You will find that when you get your maternal-care provisions of this bill in operation, you will then realize how woefully short this country is of proper maternal care. You will have to build hurdreds and hundreds of lying-in hospitals, and it will take you some time to get the necessary personnel to man these hospitals.

FINANCIAL BURDEN OF ILLNESS

That is why we have a great deal more sickness than we shou have considering the economic condition-it is bad in some parts of the country-and we have too much sickness because of the lack of proper medical care.

A major disease, a major operation or a serious disease will throw a family budget out of gear for a year or a year and a half, and th family is compelled to borrow, and then they get into a worse disease. and that is the loan sharks. Do not get me started on that, becaus I would never stop.

There is nothing new in this plan, it is just pooling the health of the country, that is all there is to it. We pool our health so that the sick, regardless of economic conditions, can get proper care when t is needed. And in 5 years, gentlemen, if this plan is operated properly, you will be able to reduce your hospital cases and sickness by percent, and that is no exaggeration.

I am not worried at all about the cost. No matter what the cost is it is a good investment. Your operating costs will be greater th first 5 years and then will diminish. If you have the money on th table at this moment and say that you are going to start this plan a.. over the country on July 1, you cannot do it. It will take time to ge this going in the entire country, and it is of great importance that starts right, and if it starts right, it will be perfected and it will cla If it starts wrong, it will take a generation to correct the mistake Now, I have said that I do not care what you call the bill, the purpo is to provide the best medical care, the most skillful surgical servi to all, and that is the objective and that is all-important. The pligh of the pill doctor does not concern me at all. But you will find the the outstanding physicians and surgeons of this country will suppor this bill individually. I know, because I have talked with them. W have been working on a health insurance plan in New York City for the last 5 years. It is just about ready to go into operation, and ! announced 5 years ago, and I have announced it every time that I ha mentioned it, that the minute that this goes into operation, we go out business and we will turn over our experience to the Federal plan. Senator ELLENDER. Do you not think that your plan might be : good as this or better?

NATIONAL INSURANCE BETTER THAN LOCAL PLANS

Mr. LAGUARDIA. No. I think that we would be better the firyears in services, but I believe that the broader and the larger t plan is and the more people that it takes in, the cheaper it is of oper. tion, and our plan is an emergency plan to take care of 72 milli people in New York City until such time as Congress enacts a nation plan, and I am strong for a national compulsory plan. Ours is pure voluntary.

Now, there is provision here about all physicians being eligible, and that is all right. But we have to be realistic, and there is a great deal of misapprehension and misunderstanding as to medical care. A great many do not know the difference between public health and the practice of medicine, and that they are two distinctly different branches of medical science.

One is to prevent people from getting sick, and the other is to cure the man who is sick. No one doctor can handle a community. Oh, yes, you can tell me, "The old country doctor. he used to do it." Sure he did it because we did not know any better. I was raised with a post doctor, a regimental doctor, out in Arizona. That did not do us any good, but that is all that we had in those days. Now, no doctor can attend a community of and by himself any more than a man can pitch a game of ball by himself, or a quarterback can play a game of football by himself. You must have a team, and that is the way that we are organizing in New York City with these medical groups. Let us call them a medical team. This is the way you do it. You have your clinics. We did not invent that. The Mayo brothers did and others. We have an excellent clinic in Boston and one in Rochester, Minn. You start with your clinic and every insured person has the services of that clinic, and he goes at regular stated intervals, once a year or twice a year, and he gets a thorough overhauling, and they know all about him. All right, if he has a belly ache on the way home, he can stop at the doctor's office or the clinic and get fixed up." If he is sick at home, he can choose from a panel of doctors, and he gets treatment at home, and if the patient is so sick that he must be hospitalized, he gets a specialist of his particular case. If consultation is ready, they are right there in that panel. If an operation is necessary, the right man operates.

Now, in the first years we are going to have a heavy load, not because there are more people sick, but there are more people who will have the benefit of getting medical treatment that now neglect themselves. This bill is going to be tough on the undertakers, it is going to reduce their bills, because a large number of people die because they have not any medical care, or improper medical care, that is why they die.

THE BILL DOES NOT REGIMENT DOCTORS

There has been a great deal said that this would regiment the medical profession. Well, I could almost hear some of them say it. It will not regiment them at all, but it will certainly given an opportunity for the skillful doctor, the studious scholarly physician, that keeps abreast, to develop and grow and to practice his profession. No one contemplates for a moment that skill should not be recognized. Under our plan in New York City, we estimate paying some salaries of $25,000 or $30,000 and here is the opportunity for the young graduate of medical schools to have a chance of really getting a start, and in many sections of our country they have no such opportunity.

We are limited in our capacity, in our hospitals, for interns, and in smaller communities the young graduate just has to grope his way along. This would provide a constant 24-hour medical service, emergency cases would be cared for by the younger doctors, who would immediately call for help if they found a serious case, and provide for office treatment, in the offices of the doctors, and provide for home

treatment and for the complete hospitalization including nursing. What you have here that we have not got yet-and we are a little scared of it because we could get no figures on the cost-you very sensibly provide for dental care and that is very good, because we have learned that neglect of the teeth, particularly in children, leads to disease and sickness, or weakens resistence to such an extent that the child or the person is more susceptible to contagion. That is very wise.

I do not believe you will have any trouble at all in the limitations proposed by the bill for the time of treatment. I think that that would take care of itself. No one wants to remain sick. You will have no trouble with that.

IMPORTANCE OF GROUP PRACTICE

We will have a little trouble in such communities where you will not be able to form a complete team, and it is just left deuces wild. and you will have some cases of collusion. Now, we had them in New York City during the home relief days. During the home relief days when I had a load of about 350,000 families and 1,000,000 people, we established medical care for the home, and we did not have room in the hospitals for all of them, and there we found cases of collusion. It is quite true we have had cases of collusion in employers' liability work and that recurs from time to time. That is just human weakness, and there is nothing that you can do about that.

But by providing the proper balances and completed medical teams. all that will be avoided, because they arrange among themselves for pooling all of the fees.

Now, I want to be very frank in saying that I feel very strong about that.

Senator ELLENDER. You mean under your plan that you had in New York?

Mr. LAGUARDIA. That we are planning.

Senator ELLENDER. In New York?

Mr. LAGUARDIA. Yes.

Senator ELLENDER. You said all of that was on a voluntary basis? Mr. LAGUARDIA. Yes, sir.

Senator ELLENDER. How did you raise the funds in order to fill the kitty, as it were?

Mr. LAGUARDIA. By groups, a large industry coming in with all of its employees. The city of New York I expect will come in with all of its employees.

Senator ELLENDER. And a certain percentage of the salaries is put up.

Mr. LAGUARDIA. We figure on 4 percent, 2 and 2. We think that can be reduced once we get started.

Senator ELLENDER. How much more or less would it cost the city if your plan should go through than it has cost in the past?

Mr. LAGUARDIA. I think the first year, Senator, I think it woul cost us more the first couple of years, and after that I think that our hospital budget would reduce materially, because provision is made for paying the hospital expense.

Senator ELLENDER. Well, most of the money that has been spent in the past in New York City has been for preventive medicine, has it not'

Mr. LAGUARDIA. And cure. I have the hospital budgets of nearly $50,000,000 in addition to the health.

Senator ELLENDER. How much of that was to operate hospitals for ure, curing people?

Mr. LAGUARDIA. You see, our hospitals are separated from health. When I say hospitals, I mean just hospitals.

Senator ELLENDER. Are they operated on a more or less charity basis o patients, or must they pay?

Mr. LAGUARDIA. I understand what you mean. We do not use the Ford charity, I do not in my vocabulary. They are operated on the asis of need, free. If we pick up an emergency case on the street for nstance, and it does not qualify for free treatment, then arrangement s made to transfer it to a hospital, or then they pay what they should intil he can be moved. But it is on the basis of free treatment.

Senator DONNELL. Do any of the hospitals that treat people free nake charges for those who can pay?

Mr. LAGUARDIA. Only if they are brought there through emergency, and otherwise we do not admit them.

Senator DONNELL. I see.

PLAN SHOULD BE PUT INTO EFFECT GRADUALLY

Mr. LAGUARDIA. Now, what I want to stress is that the bill make it very clear that States should be able to qualify by presenting a plan ontaining sufficient medical and surgical personnel, and States should be also able to divide their territory, because it will take several years before some States and parts of States will be able to provide the necesary medical talent. It just does not exist today. You have an opporunity to get a splendid start here by taking it in localities where they re able to give the service, because it would be manifestly unfair to nake a charge and not be able to give the proper kind of service.

Senator DONNELL. I am not clear as to which part of the bill you are alking about when you speak about qualification by the States. To nake my inquiry somewhat more concrete, title I of the bill pertains to grants to States for health services, and on page 35 you take up title II n regard to prepaid personal health service benefits. Now, is it not a fact that title I proceeds on the theory of grants-in-aid to the States who shall operate the facilities, and title II, on the contrary, contemplates not an operation by the States, but an operation by the Federal Government?

Mr. LAGUARDIA. That is right

Senator DONNELL. So is your qualification of States that you are speaking of cnfined to title I of the bill?

Mr. LAGUARDLA. No.

Senator DONNELL. Just what do you mean by "qualification of the States" as referred to in title II?

Mr. LAGUARDIA. In title I, to provide adequately there were certain qualifications. Now, on title II, perhaps the word "State" is bad. You can say area, if you please, because title II covers people, it is a Federal operation, is that right?

Senator DONNELL. That is the point that is in my mind. I could not understand what you were referring to by State qualifications under the nationally operated system.

Mr. LAGUARDIA. I say that we should not go in a given area, unless we are able to provide the proper kind of medical service, because the people are paying on that.

Senator DONNELL. But, Mr. LaGuardia, is not title II Nation-wide and does not involve State administration at all?

Mr. LAGUARDIA. No.

Senator DONNELL. Then where is there any necessity for State qualification under title II, that is what I am trying to find out? Mr. LAGUARDIA. We will call it area qualifications.

Senator DONNELL. Area qualification for what?

Mr. LAGUARDIA. Before you start to charge the people, on the p rolls, you should have the ability to give the service, is that not right! Senator DONNELL. I would think so; yes.

Mr. LAGUARDIA. And I say you cannot do it overnight. We ougi: to start the system in areas where it is possible to give the proper kir! of medical, surgical, and hospital care.

Senator DONNELL. Mr. LaGuardia, pardon me; perhaps I do not g your point, but as I understand title II, it involves a Nation-wide ope ation, that is to everybody in New York and everybody in Wyomi and everybody in my own State of Missouri, shall be entitled to t benefit of it. Now, I do not find in title II anything that refers to State qualification, and I wish you would be kind enough to point that out. Mr. LAGUARDIA. There is nothing.

Senator DONNELL. So that you are recommending an addition t title II. In other words, as I understand your testimony, while it is Nation-wide operation, you would defer the benefits of that operati: to any given area until the area shall have provided necessary faci ties to enable the operation to be successful; is that your thought! Mr. LAGUARDIA. Until the administration can get the doctors :: there.

Senator DONNELL. Under the Nation-wide administration?

Mr. LAGUARDIA. Your administration is provided for here, a that is quite all right.

Senator DONNELL. Which section is it that you are referring to, M:. LaGuardia?

Mr. LAGUARDIA. I am referring to the whole thing. I want to po out that if this were to go into effect on July 1, in many sections of 02: country we cannot provide proper medical care.

Senator DONNELL. The point I do not understand of your testimer) is where the States are required or can practicably be required und title II, to qualify, because title II is a Nation-wide insurance plan. Mr. LAGUARDIA. I grant you that.

Senator DONNELL. And when the man in Dakota pays his perce age, he is entitled to the benefits under title II, and it would not fair to him to defer his getting the benefits until the National Gover ment should have caused some people to come in as doctors to sett there.

Mr. LAGUARDIA. I hope that they will not charge the man in ar area where we are not able to give the services, until such time as w are able to give the services.

Senator DONNELL. In other words, you would not then institute Nation-wide prepaid personal health service benefit at this time. Y would require, as I understand it, that each State or each area, perhaps better stated, shall have first demonstrated its capacity to tak