they don't go to any of the people they now go to and go out and see some people they have never heard of.

It is a strange and frightening thing to suggest to people.

Mr. Copp. Sir, without a lot of hardcore data behind me at the moment, I think the population of Hawaii is not quite representative of the rest of the U.S. society, in that Hawaii is a tourist and resort microcosm and the cost of living is extremely high.

Mr. HEFTEL. Hawaii is a cross-section of America, and I guarantee it. Seventy percent of the people are not Caucasian, and I could assure you that there is a cross-section of America.

Mr. RAIFORD. By your own statement, Hawaii is not representative of the U.S. health care system. It seems to be unique. We have been here all morning and heard all of the testimony and nothing comes close to what you have in Hawaii.

Mr. HEFTEL. What I said was that in Hawaii it is 84 percent. In some other area it may be 50 percent. What I was trying to say is, whether it is 84 percent in Hawaii or 50 percent someplace else, the people are using a system they are reasonably satisfied with. To suggest they will suddenly discard it and no longer use it and go to this new system is not being realistic.

Mr. RANGEL. Even if I were to disagree with you and to inject that the people really don't have the opportunity to choose between what they have now and what is being proposed, I still don't see how the proponents would believe that we could attract and keep the people and provide the incentives to keep the people into this system.

I believe what you are saying is it is going to be so strong and so effective and it is going to attract so much of the American population that it will drive the private sector out of business.

Mr. COPP. The private sector must cooperate in terms of providing the technology, the pharmaceuticals, and the apparatus, et cetera. The bill does not mandate anything in terms of manufacture

Mr. RANGEL. I meant the private medical delivery system. I want you to know that this committee has heard from Mr. Dellums and proponents of the Dellums bill. We are going around the country and we are going to need a lot of political assistance in order to bring about this dramatic change in the delivery of health care for the Nation.

Miss SCHEUER. I would like to state on the record that we are supporting not one bill. We are an institute of higher learning and we are supporting the principle, that is all.

Mr. RANGEL. I didn't get that from your testimony.

Mr. RAIFORD. We said something on the order of the Dellums bill. Mr. RANGEL. That is very good. It is the only one that we have and is there anything you could do to make it politically possible to bring this thing out of subcommittee?

Mr. Copp. We would expect the same thing of you.

Mr. RANGEL. I was trying to assure you that my task is much more difficult than yours. Thank you and let me say this: We hope none of you are discouraged from the course which the questions have taken, and we seriously thank you for coming with an interest, and to come and present your views to the committee, and just as importantly for the record those people who would be seeing how our hearings are

We hope you don't take the sharpness of the questions as any lack of support for the position which you have.

STATEMENT OF RAYMOND C. FAUNTROY, EXECUTIVE DIRECTOR, MIAMI BRANCH, SOUTHERN CHRISTIAN LEADERSHIP CONFERENCE

Mr. RANGEL. We have now Raymond C. Fauntroy, executive director of the Southern Christian Leadership Conference, a member of a family of outstanding achievement.

Are you a reverend?

Mr. FAUNTROY. No.

The fact of the matter is, we have people out here in this country who are unhealthy, who are suffering and who are dying and who could not afford medical care, and who are not getting medical attention.

We have prepared a statement here in which we have some facts and it will only take me a minute to go through this.

Today I have the honor of presenting the views of the Southern Christian Leadership Conference's Miami branch concerning health insurance to your subcommittee?

We believe that America requires a comprehensive revision of its health care system in order to meet the needs of all citizens, but particularly to meet the unmet needs of blacks, hispanics, the elderly, and low income people.

We feel that a different system of health care would provide better quality service at lower costs. I would like to illustrate the need for a new system on the basis of existing unmet health care needs in the black community.

Blacks have a life expectancy at birth which is a full 5 years shorter than that of whites. Much of this difference in life expectancy is accounted for by the inaccessibility of the existing systems of health care or blacks. They cannot afford high quality care, health care services are not located in black neighborhoods, and the health care made available to blacks is often inconvenient and of low quality.

Let us examine different aspects of the health care needs of blacks and the lack of responsiveness of the existing system in meeting those needs.

The infant mortality rate of blacks is 41 per thousand live births, compared to only 21 per thousand for whites. Only 11 percent of pregnant black women see a doctor during the first 3 months of pregnancy, compared to 52 percent of white women. Only 25 percent of pregnant black women have at least nine prenatal visits to the doctor, compared to 57 percent for white women. The high cost of medical care and lack of accessible medical facilities are responsible for these differentials and for the consequent high rate of infant and maternal mortality among blacks.

Blacks are forced to use free public health facilities because they lack the funds or private health care. These public facilities are less convenient and provide more perfunctory care. Twice as many infant deaths occur with those using public facilities as opposed to those receiving private care. Problems of poor nutrition and poor maternal

health are compounded by poor medical treatment under the existing system.

Blacks generally visit doctors less frequently than whites, in spite of the fact that blacks have generally poorer health than whites. Blacks are four times as likely as whites to be treated in impersonal and inferior hospital outpatient clinics.

Blacks generally see a physician only when their condition has become severe. The existing system of private medicine in the United States prevents adequate preventative medicine and early treatment for blacks.

The health conditions of black males are worsening in several important ways in the last few decades. Unemployment has resulted in widespread psychological despair among black males and a consequent increase in alcoholism. The rate of death from cirrhosis of the liver was lower among blacks than whites in 1950 but it is now twice

that of whites.

The concentration of black males in the dirtiest, most dangerous industrial jobs is also causing an increase in the cancer death rate in this group. While cancer deaths among whites rose 3 percent from 1950 to 1975, they rose 20 percent among blacks in the same period. The lack of an effective public health system in the United States has prevented the correction of this worsening problem of job-induced disease and death.

Another aspect of the inferior medical care for blacks is shown by the fact that although blacks have a higher prevalence of cardiovascular disease and a higher death rate from this source than whites, they have a lower hospitalization rate for cardiovascular disease. Treatment for this disease is expensive, and blacks are disproportionately excluded from high-quality medical care in its treatment.

Progress was made in reducing the death rate from cardiovascular disease among blacks with the introduction of medicaid, but further progress awaits new Federal measures to increase the accessibility of medical care for blacks.

The same problem can be observed among victims of cancer. Fewer blacks than whites, proportionally, are hospitalized for cancer, although more blacks than whites, proportionally, die from cancer. The better medical care available to whites allows them to live longer once a localized cancer is detected. Fifty-nine percent of white males live longer than 5 years after the discovery of localized cancer, compared with only 49 percent of black males.

Another treatable disease is diabetes. Over twice as many blacks as whites, proportionally, die of diabetes, and this difference is partially due to the inferior medical care available to blacks under the present system. Too few blacks with diabetes can afford doctor visits or hospitalization.

Similar problems exist in the field of mental health. Conditions of racism, oppression, unemployment, and poverty creates greater mental stress for blacks than for whites in the United States, but blacks are given inferior mental health care.

More blacks, proportionately, are hospitalized for mental problems and the treatment available to blacks on an outpatient basis is often perfunctory: 15 minutes of consultation and frequent drug prescrip

tions. An equitable national health program would include equal access to quality medical care for all Americans.

Dental care for blacks is inferior to that received by whites. The high cost of dental care causes many blacks to put off preventive visits to the dentist and only to see a dentist when they need a tooth extracted. While 30 percent of black dental visits include a tooth extraction, this is true of only 14 percent of white visits. While 45 percent of all whites visited the dentist at least once in the past year, this is true of only 23 percent of blacks. The consequence of inferior dental care for blacks is that blacks lose their teeth at an earlier age than do whites.

Medical care for children is shockingly substandard under the existing system. There has been a major decline in the immunization of children against polio since 1965, and this has been particularly pronounced in the black community.

While 67 percent of white children between the ages of 1 and 4 are immunized, this is true of only 49 percent of black children. Government spending on the health care needs of children should be rapidly increased. We cannot endanger the health of future generations of Americans by perpetuating the existing system of private medical

care.

Broad problems of access to medical care under the existing system are obvious in the following statistics: Only 33 percent of blacks get annual physical checkups, compared to 40 percent of whites; 65 percent of blacks have to travel more than 15 minutes to reach their medical care center, compared to 46 percent of whites; and only 39 percent of blacks get to see a doctor within 30 minutes of arrival at their medical care center, compared to 59 percent of whites.

Medicare and medicaid are responsible for distortions in medical care offered to blacks, low-income people, and the elderly: Hospitalization and operations which are covered thoroughly under these plans are prescribed too frequently while outpatient treatment which is less thoroughly covered is not prescribed enough. Any health insurance program which does not provide comprehensive coverage will simply magnify these distortions, while enriching doctors, hospitals, and insurance companies in the process.

Blacks and low-income people need more adequate preventative care and early diagnosis, and not simply catastrophic health insurance

coverage.

Health care costs in our society are inequitably distributed: Lowincome people pay 12.6 percent of family income for health care, compared to only 3.5 percent of family incomes for affluent people in 1970.

Only 39 percent of families with incomes under $3,000 are covered by health insurance, compared to 90 percent of families with incomes over $10,000 in 1970. This means that a serious accident or illness is much more damaging to the finances of a low-income family than for high-income families.

In summary, the following measures would best meet the health care needs of the black community:

There should be no costs associated with medical treatment which would discourage preventative care and prompt early treatment of disease.

There should be a vast expansion of medical facilities within the black community itself. A network of neighborhood clinics, staffed on a regular basis by nurse-practitioners with weekly visits by various physician specialists, would offer a practical solution to the problem of accessibility of medical care for blacks.

More attention should be paid to reducing occupational accidents and disease, and especially to reducing the exposure of workers to carcinogens.

A national health system, as provided by the Dellums bill, would accomplish the goal of a democratic, egalitarian health system more efficiently than any of the insurance proposals.

Public ownership of clinics and hospitals and Government salaries for physicians, nurses and other health care workers would bring medical costs under control more effectively than any alternative. Democratic community control over local health systems is essential, and this is provided for in the Dellums bill which would allow every neighborhood of 50,000 people to control its own medical care system. This would provide for effective control by the black community over its own health care system. Only such a system can guaranty equity and accessibility to health care services for the black community.

Mr. HEFTEL. You focus upon a very important question. I have read your statement and I think all of your statistics are probably quite accurate, but is it reasonable to assume that the solution will be one in which 100 percent of the people will abrogate the present system? You say, on page 4:

A network of neighborhood clinics, staffed on a regular basis by nurse-practitioners with weekly visits by various physician specialists, would offer a practical solution to the problem of accessibility of medical care for blacks.

If we are really talking about something that will better address the problem of health care, and health care particularly to the poor blacks, wouldn't it seem that that is what we have to look at, that paragraph, which says if we can't today change the sysem, if we can't today get everybody to abrogate the present system, and I think the chairman has rather geographically pointed out that isn't realistic, would we be better off if we tried to focus the so-called medicaid dollars into a better way of serving the poor areas of the country?

I am not saying that we should or shouldn't, but I would like your opinion on whether we are being unrealistic in concentrating on the national health program system, as opposed to trying to do a better job of what we do with our dollars in these areas of poor population. Mr. FAUNTROY. I would say it is obvious that the present system is not working. If it were working then we would not have the problems in the communities that we have today. With that in mind, I would say that we would have to have some sort of alternative plan that would include those citizens who are being left out of this present plan.

I believe that this plan would work.

Mr. HEFTEL. You are talking about this national health system plan?

Mr. FAUNTROY. Yes.

Mr. HEFTEL. But that means the whole system of America has to be changed and if the overwhelming majority of the people don't want