to some of the leading figures in the more widespread and successful voluntary organizations, and the California Physicians' Service told me they had no difficulty getting an acceptable fee schedule for the major and recognized medical or surgical procedures satisfactory to the medical elements in the community. Senator ELLENDER. I presume we are going to have evidence before this is over to show how you reached the 3 percent figure, as to whether or not that would take care of the situation that you are now trying to remedy. Do you know why it is 3 percent? Have you made any estimate? The CHAIRMAN. That will all be brought out in testimony here. Dr. MOUNTIN. It is roughly contemplated that some $26 per capita would be involved in delivering the benefits that are provided for in the bill, as I recall the estimates. Senator ELLENDER. $26. Dr. MOUNTIN. Something of that order. Senator ELLENDER. That would be 26 times our entire population? Dr. MOUNTIN. That is right, if the entire population should be covered. Senator ELLENDER. That would be the amount required? Dr. MOUNTIN. That is right. That is out of this fund. Senator ELLENDER. Will that percentage produce that much money ? Dr. MOUNTIN. That is my recollection. The CHAIRMAN. Estimates have been made, also, of the cost of medical care to the people of the Nation under the existing system, the present system. Dr. MOUNTIN. That is right. There are some benefits, we should remember, that are not fully covered in this bill. Full dental benefits are not provided for at the outset, and this also applies to nursing services, so it is deficient in that respect. However, the bill does provide that special studies of these categories of service will be made in the few years immediately following enactment of the bill, and that appropriate recommendations for the inclusion of these benefits, as well as methods of financing them, will be made on the basis of the findings of these studies. The CHAIRMAN. Under the bill it is provided that the Advisory Council shall advise the Surgeon General with reference to questions of general policy and administration in carrying out the provisions of this title, the establishment of professional standards, and the designation of specialists and consultants; so that they would set up specialists and consultants under this bill so that for whatever might be required there would be a list of specialists available. Dr. MOUNTIN. That is right. There are, Mr. Chairman, specialty boards now set up covering most of the specialties. Some others are in the process of organization. All the applicants have not as yet been examined. aminions have bee interrupted somewhat by the war, but as th -to great help to the committee. Your full statement, of course, will be carried in the record, as well as your oral statement. Dr. MOUNTIN. Thank you, sir. The CHAIRMAN. We will meet again tomorrow morning at the same hour. Mr. Arthur J. Altmeyer, Chairman of the Social Security Board. will appear at that time. We will suspend now. (Whereupon, at 12: 10 p. m., Wednesday, April 3, 1946. the com mittee recessed until Thursday, April 4, 1946, at 10 a. m.) NATIONAL HEALTH PROGRAM THURSDAY, APRIL 4, 1946 UNITED STATES SENATE, COMMITTEE ON EDUCATION AND LABOR, Washington, D. C. The committee met at 10 a. m., pursuant to adjournment, Hon. James E. Murray (chairman) presiding. Present: Senators Murray, Ellender, Aiken, and Donnell. The first witness this morning is Mr. Arthur J. Altmeyer, Chairman of the Social Security Board. Mr. ALTMEYER. Mr. Chairman, I have submitted a formal statement here, rather lengthy, and I do not propose to read it all. With your permission, I would like to read those parts that seem to point up what I am trying to say. The CHAIRMAN. I have been glancing over it, and I notice that it is a very comprehensive statement, and yet it is necessary for us to cover every feature of this proposed legislation, and we do not want you to skip anything that is important for us to hear. Mr. ALTMEYER. May I have the entire statement put in the record and then cover those parts that seem to summarize the various points? The CHAIRMAN. That may be done. STATEMENT OF ARTHUR J. ALTMEYER, CHAIRMAN, SOCIAL SECURITY BOARD * * *99 Mr. ALTMEYER. The interest of the Social Security Board in national health is fundamental to its responsibility under law for administering social security programs and for "studying and making recommendations as to the most effective methods of providing economic security through social insurance Health is basic to the security of the men, women, and children-the families-of America. Sickness and premature death are among the most important causes of insecurity. Progress in national health is essential to progress in social security. Protection against the costs and the losses that follow upon sickness is an integral part of social security. HOW HEALTHY ARE WE? We have been told that we are the healthiest country in the world. If we are, why do we need a national health program? No one would deny that we have made outstanding health progress over the past 50 years. Since 1900, our general death rate has been cut by about 40 percent. Our achievements in sanitation, in communicable disease 85907-46-pt. 1-12 169 control, and in medical science in general have been notable. We have among the finest hospitals, the best-trained and the most skilled physicians in the world. Still we are not the healthiest nation; we have by no means done as well as some other countries in protecting health, and we are far from doing what we can do. Although we are the wealthiest among the nations of the earth and have high standards of well-being, we have not yet attained for all our people that level of security of life which has been achieved in some nations with smaller economic resources. When we use mortality rates as an indication of our state of health, two important factors must be kept in mind. First, the general rates are averages for the country as a whole. Within these averages are concealed rates which are alarmingly high for modern times. Second, we must bear in mind that a large part of the reduction in death. rates that occurred in the past 20 or 50 years has been largely due to reduction in deaths from infectious diseases-typhoid, diphtheria. malaria, and others- that are susceptible of mass control. At present a much larger part of the burden of ill health and postponable death comes from illnesses which are not susceptible of mass control, but which require the highly individualized services of physicians, hospitals, laboratories, and technicians. These are the serv ices for which the American people now pay, when they receive them. as individuals. While we have achieved high standards in medical and hospital care, this high-quality care is not within the actual reach of large numbers of our people. Putting it bluntly, there are many Americans this very minute who are suffering and dying needlessly for lack of medical care. BARRIERS TO ADEQUATE MEDICAL CARE Many barriers stand between the individual and the medical care he needs. Briefly, these are: Lack of recognition or neglect of illness; unpredictability of illness; maldistribution of medical personnel and facilities; the unpredictability of medical costs; and the inability of a large proportion of families to pay for needed care. I will not take the time to review the evidence on these points. It is summarized in the document, Need for Medical Care Insurance," which we furnished the committee, and which you already have available to you as your Committee Print No. 4 on the National Health Act. BUDGETING FOR MEDICAL COSTS A major reason for neglect of recognized disabilities is, of course. the impact of medical costs on the family budget. No one can anticipate whether he or his family will go through a year with little or no illness or will suffer an extended and expensive period of sickness The large variations in the occurrence, duration, and severity of illness among individuals cause similarly large differences in their need for medical services and in the costs they have to meet. The costs of medical care, unlike those for food, clothing, shelter and other necessities, are not budgetable by the individual family, because they do not occur in a fixed pattern and cannot be foreseen by the in dividual or the family. A particular family may go for years with below-average medical expenditures, but in one year's time it may find its entire savings exhausted by a long and expensive illness. The medical care a family now receives is largely dependent upon its income. Despite all the public provisions for medical care, and care given through philanthropic organizations and free-of-charge by physicians, hospitals and others, low-income families receive, on the average, much less care than the well-to-do, though their needs are greater. Families with low incomes not only receive less care, but they spend a greater proportion of their incomes on sickness costs than families in better financial circumstances. BORROWING TO PAY FOR MEDICAL CARE Although medical care expenses take only about 4 to 5 percent of the average American family's income in normal years, more people borrow money to pay for medical care than for any other single item in the budget. In a poll taken in 1944 by the Physician's Committee on Research, some 23 percent of those canvassed said they borrowed money in order to pay doctor or hospital bills. A number of studies of loans made by banks and other small-loan organizations indicate that 3 out of every 10 persons who borrow give the payment of "medical bills" as the purpose for which the money is to be spent. Many others, unable or unwilling to borrow from lending agencies, borrow from friends and relatives. But not all families are able to borrow. As a consequence, many bills. remain unpaid. Studies before the war showed that, on the average, doctors fail to collect a fifth to a third of the value of their bills each year. ADEQUACY OF MEDICAL CARE, FACILITIES AND PERSONNEL How adequate is the care which the American people receive? Some 15 years ago, a quantitative standard of adequate care, usually known as the Lee-Jones standard, was developed on the basis of the best available medical opinion of what was necessary for "good medical care" at that time. Today, these standards would need modernization, but so far as amount of care is concerned, they probably would be challenged mainly as being too low. Comparison of the Lee-Jones standards with the services actually received indicates that even people in upper income brackets-those with annual incomes of $10,000 or more-fail to receive all the service which professional judgment considers desirable. But low-income families suffer more illness than the well-to-do and receive less care. The gap between care received and care needed is much wider at the bottom or near the bottom of the income ladder than it is higher up. The reason for this difference should be obvious. Medical care costs money and the poor have less money to pay for it. Various public opinion polls show that from 30 to over 40 percent of the American people have put off going to a doctor because of the cost. Individual doctors are not to be blamed for this. Financial barriers-not doctors are the cause of the inadequate medical care which our people receive. |