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still studying the question, and to date, has recommended only certain conditions that any such program must meet.

They recommend, first, that the medical care given must be complete carethat is, including hospitalization, general medical care, including all modern diagnostic and preventive services and dental care. Insurance against so-called catastrophic illness, or a portion of the medical bill, is not enough. Second, the cost of the service must be low enough so that most of the people can be included in the system, which will require governmental subsidies.

Many feel that an extension of the social-security benefits to include complet medical care is the answer. This program of cradle to the grave security as proposed in the Murray-Wagner-Dingell bill introduced in the last session of Congress provides complete protection-medical and hospital care as well as mater nity benefits, old-age benefits, and unemployment compensation for virtual the entire population. It is financed through employer and employee pay roll tax of 6 percent each on wages up to $3,000 per year. A new and improved bill, to be introduced soon in this session of Congress, is expected to reduce the tax to 4 percent each. This type of program, endorsed by all the labor organizations and many groups in the medical field, is similar to Britain's postwar health insurance program and according to a poll of the National Opinion Research Center is favored by 68 percent of the American people.

THE CURE IS UP TO US

Critical though the case of the South may be. lacking though the facilities are. difficult though the prescription is to fill, the cure is possible. And the treatment is in our hands.

What can we do?

1. We must enlist the interest of our whole community in these problems. Health is one issue upon which agreement can be reached among all groups i the population. It is our responsibility to bring about such agreement-to form community councils on health representing business, farm organizations, labor unions, parents and teachers, women and civic groups, the church, Negro organi zations as well as the medical profession and public health representatives.

2. These councils must study the community health problems, and plan a pregram to meet local needs. They must work with other such groups in the State and present their proposals to the governor or appropriate State agencies, urging legislation and other necessary steps to implement them.

NORTH CAROLINA SETS THE PACE

North Carolina presents a splendid example to the South. There, Governer Broughton appointed a commission on hospital and medical care which, on the basis of an exhaustive and careful survey of medical care service in the State. prepared a series of recommendations. These include:

(a) The expansion of the 2-year medical school at the university to a 4-year school with a central hospital of 600 beds; with scholarships for promising youth; the establishment in cooperation with neighboring States of a regional medical school for Negroes;

(b) The appropriation of $5,000,000 to aid communities and counties to build new hospitals and health centers and to expand present facilities;

(c) Encouraging the development of health insurance and group medical care plans;

(d) Expansion of public-health program, including the general examination of all school children with treatment of remedial defects and an adequate program of disease prevention;

(e) Hospital aid for low income groups.

The public interest and effort that produced this program in North Carolina must be duplicated in all Southern States.

PENDING LEGISLATION IN WASHINGTON

3. Community groups must study and lend active support to Federal health legislation that offers Federal financial aid to implement local programs. First in immediate importance is the Hill-Burton hospital construction bill. Southern Congressmen, especially, must be urged to lend Senator Lister Hill their support in pushing through this bill, which will cover the South with desperately needed health facilities. The provisions of the new Murray-Wagner-Dingell bill, shortly to be introduced, must be brought to public attention.

We know that the South is in ill health because the South is poor. It is clear then that the problem of health cannot be solved as an isolated problem. The South's future-in wealth and health-lies down the road of industrializationtoward an expanding economy and full employment.

Our goal must be to secure what Franklin D. Roosevelt outlined in his economic bill of rights:

"The right to adequate medical care and the opportunity to achieve and enjoy good health" for every person in the South, regardless of where he may live, regardless of his ability to pay, regardless of his color.

The South needs the full strength of all its citizens in the days ahead-in the fight to build a happy, prosperous and democratic South, in a peaceful and secure family of nations.

Senator DONNELL. Pardon me, this newspaper is published by the Southern Conference for Human Welfare?

Dr. FOREMAN. Yes, sir.

The Southern States had a 40 percent higher selective-service rejection rate than the rest of the Nation. Our rejection rate was 50.4 percent, while that of the rest of the country was 35 percent. Yet we have a warm climate, most of our people live in the fresh air of the countryside, and we have certain other natural advantages that might be expected to make our population healthier.

Pellagra, due to severe food deficiency, and malaria death rates are 400 percent higher in the South than elsewhere in the country. Syphilis mortality is far above the national average. Even tuberculosis, influenza, and pneumonia rates are higher than elsewhere, even though our warm climate should certainly give us a natural advantage in the respiratory group of diseases.

Our maternal mortality rate is 3.6 deaths per thousand; that of the rest of the country 2.2, or 40 percent less. Our infant death rate is 48.6; that of the non-South, 40.6.

These are a few statistics. Most of us know the tragedy and suffering they illustrate and the regional backwardness they foster.

THE CAUSES

The two main sources of this misery are clear, namely, poverty and inadequate medical services. The two main sources of this misery are

clear, namely, poverty and inadequate medical services. The two are interconnected; but we have learned that attention must be paid to both, that there is nothing completely automatic about improvement in, one improving the other and, conversely, that we do not have to wait for improvement in one to begin improvement in the other.

We certainly abhor our poverty. As individuals and through organizations such as the Southern Conference for Human Welfare, we are fighting to overcome the economic backwardness of the South, to take it out of its feudal past into a prosperous free future.

What are the inadequacies of our health service? Our sanitation is miserable. According to the United States Public Health Service, 657,799 southern rural homes have not so much as an outdoor privy, much less an indoor toilet.

Our shortage in hospitals, doctors, dentists, and nurses is severe. We have over 40 percent fewer hospital beds and doctors per person than the rest of the country; yet we certainly need them as much or more because of our high sickness rates. But we do not even utilize fully those facilities and that personnel we do have. Our hospital occupancy rates, despite the vast need, are actually lower than those elsewhere. Why? Because of inability to pay. The economic aspect, the financial barrier to medical care, the lack of medical purchasing power; these are the root causes.

VOLUNTARY HEALTH INSURANCE NOT THE ANSWER

Does private or voluntary health insurance offer us the way out! We do not think so. The private medical insurance we can get now is far too expensive and does not meet our health needs. The commercial policies sold provide small amounts of cash, not medical care, in the event of disabling illness; but they have such a huge overhead that onlly 40 percent of the premiums paid in comes back as benefits. The rest goes for company administrative costs, profits, commission, and the like.

Blue Cross hospitalization is good as far as it goes, but it does not go very far. If one belongs to an eligible group, it costs a family about $24 a year, but covers only the hospital bill. Yet doctor services alone take three times as much in the average medical dollar. Most incomes are so low, such an outlay is too much.

How can a farm family netting only a few hundred dollars a year afford to belong? This is the usual average of rural annual income in the South. Not for just a few families, mind you, but the average. So the answer is-they do not join. I do not know the figures on Blue Cross membership in the rural South, but I doubt that it exceeds the national figure of less than 2 percent of all rural families. We have heard a lot of exaggerated claims about Blue Cross, but it offers little prospect of meeting our needs.

There are some medical society plans available but they offer even less. They cost about as much as Blue Cross, and cover only the surgical or obstetrical fees. They do not cover preventive, diagnostic, or home and office care.

Much of the best we have now comes from Government-sponsored voluntary prepayment plans under the Department of Agriculture; but even these suffer from the inherent defects of voluntary medical insurance. The Farm Security Administration has been able to work

wonders in assisting half a million low-income farmers to form voluntary health associations for prepaid medical care. The associations have improved the health of these families considerably, but they are not enough.

Adequate medical care costs $100 a year, according to experts, and poor families cannot raise such amounts, no matter how they pool their resources. Further, turn-over in membership, low percentage of eligibles joining, and other problems have beset these organizations. Much the same has been true of the Department of Agriculture's experimental tax-assisted voluntary plans in five southern counties. These are open to all farm families, and were described by Senator Claude Pepper, chairman of your Health Subcommittee, in his testimony before this committee on April 2.

Thus, despite all the belated and extravagant claims of the American Medical Association (which in 1932 through its spokesman, Dr. Morris Fishbein, branded voluntary prepayment medical service plans "socialism and communism, inciting to revolution"), we see no evidence that private medical insurance alone, or tax-subsidized, can do the job.

NATIONAL HEALTH INSURANCE IS ESSENTIAL

A national health program, as recommended by President Truman in his health message of November 1945, is necessary if we are to get more hospitals, public-health services, doctors, dentists, and nurses, and to be able to go to them when we need medical care. We want to pay for our own doctor and hospital care, but through a national health insurance system whereby we will pay small sums in advance to obtain such care.

Specifically, our organization wants to see the Wagner-MurrayDingell national health bill, S. 1606, become law. All the provisions of this bill would be of value to us, but perhaps the health-insurance section needs the greatest emphasis, since that is the most controversial part.

Under title II, a fund would be created which would pay for doctor and hospital services. Wage earners, we understand, would pay about 12 percent of their incomes to cover themselves and their families; an equal amount would be paid in by the employer. Self-employed farmers, shopkeepers, or small businessmen for example, would pay about 3 percent of their incomes under $3,600 a year. We, that is the people of the United States, pay 4 to 5 percent of our incomes now, on the average, so this would not be more, and in most cases less, than we are spending as individuals at present. The average farmer in the South pays from 8 to 10 percent of his income. For those families that are hit hard and have to pay 10, 20, 50, or more percent of their income for medical care, it would make all the difference between catastrophe and security.

We expect to be entitled to go to our family doctor or any other doctor participating in the system, and most will participate, though they will not be forced to. Instead of putting our money on the line at the time we receive the care, or paying the bill later, we will go to the doctor or hospital when we need to. They will collect the money for the service rendered by a suitable arrangement with the insurance fund. There would be no direct financial dealings between doctor

and patient. Instead there would be, as there ought to be, a strictly professional relationship. Doctors will not have to spend so much of their time and energy trying to collect bills, and we will not have to hold back on going to doctors because we cannot afford the cost. The same goes for the hospital.

With insurance, we could get modern medical care when we need it, including regular health examinations and preventive care. This will prevent some critical illnesses which would not be allowed to drag on until it is too late for the doctor to do anything about them.

MEDICAL ADVISORY COUNCIL

We attach the greatest importance to the Federal and State Advisory Policy Council created under title II of the bill. We would emphasize the part lay groups, the consumer of medical care, must play in such councils.

The public is best qualified to know how things work out and to set broad policy. On such a medical policy council should be representatives of the Negro people, the sharecropper, the industrial worker and other groups especially interested in this bill. Probably no set formula can be written into the legislation to assure this, but a very clear policy in favor of such participation, as part of the legislative history of this measure, is vitally necessary.

The South can afford its part in a national health program. It cannot afford to do without such a program. The need for it is now. We therefore urge speedy passage of this bill.

The CHAIRMAN. Thank you, Mr. Foreman. Have you studied the bill in detail, the various provisions of it?

Dr. FOREMAN. Senator, I have studied some of the provisions of it in detail. I have read the President's message, and I have gone into certain aspects of it, but I have not studied the whole bill, item by item.

The CHAIRMAN. You would not be prepared, then, to analyze the various provisions of it, but you are here just giving us your over-all views of the need of such a system in the South, and the provisions that would put that into effect would be a matter for technical action on the part of men who would be capable of putting it in the proper phraseology.

Dr. FOREMAN. My object in coming here was to say for the southern people how greatly they need health insurance, and the details, as you say, I am perfectly willing to be left up to people who know the situation more expertly than I.

The CHAIRMAN. I am sure that the statement that you make here this morning is not in the least bit exaggerated, because we have hai hearings before on this subject, and we have had representatives from the various States of the South appear here and testify with reference to the great need of medical care in that section of the country. Senator, do you wish to ask some questions?

Senator DONNELL. I would like to ask the Doctor some questions. Now, Dr. Foreman, are you a physician?

Dr. FOREMAN. No, sir.

Senator DONNELL. You hold a degree of what?

Dr. FOREMAN. Doctor of philosophy.

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