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Volume III NATIONAL HEALTH INSURANCE

MAJOR ISSUES

HEARINGS

BEFORE THE

SUBCOMMITTEE ON
HEALTH AND THE ENVIRONMENT

OF THE

COMMITTEE ON INTERSTATE AND FOREIGN COMMERCE

HOUSE OF REPRESENTATIVES

NINETY-FOURTH CONGRESS

SECOND SESSION

ON

CONSIDERATION OF THE MAJOR ISSUES RELATING

TO NATIONAL HEALTH INSURANCE

FEBRUARY 3, 4, 5, 9, 10, 11, 17, 18, 19, 23, 24, 25, AND 26, 1976

Serial No. 94-91

Printed for the use of the
Committee on Interstate and Foreign Commerce

U.S. GOVERNMENT PRINTING OFFICE

70-411 O

WASHINGTON : 1976

For sale by the Superintendent of Documents, U.S. Government Printing Office

Washington, D.C. 20402 · Price $6.15

14 SU

XL 1102 31150-200 HULE

COMMITTEE ON INTERSTATE AND FOREIGN COMMERCE

HARLEY O. STAGGERS, West Virginia, Chairman TORBERT H. MACDONALD, Massachusetts SAMUEL L. DEVINE, Ohio JOHN E. MOSS, California

JAMES T. BROYHILL, North Carolina JOHN D. DINGELL, Michigan

TIM LEE CARTER, Kentucky PAUL G. ROGERS, Florida

CLARENCE J. BROWN, Ohio LIONEL VAN DEERLIN, California

JOE SKUBITZ, Kansas FRED B. ROONEY, Pennsylvania

JAMES M. COLLINS, Texas JOHN M. MURPHY, New York

LOUIS FREY, JR., Florida DAVID E. SATTERFIELD III, Virginia JOHN Y. MCCOLLISTER, Nebraska BROCK ADAMS, Washington

NORMAN F. LENT, New York W. S. (BILL) STUCKEY, JR., Georgia H. JOHN HEINZ III, Pennsylvania BOB ECKHARDT, Texas

EDWARD R. MADIGAN, Illinois RICHARDSON PREYER, North Carolina CARLOS J. MOORHEAD, California JAMES W. SYMINGTON. Missouri

MATTHEW J. RINALDO, New Jersey CHARLES J. CARNEY, Ohio

W. HENSON MOORE, Illinois
RALPH H. METCALFE, Illinois
GOODLOE E. BYRON, Maryland
JAMES H. SCHEUER, New York
RICHARD L. OTTINGER, New York
HENRY A. WAXMAN, California
ROBERT (BOB) KRUEGER, Texas
TIMOTHY E. WIRTH, Colorado
PHILIP R. SHARP, Indiana
WILLIAM M. BRODHEAD, Michigan
W. G. (BILL) HEFNER, North Carolina
JAMES J. FLORIO, New Jersey
ANTHONY TOBY MOFFETT, Connecticut
JIM SANTINI, Nevada
ANDREW MAGUIRE, New Jersey

W. E. WILLIAMSON, Clerk
KENNETH J. PAINTER, A88istant Clerk

Professional Stall
CHARLES B. CURTIS

WILLIAM P. ADAMS
LEE S. HYDE

ROBERT R. NORDHAUS
ELIZABETH HARRISON

BRIAN P.. MOIR
JEFFREY H. SCHWARTZ

WILLIAM G. PHILLIPS
JAMES M. MENGER, Jr.

KAREN NELSON
JOHNNIE L. GALLEMORE, Jr., Associate Minority Counsel

SUBCOMMITTEE ON HEALTH AND THE ENVIRONMENT

PAUL G. ROGERS, Florida, Chairman DAVID E. SATTERFIELD III. Virginia TIM LEE CARTER, Kentucky RICHARDSON PREYER, North Carolina JAMES T. BROYHILL, North Carolina JAMES W. SYMINGTON, Missouri

H. JOHN HEINZ III, Pennsylvania JAMES H. SCHEUER, New York

EDWARD R. MADIGAN, Illinois
HENRY A. WAXMAN, California

SAMUEL L. DEVINE, Ohio
W. G. (BILL) HEFNER, North Carolina (Ex Officio)
JAMES J. FLORIO, New Jersey
CHARLES J. CARNEY, Ohio
ANDREW MAGUIRE, New Jersey
HARLEY O. STAGGERS, West Virginia
(Ex Officio)

STEPHAN E. LAWTON, Counsel
JO ANNE GLISSON, Staff Assistant
STEPHEN J. CONNOLLY, Staf Assistant
DONALD K. DALRYMPLE, Assistant Counsel

(11)

CONTENTS

(The same table of contents appears in volumes II and III.)

February 18, 1976 (quality assurance).---

829

February 19, 1976 (who should be covered?).-

937

February 23, 1976 (how should providers and institutions be reim-

bursed?).

1009

February 24, 1976 (how can cost be controlled?)

1081

February 25, 1976 (budget and financing issues).

1157

February 26, 1976 (administration)-..

1323

Statements of -

Adams, Hon. Brock, a Representative in Congress from the State of

Washington.-

1157

Altman, Stuart H., Ph. D., Deputy Assistant Secretary for Planning

and Evaluation/Health, Department of Health, Education, and

Welfare.

3, 37, 1176, 1214

Amidei, Nancy, Washington, D.C..

937

Ball, Robert, senior scholar, Institute of Medicine, National Academy

of Sciences..

1323, 1373

Bawden, James W., D.D.S., professor, Department of Pedodontics,
University of North Carolina, School of Dentistry--

585, 734

Beall, Hon. J. Glenn, Jr., a U.S. Senator from the State of Maryland.. 791

Beigel, Allan, M.D., director, Southern Arizona Mental Health

Center..

585, 671

Berman, Richard A., associate director for ambulatory services,

the New York Hospital, and assistant dean of Cornell University
Medical College.

1081
Butler, Patricia A., associate director, National Health Law Program 142, 171
Cohen, Harold A., executive director, Health Services Cost Review
Commission, State of Maryland.

1010, 1017
Conable, Hon. Barber B., a Representative in Congress from the
State of New York..,

781
Cooper, Theodore, M.D., Secretary for Health, Department of Health,

Education, and Welfare.
Cornely, Donald A., M.D., Department of Maternal and Child Health,
School of Public Health, Johns Hopkins University

937, 946

Cruikshank, Nelson H., president, National Council of Senior

Citizens.

309, 316

Davis, Karen, Ph. D., senior fellow, Brookings Institution.--- 142, 148

DeCencio, Dominic, Ph. D., executive director, Cumberland Regional

Health Plan..

142, 185

Durkin, Robert, administrator, Division of Health Policy and
Planning, State of Wisconsin.--

29

Ellwood, Paul M., Jr., M.D., president, Interstudy

467, 496

Falk, Isidore S., professor of public health, Yale University School of

Medicine, and member, Executive Committee, Health Security

Action Council, and chairman, Technical Subcommittee, Com-

mittee for National Health Insurance.

1323, 1386

Fifer, William R., M.D., professor of medicine, University of Min-
nesota.

870

3, 37

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