Dr. DAVIS. These statistics are not totally accurate. I am not saying that this did not happen because it probably did. If this did occur, it was because the women did not seek this care. I deliver babies, and I arrive at the hospital some nights at 3 in the morning and deliver an Indian lady who is supposed to be under the care of the free Indian hospital, and she has never been seen or been taken care of.

So there again it is education. It is not a lack of facilities as such, and I am sure that none of us want to arrive at 3 a.m. in the hospital and deliver women, when nothing is known about them. We have other facilities available in Shawnee but we cannot make these people use these facilities.

Mr. CRANE. Dr. Davis, unfortunately my time has expired and I appreciate your testimony this morning.

Mr. ROSTENKOWSKI. Mr. Corman will inquire.

Mr. CORMAN. Thank you, Mr. Chairman. Doctor, is Los Angeles County one of your constituent groups?

Dr. DAVIS. Yes, sir.

Mr. CORMAN. We have a serious problem in California concerning medical malpractice insurance. Do you think the Federal Government should do anything in that respect?

Dr. DAVIS. I have no answer to malpractice insurance. I do not think anyone does at this time. I certainly do not think it is a Federal problem. I think it must be acted on at the State level. I think we have many other problems in insurance, very similar problems. I do not think it could be answered by Federal laws.

Mr. CORMAN. Thank you.

Mr. ROSTENKOWSKI. Mr. Burleson.

Mr. BURLESON. Thank you, Mr. Chairman.

Doctor, I assume that, from your testimony, there is no national health insurance legislation that you think would be proper?

Dr. DAVIS. No, sir. Medical care is too personal. It must be handled in the private area and it can be handled in the private area. I think all of us believe these problems, including catastrophic insurance, can be handled privately. Catastrophic insurance can be sold very cheap and I do not think this is the place for the Federal Government. We know it is not. I think statistics prove us out on this fact very definitely. Mr. BURLESON. Thank you.

Mr. ROSTENKOWSKI. Mrs. Keys will inquire.

Mrs. KEYS. Thank you, Mr. Chairman.

I would like to ask one question of you. I was a little concerned with your statement that the usurping of health care personnel and facilities time by the healthy interfered with the availability for the sick. We have heard a great deal of testimony in this committee and most of it has been very cognizant of the fact that preventive care is very much needed in order to lessen the demand on acute care and that really our system now does not encourage or make it possible for people to have preventive care unless they happen to be very wealthy and able to afford it.

Dr. DAVIS. Well, I practice in a town that is not wealthy and we have plenty of preventive care. I am sure that is not true there and I am sure it is not true in Kansas and many, many areas.

Mrs. KEYS. Do you believe it is important that we have a system that makes preventive care accessible to people?

Dr. DAVIS. Well, it is already accessible but you cannot educate people to avail themselves of this. This is it. We have pap smears, ladies can go get them after 6 or 3 months if necessary. And many welleducated people do not show up until 5 or 10 years and it is too late. But that is education.

Mrs. KEYS. You are talking to me about your situation. I understand that. I wonder if you did agree that this was a part of providing health care for people that they had the availability of preventive health care and it was an important factor in not only lessening the total cost of the health care burden in this country but in making people able to live happy, healthy, longer lives?

Dr. DAVIS. I think this is available in most areas and I am sure it is. Our problem is simply that people will not obtain it when it is available. I do not believe this is the place for the Federal Govern

ment to enter.

Mrs. KEYS. I believe that you have said you do believe that it is important that it be there, though.

Dr. DAVIS. It is there in the private practice there today. Come in my office and that is what I do about 50 percent of the time, preventive medicine.

Mrs. KEYS. Thank you, sir. You have answered my question.

Mr. ROSTENKOWSKI. Doctor, does your organization do anything to encourage mothers to have their children inoculated from polio, diptheria or anything like that? Does your organization encourage this, do they have any program to encourage mothers to have their children inoculated?

Dr. DAVIS. Not per se. This is not part of our work. Each doctor in the organization certainly encourages it.

Mr. ROSTENKOWSKI. Are there further questions?

Thank you, Doctor.

Dr. DAVIS. Thank you.

Mr. ROSTENKOWSKI. Our next witness is Mr. Leonard Woodcock. Welcome to the committee, Mr. Woodcock. If you would identify yourself and the organization you represent and proceed with your testimony.

STATEMENT OF LEONARD WOODCOCK ON BEHALF OF THE HEALTH SECURITY ACTION COUNCIL AND THE INTERNATIONAL UNION, UNITED AUTOMOBILE, AEROSPACE & AGRICULTURAL IMPLEMENT WORKERS OF AMERICA, UNITED AUTO WORKERS, ACCOMPANIED BY DR. I. S. FALK, PROFESSOR-EMERITUS OF PUBLIC HEALTH, YALE UNIVERSITY, CHAIRMAN, TECHNICAL COMMITTEE, COMMITTEE FOR NATIONAL HEALTH INSURANCE; MELVIN A. GLASSER, MEMBER, TECHNICAL COMMITTEE, AND DIRECTOR, UAW DEPARTMENT OF SOCIAL SECURITY; AND MAX W. FINE, EXECUTIVE SECRETARY, HEALTH SECURITY ACTION COUNCIL

Mr. WOODCOCK. Thank you very much. I assume the statement I provided will appear in the record.

Mr. ROSTENKOWSKI. In its entirety.

Mr. WOODCOCK. Mr. Chairman, and members of the Health Subcommitteee, my name is Leonard Woodcock and I appear before you

today on behalf of the 5 million members of the United Auto Workers families, and the 80 national organizations which comprise the Health Security Action Council. With me is Dr. I. S. Falk, professor emeritus of public health, Yale University, chairman of the technical committee of the committee for national health insurance; Melvin Glasser, member of the technical committee and director of our department of social security. To my extreme left, Max Fine, executive secretary of the health security action council.

Mr. Chairman, we are here today in support of the Health Security Act, H.R. 21, and to comment on other health care proposals under consideration. We have already testified extensively before the Ways and Means Committee and two committees of the U.S. Senate about why we support the Health Security Act. We are grateful to the more than 100 members of this body who are cosponsoring this important and inevitable legislation. We stand for health security. Our reasons are on the record.

We have testified as to what health security is and what it is not. We have shown how it will produce urgently needed changes in the health care delivery system. We have discussed its quality control features, the needs for which are growing even faster than malpractice insurance premium increases. We have provided data about its costs, cost controls, and cost-saving features, and we will continue. to update these data and not be intimidated by those who are deliberately misinterpreting the costs of health security.

Your committee has not yet acted on this urgent problem, but we hope that the new round of hearings which you are now undertaking will finally produce a health security program for all Americans.

As a result of the administration's totally incomprehensibe position on this issue, not much attention has been paid to the health care problems of the American people in the past year. However, it has been a year in which the health care crisis has grown worse.

The problems of poor distribution of services, shortages of family physicians, and duplicated, disorganized and excessively high cost of services have all intensified.

It has been a year in which millions of American families played Russian roulette with the lives and health of their children-a year in which 5.3 million of our 13.2 million preschool children were unprotected against the killing and crippling infectious diseases: polio, measles, rubella, diphtheria, whooping cough, and tetanus.

It has been a year in which one-third of all pregnant women who delivered in public hospitals had no prenatal care and consequently ran high and unnecessary risks to themselves and their babies.

It has been a year in which millions of America's laid-off workers joined both the lines at the unemployment office and the swollen ranks of 40 million Americans who face disaster in the event of even a short acute illness or injury because they have no health insurance at all.

And it has been a year in which health costs have gone completely out of control, with physician fees escalating 40 percent faster than other items in the Consumer Price Index and hospital charges soaring 105 percent faster, while the hospital placed the blame on their own employees whose wages still averaged under $7,800 per annum in all hospitals and at the poverty level of $5,800 in small hospitals.

Mr. Chairman, these are the types of problems with which your committee must deal, and not merely the problem of which new financial patch to apply to a defective and already overcostly health care system. These are the problems which even the administration has noted, and ignored on grounds that the Federal budget can absorb no new spending programs.

Placing total reliance on the failing private insurance industry to solve our health care crisis, the administration 11 months ago shelved for a year its own national health insurance plan. Whether or not the shelf life will be extended is not yet clear. What is clear is that the problems which caused an initial, if tardy, administration response have not been solved and, indeed, have been more fully exposed to public view.

Sometimes it seems that the medical and medical insurance bureaucracies have ruled out compassion in dealing with people, but it is the fearful cost of health services that, rightly, draws most attention to the problems.

When the Committee for National Health Insurance was organized in 1968, Federal, State and local governments spent $20 billion for health purposes. Last year, costs of the same services escalated to $41 billion. Two years from now, the governmental budgets will be emptied of over $55 billion for health care unless changes are made in the system. Total costs, private and public, now are an estimated $118 billion annually and consume 8.3 percent of the GNP versus $54 billion and 6.5 percent of GNP in 1968.

It is, therefore, not a question as to whether the Congress should delay action on the issue of health care. The crisis has moved to such a stage that you will have no choice but to provide for an inordinate number of additional billions of dollars or say to the elderly and the poor, "We'll have to take back what we've given you."

The illness that afflicts the health care system is now generally diagnosed. In order to provide effective treatment, it should be clear that each of the causes must be dealt with, and dealt with concurrently.

Unfortunately, all but one of the major bills before your committee, Mr. Chairman, choose to ignore most of the causes or even the symptoms of the illness.

An example is the plan developed by the American Medical Association, which resembles the previous Nixon and Ford plans. While it is generally agreed today that every American should have health insurance coverage, the AMA insists that coverage must be voluntary and not universal-or as they call it, "compulsory."

This bill (H.R. 6222) asks you to pass a law to mandate employers to offer second-rate private health insurance policies, purchased from carriers of the employers' choice, to all employees. However, the employee could be required to pay 35 percent of the premium costs. The marginally employed and the low-income employer would be reluctant to pay about $350 a year for their share of the insurance. Many could not afford it. Others would not want it after they examined the policy and found that they and their families would still be liable for up to $2,000 per year in coinsurance payments, or up to $1,500 if they were single. Many services would be limited, others excluded entirely.

The AMA bill is typical of others which would mandate employeremployee insurance. These bills provide for the most inequitable financing of services. An employee earning $6,000 per annum would pay as much as an executive earning $60,000.

Since the AMA bill is totally lacking in cost controls, even greater escalation of medical costs than at present would occur should this approach be enacted.

Since quality controls would be absent and more dollars available, even greater incentives would be provided for overutilization, overprescribing and unnecessary surgery.

Mr. Chairman, doctors are not ogres. We believe that the large majority of physicians are dedicated, hard-working, competent and concerned individuals. Our quarrel is not with our doctors. Our quarrel is with a system which corrupts its own members and fails to meet the needs of the people-with a system which produces too few doctors, rewards inefficiency and ineffectiveness, leaves millions unserved in rural America and the inner cities and forces consumers to pay astronomical amounts for episodic care.

The AMA bill would not remove patient frustration which plague the doctor-patient relationship.

It would only extract higher fees from patients and make solo practice, fee-for-service even more rewarding for doctors than at present.

In the health security bill (H.R. 21) which we support, provision. is made to continue the fee-for-service system, but to introduce essentially needed controls on the cost and quality of the services delivered under this system.

Early in this century, in a preface to his book, "The Doctor's Dilemma," George Bernard Shaw wrote:

That any sane nation, having observed that you could provide for the supply of bread by giving bakers a pecuniary interest in baking for you, should go on to give a surgeon a pecuniary interest in cutting off your leg, is enough to make one despair of political humanity.

Those who believe that progress must be made incrementally regard the Long-Ribicoff catastrophic insurance plan as an acceptable response to the health care crisis. We believe, however, that this bill has serious and even fatal flaws.

While the bill lacks any provision for representation of the consumer, it is clear that it would greatly strengthen the position of the private insurance companies.

A $30 billion industry which has failed to provide universal coverage, failed to control medical costs, failed to assure quality and which has insured great success to date in defeating real national health insurance proposals would be further enriched by the Long-Ribicoff bill.

By law, the major share of the estimated $8.9 billion additional first year costs of the program would flow through the insurance industry, which already retains $4 billion for its operating expenses and profits in ineffectually administering current health insurance plans.

We have provided in appendix A, case histories of people who would not be helped by catastrophic insurance.

[Appendix A follows:]