cedure, and of course the very marvelous and brilliant advance in therapeutic measures. Nobody is more zealous than I am for the high ethics of American medical practice.

I would not be a party to attempting to force down the throats of American medicine or the people anything not right. But I believe with all of the advances which have been made and with a fairly certain knowledge of the successes and failures of the voluntary systems, that now is the time for the Central Government to spearhead this effort. I think that we can no longer wait.

With great credit to American men and women physicians, the vast amount of free service they do, and the great support that they give to the communities and to our democratic aspirations and advances on all levels, I think that we want to make sure that an anguished mother with a sick child in her arms does not have to go some place and knock at a door and grovel to get the attention that she wants for that baby. That that is a little extreme, I will have to admit, but it is the core of what we are talking about.

Too many of us because of that reason trust too much to optimism that nature will take care of us. There are so many other things in our budget that are so important, and the person has the feeling, "I will get along all right," and that extends even to giving the kids music lessons when they suffer because they do not get medical attention early enough.

ADVANTAGES OF THE BILL TO BUSINESS

The CHAIRMAN. Would the establishment of such a system as here proposed be of benefit, also, to business and industrial interests of the country?

Mr. MILLER. Oh, yes, without doubt. I think that the figures of absenteeism were rather completely exposed to the committee by one of the Senators, perhaps Senator Pepper, but I have pulled together a few figures here.

In the critical year of 1942-our first full year of war-illness in one way or another cost American industry 4,000,000,000 workdays, the equivalent of a full year's working time for 13,000,000 people, or more than the total strength of our armed forces.

Senator AIKEN. You say that 4,000,000,000 workdays were lost in the full year in the war from illness?

Mr. MILLER. Yes.

Senator AIKEN. Do you happen to know how many days were lost by strikes in the same period?

Mr. MILLER. I have read the figures but actually I do not have them offhand.

This figure breaks down into 500,000,000 lost workdays of absenteeism caused by illness and accident, the equivalent of 1,000,000,000 lost days due to permanent disability, and a billion and a half due to premature death, and still another billion attributed to the reduced efficiency of those who stuck on the job when they were really too sick to work. Somewhere around 7,000,000 men and women in this country are too sick to work on the average every working day in the

year. The price we paid for sickness and disability in 1943, the wages lost by workers and the costs to business, added up to not less than $15,000,000,000.

The CHAIRMAN. Thank you, Mr. Miller, for your statement here this morning. I am sure that it will be of benefit to the committee. Mr. MILLER. I regard these hearings as the most momentous that I have been privileged to attend in two decades or more.

Senator AIKEN. I was interested in Mr. Miller's observations on socialistic ideas. Am I right in the understanding that when a socalled socialistic idea is approved by the majority of the people, through their duly elected representatives, that in your opinion it becomes part of our democratic processes no matter what it was called before?

Mr. MILLER. I do not think that it can fail to do it, the electorate having the right to reverse themselves.

Senator AIKEN. So long as it expresses the desires of the majority of the people, you would call it a democratic process?

Mr. MILLER. Using the term in its best sense, although I am a member of that party that spells it with a capital letter.

Senator AIKEN. The first socialism that I heard of was when I was just old enough to remember it, when it was first proposed to have the RFD routes established, to have the mail delivered to the country people the same as it was to city people, and the charge of "socialism" was made against the RFD at that time. And then the parcel post was a socialist idea, and then the Postal Savings Bank-that was very definitely socialism.

But according to you, when it was accepted and voted for by the majority of the people, I understand that you would take it out of the realm of socialistic ideas, out of that category?

Mr. MILLER. Still admitting that I do not understand the word "socialism," that it may be rather a complex mosaic, I am not sure that I would recognize a Communist and I hear that name a good deal, if I saw one behind the gooseberry bush in the garden, I do sincerely think that this would be democracy in action.

It is pretty difficult for people to realize that when selective service came along, that it really was not a drafting, using the term in its most objectionable sense, but a spectacle of the entire Nation volunteering, and that is what it came out to be.

Senator AIKEN. That was established 150 years ago, I would say. The CHAIRMAN. The free public school system was very bitterly opposed in this country when it was first proposed, is that right? Mr. MILLER. Yes. There is so much evidence and I do not want to detain the committee too long. We have never objected, so far as I know, to medical students who have gained their medicine through taxsupported institutions, and that could well be termed "socialized medicine," or "socialized medical instruction." We have a social country here.

The CHAIRMAN. Dr. Mountin is the next witness.

STATEMENT OF DR. J. W. MOUNTIN, MEDICAL DIRECTOR, UNITED STATES PUBLIC HEALTH SERVICE

INTRODUCTORY REMARKS

Dr. MOUNTIN. Dr. Parran, whom you invited to appear before you today, asked me to express to you and to the committee his very deep appreciation of the opportunity for the Public Health Service to present testimony with respect to S. 1606.

As he has informed you, Dr. Parran is in Europe, serving on a committee to form an international health organization under the United Nations Organization. He has designated me to appear in his stead, and to express the point of view of the Public Health Service.

Yesterday, Mr. Chairman, when presenting your opening statement you inserted in the record the President's message, on a national health program and expressed the deep interest of the President in this measure. Now, on behalf of the Public Health Service and, in fact, on behalf of public health workers generally throughout the Nation, I want to say how deeply we appreciate the President's interest and his having brought this matter so forcibly to the attention of the Nation. He has, in fact, elevated human health to the position of a major social objective.

On this occasion, too, Mr. Chairman, we wish to record our appreciation of the work of your Committee on Education and Labor and its subcommittees. The facts revealed and, the reports based upon these facts, are classics in their respective fields. They have served in great measure to crystallize the health issue in its present clearcut form and to rally suport for remedial measures.

Yesterday, the authors of the bill gave us their interpretation of its provisions. They told us, also, that additional measures to complete the President's program were contained in other bills now before the Congress. The hospital survey and construction bill, for example, which has passed the Senate and which is now before the House, authorizes funds for the construction of physical facilities essential in a comprehensive health program-not alone hospitals, but health centers, laboratories, and the accessory utilities that go with these main structures. As I recall their statements, a bill is before the House to expand the provisions of the Social Security Act, and to take up the remaining item in the President's health message compensation for wage loss due to illness and disability.

In this connection, too, I should mention other pending legislation. perhaps not directly related to personal health services or medical care in the restricted sense, but which is very important from the standpoint of public health. I refer to sanitation legislation, particularly those bills that are designed to remedy the rather disgraceful pollution now being added to our inland and coastal waters.

Senator AIKEN. Is there any program being worked out to eliminate stream pollution? Is your agency working with other Government agencies on any program to eliminate stream pollution through

the country? I agree with you that it is disgraceful, and it is also unprofitable to let it continue.

Dr. MOUNTIN. A specific program of remedial measures, no, but basic studies and field surveys are in progress. Additional legislation is needed which will take us beyond the study and the survey stages, into actual aid on the construction of needed facilities.

Senator AIKEN. I have not heard this matter mentioned by any witness up to now, and I am particularly interested in it, because I think it is one of the most important undertakings that the country can embark upon.

When we see our little streams polluted as they are, carrying disease and spoiling the fishing, it strikes me that it would be one of the most profitable undertakings that we could engage upon, and not only from the health standpoint, but the recreational standpoint, the industrial standpoint, and every other standpoint. It could be worked in in some cases with flood control. It is so very important that it is a mystery to me why we have not been doing something about it before now, and why we delay any longer in undertaking it.

Dr. MOUNTIN. In addition to the point you have raised, Senator, there is one still more serious. On account of the pollution now going on many streams that otherwise would be suited as sources of water supply are rendered not available for that purpose. It is a serious economic situation. I am, perhaps, dragging in this subject at an inappropriate time since it is not up for consideration, let me therefore return to S. 1606.

Senator AIKEN. It is tied in with the entire subject of rural sanitation, as well as urban sanitation.

Dr. MOUNTIN. That is correct.

At the outset, I should like to record that the Public Health Service is heartily in sympathy with the type of program that is envisaged by S. 1606. I have a prepared statement which I shall be glad to read if you choose, Mr. Chairman. If the committee would agree, however, I would prefer to submit it for the record and then proceed to an informal discussion of some of the high points, at the same time. answering the questions that you might raise.

The CHAIRMAN. Of course, if you desire, it will be incorporatd in the record, and then you can dwell on the high points in the statement. (The statement is as follows:)

STATEMENT OF JOSEPH W. MOUNTIN, M. D., MEDICAL DIRECTOR, U. S. PUBLIC HEALTH SERVICE, ON S. 1606, BEFORE THE SENATE COMMITTEE ON EDUCATION AND LABOR

OBJECTIVES OF THE BILL

The Public Health Service interprets the bill before this committee, S. 1606, as a vehicle to put the major elements of the President's national health program into effect. The objective-the goal of the President's program and of this bill is to assure every citizen "the opportunity to achieve and enjoy good health." In its underlying philosophy this program recognizes the fact that good health for all our people is a national asset, in peace as well as in war, and that investments in health yield handsome returns in national vigor and productivity.

But it rejects the notion that health is a commodity which can be nicely calculated and distributed according to the standards of market-place economics. Rather its fundamental premise is that ready access to health service and medical care is not a luxury to be bought only by those who can pay, but the right of every American-wherever he may live and whatever he may earn. Unlike most previous health legislation proposals, therefore, this bill does not confine itself to a single facet of our national health program. Instead, its sponsors have taken the broad measure of our health needs as a whole and have boldly proposed action designed to meet these needs.

I have underscored this question of goals because I believe it is fundamental to the consideration of the bill before this committee today. Unless the objectives of this bill are first compared with those of more restricted proposals, the merits of its specific provisions cannot be fairly appraised.

As the Federal agency primarily responsible for the protection and promotion of the Nation's health, the Public Health Service believes that public recognition of this goal of good health service for all our people is long overdue. We further believe that this goal is within our power as a nation to achieve as soon as a program is adopted which is based on a forthright appraisal of needs.

I am sure it is not necessary here for me to review in detail the facts surrounding our national health needs or to demonstrate that the American people are not now enjoying the full benefits of modern medicine. The Public Health Service on several previous occasions has submitted to the Congress comprehensive studies of our health deficiencies, and this committee has summarized these needs in its own publications. There are several salient points, however, that I should like to recall to the committee's attention because of their direct bearing on the issues underlying S. 1606.

All of us-laymen and medical men alike derive a large measure of satis faction from reviewing the progress made to date in the battle against disease and preventable death. Through the combined efforts of scientists, medical practitioners, and public health officials, the average life expectancy at birth has been steadily extended from 49.7 years in 1900 to 65.1 years today, as indicated by chart I. The progress represented by these statistics is indeed gratify ing, and we all have reason to be proud of these accomplishments. But I am afraid many people are prone to assume that these favorable trends have some magic capacity to project themselves automatically into the future, and that time alone will extend the conquest of disease.

Unfortunately, this comfortable fatalism is not supported by the facts. Even a brief analysis of our progress will demonstrate why we cannot rely on present momentum to overcome all obstacles to good health. As chart II shows, im provement in life expectancy at birth has not been paralleled by a corresponding improvement in the expectancy of persons who have reached the age of 40. In fact, the remaining life expectancy for people at this age has been extended only a little over 3 years since 1900. Thus, the average life expectancy of most of us here today has increased very little over that of our grandfathers in 190 even though babies born today have a much greater expectancy than those of us born around 1900.

The age factor in life expectancy is particularly important when we recall that our national population as a whole is becoming older. In 1900, 1 person in 25 was 65 years of age or older; today, 1 person in 15. By 1980, the ratio will be 1 to 10. At our present rate of progress, more babies will live to maturity. but the years of maturity will be extended only slightly, if at all.

This conclusion is partly explained by a comparison of diseases which have already been brought under control with those for which the death rate is in creasing. I believe that the representative sample of diseases in these two cate gories portrayed in charts III and IV will serve to indicate the significant features of this comparison.

Chart No. III shows the trend in death rates for four diseases—typhoid fever, diarrhea and enteritis, diphtheria, and tuberculosis-which have been substan tially reduced or even virtually eliminated since 1900. Also included in this category are such diseases as smallpox, yellow fever, and pellagra. It is larges through progress in control of such diseases that the life expectancy for peop under 40 has been so strikingly improved.

This progress has, for the most part, resulted from new scientific knowledge applied through organized programs of mass prevention or treatment. Typho fever, diarrhea and enteritis, malaria and yellow fever were conquered environmental sanitation; diphtheria and smallpox by immunization; pellagra by