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July, first announced on June 24, 1975 (see: Press Release #7). It is expected that the Subcommittee will schedule public hearings on this subject in the late summer or early fall. The membership and structure of each panel discussion is attached.

JULY 10, 1975

SUBJECT: BROAD ASSESSMENT OF AMERICAN HEALTH STATUS AND THE AMERICAN

HEALTH CARE DELIVERY AND FINANCING SYSTEMS

Panelists

1. E. L. Wynder, M.D., President, American Health Foundation. 2. John G. Freymann, M.D., President, National Fund for Medical Education. 3. Rashi Fein, Professor of the Economics of Medicine, Harvard University. 4. Uwe Reinhardt. Professor of Economics, Princeton University. 5. Kerr White, M.D., Professor of Health Care Organization, The Johns Hopkins

University.

The panel will begin its presentation to the Subcommittee at 10:00 a.m. on July 10, 1975, in the Main Hearing Room of the Committee on Ways and Means in the Longworth Building at New Jersey and Independence Avenue, S.E.

JULY 11, 1975

SUBJECT: THE ROLE OF GOVERNMENT IN AMERICAN HEALTH

Panclists

1. Lewis H. Butler, Professor of Health Policy, University of California. 2. Pierre R. de Vise, Professor of Urban Science, University of Illinois at Chicago

Circle. 3. Richard Heim, Executive Director, Health and Social Services Department,

New Mexico. 4. Lowell Bellin, M.D., Commissioner of Health, Yew York City.

The panel will begin its presentation to the Subcommittee at 9:00 a.m. on July 11, 1975, in the Main Hearing Room of the Committee on Ways and Means in the Longworth House Office Building at New Jersey and Independence Avenue, S.E.

JULY 17, 1975

SUBJECT: PRIVATE SECTOR ROLE IN AMERICAN HEALTH

Panelists

1. Herman M. Somers, Professor of Politics and Public Affairs, Woodrow Wil

son School of Public and International Affairs. 2. Nathan J. Stark, President, University Health Center of Pittsburgh. 3. Robert G. England, M.D., Carlinville, Illinois, 4. Lawrence M. Cathles, Jr., Retired Senior Vice President, Aetna Life and

Casualty. 5. John Larkin Thompson, President, Blue Shield of Massachusetts.

The panel will begin its presentation to the Subcommittee at 10:00 a.m. on July 17, 1975, in the Main Hearing Room of the Committee on Ways and Means in the Longworth House Office Building at New Jersey and Independence Avenue, S.E.

JULY 24, 1975

SUBJECT:

PROBLEMS AND ISSUES IN HEALTH CARE ORGANIZATION, DELIVERY AND

FINANCING

Panelists 1. Martin S. Feldstein, Professor of Economics, Harvard University. 2. Herbert E. Klarman, Professor of Economics, New York University. 3. Wilbur J. Cohen, Dean, School of Education, University of Michigan. 4. Charles A. Siegfried, Madison, New Jersey. 5. Avedis Donabedian, M.D., M.P.H., Professor of Medical Care Organization,

University of Michigan.

The panel will begin its presentation to the Subcommittee at 10:00 a.m. on July 24, 1975, in the Main Hearing Room of the Committee on Wars and Means in the Longworth House Office Building at New Jersey and Independence Avenue, S.E.

[Press release No. 9 of Wednesday, July 23, 1975) SUBCOMMITTEE CHAIRMAN DAN ROSTENKOWSKI (D., ILL.) ANNOUNCES PANEL Dis

CUSSION ON NATIONAL HEALTH INSURANCE (WITH PANELISTS SELECTED BY THE MINORITY) SEPTEMBER 12, 1975

Subcommittee Chairman Dan Rostenkowski (D., III.) of the Subcommittee on Health of the Committee on Ways and Means, today announced an additional panel on national health insurance, with panelists selected by the minority. The panel discussion will begin at 9:00 a.m. in the Main Hearing Room of the Ways and Means Committee in the Longworth House Office Building.

It is expected that public hearings on national health insurance will begin later in September or early October.

The list of panelists for September 12 will be released in a later announcement.

(Press release No. 12 of Wednesday, Aug. 20, 1975) SUBCOMMITTEE CHAIRMAN DAN ROSTEN KOWSKI (D., ILL.), SUBCOMMITTEE ON

HEALTH, COMMITTEE ON WAYS AND MEANS RELEASES MEMBERSHIP OF PANEL DISCUSSION FOR SEPTEMBER 12, 1975 SELECTED BY THE MINORITY MEMBERS OF THE SUBCOMMITTEE

Subcommittee Chairman Dan Rostenkowski (D., Ill., )of the Subcommittee on Health of the Committee on Ways and Means today released additional information about the panel discussion on national health insurance scheduled for September 12, 1975, first announced on July 23, 1975. (See: Press Release #9)

A list of the members of the Panel selected to represent the minority follows:

TENTATIVE LIST OF WITNESSES 1

Panel of Witnesses for 9:00 a.m. :

Dr. Max Gammon, London, England
Mr. Anthony Lejeune, Middlesex, England
Dr. Sigmund J. Lofstead, Chicago, Illinois
Dr. Reginald Murley, London, England

Dr. Bette Stephenson, Toronto, Canada
Panel of Witnesses for Afternoon Session:

Dr. John H. Burkhardt, Knoxville, Tennessee Dr. John Hamilton, Rochester, New York Dr. Marvin N. Lynberis, Charlotte, North Carolina Dr. Clinton S. McGill, Portland, Oregon Dr. David S. Masland, Carlisle, Pennsylvania Dr. Donald Quinlan, Northfield, Illinois Mr. ROSTENKOWSKI. The Subcommittee on Health will come to order.

Today the Subcommittee on Health begins active consideration of national health insurance. Instead of first receiving testimony on specific proposals from interested organizations and individuals, we thought it would be useful to begin by exploring, with a series of expert panels, the broad outlines of health care in the Cinted States and some of the major issues we will need to address as we frame a national health insurance bill. Later, probably in early fall, we will likely hold public hearings at which all interested parties can express their views.

At the beginning of this year the subcommittee invited individuals and organizations to submit written statements on the subject of na

1 Additions or changes may be announced at a later date.

tional health insurance. This permitted the updating of testimony presented during the extensive hearings on national health insurance the Committee on Ways and Means completed a year ago, and also offered a fresh opportunity for the expression of views by those who had not previously testified. These statements will soon be available in the form of a printed record thus furnishing the subcommittee the full benefit of the information and views presented before we begin consideration of specific national health insurance proposals.

The panels of experts who will be sharing their knowledge of the American health care system with us during this month were selected, like the larger advisory panel of which they are a part, not to represent the viewpoint of any organized group but rather to let us benefit from the fruits of their own individual studies and experiences in health care and health care financing. There will be ample opportunity later for the expression of official positions by organizations and individuals. Our objective for the moment is simply to learn and try to understand, so that the decisions we make later will be soundly based.

We begin our broad review of this subject with an exploration of American health status, our health care delivery system or systems, and how we finance the $100 billion or so being spent for personal health care. Tomorrow we will take a broad look at the role of Government at all levels in American health. On July 17, we will examine the private sector role. And on July 24, we will take up problems and issues in health care organization, delivery, and financing.

I believe that the subcommittee will agree with me that we should plan for additional sessions like the ones already scheduled with selected members of the subcommittee's advisory panel as we narrow our attention to more specific issues. I say this because one thing that has become clear to me in the months since I assumed chairmanship of this subcommittee is that the American health care system is extraordinarily complex. You cannot change any part of it without affecting other parts—perhaps in ways not able to be anticipated. We need to learn a great deal about the American system of health care, and we must approach the task of framing national health insurance legislation with a great deal of sensitivity and even humility.

I have been looking forward to beginning these panel sessions. We have a fine group of expert witnesses who have agreed to meet with us and I want to have every member participate in these sessions to the fullest.

We hope to proceed somewhat informally today, using a format that will promote understanding and the exchange of views. The panel members have been asked to make a brief opening statement, so as to leave adequate time for questioning and discussion among both panel and subcommittee members.

I would like at this time to open for any comment that any member of the subcommittee would like to make before I introduce the panel.

Mr. DUNCAN. Mr. Chairman, I apologize if you mentioned it in your statement; I didn't have it. I noticed today that we have a panel of people apparently who do not practice medicine and wouldn't have first-hand knowledge of such practice. Are we planning on a panel of actual physicians or people in the medical field who are actually out in the boondocks practicing medicine? I would say that the panel

today is composed of people who have never practiced, I think could have been a little better balanced.

Mr. ROSTENKOWSKI. As I said earlier, Mr. Duncan, it's primarily for an educational process and for the exploration of the experience that these gentlemen have. We expect certainly to have public witnesses and general practitioners at some time in the future.

Mr. Duncan. Thank you, Mr. Chairman.

Mr. Pike. Thank you, Mr. Chairman. I am delighted that we are embarking on these hearings on a subject in which I have been very, very interested for a great many years. I think that I should say at the outset of these hearings, just so you may understand some votes that I cast in the future, that for 25 or 30 years now I have been either a director of a general hospital or a director of a proprietary hospital and an officer thereof. So I do have some frame of reference in regard to this matter.

We are going into this in a very broad sense. When we get to actual voting on an actual bill, which looks a long way down the road, I may feel compelled to vote present sometimes but it will not be for lack of interest on the subject matter.

Mr. ROSTENKOWSKI. I hope, Mr. Pike, that the opportunity for you to cast your vote will not be in the too long distant future.

Mr. Cotter?
Mr. COTTER. Thank you.

A PANEL CONSISTING OF E. L. WYNDER, M.D., PRESIDENT, AMERI.

CAN HEALTH FOUNDATION; JOHN G. FREYMANN, M.D., PRESI. DENT, NATIONAL FUND FOR MEDICAL EDUCATION; RASHI FEIN, PROFESSOR OF THE ECONOMICS OF MEDICINE, HARVARD UNIVERSITY; AND UWE REINHARDT, ASSOCIATE PROFESSOR OF ECONOMICS AND PUBLIC AFFAIRS, PRINCETON UNIVERSITY

Mr. ROSTENKOWSKI. Gentlemen, we certainly welcome you. I am hoping this will be a refreshing beginning. I know that we on the panel here and you on the panel there are all certainly hopeful that we can develop some worthwhile legislation. I think we are in total agreement that the country is in need of some health insurance program.

It is at this time that I would like to welcome Dr. Wynder, president of the American Health Foundation; Dr. Freymann, president of the National Fund for Medical Education; Professor Fein, professor of the economics of medicine at Harvard University; and Professor Reinhardt, professor of economics, Princeton University. I am sorry to say that Dr. Kerr White, who was originally scheduled, is ill and will be unable to appear today, but we hope to have him sometime in the future. Dr. Wynder, if you would like to begin the discussion, please do so.

STATEMENT OF E. L. WYNDER, M.D. Dr. WYNDER. I would like to comment on the opening statement. I have and I do practice preventive medicine and if we in the medical profession would have succeeded in the practice of preventive medicine, it is unlikely that we would have to hold the hearings today.

It would seem from the history of medicine, as indeed from history in general, that while man has obviously enhanced his knowledge, he has not enlarged his wisdom. Forty-five hundred years have passed since Huang Ti declared in China :

Hence the sages did not treat those who were already ill; they instructed those who were not yet ill. ... To administer medicines to diseases which have already developed and to suppress revolts which have already developed is comparable to the behavior of those persons who begin to dig a well after they have become thirsty, and of those who begin to cast weapons after they have already engaged in battle.

Several decades ago, William James Mayo was quoted as saying:

The aim of medicine is to prevent disease and prolong life. The ideal of medicine is to eliminate the need of a physician.

We would concur that this is still the basic goal of medicine, as indeed is well reflected in an old Greek motto that has become the basic saving of our foundation that it should be the function of medicine to help people die young as late in life as possible.

THE ISSUE

This being the case, we should ask how our current medical care delivery system is addressing itself to this issue, where the primary problems in achieving these goals lie, and how a program of national health insurance could contribute toward its attainment. With a decreasing birth rate, we are faced over the next few decades with the predictability of fewer wage earners as healthy as possible and reduce the need for unnecessary and increasingly expensive hospitalization among our older individuals.

If we fail in this, our Nation will be required to undertake a major shift of priorities in the national economy; one that would see an ever-increasing percentage of the gross national product tied up in health care delivery services. This would be a task of unprecedented dimensions, and one that might well be impossible within the present productive framework of our Nation, particularly in view of other formidable competing priorities.

The consideration of a national health insurance system is politically natural in the increasingly mutualistic atmosphere of our democracy. A health insurance system immediately brings to mind hospitalization needs and the coverage of disease costs, but if we are not to make of this system an economic monster, I urge you to consider how disease, life, and moneysaving measures can be built into such a system.

That is why I shall stress in my remarks areas involving preventive medicine. I would like to caution, however, that as has been experienced by national health insurance systems in other countries, and indeed from our own experience with medicaid and medicare-a cost-effective health insurance system requires, in order not to be economically overburdened, a disciplined population and a disciplined health care profession in order that its obvious advantages are not destroyed by an overzealous use of its opportunities.

It seems appropriate that, in discussing the health needs of the the United States, one begins by enumerating the major causes of death

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