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the hands of private parties, especially when such parties have an interest-even indirectly in the matters upon which they have to take action under the program.
We are in favor of a council with advisory powers only. We think the provisions in section 633 of the Priest bill giving the council authority to meet on its own motion, directing that its views be published and sent to the Congress, and that there, by equal representation of consumers of hospital care on the council, give adequate assurance that the views of the interested groups will be taken into account.
No health program can be really effective unless it takes into account the views of the consumers of medical care. A sound health program is not merely a matter of doctors, nurses, hospitals, or X-rays. There also must be community participation and understanding of health problems. That is why hospital construction and maintenance should not be controlled solely by the doctors or the hospitals through the American Medical Association and the American Hospital Association. There must be a partnership between the professional people, the consumers of hospital and medical care, and the Government if we are to make real progress. The Priest bill meets this modern idea of medicine. One other point needs some discussion. There is no actual assurance that if hospitals are constructed in the communities, under this bill or any other bill, which really need them that they will be able to support themselves after they are built. This deficiency is inherent in any construction program based upon need for hospitals unless income to hospitals is assured through a contribution toward the cost of maintenance or through hospital insurance. Only one solution is really practicable-a national insurance program.
We hope that this subcommittee after its consideration of the hospital construction bill will consider the National Health Act of 1945, H. R. 4730, introduced by Representative Dingell, which carries out three of the other recommendations in the President's national health program. We endorse the Dingell bill and know that this subcommittee will give fair and sympathetic attention to our views when we return to testify on that bill.
We want to see a sound hospital construction bill passed. We also urge the adoption of a comprehensive national health insurance program. But we know such legislation requires adequate personnel and facilities. The Priest b'll is an essential step in the direction of achieving a national health program for all.
Mr. GOODMAN. Many unions have found that the problem of the inability of their members to secure any medical care so serious that they have taken steps to bring some medical care to their members.
The type of procedure in bringing that about varies from the establishment of their own hospital, with full facilities, as has happened in some cases, to the establishment merely of insurance plans to pay the costs of medical care.
Many unions have had the experience in the problem of securing medical care for large groups of people.
In Congressman Cannon's district, my union, the Union of Retail, Wholesale, and Department Store Employees of America, has established the clinic known as the Labor Health Institute, which functions on a payment, after negotiating by the employer, of 3 percent of wages toward the cost of establishment and operation of a clinic under which it is possible for the members to receive out-patient care-not hospital care of all types on the payment of a small fee for service of 50
I cite that case only to show the committee that there are members in even Congressman Cannon's district who feel otherwise than the point of view he expressed here earlier.
I think it would be valuable for the committee to have a complete report of some of those centers, and I will make one such available of union health centers that have been prepared by private organizations.
I want to stress two further points. One is that the CIO recognizes this bill will particularly or should particularly help the rural areas where the need is the greatest, and that is true particularly of, Mr. Lamb stressed, west of the Mississippi, south of the Mason and Dixon line.
I also feel that the establishment of this kind of program envisioned in the committee's bill makes possible the treatment of another serious problem which is that may ill children who need medical care in rural areas fail to receive any education. And in the establishment of a hospital or medical center, it would be possible for the community, by bringing the sick children together, to provide some educational facilities for them, so that a child who is sick, we will say, with rheumatic fever, for a period of 3 or 4 years, will not have the social handicap of being delayed in his education for that period of time and come out with a feeling that he has an inferiority complex for the rest of his
This bill, aiding the establishment of medical centers in rural areas, will make such a program possible.
Mr. PRIEST. Are there any questions?
Mr. WINTER. Where is your home, Mr. Goodman?
Mr. GOODMAN. Washington, D. C., sir.
Mr. WINTER. Have you ever lived west of the Mississippi River?
Mr. GCODMAN. I have lived in St. Louis, Mo., sir.
Mr. WINTER. Is that as far west as you have ever lived?
Mr. GOODMAN. Yes, sir.
Mr. WINTER. And you say that this bill is urgently needed to take care of the conditions that exist west of the Mississippi River?
Mr. GOODMAN. I think the witness yesterday for the American Farm Bureau Federation, who represents more than I do the inhabitants of the States west of the Mississippi River and south of the Mason-Dixon line, stated that there were some 1,200 counties mainly in the west and south that did not have any hospital facilities.
Mr. WINTER. That would be practically all of the counties in the west and south. There are only 3,000 counties in the entire United States.
The reason I asked you that question is that I do not want to take issue with you on any of these things, because I think there is a prob- · lem here that the Congress has to meet, and that the people of the United States want met, but you stated that in the slum areas, that this hospital program was needed, and then you state that it is needed in the rural areas because of the fact that we do not have hospitalization out there.
Mr. GOODMAN. I think you are tying two unrelated sentences together. I said that this bill would provide the possibility of a pregnant mother bearing her child in a hospital rather than in the slums, and that would be true primarily in the cities.
Mr. WINTER. I did not get the question correct. I agree with you. on that, but in our part of the country, I am interested in finding out where you get your information that we need this kind of a program out there.
Mr. Anderson's testimony was that the people properly educated in this hospital program, this particular program, in the lowest income areas we have, can locally finance the operations of hospitals.
Mr. GOODMAN. I happen to have the best of evidence, Mr. Congressman. I do not want this to go in the record. I have a brother who
served in the Medical Corps for 51 months in the South Pacific. He trained in the best medical schools and went west to Chicago for his internship and the establishment of his practice. As is indicated. on the envelope I have just handed you, he has gone and established his practice in a small-town community to have personal experience with the medical needs, the medical-care problems of a typical, southern, small American community. That town prewar had 936 population. It has ended the war period with over 6,000 population.
He has been established there for over 6 inonths, was greeted there by the town with open arms. The mayor granted him the key to the city. They gave him the best apartment available in the town's one housing center. They were that grateful to have a doctor in the community.
Mr. WINTER. I think that is correct.
Mr. PRIEST. I am sure of that.
Mr. WINTER. That is correct, all over the country, but that is not the fault of not having hospital facilities altogether.
Mr. GOODMAN. Well, Congressman, you raise a very technical problem there.
Under the practices of the American Medical Association it is incumbent upon the doctor to be on the staff of a hospital in order to be able to treat patients in the given hospital.
If you had in, say, Terre Haute, Ind., a lack of hospital facilities, and the doctor had a patient that had a brain tumor that needed to be removed, and the doctor was not a member of the staff on, let us pick a good one, Cornell Medical Center in New York City, where, let us assume for the record, they specialized in the removal of brain tumors, that doctor could not take his patient to Cornell Medical Center and work on the problem of developing his skills to become expert at the problem that he might face in Terre Haute, Ind., any day, because, under the American Medical Association practices, he would not be permitted to operate, to function, in Cornell Medical Center.
Mr. WINTER. Well, by the same token, if I were an expert machinist, the best in the world, and I did not see fit to join your organization, you would not let me work in the General Electric factory or automobile factory or anywhere else.
Mr. GOODMAN. I think the Congressman is mistaken. You would find that that statement that you made applies where we have closedshop agreements. And I do not want to discuss the closed shop here, but in the majority of plants in which we operate, we do not have closed-shop agreements, and you could work in the General Motors or General Electric plants without becoming a member of our union, or you might find for your own personal wishes, I am not urging you to do so, you might find it desirable to go to work in a plant operating under the American Federation of Labor.
There are still thousands of plants that are not organized by a labor organization at all. You might work in one of those.
Mr. WINTER. That is correct.
Mr. GOODMAN. But the medical profession has their industry wound up tight, sir, and if you violated one iota of any one of their regulations, you cannot continue in the medical profession. Of course, they do not do these things overtly, and they do not expose themselves to the
public censure by using the public powers openly against the individual, but they have developed techniques which I would be glad to discuss at length before your committee under some more appropriate occasion, which are the worst and most oppressive against the expansion of the medical profession that a layman could possibly conceive of.
Mr. WINTER. Is not the medical profession, the American Medical Association, for this bill?
Mr. GOODMAN. It is hard for me to know, sir, what they say with tongue in cheek represents their real interest. I do not want to dissuade them from any interest, but I just raise some of the problems that I think this bill would help resolve by expanding the whole field of medical care.
Mr. WINTER. You made the statement that the American Medical Association was pressuring this committee.
What did you mean by that?
Mr. GOODMAN. I said they were pressuring and they are openly pressuring, and they pressured the Senate on the specific provision, particularly of the advisory council. They want to control the advisory council.
Mr. WINTER. You said that as to the advisory council, but as I take it, I have been a member of this committee for several years and we have had these things under consideration and I have quite a number of letters from members of the medical profession who belong to the American Medical Association, and those that do not, and practically all of the practicing physicians and surgeons in my area are for this bill.
Mr. GOODMAN. Yes, sir.
Mr. PRIEST. Of course, the record will show that the American Medical Association, through its representatives, testified in favor of the bill..
Mr. WINTER. Now, then, has your organization ever taken any steps to educate your members or put on a program among those who are financially able to join the Blue Cross and do something for themselves to get medical attention?
Mr. GOODMAN. I have already stated that many of our unions have established medical-care programs of various types; and I intend to provide the committee with sufficient copies for each member of a study of union health centers.
Mr. WINTER. How many members does the CIO have?
Mr. GOODMAN. Approximately 6,000,000.
Mr. WINTER. About 6,000,000. And you do not know what percentage of those men and women are taking advantage of the Blue Cross, or other organizations of that nature?
Mr. GOODMAN. No, sir; I do not.
Mr. WINTER. I think that is all.
Mr. PRIEST. Mr. Goodman, we appreciate your testimony, sir.
May the Chair state at this point we have some other witnesses, all of whom are expecting to be heard. At the same time, it will be necessary for the committee to adjourn by approximately 12:20, because there is an important roll call coming immediately after the House meets today, and it will be necessary for the committee members to be on the floor.
We hope to proceed, however, and will if possible clear those witnesses who are here today and expect to testify today. We will next hear from Mr. Russell Smith.
STATEMENT OF RUSSELL SMITH, LEGISLATIVE SECRETARY FOR THE NATIONAL FARMERS UNION
Mr. SMITH. My name is Russell Smith. I am the legislative secretary of the National Farmers Union.
I will not trespass greatly on the committee's time.
I testified on S. 191 in the Senate, and the remarks I made at that time, I suppose, are still pretty much applicable and they are available to the committee. It is simply a matter of bringing those up to date
on two counts:
One is that since that time the bill offered by the chairman has been introduced, and the other is that I just returned from our convention in Topeka, Kans., at which time our organization adopted resolutions on this subject.
Mr. PRIEST. I believe I received a copy of those resolutions from Kansas City.
Mr. SMITH. Yes, sir.
I assume, then, Mr. Chairman, that you are aware that our organization is in favor of legislation that would go considerably beyond the scope of this bill even, and that the Kansas Farmers Union indicated it thought conditions were not all they might be even in Kansas, that Federal action was needed.
We believe that H. R. 5628 represents a considerable improvement in some respects to S. 191. We, therefore, are glad to endorse it.
At the time I testified on S. 191, I endorsed that bill. The conditions were so desperate that we felt that any legislation, even if it were nothing but surveys, that would make a start on the problem, ought to be supported.
We do feel that there are a number of points at which H. R. 5628 strengthens the other bill.
We particularly are glad that the House bill deletes the judicial review provision of S. 191. That provision is not contained in the Smith-Weaver act or any of the other acts.
In connection with that, we believe that the requirement for a report by the Surgeon General, which would include legislative recommendations, is very desirable.
We believe, too, that the clauses in the Houes bill which attempt to require some compliance with national standards is not only a safeguard from a health standpoint or the operations of the bill, but it is also fair to the taxpayers who are investing money in this proposal that a requirement that the States comply with the minimum standards is only fair to the people whose money is being spent.
Of course, it would seem obvious that the House bill provision that facilities should be available to all practitioners ought to be included. We concur in what has been said about the desirability of balance between laymen and experts on all of the councils and their return to an advisory role.
It seems to me that is one point that is extremely important in all future legislation dealing with postwar situations.