prepayment medical insurance is both necessary and desirable. Operating upon the sound and

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time tested insurance principle that a large number of insured will permit a greater coverage in services, smaller premiums and less administrative expense than will smaller groups of insured persons, the national health bill proposes that the entire population earning an income be taxed a small percentage of earnings (percentage to be determined), which shall provide ultimately for complete coverage of medical services with a similar provision for the medical care of the indigent. The American Medical Association proposes that on a trial and error basis various forms of voluntary prepayment medical care plans be tried out until optimal procedures are determined by experience. It further proposes that regional plans shall be locally determined.

Already it has been evident that all such plans so far proposed have the weakness that they are available to the relatively small groups who are able to pay for them and have but limited coverage and high premiums, so that still the people who need medical care most are not able to provide for it. The American Medical Association's proposal then blandly suggests that the indigent, who are not able to be provided for through some prepayment medical care plat... or local public funds, should be cared for by Federal funds. Where the Federal Government would obtain these funds the American Medical Association does not indicate. The voluntary prepaymer: plans are particularly little available to the poorly circumstanced of the American population of whom Negroes constitute the largest group. In addition, where these plans have already appeared and are operating, besides being little available to Negroes on an economi basis, they have been closed to them by reason of racial discriminstion as well. The law has been the best safeguard of the underprivileged throughout our history. Therefore, the association firmy believes that equal justice in the securing of adequate medical care for all citizens would be better obtained by national legislation to that end than by other means.

The association affirms that the profession of separate, but equal facilities for the care of Negro population in those areas where that population is concentrated has always been a myth, and would prov again to be a myth should it be attempted. Specifically the associa tion wishes to declare against the principle in the application of this bill to the development of separate hospitals, separate health centers, separate training programs, and separate public health programs. We wish to declare emphatically for the elimination of the entire racial separation practice in the construction of any new facilities, and in the operation of all new plans for the distribution of medical care and for the integration of Negro professional personnel inte all levels of the plan according to qualification. Recent experience with attempts to assure adequate professional personnel through the separate system of professional education have proved how sterile and ineffective is this plan. It has resulted in there being not only inadequate numbers of general practitioners (and nurses), but also of spe cialists in the respective fields.

The association's study of this bill indicates that it might be pos sible for the administration of the program to be assigned through private auspices, particularly State and local medical societies. Thi association would be unequivocally and unalterably opposed to any arrangement of this kind. In many States, including the entire

South and the District of Columbia, local medical societies have consistently barred Negro physicians from membership, and the American Medical Medical Association, through the technicality of not admitting to its membership physicians who are not members of their local societies, has extended the effect of this racial discrimination. This association, therefore, would see no outlook but the perpetuation of these discriminatory practices in the administration of a national health program and advocates that the administration be entirely in the hands of responsible public officials.

SUMMARY

In the summary it may be stated that from the point of view of the NAACP, S. 1606, for the first time in our history, provided a means whereby the economic barrier to the extension of medical care to the millions of American citizens who so sorely need, but cannot afford such care, may be overcome. It provides a means, further, whereby the tragedy of economic collapse brought upon families by expensive illness may be averted. This plan appears conceived upon the soundest possible basis; namely, the distribution of cost over the entire earning population so that maximum coverage for all may be achieved while administrative expenses are held to a minimum. The association would like to note the endorsement of this bill by the MedicoChirurgical Society of the District of Columbia.

This organization of 188 physicians, is the oldest Negro medical organization, and the largest local society of this group. This body was formed in 1884 as the result of the determined refusal of the Medical Society of the District of Columbia, supported and confirmed by the American Medical Association, to admit qualified Negro physicians to membership. These physicians individually and collectively are a prosperous group, but they have seen in the national health bill the same advantages for the American people which the Association has briefly described.

In closing, the NAACP regards S. 1606 as one of the most progressive and potentially beneficial pieces of legislation of recent years. It is sorely needed by the great majority of Americans, but it is most acutely needed by our 14,000,000 American Negro citizens. The association unqualifiedly endorses this bill and strongly urges its passage. The CHAIRMAN. Thank you, Dr. Cobb.

Are there any questions?

Senator PEPPER. I have no questions, except that you have made a very fine statement.

Senator DONNELL. I have just one or two questions, Doctor. I believe that you stated that you are on the faculty of Howard University. Dr. COBB. Yes, sir.

Senator DONNELL. And you have been a practicing physician for approximately how many years?

Dr. COBB. I am not in active practice at the present time. I am a full-time professor of anatomy and I was licensed to practice in 1930. Senator DONNELL. Have you been a practicing physician?

Dr. COBB. No, sir.

Senator DONNELL. And you have never been a practicing physician? Dr. CоBB. No, sir.

Senator DONNELL. Now, the NAACP, that is a very large organization of over 520,000 members?

Dr. COBB. That is right.

Senator DONNELL. And you are a member of the national medica! committee of that organization?

Dr. COBB. Yes, sir.

Senator DONNELL. Has the organization itself the custom of having annual meetings?

Dr. COBB. Yes, sir.

Senator DONNELL. Has there been any resolution adopted by the association itself on this matter of S. 1606?

Dr. COBB. At the regular monthly meeting the board of directors of the association, held in New York City on February 11, 1946, upoz motion duly seconded it was voted "That the association actively support the Wagner-Murray-Dingell health bill."

Senator DONNELL. Just how does the national medical committee derive its authority to speak for this membership?

Dr. Cовв. From the board of directors of the association, and I was instructed to present this statement by the chairman of the board of directors, Dr. Louis T. Wright.

Senator DONNELL. How large a body is the board of directors! Dr. Cовв. Approximately 50, I should say.

Senator DONNELL. Has it passed any resolution with respect to this particular bill, S. 1606?

Dr. COBB. That I do not know.

Senator DONNELL. You do not know of any; is that correct? Dr. COBB. That is correct.

Senator DONNELL. Your authority to appear here today is derived from the instructions which you received from Dr. Wright?

Dr. Cовв. From the board of directors, through Dr. Wright. Senator DONNELL. Did you see any direction from the board of directors or did you simply receive word from the board of directors as he stated, to appear here?

Dr. COBB. It is in writing from him as chairman of the board of directors.

Senator DONNELL. That is all.

The CHAIRMAN. Has your organization in its national meetings discussed this problem of medical care?

Dr. COBB. Well, that I cannot say. I have not attended any.

The CHAIRMAN. You were just selected for the purpose of presenting this statement?

Dr. COBB. I have been a member of the national medical committe for some time.

The CHAIRMAN. You were designated by your national committee to present this matter here this morning?

Dr. COBB. That is right.

The CHAIRMAN. Thank you very much for your statement.

The next witness is Miss Pauline M. Newman. Do you have s statement that you want to make to the committee?

Miss NEWMAN. I do.

The CHAIRMAN. Will you state the organization that you repre sent and where you reside, and so on.

Miss NEWMAN. The name is Pauline M. Newman, national executive board member of the National Women's Trade Union League of America.

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