STATEMENT BY I. W. MYERS, LEGAL COUNSEL, IOWA MEDICAL SOCIETY The doctors of Iowa who constitute the Iowa State Medical Society, have had a deep concern about anything that bordered on the lines of socialism, or that placed control over local matters in hands of the Federal Government and I sincerely believe that is their philosophy. They are familiar, too, with the decision by the Supreme Court of the United States in the case of Claude Wickard, Secretary of Agriculture, v. Roscoe C. Filburn (decided November 9, 1942, 317 U. S. 111, (131), 87 Law Ed. 122, (138)), "It is hardly lack of due process for the Government to regulate that which it subsidizes." The Iowa State Medical Society also believes that tremendous progress is being made in the State of Iowa and at the local level by groups working together. They do not claim, however, to be perfect or to have solved all the problems, but believe progress is being made. They do not feel that the Federal operation of matters is perfect either or that faster progress could be made by Federal intervention. They have been meeting with different groups in the State of Iowa and just recently sponsored a dinner for the Farm Bureau and the new dean of the medical school to discuss mutual problems and in the next week will meet with the State board of education, which has under its jurisdiction the medical school. I mention these meetings, and they have had many more, as indicative of the action of the Iowa State Medical Society to meet the health needs of the people of Iowa. The Iowa State Medical Society has committees active and functioning on some of the following subjects: Committee on scientific work, committee on legislation, committee on medical service, committee on insurance, committee on veterans' affairs, committee on medical services to the indigent, committee on medical education and hospitals, grievance committee, committee on public health, committee on cancer, committee on geriatics, committee on rehabilitation, committee on maternal and child health, committee on industrial health, committee on national health association, committee on gamma globulin, committee on rural health, committee on interprofessional relations, committee on doctor-patient relations, committee on labor and industry, committee on health education, committee on national emergency medical service, committee on nursing education and service, and others. Of course you are interested on what are some of the results of this work and here are a few examples. For several years there has been a grievance committee before which any patient or any other person can appear and be heard on the matter of fees or the treatment he has received by the doctor or any other matter, and they have handled many cases. The availability of this committee has been announced many times in newspapers. In connection with the indigent in Iowa you will find in history that Iowa was one of the first to establish a plan whereby there was a State university hospital established at the medical school which is available to the indigent and the doctors used are the faculty and residents of the Iowa State Medical School, and in addition thereto, practically every county medical society contracts at modest rates for sums with the board of supervisors to see that the indigent have adequate medical care at the local level and this has been going on for years. About 5 years ago the Iowa State Medical Society endorsed and supported a bill in the Iowa Legislature to increase by 33% percent the admissions to the Iowa State University Medical School and this increase has been practically maintained clear through the senior class and in the main, this additional load on the medical school has been carried on a local level, together with money raised at a local level. The Iowa State Medical Society has also established a loan fund raised from Iowa doctors in an amount now in excess of $30,000 and growing, for students at the University of Iowa Medical School, primarily to help worthy students and to encourage them to locate in the general practice in small communities. The Iowa State Medical Society, with the medical school, several years ago established a preceptor plan where junior M. D.'s lived in homes with country doctors to learn about general practice and smaller communities, to encourage locating. In the past several years the Iowa State Medical Society has helped place approximately 200 new doctors in rural communities and is constantly working on satisfying the needs of the people. There is hardly a spot in the State of Iowa now where a doctor is not within a 10- or 15-minute drive of any citizen, although some small towns (where it is debatable if it is economically sound) do not have a doctor, but many of these are not over 10 minutes from a county seat. Iowa's present hospital needs for acute cases, except for possibly Des Moines and 1 or 2 isolated areas, has now been met as records reveal that there is only approximately a general overall 70-percent usage and in many of the smaller communities not over a 40- to 50-percent usage of available beds. Hill-Burton funds must be given some credit for this growth although, of course, local funds paid two-thirds of the cost. One could go on with many other illustrations of efforts being made by the Iowa State Medical Society to improve the conditions in the State of Iowa and can be given if desired. However, I don't believe that the Iowa State Medical Society would want me to contend perfection or a utopia has been reached, nor has such perfection or utopian been reached in any profession, or business, or any other endeavor, in the State of Iowa, and the Iowa State Medical Society can compare favorably with any other activity in the State or Nation. In spite of this, the Iowa State Medical Society is conscious of the fact that many say that they appreciate the fine advances that medicine has made in curing, preventing, and alleviating disease, and the fine work that doctors are doing, with a "but" always added and then go on to tear down all that the medical society stands for or tries to do. The Iowa State Medical Society does not claim perfection, but they're working hard toward it. I have not had as much time to do research in connection with Blue Cross and Blue Shield as I would like to do and I do not represent the Blue Cross Plans. However, I can point out that the doctors helped at the start to organize Blue Cross Plans in 1939 and some of them still serve on the Board of Directors. In 15 years, which is a comparatively short time, Blue Cross alone covers 1 out of every 4 people in Iowa and it is estimated with the commercial companies added thereto and other plans, approximately one-half of the people of Iowa are covered. Blue Cross has constantly increased its benefits and now has a comprehensive 70 policy which covers most major things that could happen to an individual, but of course, they should make their own testimony. In 1945, only 9 years ago, the doctors of Iowa went to the Iowa Legislature and secured the enabling legislation to provide the Blue Shield plan to cover the low-income group on medical and surgical bills and sponsored this legislation. They personally financed and underwrote the company and still do in every way. The doctors of Iowa did and now agree by individual contracts that in the event the company can't make the payments provided for in the policy that they will accept a lesser amount and yet credit the patient's bill for the fuil amount called for in the policy. The doctors of Iowa further agree that if a man's income is under a certain amount that they will accept in full of his account the benefits of the policy for the surgery or medical care in the hospital, irrespective of what the bill is, or, in other words, the low-income man has practically full coverage for the catastrophic case. In 1945 they first agreed to cover a family man of the low-income group on such earnings of approximately $50 per week, which was the figure below which one was considered in the low-income group, as they attempted to learn actuarily and other ways what the effects of this type of plan were. In 1950 they agreed that the low-income group should have this coverage, catastrophic or otherwise, whose income was up to $58 or $60 per week and in 1953 the doctors voluntarily increased this full coverage of the low-income group of a family man earning up to approximately $71.50 per week, so progress has been made and real effort is being made as they learn the actuarial information needed and attempt to solve the problem of covering more and more of the people in the lower income group, although if you care to check the figures on Iowa, you will find that the average weekly earnings of those employed is less than $71.50 per week according to the employment security commission. This Blue Shield Co. of Iowa is sound and solvent and has never cost the taxpayers one single penny. The Iowa State Medical Society even bore the expenses of obtaining the necessary legislation to make this kind of plan possible. The Iowa State Medical Society even paid salaries of people to contact the doctors on matters of contracts, forms, and the handling of this type of insurance to get it started. There has been a steady growth and now in Iowa approximately 1 out of every 6 is covered by this plan alone and it is estimated that over half of the people of Iowa have some form of medical and surgical insurance. Men with a family now pay $3.50 per month under the group rate for this Blue Shield insurance, which is less than a package of cigarettes a day. Origi 39087-54-pt. 7-39 nally this plan was only available to groups of 50. Then it was made available to farm groups. Then to groups of down to five. Now it is available to individuals at a premium of $3.85 per month. You will find a similar Blue Shield plan in practically most of the States of the Union. I would like to point out to you at this point although a good deal of interest is being exercised by several different groups about the cost of medical care-that the people of the United States spend less for their medical care than they do for their liquor and tobacco. No one has suggested yet that you establish some insurance plan or that Federal Government make an appropriation for the liquor and tobacco items of the American budget, or their budgets for automobiles, plumbing, television sets, food, or clothing, all of which exceed their medical bills. I would also like to point out that in the first instance Blue Shield was founded in 1945, it provided for medical care and hospital care for 30 days and that has now been increased to 70 days. The benefits provided in the contracts have been increased over 25 percent since the start of the company. One recent addition was payment for radiology treatment of cancer and the policy provisions have grown and expanded each year since the forming of the company at a local level done by local people, the way so many things have been accomplished in the American way. Again, in closing let me reassert that the feeling of the Iowa doctors that this inatter of health can be best handled at the local level and that the local people are making progress in their handling of such matters. The doctors of Iowa don't want socialism or any other "ism" either in a package bill, or in bills that do it bit by bit. They know that in England the Socialists always said don't talk socialism on a direct program, but talk better housing, better health, etc., and attack all the present plans and end up with a conclusion that the government can do it better. APPENDIXES APPENDIX A DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE, Hon. CHARLES A. WOLVERTON, Chairman, Committee on Interstate and Foreign Commerce, House of Representatives, Washington, D. C. DEAR MR. CHAIRMAN: This is in response to your request of February 8, 1954, for information on (a) costs of hospital construction; (b) the use of hospitals and nursing care for persons aged 65 and over; and (c) the number of professional and practical nurses needed. We enclose the following materials for inclusion in the record of hearings held by your committee on health problems: 1. Hospital construction: Progress and Prospects. uary 1954). Hospitals 28:53-55 (Jan [Table 2 on page 55 contains hospital construction costs by size of hospital.] 2. Hospital and nursing care utilization by persons 65 and over: Statement prepared in the Division of Hospital Facilities, Public Health Service. 3. Facilities required to provide comprehensive hospital service: Statement prepared in the Division of Hospital Facilities, Public Health Service. 4. Distribution of hospital nursing services, Public Health Reports 68: 933939 (October 1953). Sincerely yours, OVETA CULP HOBBY, Secretary. HOSPITAL CONSTRUCTION-PROGRESS AND PROSPECTS (John W. Cronin, M. D.1) In 1946, a deficit of nearly 900,000 hospital beds existed in the United States. Very few hospitals had been constructed during the depression years of 1929 and 1939. During World War II the requirements for materials and manpower to prosecute the war brought civilian hospital construction to a low ebb. The increasing margin between new construction and new need arising from population growth and obsolescence of existing facilities still continues. As our Nation approached the return from a wartime to a peacetime economy, hospital construction began the long, slow process of catching up with the need. The hospital survey and construction (Hill-Burton) program came into being as a result of the studies of the Commission on Hospital Care, which, under the auspices of the American Hospital Association and supported by other national and local professional and citizen groups, had brought into clear focus the Nation's needs for hospital and related health services. The Hill-Burton program, designed as a cooperative effort between local community groups and State and Federal representatives, has had wide acceptance all over the country. The program has stimulated: (1) Interest of local citizens in acquiring good hospital services; (2) statewide planning; (3) improved hospital design; (4) improved hospital standards; (5) efforts to acquire health facilities in areas of greatest need; (6) the attraction and retention of physicians and other health personnel to and in rural communities; (7) the construction of hospitals without the use of Federal funds; and (8) the interest of citizen 1 Dr. Cronin is Chief, Division of Hospital Facilities, Department of Health, Education, and Welfare, Washington, D. C. groups in the overall hospital needs of the Nation as a bulwark of our national defense. As of October 1, 1953, the 2,132 projects which have been approved will add 103,405 hospital beds and 422 health centers. The total cost of these projects represents more than $1 billion of which the Federal Government is contributing $589 million and the sponsors more than a billion. There are 1,297 (61 percent) of these projects adding 53,262 beds, open and in operation; 715 (34 percent) projects which will provide 43,217 more beds, are under construction; the remaining projects with 6,926 beds are in preconstruction stages. TABLE 1.-—Value of all United States hospital construction-1945-54 In dollar volume, the total value of hospital construction placed in 1950-52 was nearly 5 times the wartime low of 1945-46. Some decrease has occurred subsequently. Federal hospital construction, chiefly by the Veterans' Administration, has accounted for from 15 percent to 20 percent of the total volume. Beginning in 1948, construction with Federal assistance under the Hill-Burton program has contributed even more significantly to the total than the volume of direct Federal construction. The volume of hospital construction placed since 1945 appears in table 1, together with an estimate for 1953 and a forecast for 1954. The recent high levels of recent hospital construction have constituted approximately 3 percent of all new building construction in the Nation and therefore represent only a minor influence in the total national economy. Measured as a part of the gross national product annually, all hospital construction is one-fourth of 1 percent of the national productive effort. The regional volume of construction per capita varies markedly according to the average income of the area. Data on these variations have been made possible by the controls placed on materials after the beginning of the Korean conflict. Chart 1 displays the variation in volume by census regions for all hospital construction in 1950 in relation to average per capita income of the region. This chart shows a regional range in volume fom $2.7 per capita in the lowestincome region to $5 per capita, or more, in the wealthiest region. The volume of construction provided with Hill-Burton assistance is also shown in chart 1. Hill-Burton construction amounted to nearly all of the work undertaken in the lowest income region, but constituted only 20 percent in the wealthiest regions. This relation is in accordance with the basic intent of the Hill-Burton Act to provide maximum aid in States of lowest income. |