unwillingness to posit the point of view that health care is a right; but what astounds us even more is their inability to see a health crisis. They continue to talk about the health insurance coverage of the majority of the American people, and while statistics will show such coverage, it should be pointed out that most health insurance policies are for treatment, not prevention.

Because of the high cost of office visits, which are not covered by most policies, many people must ignore warning signs of impending health problems and wait until there is actual illness in order to be hospitalized and receive free treatment. This causes two obviously inherent problems: First a contagious illness will be incubating prior to the onset of debilitation. During this period, many more people can become infected, thereby creating a possible epidemic.

Second, to wait for debilitation and hospitalization is very expensive in terms of human life, loss of manpower and earning power, and the actual cost of treatment itself. As the costs of medical care continue to spiral, fewer and fewer people will be able to afford preventative dental care, optical care, and general medical care. Then the crisis which the economics cannot currently see, will force a governmental response to health care needs.

We think it is past time for the Federal Government to take a decisive stand to prevent crisis, not wait for it. We are encouraged by the fact that your committee has come to the people, as it were, and we take this as a sign that the Government is indicating a readiness to create legislation to deal effectively with the issue of health care.

We see this as a very serious issue. Today, there are 51 million Americans living in 50 counties where there are no medical facilities, no doctors, and no nurses; but even in locations where health care is accessible, its costs remain beyond the reach of a substantial number of people.

While inflationary costs are generaly doubling, for medical services, it is tripling, and private insurance has not provided sufficient remedy. Eighteen million Americans have no health insurance and do not qualify for most public health services.

Also, there are 19 million Americans who, though insured, have no comprehensive coverage. Any major or prolonged illness would render them medically indigent.

We are fully aware of the nature of policy formation and the difficulty of establishing a comprehensive plan which will be at once effective enough to seriously address the issue and nonthreatening enough to be acceptable to strong vested interest groups.

We have looked closely at those organizations and individuals who are likely to oppose an effective national health insurance plan and they appear formidable. Those who are likely to support such a plan, like ourselves, espouse the sentiment of the American people, but have no lobby, no money, and therefore, very little voice.

That is why we urge your committee to act in the best interest of the American people, not the specialized and powerful vested interest groups.

We have examined three of the major national health insurance plans. We find that President Carter's plan, or the administration

plan, is not at all comprehensive, although it is called that. At best it is a passive reaction to a very important and serious issue.

The Kennedy proposal is more comprehensive, but still too timid in terms of putting forth a strong Federal plan. His reliance on the insurance industry to administer such a crucial Government service is obviously intended to reduce the likelihood of strong opposition from that sector. We see this as the "half loaf is better than none" syndrome. We are not convinced that the whole loaf is unattainable. We are convinced that it is needed, and we are convinced that the American people would indeed support an effective national health insurance plan.

Furthermore, we are discouraged by the lack of emphasis on preventative care by both Carter and Kennedy. We feel that Carter's plan is wholly without a consideration for preventive medical service, and that Kennedy's plan, while ostensibly addressing the issue of prevention, is certainly too restrictive to be called truly comprehensive.

He places limitations on essential services, including nursing home care, dental care, and psychiatric care. Out of a total projected budget of $200 billion, the Kennedy plan would allocate only $500 million for prevention.

In our exploration of major national health insurance plans, we find ourselves leaning toward the Dellums plan, not because the Congressman is a social worker, but because it represents the most comprehensive approach to health care of any plan we have examined.

His plan is put forth as one addressing the realistic health needs of the American people. It does not try to tailor the definition of needs to fit an arbitrary budget. We take the position that needs are defined independently of budget considerations. In other words, definition of needs are prior to the determination of resources.

This plan at least defines the health needs of the American people. So we join the Gray Panthers and other groups here today in calling for a comprehensive national health plan on the order of the one proposed by Congressman Dellums.

We firmly believe that the American people need it; that they want it, and that they will support it.

We thank you, Mr. Chairman.

Mr. RANGEL. Thank you, Miss Scheuer. Most people don't refer to the Dellums plan as an insurance plan. You are basically talking about a health system.

Miss SCHEUER. It is more of a health program than an insurance plan.

Mr. RANGEL. And I assume that your full hope that we would nationalize health services?

Miss SCHEUER. That is right.

Mr. Copp. Sir, if I may add, under the Dellums plan there would be total provision for private practice. Representative Dellums set it up so that there would be a health service that is monitored by the communities, and it is organized by a health board.

Mr. RANGEL. What happens to all of the surgeons and doctors that have testified under the plan as you see it? Will they continue their practices and fee for services and we will set up an alternative system? Mr. COPP. Exactly. They are free to practice privately.

Mr. RANGEL. Where do we get the people for the health system to deliver that service?

Mr. Copp. This is probably the crux of the Dellums plan, in that it provides both the funding and budgeting and the ethos for training the health professional.

Mr. RANGEL. We have to have a health system and we are going to have some doctors and nurses and hospital executives and paraprofessionals and we need a whole system. Now, you are not talking about the system that we have now and they are out there and they are making money and they are looking for tax shelters and they are all right. I am asking, where are we going to get the troops for the health system?

Mr. COPP. Part of the plan involves a transition period, and the bill provides for that. I believe there is a 4-year period or I may be confusing that with the amount of money, $4 billion allocated for the transition.

Mr. RAIFORD. I am a professor at Barry School of Social Work. Your question is a very good one but it reminds me of the one you asked Monsignor Walsh, why doesn't the Catholic community now train medical professionals?

Mr. RANGEL. We could train them and we train everybody, social workers and whatnot, and as soon as they get the training they go. How do we keep them?

Mr. COPP. Under this bill the trainees are responsible for years of service equal to the amount of years that they have been trained, so that if you have an X-ray technician trained for 2 years, then they are responsible for 2 years' service.

Mr. RANGEL. Under what sanctions?

Mr. Copp. Under the sanctions of the bill. The bill provides elaborate mechanisms for insuring that.

Mr. RANGEL. Tell me what happens to a person that is trained to become a doctor under this system, and he or she has certain obligations? One of the reasons I didn't go into it with the good Father is that they have trained a lot of nuns and priests and they are losing them and not for medical purposes. They get their degrees and they are going into other areas.

All I am asking is that you have your national system and you have trained the doctor and you have trained the surgeon and you have trained the nurses and you have trained the hospital directors, and so we have done our job in funding the training.

After they receive the training, they have decided to join their dads and uncles in their private sector. I am asking you, what do you believe under the laws of our country that we could do with these people that we have trained if they have decided to leave the system?

Mr. Copp. Mr. Chairman, the bill provides for people who choose to leave the health system, to pay a ratio of money back into the system and to make amends for breaking the negotiated agreement. Mr. RANGEL. To buy out of the system?

Mr. COPP. Exactly.

Mr. RANGEL. And not to be allowed to practice what they have been trained in unless they are able to purchase their freedom?

Mr. Copp. It is an incentive to stay. You asked what the incentives

were.

Mr. RANGEL. That argument has been used for slavery.

Mr. Copp. I think also worked into the bill, as I said, is the ethos to encourage people down the line in 10 years or so, or maybe 20, that there needs to be a revamping or refocusing of the attitudes, and this is the goal.

After awhile people will see the value in it.

Mr. RANGEL. Wouldn't you have to deny licenses to people and would you really have to eliminate the competitive nature of it?

Mr. COPP. The Federal Government, wouldn't be the only sole supplier of services. I just can't conceive of anybody, given the optionnot everybody-but I don't see how it would not work, present doctors excepted, given the opportunity to go out and compete in this market for dollars.

Mr. RAIFORD. We are talking, as I said, about ethos, the whole thing has to be changed. We are not talking about the doctors only. We are talking about pharmaceutical companies and the whole medical industry.

Mr. RANGEL. And you believe this could be done without bloodshed? Mr. COPP. There was a lot of opposition to the New Deal and other large systems that were changed in social reforms. Yet we have social security in this country now and we have similar such programs. Mr. RANGEL. Where did social security come into this?

Miss SCHEUER. We are talking about social changes which have taken place without bloodshed.

Mr. HEFTEL. Social security is a different kind of program. It is a program in which the person has a given amount withheld and then the funds are distributed back after a certain age and nobody's career was sacrificed and nobody felt that they changed their way of life.

You made no social reform or social change under that. There is no relationship between what we are talking about today and the social security system.

Miss SCHEUER. Was there no resistance to that system before it was enacted?

Mr. HEFTEL. In fact if there was resistance to two different things, it doesn't mean that there is anything comparable.

Miss SCHEUER. You don't think the Social Security Act was a social reform policy at all?

Mr. HEFTEL. There is no analogy between that and this program that you are talking about. There is no relationship whatsoever. Mr. RANGEL. I certainly see it as a progressive social program. Mr. HEFTEL. It doesn't change their attitude toward society. Mr. RANGEL. You are forcing someone under the social security program to invest, and also you are providing the services, but you are forcing the investment. I suppose that is the only resistance where some freethinkers might believe the Government should not interfere. But you do provide a benefit for everybody and force them to become a part of a system.

Now, where would somebody believe that the free enterprise system was letting him or her down under the Social Security Act? If you want to make the analogy, you know what we are up against, and whether we like the system or not, you are talking about from the pill roller to the nurses, the hospitals, the whole system and you know the army is out there. I am asking you, where would that army have

been when you talked about the social security system, where the army became the beneficiary of this social progress? You are saying that the service would be out there. I don't have any problem with saying that under this you would have a broader and more comprehensive health system, but I don't see how you could do it without the benefits of a draft.

Mr. RAIFORD. Could we ask a question of you?

Does the committee see health as a right, health care as a right, and are you proceeding as if it is a right?

Mr. RANGEL. We are proceeding as though it were a right and we are fighting as we have with many other rights, to get legislation to support it. There is no question that people should not be denied health care because of their inability to purchase it, so it is a right.

I perceive shelter to be a right and people should not determine whether or not they are going to live in the woods or whether they could afford to rent a home or an apartment. I consider that a right.

The right to live is a right which has been conditioned by the system in which we live. Now we want to change that and we are all on the same side, but we have to legislate and we need your help to do that and that is why I am asking you.

If you are talking about why we are going to draft these rascals into a system and mandate they provide the service and court marshal them if they decide to leave, let us do it. But don't tell me that they are going to have all of this free option about buying in and buying out after we train them. What are you going to do jail them?

Suppose they don't pay? Are we going to brainwash them and take back all of these great surgical skills we have given them? Miss SCHEUER. Then they have committed an offense.

Mr. RANGEL. Are we prepared to lock them up for it?

Mr. HEFTEL. Mr. Chairman, if we think about it a moment, once the man has gained a medical degree, and all he has to do to no longer have to serve in the system is pay something back, there is no problem in gaining the finances with which to pay it back. So you have no reason for staying in, except the desire to do so; but as far as economic conditions you impose, it will not affect it at all.

Mr. COPP. The physician or the service provider must have consumers to provide the services to and the consumers are going to have control over their health care under this system. They could refuse to go to that provider and choose to go to the provider that is going to be equitable to them.

So there is going to be a large incentive there. The bill absolutely insures consumer input.

Mr. HEFTEL. If it were true that 100 percent of American people who are not physicians want the system you are describing, I would agree, but since probably 50 or 60 percent at least want the system we have now, in Hawaii it would probably be 84 percent, there is no reason to do anything.

Mr. Copp. I think you are referring to a poll.

Mr. HEFTEL. This is the percentage in Hawaii who are participants in health insurance programs who are satisfied with the system and are probably doing very well medically under the system. They are not going to discard that system for some unknown system in which