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great percentage of the households in the United States.

I worry that bureaucrats are not knowledgeable about good medical care; they really are interested in saving money in health care, by promising the same quality and more quantity of care at lower cost. Such an approach can only lower the standard of care, cutting back on immunizations, preventive care, etc. Quality care is going to cost money!

I am convinced, that we do not have the resources for National Health Care at this time, if it is to be simply an addition to our present delivery system by money or appropriations and without meaningful attention to innovative changes that will be necessary to accomodate the increased demand. I envision that it might take 25% of our resources for health care under a national program; we simply do not have those kinds of resources! health care when all segments of our society need monetary transfusions? What about the deterioration of our cities (where much of our medical problems excist because of this very deterioration?)

Can we involve that much money in

And I understand

that our entire industrial system is in urgent need of capitalization funds to make it competitive in future world markets

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I worry!

The rationing of medical services will be by federal employees

bureaucrats, if you will

not by the ability to pay which has been

traditional; not by doctors, not by patients, nor even by you law

makers. And if we have medical care dictated by edicts in the Federal Registry then surely we shall have chaos.

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And perhaps not lastly, I wonder about my own working habits and those of my fellow physicians. For many years now I have worked 60, 70, yes, even 80 hours per week. I have a daughter who is teaching mcdicine at the University of Illinois branch at Rockford who estimates that she is working 100 hours per week, what with her teaching responsibilities and patient care. What will we do under N.H.I.? Well, I

plan to work 40 hours per week. How can you require me to work more hours than the national work ethic? It will take 21⁄2 doctors to replace one of myself, or of the Dianes whom I am describing. Coming from rural America I can tell you we are already short of doctors now!

Paperwork! In an office of 3 doctors, we have 2 full-time employees doing nothing but that, and it must occupy 10-20% of my time. Any N.H.I. plan will surely increase this burden, the costs, and take me further away from patient care.

These are some of the problems that come to mind when we discuss National Health Insurance. I feel you gentlemen have an awesome responsibility in this field. There is no question but that National Health Insurance will shape all medical care delivery in the future. I must tell you that if you plan to build upon the past

that if you plan

that that

to bring the system of today within the reach of everybody

concept simply is not possible. And I fear that all of our present concepts of N.H.I. are really just "patches", on a system already taxed to its capacity.

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What to do?

I believe it is your responsibility to determine what you want our health care system to do. What really are the priorities, since

"Do you have

we cannot do everything? If your conclusions are that you can provide all the medical care everyone might want in today's system, then you are dealing with an impossibility. And, if you ask mз: an answer to this question?" my answer is a loud, "NO". innovation is required, not just more money into the system.

But creative

There is no question but that the change must be evolutionary, not revolutionary, as has been the case in some other countries. An entire new program should not be installed full-blown upon our already over-strained medical system.

It seems to me that such an evolutionary concept of National Health Insurance needs to include only the following at this time.

1. Coverage of the Catastrophic illness;

2. Preventive Medicine;

3. Care of chronic illness, such as Diabetes, Hypertension and

Just these are ambitious projects for the present. They, like

any others, are going to cost money, much money! You must be prepared to pay for the program you select. I don't believe it is fair to

promise programs which cannot be delivered because of cost, as has been

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so heart-breakingly true of the Medicare program! Let us not allow "politics as usual" to be that callous again!

If I may be permitted a personal conclusion, I would state that

I probably will not be accorded the opportunity to again appear before the House Ways and Means Committee when it considers such a momentous issue as National Health Insurance. Therefore, I would like to

challenge this committee to decide what kind of social changes you, the legislature, or society in general wants made through the Health Care System. Then fund National Health Insurance in such a way to insure that these things might happen. Anything less would be a

betrayal of the American people.

Thank you!

STATEMENT OF DONALD QUINLAN, M. D.

Chicago, Illinois, September 12, 1975

before the Subcommittee on Health

of the Committee on Ways and Means

United States House of Representatives

I thank this Committee for providing the opportunity to give you my views

on so-called National Health Insurance

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which, of course, isn't insurance,

but a governmental taxation and control scheme.

I am Donald Quinlan. I'm engaged in the practice of private medicine in Chicago, Illinois. I was educated in Ireland, England and Switzerland, and served from 1948 to 1953 in general practice under the British National Health Service. I emigrated to the United States in 1958. Since then I have obtained additional resident training, and United States citizenship. I have practiced in Chicago since 1960 as a specialist in internal medicine. My professional time is totally devoted to the ethical care of patients, and defending the right to such practice.

After reviewing the debate in this country on this subject, and considering my experience both here and abroad, I have decided to discuss the subject under three headings:

I.

II.

III.

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Compulsory Politicalized Medicine a description used in preference to the misleading and inaccurate term National Health Insurance; Prepaid Per Capita Group Practice used instead of the misleading label Health Maintenance Organizations (HMOs) used by its proponents;

Devices for Government Dictation and Control which are deceptively referred to by their proponents and apologists as Utilization Review, and Professional Standards Review Organizations (U/R and PSRO).

The latter two items are actually a part of the whole scheme to nationalize Medicine. But, since the HMOs and PSROs have been the subjects of separate acts

-

they

of Congress even though the planners see them as a part of the whole drive to politicalize medicine, and defraud free citizens of their birthright should be dealt with separately.

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