Mr. ALTMEYER. Yes, sir; I have myself participated actively since 1933 in the development of a national health plan. As the Senator points out, in 1939 there was a national health bill introduced, and over the course of the years there have been many people consulted in the development of a national health plan, including the representatives of the American Medical Association.

The CHAIRMAN. And suggestions have been made by members of the medical profession; letters have been sent in. I have had a great many letters from doctors in various parts of the country in which they suggest different provisions and proposals in connection with the national health program, and is it not true that in nearly every community in the country, there are some medical men who, even though they belong to the American Medical Association, feel there is a great need for an insurance system of this kind?

Mr. ALTMEYER. Yes, sir. I feel that if the medical practitioners of this country could sit around this table as we are sitting around it today, we would get a majority vote in favor of this bill.

The CHAIRMAN. At the commencement of the discussion of the proposed health legislation, the medical profession took a very decided position against it and did not attempt to assist in working out a program but merely abused it and criticized it and took no part in it, and they organized a program of carrying on propaganda against it; is that not true?

Mr. ALTMEYER. I am afraid it is.

Senator DONNELL. Has there been any poll taken among the prac titioners as to how they feel on the subject of compulsory health insurance, Mr. Altmeyer?

Mr. ALTMEYER. Yes; I think that there was one taken. I do not recall when and what it showed.

Senator DONNELL. Do you remember who took it?

Mr. ALTMEYER. I do not remember that, I just have a vague recol lection that there was a poll taken, and I do not remember whether the question was formulated so that you got a clear-cut reaction or not. It makes a great deal of difference if you put in some negative words in the question. Then you are sure to get an unfavorable response. Senator DONNELL. In reference to Mr. Falk, he is not a physician. is he?

Mr. ALTMEYER. No, sir; he is a biologist and an economist. Senator DONNELL. I think he holds a doctor's degree, doctor of philosophy, but he is not a physician.

Mr. ALTMEYER. No, sir.

Senator DONNELL. Or surgeon?

Mr. ALTMEYER. That is right, and neither am I.

Senator DONNELL. I see.

Mr. ALTMEYER. At the bottom of page 5 there was something missing, and I would like to read that sentence.

Voluntary insurance is necessarily expensive, because it is constantly exposed to an adverse selection of risk among those who enroll or stay enrolled. Comprehensive insurance requires the united effort of the entire public. Experience the world over has shown that only through Governme:.: action can large-scale or complete coverage be achieved.

Senator DONNELL. Do you mind telling us just briefly what your own professional background is, and your educational background. so that we can have it here for the record?

Mr. ALTMEYER. Well, I studied economics at the University of Wisconsin and graduated in 1914. I was a school teacher for 4 years, and I returned to the university to take graduate work. In the midst of my graduate work, I became statistician for the Wisconsin Tax Commission, later senior accountant, and later chief statistician for the Wisconsin Industrial Commission, and still later secretary of the Wisconsin Industrial Commission. In 1933, I came down here representing the State in its relations with the Federal Government because our commission, besides administering all of the labor laws of the State of Wisconsin, also administered relief, general relief during the depression.

I stayed on down here as an official of the NRA in charge of labor law compliance, became Assistant Secretary of Labor in 1934, and was chairman of the Technical Committee which advised the Cabinet Committee on its recommendations which form the basis of the present Social Security Act, which was enacted in 1935.

In 1935, when the Social Security Board was appointed, I became a member, the Chairman, Governor Winant, resigned the early part of 1937, and I then became Chairman. I have been Chairman since then.

Senator DONNELL. Thank you.

Senator AIKEN. I think that you might add, Mr. Altmeyer, that some of the great discoveries and inventions have been made by those who were outside the industry which they were intended to benefit. I think that you have had demonstrations during the recent war. Some of the small boat builders never built any boats before. They got very high commendation from the Navy. They never built a boat before, and therefore were not orthodox and cut a lot of corners which the orthodox boat builder always kept in his practices. There happened to be a little concern in my own State, and they got very high commendation from the Navy.

So I do not think it is necessary that a man should be a doctor or connected with the medical practice in order to have some good ideas in regard to improving public health. On the other hand, I would not say that his ideas would always be sound and warranted of application.

Senator DONNELL. The Senator would say that the views of physicians and surgeons would be worthy of consideration and should be considered.

Senator AIKEN. If a man is sick and believes in the use of medicine, he would go to a doctor.

Senator DONNELL. I assume that we all think that, with all due deference to Mr. Altmeyer, and we are glad to have his views and appreciate them, but nevertheless, it is likewise proper to consider the views of gentlemen who are engaged in the profession of medicine and surgery.

Senator AIKEN. Perhaps we should not bring up so many matters here, but it is sure to come up sooner or later. What would you do, Mr. Altmeyer, about the conscientious objector who does not believe in the use of medicine, but would be required to pay his share of the costs?

Mr. ALTMEYER. That is a policy question, that this committee would have to decide. It is not an economic question, and it is not a professional question. It is a matter of religious conviction. We had

the same problem under state workmen's compensation laws. Some religious sects felt that they should not carry workmen's compensation. but so far as I know, the State laws required them to carry workmen' compensation insurance for the protection of their workers. Bu that question is of high policy.

Senator DONNELL. One further question, if I may ask. Mr. Alt meyer, is there any book that you know of in which the results of the compulsory health insurance in these various countries that you have referred to are described, and give that in some detail so that any of us who might desire to obtain by some ready reference manual, information along that line might be able to do it without too muc scattering into different books.

Mr. ALTMEYER. Yes, there are several. Of course during the wa it has been very difficult to study the functioning of these foreig systems, but I will be glad to go over the literature.

Senator DONNELL. Would you mind filing with the committee suc memorandum as you think appropriate, giving us a short bibliography or as long as you deem proper along those lines.

Mr. ALTMEYER. May I point out in connection with the attitude of the medical profession that the British Medical Association, of course. favors compulsory health insurance and has spearheaded the movement to extend the coverage of the British health insurance system.. to include dependents as well as the insured workers themselves and t cover services not now covered under the system.

Likewise, the Canadian Medical Association has come out in fav of compulsory health insurance.

So I do not think that we should draw the conclusion that it is necessarily inimical to the profession or that the profession as such. all over the world, is opposed to the idea of compulsory health ir

surance.

Senator DONNELL. I do not want to leave the implication by the question that I think the American Medical Association should b influenced, either primarily or solely, by their own financial positio either under or outside of the compulsory health insurance. I thoug however, that the point that the chairman had suggested, that the doctors would really receive larger financial returns under the compulsory insurance, that it would be of interest to know, which I have no doubt we will later learn from them, what is their basis of opposition to this proposed insurance.

The CHAIRMAN. I am sure that we will have that during the cour of the hearings, and I suppose that we will have representatives of the American Medical Association here, and they have already indicate their intention to be here and the representatives from several of the State organizations will be here.

Mr. ALTMEYER. I would like to say this as a nonmedical man, tha I would not accuse or even think that the opposition of the America Medical Association is wholly economic. I think a large part of is actuated by a genuine concern as to the effect on medical praction. I think they are unnecessarily alarmed, but I would not want to g further into that.

The CHAIRMAN. It is the experience that all institutions are adver to any radical departure from the usual practice. Innovations have to come only after long periods of agitation and discussion, and there

has been considerable change in the minds of physicians in this country as a result of the discussions that have taken place here during the past few years in connection with this problem. We have received letters from them indicating their changed ideas.

Mr. ALTMEYER. If you are interested in the historical attitude of the American Medical Association, according to my recollection back in 1916, when I was studying the social insurance movement in this country, which started way back there-a committee of the American Medical Association studying the subject issued a statement favorable to compulsory health insurance in 1916, 1917, and 1919. But in 1920 the house of delegates of the A. M. A. came out in opposition to compulsory health insurance.

In 1932 there was a report on the cost of medical care by a committee under the chairmanship of Dr. Ray Lyman Wilbur, who was Secretary of the Interior in the Hoover administration. The majority report came out in favor of a plan for financing the cost of medical care either through taxation or through insurance.

The minority, which was composed, as I recall, rather largely of representatives of the American Medical Association, opposed the majority report, but said that if they had to choose between voluntary health insurance and compulsory health insurance, they would choose compulsory health insurance, their opinion being based on the experience of the two types of insurance in this country and abroad.

Senator DONNELL. That was the minority of the committee?

Mr. ALTMEYER. Which was composed largely of the representatives of the American Medical Association, in 1932, and which said that if they had to choose between voluntary health insurance and compulsory health insurance they would choose compulsory health insurance, as the lesser of the two evils. The American Medical Association formally approved that minority report.

Senator DONNELL. The house of delegates of the American Medical Association is the governing body of that association, is it not? Mr. ALTMEYER. Yes, sir.

Senator DONNELL. And at no time has the American Medical Association, through its house of delegates, expressed approval of compulsory health insurance?

Mr. ALTMEYER. No, sir.

The CHAIRMAN. But the organization itself in its convention did adopt a resolution favoring compulsory health insurance at one time? Mr. ALTMEYER. It was this committee of the American Medical Association that issued the statement that I have in mind, back in 1916 or thereabouts.

The CHAIRMAN. What committee is that?

Mr. ALTMEYER. I can furnish the exact title. It was the committee on social insurance of the council on health and public instruction (1919).

Senator DONNELL. That committee report was not adopted by the association, is that correct?

Mr. ALTMEYER. I do not believe that the association ever gave any affirmative approval to compulsory health insurance.

Senator DONNELL. In fact, the association took the view contrary to that recommendation?

Mr. ALTMEYER. My recollection is that in 1920 the house of delegates voted in opposition to compulsory health insurance. The CHAIRMAN. You may continue.

COMPULSORY INSURANCE

Mr. ALTMEYER. The greatest value of voluntary health insurance has been the experience gained in learning how to operate compulsory prepayment plans. By a study of the accomplishments of voluntary insurance and the difficulties it has encountered, a program can be worked out which can succeed where voluntary plans have failed The principal reason why voluntary programs have not succeeded. and cannot succeed, is economic. Unless adequate funds are available. no program can adequately extend either its membership or the scope of its services.

A comprehensive health insurance program must rest on a method of financing which makes it possible for the family to budget the costs without having to deny itself the essentials of everyday living. The costs must also be distributed among a membership that is large enough to keep the premium low and in accordance with ability to pay. To accomplish these ends, compulsory insurance is necessary.

Compulsion is not a word that is accepted lightly by the American people, and the opponents of compulsory health insurance have made much of this natural antipathy.

VOLUNTARY PLANS ARE NOT DEMOCRATIC

The American Medical Association and other organizations favor ing the present inadequate voluntary plans or sponsoring new voluntary insurance programs have implied that a compulsory system of health insurance would result in regimentation and a form of totali tarianism which is not in keeping with the principles expressed in our Constitution and in the Bill of Rights. However, it might be pointed out that voluntary insurance, as advocated by the American Medical Association, is anything but democratic. The A. M. A recommends a series of voluntary plans, to be run by the medical societies. No mention is made of other associations or of public participa tion in the organization of these plans, in the control of the funds which the public will have to pay, in the formulation of the standards the plans will observe, or in their administration. The association. violates the first principle of democracy-the right of the public to participate to say nothing of the right of the public to control public enterprise essential to the welfare of the public.

PUBLIC OPINION POLLS ON HEALTH INSURANCE

In contrast, under compulsory health insurance, financing and administration would be determined by representatives of the publicusing the advice and the skills of professional groups on professiona! matters. That may be why the public attitude toward health insurance as a part of a system of social insurance is so favorable, as evi denced by many polls of public opinion. The Gallup Poll of 1943 showed 59 percent of the persons canvassed in favor of a compulsory