Allman, Dr. David B., board of trustees, American Medical Associa- Anderson, Dr. Odin W., director of research, Health Information Bauer, Dr. Louis H., immediate past president, American Medical Association, and secretary-general, World Medical Association_ 2164, Clark, Dr. Dean A., general director, Massachusetts General Hospital, Cooley, George, associate secretary of the council on medical service, 1907 Feldman, Jacob J., Health Information Foundation_ Gibbons, Harold, president, Labor Health Institute, St. Louis, Mo.- Gray, Gordon, president, University of North Carolina, and chairman, Leibert, E. R., Scarsdale, N. Y. 2273 1941 Lorber, Benjamin, director of insurance, Universal Pictures Co., Inc.- 2205, 2241 2319 Sorg, H. Theodore, president, New Jersey Blue Cross Plan 2064 Werch, Leon, director of research, Research Council for Economic Van Steenwyk, E. A., chairman, Government relations committee, 2347 Williamson, Kenneth, executive vice president, Health Information 2067 Blue Cross Commission, letter from Richard M. Jones, director, 2362 Commission on Financing of Hospital Care, members of... 2281 Health Information Foundation: National consumer survey of medical costs and voluntary health Research projects, 1950-53- 2091-2131 Additional information submitted-Continued Iowa Medical Society, statement of I. W. Myers, legal counsel.. Life Insurance Association of America: Memorandum on major medical expense group insurance plans__ Survey of representative major medical expense insurance plans, Page 2510 2131 Massachusetts Medical Service, memorandum concerning Blue Cross- 2498 Research Council for Economic Security: Study of prolonged illness, Securities and Exchange Commission, letter from Richard B. 2229 Statistical tables.. 2137-2139 Major Medical Expense, by Benjamin Lorbor, insurance man- 1951 Sample contract with John Hancock Mutual Life Insurance Co.. Appendix A. Letter from Hon. Oveta Culp Hobby, Secretary of Health, Education, and Welfare, transmitting information requested by Chair- Appendix B. Characteristics of 6 comprehensive medical care plans in the Appendix C. Selected bibliography on prepayment medical care programs, from Management and Union Health and Medical Programs (Public Health Service Publication No. 329) by Margaret C. Klem and Margaret Appendix D. Recent references on health services and health insurance__ HEALTH INQUIRY (VOLUNTARY HEALTH INSURANCE) WEDNESDAY, JANUARY 20, 1954 HOUSE OF REPRESENTATIVES, COMMITTEE ON INTERSTATE AND FOREIGN COMMERCE, Washington, D. C. The committee met, pursuant to adjournment, at 10 a. m., in room 1334, New House Office Building, Hon. Charles A. Wolverton (chairman) presiding. STATEMENT OF DEAN A. CLARK, M. D., GENERAL DIRECTOR, MASSACHUSETTS GENERAL HOSPITAL, BOSTON, MASS. The CHAIRMAN. The committee will come to order. Our witness this morning is Dr. Dean A. Clark, of Boston, Mass., who is general director of the Massachusetts General Hospital. Dr. Clark has administered a variety of medical-care programs, some under public and others under voluntary auspices. He has made studies of methods for the provision of medical services among many different population groups and he has written extensively in the field of medical care administration. After receiving this degree in medicine at Johns Hopkins Hospital in 1932, Dr. Clark had several years of graduate medical education at hospitals and clinics in New York and Baltimore. In 1939, he was commissioned in the United States Public Health Service, and he has been senior surgeon for the Public Health Service. In the early days of World War II he was detailed by the Public Health Service to the Office of Civilian Defense where he was chief of the hospital section, and later to the Office of Vocational Rehabilitation, Federal Security Agency, where he was chief medical officer. Dr. Clark was active in developing the framework for the Health Insurance Plan of Greater New York. After its initiation he served for 4 years as its first medical director. In 1949 he resigned his position to become general director of the Massachusetts General Hospital. For several years Dr. Clark has been president of the Cooperative Health Federation of America, an organization of about 20 consumersponsored group health plans. In 1950, he was appointed by the Subcommittee on Health of the United States Senate Committee on Labor and Public Welfare to be consulting director to the subcommittee's staff in making a nationwide survey on voluntary health insurance and in preparing the report of that survey. Dr. Clark is a member of the governing council of the American Public Health Association and chairman of the association's subcommittee on medical care. He was also a member of President Truman's Commission on the Health Needs of the Nation, and he is the fourth member of that Commission who has appeared before our committee to give us the benefit of his thinking with regard to a health program. Dr. Clark, we are very appreciative of your presence this morning. We realize that your past experience and your interest in the subject of health from the standpoint of the nation and its people, has been such that you can be of very great help to us in the views that you express. You may now proceed. Dr. CLARK. Thank you, Mr. Chairman. It is a honor which I greatly appreciate to be invited to appear before your distinguished committee to discuss the health needs of the Nation. In making this statement, I should explain that I appear as an individual and not as a representative of the trustees or staff of the Massachusetts General Hospital nor of any other organization of which I happen to be a member or an officer. It is a particular privilege to be here so soon after the submission of the President's health message, and I shall refer at times to the issues discussed therein, but there has not been time for me to prepare any full written comment upon it, although, if desired, further reference to it might be made in informal testimony later. The CHAIRMAN. May I say this in that connection, Dr. Clark, that it is our desire that you have the opportunity of making any references to it that you wish, at a later date, and when you have done so, and if you do so, it will be made a part of your testimony today. Dr. CLARK. Thank you, sir. Since it is my understanding that what your committee desires is comment upon the general issues rather than upon any specific legislative proposals, I shall refer to such proposals for purposes of illustration only and not in advocating or opposing any of them. At the outset, may I say that I am in full agreement with the President's underlying principle that "The means for achieving good health should be accessible to all," and that "A person's location, occupation, age, race, creed, or financial status should not bar him from enjoying this access." Three questions then arise: (1) How far short, if at are we of fulfilling this principle? (2) If we are short, what are the gaps, specifically? (3) If there are gaps, what should be done to fill them? In answer to question No. 1, I do not think, in spite of our spectacular progress in health, so eloquently described by the President, that it would be seriously argued by anyone that we have achieved the President's principle completely. The aged, people living in many rural areas, certain races, and people in poor financial circumstances, to name but a few groups, are too well known to lack the opportunity for comprehensive health services to need further documentation here. Specifically, what are the gaps? Summarizing them briefly, I should say the principal gaps fall into three groups: first, shortage of trained personnel and of facilities, both in general and, in particular, in certain geographical areas; second, inadequate organization of existing services to meet successfully our major needs for preventive medicine, early diagnosis, adequate treatment, and rehabilitation; third, inade quate methods of financing the needed services so that all may enjoy them. Finally, granting the presence of the gaps I have mentioned, what, if anything, should be done about them, particularly by the Federal Government? My series of proposals-none of which is new or original with mewould here fall into two categories, not entirely separable from each other in either time or place. The two categories might, however, be identified, in a rough sort of way, as those dealing with preparatory measures-a "tooling up" phase, as it was put by one of the members of the President's Commission on the Health Needs of the Nation, on which, as you mentioned, Mr. Chairman, I had the honor to serve in 1952-and those dealing with the continuing distribution of services, an "on-going phase," as it might be termed. Among the measures needed for "tooling up," the most important have to do with personnel, facilities, and the organization of services. Certainly, some form of assistance to increase our supply of doctors, nurses, dentists, and public health workers-and other workers that might be added-is necessary. With the continued growth of the population, and with the continually increasing complexity of the services needed, more health personnel of almost all types are urgently needed if we are to approach the goal set forth by the President. Facilities, too, are required. Such measures as a continued and broadened Hospital Survey and Construction Act, as suggested by the President, and the proposal of your Mr. Wolverton in H. R. 6950, and comparable Senate bill introduced by Senator Humphrey of Minnesota, seem excellent to me. These same measures, with their emphasis on statewide and regional planning, organized group medical practice, and prepayment for comprehensive medical services, would also be of assistance in improving the organization of our health services and in financing them, too. Another important element in "tooling-up" is the continuation of Federal grants for medical research, including assistance in the construction of facilities for such research, authorization for which is in most of the Research Institutes Act, but in recent years there have been no appropriations for construction of facilities for research. I think they are badly needed. While there are differences of opinion about the proper role of the Federal Government in the encouragement and financing of these "tooling-up" measures, I do not think many people would question the need for some means to be found to accomplish them. My own view is that it is possible as well as desirable for the Federal Government to take the lead in solving what is, after all, a nationwide problem without, at the same time, threatening the freedom of the medical schools, hospitals, research laboratories, and individuals involved. The "ongoing phase" is far more complex, more difficult, and more controversial. In this regard, I noted with great satisfaction as a former Chief Medical Officer of the Federal Office of Vocational Rehabilitation, the President's emphasis on enlarging and strengthening our Federal-State program for the rehabilitation of the disabled. Certainly no program in the health field illustrates more distinctly than does rehabilitation that good health pays off: in lower dependency and relief costs in productivity, even in personal income taxes. |