"It is not in the interests of the patient to eliminate all sense of va interest and responsibility in the work of the individual hospital as case if new local management committees are to be autocratical. and made responsible only for the minor day-to-day affairs of 1 := institutions. "In the interests of the patient, we stand by the constructive pla forward which fully meets the requirements of a national hospital are to all. "If we understand the Minister's proposals aright, we hope tha be opposed by all sections of the community who, with us, believe t is a personal, intimate thing, and that, above all, the human to preserved." Pride of ownership LOCAL AUTHORITIES Lord Latham, leader of the London County Council: "The L Council will lose its great system of municipal hospitals, which has be into a fine hospital service for Londoners, who are greatly attached! proud of them. They regard them as their hospitals, and so they "The London County Council has devoted much thought and making these hospitals the finest in the world. It can, therefore, be with what feelings of regret we shall see them pass from us to the of the state and to their administration by regional boards. "The majority party of the council will support the main prist government's proposals as regards taking over all the public hospitals and municipal. "The council will, of course, insist that the interests of the peop are fully safeguarded; that there is adequate representation dram council on the proposed regional hospital boards and local hospital-a committees, and that in the future administration of the hospitals tha the people of London are properly provided for." "Soulless control" DOCTORS Dr. E. F. S. Gordon, of Harley House, N. W., speaking as an general practitioner: "The public are offered a scheme effacing all tion which with the present numbers of doctors available cannot carried out. A soulless control of patients and doctors is outlined w tiation with the profession. "The bill is a cunningly devised document by Ministry of Hea Compensation of a sort is offered the doctor for a lifetime of d there is no mention of his hours of work or remuneration. Is he als a 40-hour week?" An official of the Socialist Medical Association: "We warmly welcom a whole. We know the public is behind this measure, and while careful consideration in the Commons and in the country, we hope to law very speedily. "We feel that the Minister has gone even further than need be int cessions to existing interests and institutions. We shall give him c port in resisting any attempt to reduce the effectiveness of the further concessions. The proposals in regard to the payment of be short of the policy we have advocated, and which the Labor Pary past accepted. We shall watch the basic system very closely ind "Becoming civil servants" CHEMISTS K Mr. H. Linstead, secretary of the Pharmaceutical Society of Gr "Given 30 or 50 years, one can see the present pharmaceutical **** country passing into the hands of local authorities or the Minier K one more group of the public becoming civil servants. That is the which we fear. "It is in this respect that we have difficulty with the M pensaries in open competition with the shops. It may not be no early days, but if state dispensaries are to be set up without r the needs of an area the situation is going to become difficult. "Chemists who have put much capital into businesses will be fal authority competition. That we must watch very carefully, bersa Π K day will involve twice as much dispensing by chemists as at present, and detail larger premises and bigger staffs. At the moment we seem to have taranty of security." the OPTICIANS G. H. Giles, president of the British Optical Association: "What strikes hat as matters stand we shall not be on the executive council. In anything however, we want to be constructive, not destructive. While wishing guard ourselves, we are perfectly willing, and happy, to work within the al Health Service. KENNEDY. May I complete the reading of my statement? CHAIRMAN. Yes. I was going to suggest that, Doctor. I am to have interrupted you. KENNEDY. In the English case, the standards were lowered by orking primarily, and also economic needs as a contributing d as a logical sequence, there appears justice in our claim that nmental plans have not in Europe secured the benefits of imd public health. America, on our own initiative, handicapped as well by deficienf sanitation, of housing, of food, and of recreation, we have proed and, with our accustomed methods of proving things, we hope ing to every American the utmost in good health. approve and solicit governmental aid and support in securing r living conditions and will wholeheartedly support health educawider sanitation, better housing, and all such measures as may 1 improving the public health and be outside the practice of medi e CHAIRMAN. Thank you very much, Doctor. ator DONNELL. Mr. Chairman, there is one further question I d like to ask the doctor. ctor, have you observed what Government records doctors are red to keep in Germany and Great Britain? KENNEDY. I have seen them in Germany, but I have not a very recollection of the precise forms. I have a rather clear recollecof some of the British forms, because I have seen them filled out r rather an amusing system if it had not been so potentially dan 18. record must be kept by the general practitioner working on the I system of the case of every applicant and care, together with his s. They occur in books which are made up in columns, and those ds are inspected at fairly frequent intervals, and if they are not letely made up there are fines applied. I have seen the practir repeatedly, having the names kept in proper sequence, then fill om memory the diagnoses which were absurd; and the statistics reports from them were utterly erroneous. nator DONNELL. One concluding question, Doctor. Do you favor all S. 1606, or are you opposed to it? KENNEDY. As a whole, or in part? nator DONNELL. As a whole. Well, I will put it entirely with t to the compulsory health insurance feature of it set forth in II. KENNEDY. That particular portion of the bill, from my experiand beliefs, I do object to. There are parts of it referring to better sanitation and better medical education and to the establishment of public hospitals for those unable to care for themselves and where the communities cannot do it; I am in sympathy with all those aims. Senator DONNELL. But not the compulsory health insurance? Dr. KENNEDY. The compulsory health insurance, with its necessary inevitable regimentation of medicine, I oppose. The CHAIRMAN. But you would have no objection to the establishment of a voluntary system if it could be made to apply so extensively in the country as to bring down the costs of medical care so that everybody could get access to it? Dr. KENNEDY. I am heartily in favor of it, and actively engaged and interested in the creation of a single facility for doing that. The CHAIRMAN. A single facility? Dr. KENNEDY. I am interested in one in Indiana. The CHAIRMAN. I mean to say, would you be interested in some plan that the American Medical Association, with their vast power and influence, one voluntary system which would cover the whole country and give the people low insurance rates which would enable them to get everything we are seeking to get under this bill? Dr. KENNEDY. I think that the needs of this vast country are such that it would be difficult to include within one scheme the needs of every section of the country, so I favor the State organizations, which may be fitted to their particular needs. Senator DONNELL. Do you believe those State organizations could be so organized and operated on a voluntary prepayment basis as to solve these problems to the extent or better than the Government compulsory insurance would solve them? Dr. KENNEDY. I do so think. The CHAIRMAN. You think they could bring down the cost of medical care to such a degree that it would make it possible for everyone in the country to get adequate medical care at a very low cost! Dr. KENNEDY. I belive so. I hope so, and am engaged in an effort to prove it. The CHAIRMAN. Thank you, Doctor. We will meet tomorrow morning at room 104. Dr. GOIN. May I add one statement to my statement? The CHAIRMAN. Yes. Dr. GOIN. The costs of voluntary insurance were mentioned in relation to the cost of Government insurance. I wanted to put in the record that the California Physicians' Service has undertaken to insure the California Grange, about 100,000 people, for $62 per year for the family. The CHAIRMAN. Complete medical care? Dr. GOIN. With the restrictions I mentioned in my statement. The CHAIRMAN. 10 o'clock. (Whereupon at 4:55 p. m., Wednesday, April 17, 1946, the committee adjourned to meet at 10 a. m., Thursday, April 18, 1946.) NATIONAL HEALTH PROGRAM THURSDAY, APRIL 18, 1946 UNITED STATES SENATE, COMMITTEE ON EDUCATION AND LABOR, Washington, D. C. The committee met at 10 a. m., pursuant to adjournment, Hon. James E. Murray (chairman) presiding. Present: Senators Murray, Pepper, Ellender, and Donnell. The first witness this morning is Dr. Ernst P. Boas, chairman of the Physicians Forum, Inc. Dr. Boas, do you have a prepared statement? Dr. Boas. Yes, sir, Mr. Chairman; I have a statement I would like to present to the committee. The CHAIRMAN. You may proceed. STATEMENT OF DR. ERNST P. BOAS, CHAIRMAN OF THE Dr. Boas. I represent the Physicians Forum, a national organization of doctors who are interested in the improvement of medical care and in the dissemination of information on the subject among physicians and the public. Our group, all doctors, counts among its members some of the country's most distinguished physicians, including a large number in private practice who have a first-hand knowledge of medical economics as it affects doctors and patients. Our membership also in private practice who have a first-hand knowledge of medical schools and are therefore familiar with the influence of these institutions on medical practice and the health of the public. All our members belong to the American Medical Association or to the National Medical Association. Therefore, I address you as a physician. and on behalf of physicians. ENDORSEMENT OF S. 1606 The Physicians Forum unequivocally supports the bill under consideration, S. 1606. As practicing physicians, we know better than any other group of fellow Americans the present deficiencies in medical care, the needless suffering and death constantly occurring hroughout this land because of bad distribution and scarcity of loctors and hospitals in many communities. We know that many persons cannot afford to buy ordinary medical care, and that few can cope with the costs of catastrophic illness. We know that many regions of this country cannot support the doctors and hospitals they need so badly. After searching inquiry we have reached the conclusion that national compulsory health insurance represents the only practical method to finance medical care and bring it within reach of all the people of the United States. Ample factual evidence has been presented to this committee of the need for such a program. The availability of medical care depends today on how much the patient can pay, and in what part of the country he lives, not on his medical needs. We believe that in a democracy adequate medical care is a right to which all citizens are entitled. This right is necessary for the enjoyment of all other rights and privileges, for sick people are not free people. If we agree that medical care is a right to which all are entitled and that many cannot afford to buy it, it is clear that a large part of the money to pay for it must come from other sources. There is ample precedent to look to government to fill this gap, whether it be the local, State, or Federal Government. For years government has provided medical care for the indigent, and it has borne almost the total cost of the medical care of the mentally ill and of the tuberculous, because families are unable to bear the drain of such long-drawn-out chronic illnesses. Expenditures by government for public-health activities, for child and maternal health, and for veterans run into sizable figures. Today public agencies in the United States spend hundreds of millions of dollars of tax revenues for the support of medical facilities and services for the civilian population. No one challenges the principle of the use of public funds for the prevention of disease. But the prevention of disease today involves much more than the old-line activities of the public health officersanitation and vaccination. Today the chronic, so-called degenerative diseases, such as the heart diseases, high blood pressure, diabetes, cancer, and chronic rheumatism, are the great hazards to life and health. Their control and prevention involves the creation of complete facilities for early diagnosis and treatment, and making them freely available to all. People must be encouraged to consult a physician at the first intimation of a bodily disorder, and not wait, as unfortu nately many do, until the disease has progressed to an advanced stage at which damage may be irreparable. The financial barrier that keeps patients from seeking medical advice must be eliminated. Today we can no longer say, "This on one hand is preventive, medicine, a proper function of Government; and this, on the other' hand, is curative medicine, the function of the practitioner of melcine whose services must be bought in the open market." These two aspects of sickness control have become merged; preventive medicine begins with measures of personal hygiene and health examinations conducted by the medical practitioner. So it is a logical and natural step to turn to Government for funds to extend adequate medical care to all citizens of this country. Because of the uneven distribution of wealth in the United States the Federal Government must assume responsibility. The increasing mobility of our population also makes it necessary that health plans be national in scope, so that the worker will not lose his benefits when he moves from one State to another. |