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fairly and honestly by the member. A doctor who does not profit by giving a treatment or by doing a surgical operation is not going to recommend a needless treatment or a useless surgical operation.

CO-OP HOSPITAL
By J. D. Ratcliff

A crusading Oklahoma doctor proves that health protection and grade A medical care are within reach of every purse. The first American cooperative hospital is a resounding success today and a milestone for tomorrow.

The farmer with the wrinkled, walrus-hide skin hauled himself up in bed. “There ain't no tellin' what this hospital's been worth to me,” he said. "Here I am, laid up with hernia. A couple of years ago my wife came down with milk leg and was here over a month. If we'd had to borrow money to pay for either of these—well, you know how things are we'd probably have lost our farm.”

The old man is a patient in the Community Hospital of Elk City, Oklahoma. It is the first cooperative hospital in the United States. Each member family pays regular annual dues which entitle it to free medical and surgical attention and reduced rates on hospital and dental care, eyeglasses, drugs, X-ray pictures.

There is a tremendous and growing interest in such cooperatives among consumers of medicine. A recent survey of the American Institute of Public Opinion showed 61 percent of the people willing to pay $2 per month for medical care. Twenty-five percent were against such schemes, and 14 percent held no opinion.

Inequitable distribution of medical care is responsible for tens of thousands of needless deaths. It is, for example, estimated that prompt treatment could save half the 60,000 lives lost annually to tuberculosis. The last National Health Survey indicated that pneumonia was three and a half times as prevalent among the poor as among the well-to-do. There was seven times as much tuberculosis. A quarter of a million babies are born each year with no physician in attendance.

Even among middle-income groups, sickness can mean staggering hardship, and long illness often means nkruptcy.

That's the consumer's side of the picture. The physician's side isn't much happier. Everyone thinks of the doctor as a well-to-do man, but for every physician earning over $10,000 a year there are two getting less than $2,500. It is normally a case of the physician waiting for patients while patients hesitate to seek good medical care because of cost. Solving this problem will be one of the major jobs of the postwar era.

A start has already been made. The Farm Security Administration has in. augurated a medical service plan for its clients—the poorest segment of the rural population. Each year, families pay a small sum into a fund. Patients go to any doctor they choose. The doctor sends his bill to the fund. Through county medical societies, the doctors agree in advance not to insist on full pay. ment. Even so, doctors are more than satisfied. They are getting some revenue from a class of patients who rarely paid bills before from something like half a million.

The Elk City hospital is aimed at an income group a step above the one treated by the FSA plan. It was established in 1929 by Dr. Michael Shadid. He saw that, for years, farmers had had cooperative cotton gins, cottonseed-oil mills, dairymarketing organizations. Why not a cooperative hospital?

Shadid is small and spectacled. He looks mild but isn't. He has been fighting the better part of his life. He was born on the slopes of Mount Lebanon in Syria. in a stone, mud-floored hut. Shadid isn't quite sure when he was born-the old Turkish empire didn't bother with such frills as birth certificates. So he arbi. trarily set the date at January 1, 1882.

UP BY HIS BOOTSTRAPS

As a youngster he broke rocks for road building at 10 cents an hour. He saved enough to go to the American University at Beirut; then borrowed from relatives to come to America. He peddled jewelry and knickknacks through nearly every State and saved his money for college. Other odd jobs-such as acting as a guide at the Jerusalem exhibit at the St. Louis Fair in 1904—also helped. In the end, he got a medical degree at Washington University. For several years he practiced in small towns in Oklahoma and eventually wound up in Elk City. He bullt up a practice worth $15,000 a year—and steadily grew more critical of his profession.

“A young doctor," he says, "finds that he is spending his time making money from the sick rather than preventing sickness before it comes. He has a stake in sickness, not in health. What kind of justice would one expect from our courts if the remuneration of the judges were dependent on their decisionsif 'guilty' brought them $500, while ‘innocent meant only $5?”

He went to the farmers around Elk City, which sits on the edge of Dust Bowl. There wasn't, he told them, a single urologist, orthopedist or brain man in that part of the State. When they got sick, often as not a major operation meant a lost farm. Well, they were all used to the idea of cooperatives. They owned a co-op cotton gin. Why not a hospital? If 2,000 farmers would buy $50 shares of stock, a hospital could be built, and they would get medical care for a flat yearly charge.

The farmers agreed rather enthusiastically. Local doctors-two of whom owned their own hospitals—disagreed. Shadid had belonged to the county medical society for nearly 20 years. The society was dissolved--and reorganized without himn. Thus, he lost membership in the American Medical Association—which is the national body over all county and State organizations.

An effort was made to cancel Shadid's license to practice. He carried the fight through the courts and won. He was called a Syrian rug peddler and a crook. Word went out that he had no intention of building a hospital, that he was swindling the farmers. The rumor circulated that he had Moscow gold behind him.

Shadid had a rocky time. Dust and depression struck at about the same time. Farmers couldn't scrape together the $50 for their shares. But Shadid put up $10,000 of his own money and borrowed another $15,000. The building was completed in 1931. It was a small red brick building with 20 beds, a mile outside Elk City on route 66.

Even then, the war wasn't over. Shadid attempted to assemble a staff of physicians. Whenever an out-of-State man announced that he intended to practice at the Community Hospital, he somehow failed to get a license. Shadid warned prospects to announce that they were going to practice elsewhere. After they were licensed, they moved to Elk City.

When it looked as if the $15,000 loan might be called, Shadid dressed up the hospital to make it look prosperous. On the day the loan investigator arrived, Shadid had hospital beds filled with his own children and anyone else he could round up.

During all this guerrilla warfare, Shadid's farmers stuck resolutely with him. If a little political pressure was needed to win a point, they applied it. At one time they even suggested tarring and feathering the leader of the medical opposition. Shadid recalls this stormy background in his book, A Doctor for the People.

After all these birth pains, the hospital was finally established. It has grown phenomenally. Today it has 2,400 paid-up members. It has a top-notch staff, including a urologist, an eye, ear, nose, and throat man, a radiologist, a dentistas well as surgeons and general practitioners. The hospital has been enlarged four times. At present it has 75 beds and will have 125 after the war when nurses give up their present space to move into a nurses' home. The hospital has $225,000 in assets.

It is one of the best-equipped small-town hospitals in the United States. It has complete laboratory facilities. If a farmer's wife needs a metabolism test, she can get it at the Community Hospital. There are incubators for the newborn. The hospital owns $3,000 worth of radium for cancer treatment. It has three operating rooms, three X-ray machines, a fever cabinet, a well-stocked drug store where prescriptions are filled at moderate prices.

HOW THE PLAN WORKS

Farmer Mead, who owns a quarter section of land a few miles out of town, most of it in cotton, bought a share when the hospital was organized. This share ownership entitled him to participation in the medical plan. The fee scale for a map and wife is $18 a year. If there are two children the cost is $25. For more than two children there is an added charge of $1 a year for each child.

Since Farmer Mead has four children, he pays $27 a year. His wife is about to have a baby and he takes her to the hospital. There will be no doctor bills for obstetrical service, but there are small hospital charges. The total cost of the 10-day stay will be $45.

He notes that one of the children has a pronounced squint. The child needs glasses. There is no charge for the eye examination; the glasses may be had

for as little as $4. If Farmer Mead needs a tooth pulled it will cost him 25 cents. Fillings are 75 cents each.

Suppose Farmer Mead has some really bad luck and breaks a leg. This would ordinarily be a financial calamity of first rank. But at Community Hospital his medical care costs nothing and his hospital room only $2.50 a day. Even if he has to spend 6 weeks in the hospital, his bill will be only $100.

The hospital does every type of surgery. A farm boy has a saddle nose and wants to beautified. Surgeons borrow cartilage from the boy's ribs and build him a new nose. One old man has a mouth tumor, caused by irritation of the home-made false teeth he had whittled out of an oak plank! Surgeons remove the tumor, and the hospital dentist makes a pair of plates.

Perhaps the greatest service of the hospital is its emphasis on preventive medicine. Members are urged to bring in children for smallpox and typhoid vaccination and diphtheria shots. A hospital bulletin preaches better nutritionthis being largely a sowbelly-and-cowpeas-eating country. They even sell lowpriced vitamin pills. Farmers are shown the wisdom of attending to minor ills at once, before they grow into major things.

All this is having a telling effect on the general health of the community. In the early days, fully two-thirds of the appendix cases came in with burst appendixes. Today not more than a tenth arrive in this critical condition. Similarly, staff physicians see few of the grisly overgrown tumors they used to see. When subscribers suspect trouble, they come to the hospital on their weekly trip to town. On busy days, from 60 to 100 people will crowd the out-patient department. If a patient is too ill to come in, home calls are made. In town they cost $1. The charge for country is also $1–plus 20 cents per mile for the doctor's car.

NEW DEAL FOR THE DOCTOR

Salaries of staff doctors range from $4.200 to $8,400—plus a 15 percent bonus if the hospital has a profitable year. Because all recent years have been profitable, the bonus is a regular feature. Physicians like this type of practice. They have none of the usual physician's expenses for office rent, secretary and bill collections. Staff members take turns working nights, so an off-duty doctor has free evenings to himself. All staff doctors get a month's vacation with pay, and in case of prolonged illness, salary continues for 3 months.

The hospital's work is good enough to attract large numbers of nonmembers. Nearly half of its practice is among people who are not shareholders. They pay regular fees, and this money goes into the hospital fund. The only comparable hospital is 120 miles away in Oklahoma City.

Community Hospital has an excellent record. Surgeons aren't tempted to perform operations for the sake of a fee. In its entire history, only three Caesarean operations have been performed. There hasn't been a death resulting from an appendectomy in 7 years. Last year the hospital delivered 103 babies without a maternal mortality. One case might be described as an infant deatha stillbirth.

The patients in the hospital all have about the same reaction: "There's no tellin' what this hospital's been worth to me.”

One farmer is more explicit : "Before this place was built, my boy had appendicitis. He stayed in a hospital 8 days and it cost me $215. When my girl got appendicitis, she stayed in this hospital 10 days and it cost me $42. I don't see how a man can afford to stay out of this cooperation business.”

Mr. PRIEST. The committee will stand adjourned until 10 o'clock tomorrow morning.

(Whereupon, at 12:20 o'clock p. m., Tuesday, March 12, 1946, the committee recessed to reconvene Wednesday, March 13, 1946, at 10 o'clock a. m.)

HOSPITAL CONSTRUCTION ACT

WEDNESDAY, MARCH 13, 1946

HOUSE OF REPRESENTATIVES,
COMMITTEE ON INTERSTATE AND FOREIGN COMMERCE,

Washington, D. C. The subcommittee convened at 10 a. m., Hon. J. Percy Priest, chairman, presiding

Mr. PRIEST. The committee will come to order, for further consideration of S. 191 and related House bills on the same subject.

This morning we have several witnesses. We hope to be able to finish the open hearings during the morning session.

Will you take the stand, Mr. MacCracken. .

STATEMENT OF WILLIAM P. MacCRACKEN, JR., ATTORNEY AT LAW, APPEARING ON BEHALF OF THE AMERICAN OPTOMETRIC ASSOCIATION

Mr. MacCRACKEN. Mr. Chairman, my name is William P. MacCracken, Jr. I am appearing this morning as the Washington counsel of the American Optometric Association.

Dr. William C. Ezell, of Spartanburg, S. C., is the president of that association, and had hoped to be able to appear in person, but he found that that was impossible. So I am appearing in his place primarily for the purpose of making the request that he be allowed to file for the record a written statement setting forth some of the views of the Association with reference to this particular bill.

Mr. PRIEST. Without objection, he may do so, and if the committee may suggest he have that statement in the hands of the committee's clerk as soon as possible. We want to get the hearings in the hands of the printer quickly. So, if you will suggest to him to prepare that statement as soon as possible, it will accommodate the committee.

Mr. MacCRACKEN. I will be very gad to do that, Mr. Chairman. (The statement referred to is as follows.)

STATEMENT OF WILLIAM C. EZELL, PRESIDENT OF THE AMERICAN OPTOMETRIC

ASSOCIATION

I am president of the American Optometric Association actively engaged in the practice of optometry in South Carolina where I have been practicing for the past 30 years. The American Optometric Association is the national organization representing the profession of optometry. It is constituted in the same manner as other professional organizations. The optometrist joins his local and State associations and in turn is affiliated with and becomes a member of the national association.

Although our organization has not had the opportunity of acting in convention upon S. 191 as it now reads, I know that the profession and our organization have been continuously and deeply interested in all legislation, whether on a national or State level, to afford better health care to the citizenry of the country. Our organization has in the past always gone on record in favor of bills advancing health care. Good health cannot exist unless and until there likewise exists comfortable, efficient, and useful vision. The better care afforded to our people, the greater will be their good health and happiness.

The latest available statistics indicate that 7 out of 10 persons in the civilian population who require eye care and who can afford to pay for it, voluntarily seek and obtain the professional attention of optometrists. This high percentage did not always exist. It grew to its present state because during the last 20 years the scientific advance of optometry attracted public recognition and merited public confidence.

No one can quarrel with the fundamental purposes of this bill. The physical examinations of the best of our youth during the recent war disclosed that we were living in a fool's paradise. We thought most of our people were in good health. In fact they were not. We were shocked and surprised at the large number of rejections because of poor health-conditions which might have been avoided or eliminated by proper hospital care, medical, or surgical treatment.

Although we approve the fine purposes of this bill, we believe it fitting and proper to point out the possibility of discrimination in its operation.

It will be conceded that no program of health care can be complete unless the analysis and care of vision is an integral part of the program. Referring again to the rejections of registrants by the Selective Service Administration, we find that defective vision caused more rejections than any other single physical cause. The Selective Service statistics relate only to those under 38. Carrying out these statistics to the rest of the population beyond the age of 38, the incidence of visual defects ranges much higher. In fact, at the age of 70 visual defects exist in over 90 percent of the population. We therefore know that there are not enough professional personnel adequately to take care of all these cases of defective vision. There are roughly 2,500 ophthalmologists, 6,500 oculists and 17,000 optometrists trained to offer visual care. The very facts make it apparent that optometrists must be used in any adequate health care effort and to do without them would seriously limit and impair the program.

Coming directly to the point, it has been our sad experience in the past to find that optometry has been discriminated against in the administration of statutes relating to health care. Despite the fact that optometrists constitute the only group exclusively educated, trained, and licensed by public authority in the 48 States and the District of Columbia for the care of vision and that their services must be utilized in any complete program, there nevertheless exists as a result of the economic competition between the ophthalmologist and the optometrists, a discrimination against optometrists which too often prevents the utilization of their services. We make this statement not because of self interest but because we know that discrimination has curtailed the inherent right of our people to receive professional care-the same professional care that they found to be completely satisfactory, when they sought it voluntarily.

No bill affecting the health of the public should be drawn or administered so as to give one particular health profession an economic advantage over another, at the same time depriving a substantial portion of the public of the right to receive the services of highly skilled and trained practitioners.

No bill affecting the health of the public should be drawn or administered regardless of its beneficence or primary purpose so as to promote a monopoly in favor of any specific professional group by restricting, at public expense, the activities of other important, useful, and respected professions.

We respectfully believe that S. 191 should have inserted certain safeguards and to that end we submit the following amendments: By adding to section 622, subsection (f) at the end of line 12, page 9,

*; and (3) there will be made available in each such hospital or addition to a hospital the professional services of all practitioners licensed to practice under the state law and permitting the patient freedom of choice as to type of practitioner.”

By adding to end of section 633, subsection (a) at the end of line 6, page 23, a new sentence:

"Such regulations shall not discriminate between licensed professions engaged in health care nor shall they favor one profession as against another."

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