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larged to 12 or 16 members, with the representatives of hospital, public health, and medical-care activities—language which we recommended to the Senate committee as preferable to "hospital and health activities”—forming a technical subcommittee.

It is particularly important that the State advisory councils be set up to insure adequate representation of the consumer groups, as it is on the local level that the consumers of medical care can be most valuable in pointing out where the established patterns fail to meet present-day needs.

H. R. 5628 fails to solve the problem of providing hospital facilities to areas which need but cannot qualify for facility construction because of inability to pay for maintenance costs. This is perhaps inevitable in legislation which deals with only one aspect of the medical care problem. But we want to make the point that unless some program for temporary grants-in-aid for maintenance is established, or better still, a comprehensive health insurance plan is adopted, communities which need hospital facilities most will be denied them. This is not said in criticism of the bill which your chairman has introduced and which we strongly endorse. We hope that this committee will recommend its passage by the House of Representatives as one vital and important part of the solution to the health needs of the nation.

Mr. PRIEST. Are there some questions, Mr. Winter?

Mr. WINTER. How would you divide the consumers on this board, Mr. Lamb?

Mr. LAMB. Well, in the testimony which I gave before the Senate committee, Congressman, I said that I thought that a board somewhat larger than 8 members was necessary, and it is suggested here that it should be 12 or 16.

I made the suggestion that I saw no reason why a subcommittee of technically, specially qualified people representing either the medical or hospital fields should not be established to act as the body for screening these proposals as they come from the States and submitting a technical report to the full committee, in which case it would be possible, for example, to have 4 of the 12 or 16 members representing the groups

that I have mentioned, the medical and hospital groups, and the remaining members drawn from a broad representation of consumers of medical care of all kinds, including business and professional persons other than those mentioned as representatives of agriculture and labor.

Mr. WINTER. Well, do you think that would supplement the problem so far as the Surgeon General is concerned, in having to make a decision?

Mr. LAMB. Yes, I do. I do for this reason: I think that the problem that you are confronted with here is to get the best and most unbiased surveys of need, State by State, for the 48 States.

Mr. WINTER. To which I agree. I think that is the first thing that has to be done and that has to be an honest survey, if this bill is ever to be of any good to anybody.

Mr. LAMB. And the point at which we are addressing ourselves when we opposed the original proposal of the authors of S. 191 was that the whole board be composed of representatives of health and medical groups, I mean of hospital and medical groups, is the same opposition that we have as to the principle which has come in the

several other pieces of legislation now pending, all of which we object to.

This was true, for example, in a bill before the Senate on the establishment of a national science foundation. It was also true in the legislation proposed in the House and in the Senate, the May-Johnson bill, for the control of atomic energy.

The principle has two parts: The first is that you have dollar-a-year persons serving in this capacity and that you give them the powers of determining what is done with Federal funds.

The practice of allowing representatives of private groups which have a vested interest in the field to determine the expenditure of public funds seems to us to be a dangerous and objectionable principle.

And anything that can be done to whittle that down to its proper scope where you use the technical knowledge of these individuals and groups for what it is worth, and permit the general public representation to curb them, so far as possible, and give neither of them the final responsibility, neither group, lay or technical, the final responsibility, seems to us to be in the right direction.

In other words, we are in favor of responsibility being upon public servants where you can have them removed for not only misfeasance in office but also for incompetence if it can be demonstrated and protect the public interest in that way.

Mr. WINTER. Well, on page 3 of S. 191, in section 612, subparagraph 2, in what manner does that fail to carry this out?

Mr. LAMB. I am not addressing myself to the State, but to the Federal control, and so far as the paragraph to which you refer is concerned, I see that, as you might say, an empty vessel. The question is what is poured into it. I think that the vessel is large enough and of the proper character to hold this principle that I am talking about.

And I welcome it. The language of it seems to be in the right direction.

Mr. WINTER. In other words, you are objecting to the manner in which that may be carried out unless it is specifically written into the bill?

Mr. LAMB. I am particularly addressing myself to the bill as it passed the Senate which calls for 5 and 3 and retains control in the hands of the vested interests and places a supervision over the actions of the Surgeon General in the hands of a council which is no longer called advisory as it was in the original legislation, and I think properly so, because it is not an advisory council in the Senate bill, it is a council which has pretty sweeping authority over these surveys and the determinations of the locations of new hospital facilities.

Mr. WINTER. In other words, you do not want the Surgeon General's powers clipped too much in his determinations?

Mr. LAMB. No, because I want to see him made responsible and held responsible, and I want to see him also advised in such a way that the problem will not be one of whether or not he exercises his powers in an arbitrary fashion, because the advice which he has been given I hope will give him practically no choice as to what is the right thing to do.

That choice will depend upon a consensus of opinion arrived at, first, locally, and throughout the States, and then Federally on the basis of a really adequate survey of the needs for hospital facilities throughout the country.

Mr. WINTER. How many of your membership, if you know, Mr. Lamb, has taken advantage of the Blue Cross, what percentage ?

Mr. LAMB. We have no figures on that that would be adequate. We know that the Blue Cross, throughout the country, covers some or other plans of this kind, 10 percent or so, of the total population today. And since those people are, for the most part, in the upper income brackets, they would not form anything approaching a majority:

I would say a fairly small majority of our membership.
We do have members in the Blue Cross.

Mr. WINTER. Is it not a fact that some 50 or 60 million people in the United States are taking advantage of the Blue Cross and other health and insurance plans?

Mr. LAMB. Well, I do not know what you mean, sir, by other plans, and how extensive they are, but I will say, my impression is that so far as the Blue Cross itself is concerned, it does not run upwards of 10 or 15 million.

Mr. WINTER. I think that is correct.

Mr. LAMB. That is the thing; that is the figure on which I was basing my statement.

Mr. 'WINTER. I am taking into consideration the cooperative plans, people who have purchased health insurance of their own and the Blue Cross plan together. Do not the statistics show that somewhere around 50,000,000 people in the United States are participating in programs of that sort?

Mr. LAMB. I do not have those figures, but I seriously doubt whether they run as high as 50 per cent, and I would say with respect to hospital insurance, with regard to that, we do not consider that to be at the present time any substitute for health insurance, nor do we consider that it is within the reach for the most part of our membership.

Mr. WINTER. What do you think your membership should have in the way of health protection?

Mr. LAMB. We are flatly on record as favoring the Wagner-MurrayDingell health bill, as those provisions were set forth in the original Wagner-Murray-Dingel bill, the social-security bill, and when the time comes for testimony before either this committee or the Senate Education and Labor Committee, we shall so testify.

Mr. WINTER. You heard the testimony of Mr. Anderson this morning?

Mr. LAMB. Yes, sir.

Mr. WINTER. Do you feel that such a plan as his organization has in operation in several States in the Union is a feasible program and should be expanded and worked out to the point where these communities that do not have the wealth, perhaps, that others have, could support a hospital locally?

Mr. LAMB. Well, I seriously doubt whether the number of people taken care of begins to approach the number of people who need it.

I would like to see a survey made of the Elk City area to see how many people in that area, how many families, are not within the system. And I think it is interesting to observe that there have been five of those to date and forty more are contemplated, but they certainly are not extensive in comparison with the problem.

Mr. WINTER. How do you feel about this, and when I say “you,” I mean your organization, as to the local communities doing everything they possibly can as a requirement before they get one of these hos


pitals, as to the maintenance and to support it from a local standpoint?

Mr. LAMB. Well, naturally, we are in favor of it. What we fear, however, is that particularly during the period when this is getting on its feet, these communities which have the greatest need will not be able to demonstrate capacity to maintain it, and in the absence of such maintenance, they will be turned down.

So, it becomes a vicious circle, and they never get the money in the first place.

Mr. WINTER. Do you not think that will make these communities go out and make a stronger effort to raise the money to support these hospitals rather than have it on the basis that they can get a hospital if the Government will help them obtain it anyway?

Mr. LAMB. I will tell you the immediate effect of this legislation if, as, and when passed, I think "them that has gits” under it. I think that the thing to be feared is that the more backward areas are going to be discriminated against by a demonstration that they cannot afford to keep up with the parade and so instead of achieving the objectives of the authors which is the decentralization, so far as possible, of adequate hospital facilities and medical care in those facilities, and Mr. Goodman observes, unless you have a good committee, and I think that is correct, that is the problem, but there is also the problem of maintenance that we are talking about. And the best committee in the world operating under a system which made no provision for maintenance, could not overcome the findings of fact.

I think if you mean, Congressman, with maintenance provided over a period of, let us say, three or five years, and possibly graduated down

, over those five years, a community could come in and make a showing that in five years' time, it would be self-sustaining, that I would agree with you as to the self-help necessary.

I do not want to see these communities handed something on a silver platter which they will not appreciate.

Mr. WINTERS. In other words, you are not advocating government guaranteeing the maintenance of hospitals?

Mr. LAMB. Not permanent, no sir. I am, however, urging that even under the principle that we are speaking for, that you may have communities and perhaps a very sizeable number of them in perhaps especially the South and the West, at least west of the Mississippi, which cannot carry the freight in the absence of a national health insurance plan.

Mr. WINTER. You say west of the Mississippi?
Mr. LAMB. West of the Missippi and south of the Mason-Dixon line.
Mr. WINTER. That is where I come from.
Mr. LAMB. I know that.

Mr. WINTER. I can not agree with you. I think we have a pretty substantial community out through there and we do a pretty good job of taking care of ourselves.

Mr. PRIEST. Are there any questions, Mr. Gillette ?

Mr. Priest. It has been an interesting discussion, and I appreciate your appearance before the committee.

You have covered already some of the main points in which I am particularly interested with reference to the personnel, the ratio of personnel on the council, and particularly on the court review procedure.

I think it is, as you suggested in your statement, a dangerous departure if we allowed judicial interpretation to replace administrative discretion, and entirely upset our system in that respect. We have appreciated

your statement very much. Before we have Mr. Goodman's statement, the committee is honored with the presence of the distinguished chairman of the Appropriations Committee of the House, Mr. Cannon, who left his committee to come here to make a brief statement. He has to get back.

Mr. Goodman, if you will just wait aside for a few minutes.

Mr. Cannon, the committee is very happy to have you here and glad to hear you at this time.




Mr. CANNON. Although I have been a member of the House for a number of years, this is the first time I have had the honor of ever appearing before the Committee on Interstate and Foreign Commerce, one of the great committees if not the greatest committee of the House.

Mr. PRIEST. We accept the compliment. Since the distinguished chairman represents the Appropriations Committee, we feel we will have to take second place, certainly.

Mr. CANNON. I do not know when you consider the range of jurisdiction of this committee and its vital importance and growing importance to the Nation, that any committee would take precedence of this committee.

I count it an honor to be able to appear before you today and I regret that I must appear in the unhappy role of an objector to the bill that is now before you, a portion of the bill.

I do so with hesitation and with reluctance, because I realize the appealing character of this legislation. And I realize the need and the great benefits which would flow from such a program if it could be carried out.

I am in heartiest accord with that portion of the bill which authorizes grants to the States for surveying their hospital and public health centers and for planning construction of additional facilities, such expenditures to be reimbursed by the Government when construction begins, but I note with regret the proposal to authorize grants to assist in the construction of hospitals.

And my apprehension is all the greater because a great many who advocate grants to the States and to the subdivisions of the States for the purpose of construction of hospitals, also, are already urging maintenance of those institutions by the Federal Government.

Mr. Chairman, there are over 3,000 counties in the United States and innumerable municipalities, all of which will want to be taken care of under such a proposition as this.

The commitments that are involved, the implications that are carried in this legislation are fraught with potentialities of such a serious nature that I consider this as one of the most dangerous propositions that could be submitted to Congress at this time.

Of course, there is need for these facilities. It is one of the crying needs of the time, but the States and the counties and the municipalities are all better financed today than the Federal Government.


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