young people an opportunity? For instance, in my State of Montana, we are losing population because there is no opportunity for young people out there. There would be nothing wrong with the State of Montana making some appropriations and having some of their young men study medicine and come back and practice medicine in the State where there is great need for doctors. We have to call upon the Red Cross in sections of our State. A few years ago we did that because no doctor could live there, and he could not make a living, and we had to have Red Cross relief. It seems to me that there is great opportunity in this country for bringing students out to the backward sections of the Nation and giving them an opportunity to make a splendid living.

Mr. LAGUARDIA. I do not think that they are backward sections in the real sense of the word, they are fine sections of the country needing medical services.

Senator ELLENDER. I would say our State has done a little better than Virginia has. We have a splendid medical school wherein a boy can get a medical education free of charge.

Mr. LAGUARDIA. That is pretty generous.

WHY NOT LEAVE IT TO THE STATES?

Senator ELLENDER. That is why during the course of these hearings, I have advocated that if we were to leave a little more of the planning to the States and help the States to carry it through, we might do better than to try to create a plan here that is national in scope and under the thumb of Washington.

Mr. LAGUARDIA. Well, Senator, some years ago, I think many years ago, that argument would have been all right. But I lived 14 years on the other side of this building, and every time something would come along, they would say, "Let the States do it." Now, there was one time, and the whole thing has shifted now, and people who would argue against States' rights, the old Hamiltonians, they have all become States' rights people all of a sudden, and I cannot help it. We have to live in accordance with growth and development and progress. We are growing, and the State argument just does not click any more, Senator.

Senator ELLENDER. Would you suggest that we do away with States altogether, and just have one United Nation, is that your view?

Mr. LAGUARDIA. We have a great many united ethics, and we did not have any public health originally, none at all.

Senator ELLENDER. All of that has been done by cooperation between the Federal and State Governments.

Mr. LAGUARDIA. Yes, until they found that a microbe did not recognize a State line, and public health had to step in.

Senator AIKEN. You have not heard all of the States' rights champions coming in here and asking for all kinds of Federal legislation to control labor, have you?

It is something that I cannot understand, sometimes the most ardent advocates of States' rights are asking for Federal regulations to control labor and keep union labor in the State of New York, for instance, and other States, from committing acts of violence.

Mr. LAGUARDIA. The States' rights people never object to agricultural relief.

Senator DONNELL. Mr. Chairman, may I ask Mr. LaGuardia a few more questions. Mr. LaGuardia, do you in your opinion generally speaking, do you think that this bill would prove a financial benefit to the physicians of the country?

Mr. LAGUARDIA. I think it will give them security and give them what every physician likes more than anything else, an opportunity for the full expression of his profession, because it will give him plenty of practice.

ATTITUDE OF THE AMERICAN MEDICAL ASSOCIATION

Senator DONNELL. You know it to be a fact, do you not, that the American Medical Association is strongly against this type of legisla tion?

Mr. LAGUARDIA. Mr. Fishbein is.

Senator DONNELL. Well, the association has so expressed itself, has it not?

Mr. LAGUARDIA. I think Mr. Fishbein is neither "fish" nor "bein." He is mostly "bein," and it is in his head.

Senator DONNELL. Regardless of that, the American Medical Ass ciation has gone on record very strongly, has it not, against legislatio for compulsory health insurance, of a Federal nature?

Mr. LAGUARDIA. Yes, as an association they have some resolution. but like every other kind of an organization I suppose they have board of directors. But actually I have talked with the best physiciars in this country, I think, on this question-not today or vesterday but for the last 10 or 15 years, and they all recognize that this is coming

Senator DONNELL. But the point I am making is that the America Medical Association which as I understand it is the largest association of physicians in the country, has expressed itself in opposition to copulsory health insurance, has it not?

Mr. LAGUARDIA. As an organization, yes.

Senator DONNELL. Now, Mr. LaGuardia, let me ask you, I know that you have given us very courteously and interestingly this morning your general views. Have you examined the entire bill in detail? Mr. LAGUARDIA. Not in detail.

Senator DONNELL. You mentioned earler that there is nothing new. as I understood you to say, in this plan. It is simply a pooling of resources, is that your thought?

Mr. LAGUARDIA. Yes. I said a pooling of health.

Senator DONNELL. A pooling of health, very well. Have you read that portion of the bill which appears on page 50, and which authorize the Surgeon General to prescribe maximum limits to the number of potential beneficiaries for whom a practitioner or group of practition ers may undertake to furnish general medical or general denta benefits?

Mr. LAGUARDIA. Certainly.

FREEDOM OF CHOICE OF DOCTOR

Senator DONNELL. That of course, as I see it, and I am wonderin if you agree with me, would mean that if the Surgeon General .. prescribed, we will say, for Mr. Smith, in Jonesville, N. Y., or D Smith, a limit of 500 patients, that if you desired to consult him ar

desired him to be your doctor and you were the 501st patient, that you could not get him, that is correct?

Mr. LAGUARDIA. He may drop somebody else.

Senator DONNELL. But suppose that he did not drop anybody else? Mr. LAGUARDIA. Then he is limited.

Senator DONNELL. And you could not get on his list?

Mr. LAGUARDIA. That is right. Let me say this: That is a very good provision.

Senator DONNELL. Why do you regard that as good?

Mr. LAGUARDIA. Well, I will tell you, Senator. We have had some experience on that, and this is what happened: We had the situation where we had a great deal of sickness and we could not take all of the hospitals, and you cannot take a patient and put him in a hospital. So we could not put the patients in the hospitals, and then we had doctors that had so many cases in one month that without figuring the time of travel, he could not have given his patient more than a minute and a half; and therefore we hit upon the idea of having a maximum number of visits or patients in a month, in order to curb the soliciting of business and collusion. I think that this is a good provision and the doctors like it.

Senator DONNELL. The point I was getting at was this: if in a small community, like the one in which I live, a suburb of one of the midwestern cities, If I desire to consult with a given doctor, say, Dr. Jones, and his quota is made up, he has 500 patients allotted to him, and I am 501 or 502, I cannot receive his services?

Mr. LAGUARDIA. He can drop someone else, can he not?
Senator DONNELL. I am not sure about that.

Mr. LAGUARDIA. Suppose Dr. Jones has just one patient. You come along, and he can say, "I don't want you.'

Senator DONNELL. He can do that, of course; but if he and I are willing, there is nothing to prevent that from existing under the present law existing today, at this minute.

Mr. LAGUARDIA. No.

Senator DONNELL. But if this law goes into effect and he does have his quota of 500, and he is satisfied with his quota, and I come along and want to get in myself, there is no way I can engage him without having him drop someone off his quota?

Mr. LAGUARDIA. I think that is an extreme determination, Senator. Senator DONNELL. It is true, is it not?

Mr. LAGUARDIA. Yes.

Senator DONNELL. I wonder if you have observed, Mr. LaGuardia, on page 45, subdivision (c) of section 205, that the Surgeon General has the right to determine who shall be considered "specialists or consultants". I think I am correct in my interpretation of the bill that only those persons that he may designate to be specialists or consultants can operate or practice in those capacities.

The CHAIRMAN. Before you answer that question, I would like to suggest that the bill contemplates an advisory committee made up of physicians.

Mr. LAGUARDIA. That is the practice today, Senator. That is in the canon of ethics today, that if someone wants him to act as a specialist he has to have certain experience and qualifications.

Senator DONNELL. But the point I am getting at, Mr. LaGuardia, is this: although under section 205 A, to which you referred earlier

in your testimony, provides that any physician, dentist, or nurse legally qualified by the State to furnish any services, including personal health service benefits under title II, shall be qualified to furnish those benefits under said title, there is an apparent exception set forth, namely, specialists and consultants?

Mr. LAGUARDIA. That is right.

Senator DONNELL. The point I am getting at is, that if you have been consulting over a period of years with a given doctor for any type of specialist service, heart trouble, for instance, and you deem him to be proper and want to continue with him as a specialist in that line, as I understand it, the Surgeon General here in Washington, through his agent up in New York, can determine that that man is not qualified to be a specialist or a consultant, and you cannot under this plan be entitled to use his services as a consultant or specialist?

Mr. LAGUARDIA. I think you are entirely wrong.

Senator DONNELL. Is that not the provision of the act?
Mr. LAGUARDIA. No.

Senator DONNELL. Where do you find anything to the contrary in the act?

Mr. LAGUARDIA. Let me explain.

Senator DONNELL. Yes.

Mr. LAGUARDIA. Take the case where you say you have a doctor whom you consider a specialist.

Senator DONNELL. Yes, sir.

Mr. LAGUARDIA. You can continue him to your heart's content, but if this specialist wants a consultation, if he wants a specialist for his patient for which a special and extra charge is made, therefore this plan properly and wisely and practically provides that these men who give these consultative and specialized services and are paid for such must have the qualifications. That is all this means. That is the practice today, Senator. That is the practice in every well-regulated community in this country.

Senator DONNELL. I think, Mr. LaGuardia, subdivision (c), section 205, expressly states, and I quote:

Services which shall be deemed to be specialist or consultant services, for the purposes of special rates of payment under this title, shall be those so designated by the Surgeon General, and the practitioners from among these included in subsection (a) of this section who shall be qualified as specialists or consultants and entitled to the special rates of compensation provided for specialists or consult ants shall be those so designated by the Surgeon General as qualified to furnish such specialist or consultant services.

Your interpretation is as you have given?

Mr. LAGUARDIA. Yes.

Senator DONNELL. And you may be quite right, but as I understand it, there is a restriction even under your interpretation. If an individ ual wants to avail himself of the benefits under this act, to have spe cialist aid, and the Surgeon General in Washington has said, "That specialist is not qualified," then the individual is not entitled to have him?

Mr. LAGUARDIA. He can have him as a doctor.

Senator DONNELL. He can pay for him personally, but not as s benefit of the act.

Mr. LAGUARDIA. He can have him to treat him, and he can have him. This provision of the specialists and consultants is not any different,

Senator, I assure you, than the practice and canons of ethics of the medical profession today.

Senator DONNELL. And you base your view on this wording which I have referred to?

Mr. LAGUARDIA. It is very well worded.

The CHAIRMAN. And, of course, the bill carefully provides for an advisory council.

Mr. LAGUARDIA. Oh, yes.

The CHAIRMAN. That advises the Surgeon General on these technical questions.

Mr. LAGUARDIA. And then, of course, they have these organizations that are really professional organizations, not lobbying organizations, like some I know, the A. M. A., that establish the experience and qualifications of a surgeon who holds himself out as a surgeon.

Senator DONNELL. However, this bill would provide that the persons who shall determine whether a given doctor is a specialist and a consultant under the terms of the act, and entitled to these special compensation fees, are not the medical profession, but the Surgeon General here in Washington, D. C.?

Mr. LAGUARDIA. Sure, but he will do it on advice of the proper authorities. That is provided all through the bill. You have got all sorts of advisory boards here. No one Surgeon General would take it upon himself to designate anybody as a specialist. This is not a job in the Internal Revenue service.

The CHAIRMAN. Mr. LaGuardia, do you think that this right of selection is somewhat overemphasized by the medical profession in connection with this proposed legislation?

Mr. LAGUARDIA. Senator, if we had a dollar for everybody who was operated on today thinking that his doctor did the operation, we would not be fussing around.

The CHAIRMAN. That is the point. I have known people who travel all across the continent for a specific surgeon, and when they get there they find that he is too old or in ill health, and a younger surgeon operates very satisfactorily.

Mr. LAGUARDIA. True.

The CHAIRMAN. And is it not true in the late war that the young men who went out to fight for their country did not have any right of selection when they were injured or when they were sick, and were given very adequate care?

Mr. LAGUARDIA. The medical care of the Army and Navy are the best in the world. They are very good.

The CHAIRMAN. And in this country under a bill of this kind where specialists have to qualify, the services today are pretty well established and pretty uniform, and as a general rule an assistant to a Surgeon can frequently perform an operation a whole lot better than the older surgeon.

Mr. LAGUARDIA. The patient does not know much about it now. The CHAIRMAN. And the patient who undertakes to select his surgeon is very frequently disappointed and finds that he probably made

a mistake?

Mr. LAGUARDIA. Senator, the practical provisions of the bill just follow the established custom in our country in the practice of

medicine.