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what you are driving at is to get a committee that will determine which group, the church group or the cooperative group, or the State itself, or a municipality, would be allotted that hospital?
Mr. ANDERSON. No, sir. I think the Federal concern in this is evidence that the money is there and the facilities there to take care of the other half of the construction costs.
Mr. PRIEST. Plus the maintenance ?
Mr. ANDERSON. And the maintenance. And I do not think it would be possible for you to interest yourself in local fights of that nature.
Mr. WINTER. But, then, what does your question go to other than about having a representative on this council after a decision as to where a hospital is going to be built? Somebody, somewhere, somehow is going to have authority to say which particular agency the Government is going to advance funds to.
Mr. ANDERSON. I do not actually visualize any competition between groups for a hospital. Do you?
Mr. WINTER. No.
Mr. WINTER. But I can see this, we have had the Protestant hospital and the Catholic hospital representatives and now we have you, and you are all afraid, as I get it, that the passage of this bill may leave your organization sitting outside of the picture, in so far as getting any help from the Federal Government is concerned.
Mr. ANDERSON. May I go back just a moment to make my own position clear, or the position in which the cooperatives find themselves when they begin to organize a medical-care plan and talk to a group of doctors about doing business with them on a contract basis? In my State, the laws have been enacted which require that the majority of a hospital board must be composed of the members in good standing of the medical association. This automatically makes even a nonprofit hospital, even a hospital operated by the Catholics or the Lutherans or whoever they are, outside of our sphere, in so far as doing business with that hospital is concerned. They may welcome us just as most of them welcome the Blue Cross, but if we hire a doctor who breaks away from the local medical association in order to contract with us, that doctor immediately can be- I do not say that he will be, in every case, but he can be, and they are all afraid that they will be-dropped from the medical association.
A doctor who is not a dues-paying member in good standing in his local medical association cannot operate in the hospitals in my city. There are three hospitals in my city, all owned by the same church group, but the boards of those hospitals are dominated by the medical association in that city. We canvassed those hospitals when we had interested doctors who wanted to throw in with our association.
The letters we got back from the hospitals said that any doctor who was in good standing with the local medical association would be permitted to bring patients into that hospital, which was simply a warning to
any doctor who wanted to contract with us that he could not operate in the hospitals, and, therefore, he cut off at least half of his income.
And in my State, also, it cuts him off from all insurance cases. Mr. WINTER. I do not believe you need worry about this Congress enacting any law that would preclude any citizen of the United States from hiring any doctor that he wanted or chose to take him into any
hospital that he wanted. I do not believe there is any question about the Congress, at least, knowingly passing such legislation.
Mr. ANDERSON. I believe we could take that case in my home town and win it.
Mr. WINTER. But that is not the problem we are concerned with here. I do not see how you tie that in to the problem of working out ways and means to construct hospitals.
Mr. ANDERSON. I merely am asking, so far as the amendment is concerned, that in this committee, on the State-wide basis—this advisory committee which will advise with the State agency-I am merely asking that instead of exclusively appointing men who are interested in medical practice and hospital practice, that you also have some men on that committee who are not practicing physicians, who are not operating hospitals, but who are laymen in that respect.
Mr. WINTER. In other words, you want somebody that is interested in going out and organizing a hospital district and getting it started from the standpoint
Mr. ANDERSON. No, we would not indicate who we wanted on the committee, just merely that type of representation. In fact, it has been provided for. I do not think it is unreasonable. That is the bill introduced in the House, introduced by Mr. Priest. That is exactly what I have in mind. That is the thing that I criticize in S. 191.
Mr. WINTER. That is the point that has been bothering me all of the way through this thing, is the survey, the organization of the hospital district, and getting them into the places that actually need them, such as you have given us the example of what has been done there in Oklahoma. You stated that there were five separate cooperative hospital associations now operating in the United States. Are they all operating on the same basis as this one that is in Oklahoma ?
Mr. ANDERSON. On practically the same basis, yes. They may vary in some local rules because they are independent associations. They make their own rules, but they are all owned cooperatively and operated
Mr. WINTER. Are they all on a sound financial basis !
Mr. PRIEST. Just one other question on that same point. I understood you to say earlier that there were perhaps 40 others in the process of being organized. Was that figure correct?
Mr. ANDERSON. That is an understatement. There are more than that, but I was quoting from a news release of the Cooperative League which was a very conservative statement, because I know of other organizations that are not listed in this release.
Mr. WINTER. Would it be possible for you to furnish the committee with a statement of where these five hospitals are that are now operating, and also, a statement as to the territory contemplated to be involved in the 40 or 50 additional ?
Mr. ANDERSON. Yes, sir.
I have this news release from the Cooperative League which is very practical. I could give you the high lights of that right now, but I will give you a written statement, if you wish.
Mr. WINTER. I think it would be better for the entire committee if we had
the written statement showing that. Mr. PRIEST. It would be very helpful, and I was planning later to make the same request, Mr. Winter.
Are there any questions, Mr. Gillette ?
Mr. PRIEST. Just one or two further questions: The subject of the discussion between you and Mr. Winter was very enlightening:
On page 3 of S. 191, I believe, we have the language providing for the State advisory council, in paragraph 2 of section 612, in which are set forth the conditions under which a State application for funds shall be received. That section reads as follows:
Provide for the designation of a State advisory council which shall include representatives of nongovernment organizations or groups and of State agencies concerned with the operation, construction, or utilization of hospitals, including representatives of the consumers hospital service, selected from among persons familiar with the need for such services in urban or rural areas to consult with the State agency in carrying out such purposes.
I wonder, to be specific, if you have any suggested language for an amendment to that paragraph in line with your position on this State advisory council, or perhaps, if you have not, maybe later on you might wish to suggest some language that would carry out your idea?
Mr. ANDERSON. Well, I would have to make a confession which I hope you will receive with charity, that in this particular provision I accepted the language which was used in the report of October 30 from the Committee on Education and Labor which did not quote the exact wording contained in this item No. 2. And now I can understand why Mr. Winter and I did not get together in talking about the same thing.
Mr. PRIEST. I did not want to interrupt you in your discussion, but it was my opinion that that pretty well took care of the suggestion that
Mr. WINTER. I could not get his position.
Mr. ANDERSON. In reading the House bill over, I read the bill and saw the wordage and assumed that it was a correction of the other item. I am very sorry.
Mr. PRIEST. We appreciate your statement, Mr. Anderson.
I believe you agreed in your original statement with my position, my personal position, and the position taken in 5628 with reference to the elimination of the court review procedure that is contained in S. 191?
Mr. ANDERSON. Yes, I think that is logical.
Mr. WINTER. You will not forget to get the information I asked for?
Mr. ANDERSON. I will get that to you without delay. I will be very glad to do that.
Mr. PRIEST. We will next hear from Mr. Robert Lamb, of the Congress of Industrial Organizations.
STATEMENT OF ROBERT K. LAMB, LEGISLATIVE REPRESENTATIVE, UNITED STEELWORKERS OF AMERICA FOR THE CONGRESS OF INDUSTRIAL ORGANIZATIONS
Mr. LAMB. I am here and Mr. Goodman, also, from the CIO, with a separate statement.
I would like to submit to the committee for its record a copy of the statements which President Philip Murray of the CIO and of the United Steelworkers presented to the Senate committee at the time when the CIO testimony was given there, and also a copy of a supporting memorandum on this subject.
Mr. PRIEST. Without objction they will be received and made a part of the record.
You may proceed, Mr. Lamb.
Mr. LAMB. And also I take it, Mr. Chairman, that it is not necessary to reproduce that in your records since you have it.
Nr. Priest. If this is already included, we will just make it a part of the committee's file; that is, if it is already printed it does not need to be reproduced again.
(The papers referred to, are made a part of the committee's file.)
Mr. LAMB. I will read, if you do not mind, this statement, and then if you have any questions, I will be glad to try to answer them.
A year has passed since I appeared before a subcommittee of the Senate Education and Labor Committee to urge, on behalf of the Congress of Industrial Organizations, the passage of S. 191, the Hospital Construction Bill. It is a matter of grave concern to the members of organized labor that progress has been so slow and halting on this and on many other pieces of much-needed social legislation. We considered the Hospital Construction Bill as but the first of a series of measures which were needed to provide better medical care for the American people, and today are still hopeful that the 79th Congress will enact into law such a comprehensive program. This committee can render a great service by urging the speedy enactment of an adequate hospital construction bill, and the other health measures necessary to round out a program of health and welfare worthy of a postwar America.
It is not my intention to give to this committee a detailed recital of the need for such legislation. It is a matter of record-presented in voluminous testimony before House and Senate committees—that adequate medical care is not available to large sections of our population and that the level of the national health has suffered as a consequence, But I do want to call to the attention of this committee the fact that I am speaking on behalf of the very people who need, want, but cannot get adequate medical care. Numerous questionnaires filled out by the members of organized labor testify to this fact, and I shoulā like to refer the members of this committee to the comprehensive CIO statement on the need for better medical care presented to the Senate Subcommittee on Wartime Health and Education in September of 1944.
In the course of that statement we declared, "When the war ends, and facilities and manpower are available, two things still stand in the way of adequate medical care on a national basis: The high cost of medical care, and the absence of facilities in many parts of the country.” The legislation now before your committee is intended to remove the second of the two obstacles, and it is about certain provisions in that legislation that I want now to speak.
In presenting the views of the Congress of Industrial Organizations on S. 191 last year, I drew attention to certain shortcomings in the legislation as then drawn which we wanted to see corrected principally the lack of consumer representation on the State and Federal advisory councils, and the lack of any provisions for maintenance funds so that hospitals and health facilities could be constructed in rural and other undersupplied areas which could not afford the upkeep of such facilities after construction.
Since the presentation of that testimony, which I would like to have incorporated as part of the record of this committee, the Senate passed an amended version of S. 191 which, far from correcting these shortcomings, added certain very objectionable provisions. We are happy to note that your chairman, Congressman Priest, has introduced a bill, H. R. 5628, which corrects most of the shortcomings of the Senate version and sets forth, in our opinion, the best program for hospital survey and construction that has yet been embodied in legislation for consideration of this Congress.
We endorse wholeheartedly the principle of limiting the functions of the Federal hospital council to that of an advisory board. We consider giving such a part-time body, which is not responsible or accountable to anyone, veto power over the decisions of the Surgeon General, the official charged with the expenditure of public funds, a highly dangerous administrative procedure, one which would rob the people of this country of the just control they exercise over the spending of public moneys. We also welcome the deletion of that provision in the amended Senate version which provides for appeal to the Federal courts should the Surgeon General refuse to approve a State plan or application,
We also support the various provisions safeguarding the expenditure of Federal funds by insisting that States receiving money under this bill set certain standards for maintenance and operation and that hospitals aided are available to all qualified practitioners in the community
We particularly welcome the section of the bill which provides equal representation of public and consumer interests on the Federal hospital council with that of the professional members. Representatives of the various consuming groups-organized labor, agriculture, and the white collar and professional middle-income groups—are needed to prevent the council from deteriorating into a body representative of entrenched medical and hospital interests, which by the nature of the training and occupation of its members will be inclined to resist the dynamic program necessary to carry adequate medical care to areas which most need it. It may be felt that a council of 8 members is not sufficiently large to provide adequate representation either of the consuming groups or the professional interests, in which case this committee may want to recommend that the council be en