Senator DONNELL. You mean to say that you think the members of the American Medical Association in large part are opposing S. 1606, because they think it will be financially injurious to the physicians, is that correct? Dr. FOREMAN. Not because it will be, but because they think it will be. Senator DONNELL. That is your judgment, that they think that. Dr. FOREMAN. Not that they think it will be financially injurious to the physicians as a whole, but to them as individuals. Senator DONNELL. That is to the members of the American Medical Association as individuals? Dr. FOREMAN. The few people who are determining this policy. Senator DONNELL. The American Medical Association has house of delegates, does it not? Dr. FOREMAN. Yes. Senator DONNELL. And the house of delegates of the American Medical Association is the governing body of that organization? Dr. FOREMAN. That is right. Senator DONNELL. And that consists of members selected from throughout the United States? Dr. FOREMAN. Yes. Senator DONNELL. There is quite a large membership in the house of delegates, is there not? Dr. FOREMAN. Yes. Senator DONNELL. And it is considered to be at least fairly representative of the entire medical association, is it not? Dr. FOREMAN. Well, I think it is representative, in one sense they represent the others, and on the other hand they are not a fair sample. Senator DONNELL. Is it likely, Doctor, in your opinion, that the members of the American Medical Association would select as members in the house of delegates persons who are not fairly representative of the American Medical Association? Dr. FOREMAN. Well, again it depends on what you mean by "representative." If you mean they are a fair sample of the medical profession of this country, I would not agree. If you mean that they are the chosen representatives of the medical associations, that is a fact. Senator DONNELL. At any rate, for some reason the physicians in this country who constitute the American Medical Association have designated as their representatives and governing body the persons who compose that body. Dr. FOREMAN. I think that those chosen representatives are more influenced in their thinking by the business aspects of the medical business than the professional aspect of it. Senator DONNELL. Now, Doctor, have you made an investigation as to the motives behind the American Medical Association, have you taken a poll of them to find their reasons, or anything of that sort! Dr. FOREMAN. No. Senator DONNELL. What is the basis on which you draw this conclusion in regard to the motives behind the American Medical Association? Dr. FOREMAN. Because so far as the study that I have made of the health situation, it is so completely contrary to the facts. Senator DONNELL. Have you studied the motives and beliefs of any considerable number of the members of the American Medical Association? Dr. FOREMAN. Well, you say "considerable." Senator DONNELL. I will ask you, have you inquired of as many as 500 members of the American Medical Association, the reasons underlying their opinions with respect to compulsory health insurance? Dr. FOREMAN. I have not. Senator DONNELL. As a matter of fact, is it fair to say that you have not talked with as many as 100 members of the American Medical Association as to the reasons for their opposition to compulsory health insurance? Dr. FOREMAN. I would say this, that I have talked to representatives of groups of much more than a hundred, the Physician Forum. As you recognize, the Physicians Forum is a group of doctors who very much favor this bill. Senator DONNELL. The Physicians Forum, it has been testified to here before the committee, as I recall, consists of about 2,000 members. Dr. FOREMAN. Yes. Senator DONNELL. Do you know what the membership of the American Medical Association is? Dr. FOREMAN. No, sir. Senator DONNELL. You know that it is many times that number? Dr. FOREMAN. I was just talking about the numbers, you mentioned 200 and 500. I am saying that the Physicians Forum with whom ĺ have discussed this matter, represents more than that. Senator DONNELL. Do you know whether the members of the Physicians Forum are likewise members in large part of the American Medical Association? Dr. FOREMAN. I think that they are. Senator DONNELL. You think that they are? Dr. FOREMAN. Yes. Senator DONNELL. And your conversations have been with the members of the Physicians Forum? Dr. FOREMAN. Not exclusively. Dr. FOREMAN. Not even primarily. Senator DONNELL. What proportion of the doctors that you have talked with are members of the American Medical Association but not members of the Physicians Forum? Dr. FOREMAN. Senator, I have been interested in this question for some years, and I have repeatedly discussed it with doctors, with representatives of doctors, with medical associations, and so forth. But I have not made any what I would consider scientific study of the motives, I am merely expressing my opinion. Senator DONNELL. And you would not undertake to tell the committee that you can accurately state what are the motives behind the American Medical Association? Dr. FOREMAN. Nor anybody else. Senator DONNELL. Now, Doctor, I take it that you agree that there is a presumption that arises that a great organization such as the American Medical Association is speaking out of what it considers to be honest motives? Dr. FOREMAN. Yes. Senator DONNELL. And the members of the American Medical Association are at least in large part composed of leading physicians, that is true? Dr. FOREMAN. I did not intend to imply that business is necessarily dishonest. Senator DONNELL. But you say, or you and I would agree, that the American Medical Association does consist in very large part of leading members of the medical profession? Dr. FOREMAN. That is correct. FINANCING NATIONAL HEALTH INSURANCE Senator DONNELL. Now, Doctor, on page 6, you give your understanding here as to how this proposed compulsory health insurance would be financed, namely, 12 percent of the incomes of wage-earners, to cover themselves and their families, and an equal amount would be paid in by the employer, and the self-employed would pay about 3 percent of their incomes under $3,600 a year. Where do you get the information that that is the method by which this plan of health insurance is to be financed? Dr. FOREMAN. From title II. Senator DONNELL. Now just where is that in title II, is there anything about that? Dr. FOREMAN. I will be glad to find it. Senator DONNELL. If you will just find that, I would like to see it. Title II begins on page 35. Dr. FOREMAN. The fund will be set up, as I understand it Senator DONNELL. We will come to specific sections if you will call my attention to it, to where it is from title II that you derive this understanding as to how this proposition is to be financed, by payments by the wage-earners of about 112 percent of their incomes and so forth. Dr. FOREMAN. I am not sure that I can put my finger on it right away, I will be glad to supply that reference. Senator DONNELL. I think, perhaps, we might pause on that and just see where it is in here, in title II.'" Dr. FOREMAN. Does the Senator challenge this fact? Senator DONNELL. Yes, I do. I want to call your attention to section 212 (b) and ask you if that is what you have in mind? Is that the section on which you have based your conclusion, Doctor, with reference to the method of financing? Dr. FOREMAN. I regret that I cannot point that out at this time exactly, Senator. Senator DONNELL. Well, Doctor, I think that I am correct in this statement, that with the exception of section 212 (b), and I may be in error, but with the exception of 212 (b) which reads: From such appropriations, the Secretary of the Treasury shall credit quarterly to the account amounts equivalent to 3 percentum of the wages as defined in section 217 (a), paid after June 30, 1946, with respect to employment, as defined in section 217 (b) after such date. I say with the exception of that section, I do not think that you wil! find anything in here which even remotely undertakes to express how it is that this plan is to be financed. I think, Doctor, perhaps you have confused your recollection of title II with some part of S. 1050 which is a much larger bill, which is also pending before the Senate at this time. Do you know of any other provision in title II, other than the one that I have cited, that even remotely refers to anything about a 3 percent aggregate of wages? Dr. FOREMAN. I am afraid that I do not, I am not able to put my fingers on it, Senator. Senator DONNELL. Now, Doctor, you referred to this bill, S. 1606, as the main measure to carry out the program of the President. You are aware, are you not, that S. 1606 was taken in largest part directly from S. 1050? Dr. FOREMAN. I know that. Senator DONNELL. And you know, do you not, that generally speaking, 1606 is but one link in the chain of the large program contemplated by 1050. Dr. FOREMAN. In my opinion, the health insurance is the main link, though. Senator DONNELL. You think that that is the main link? Dr. FOREMAN. Yes, sir. Senator DONNELL. Now, Doctor, on page 4 of your statement from which you read, in line 1, you state, referring to commercial policies, that only 40 percent of the premiums paid in come back as benefits. Could you tell us what the figure is in Blue Cross and other voluntary plans, with respect to the administrative and acquisition costs? Dr. FOREMAN. I got that figure from some published data of the Department of Agriculture, and I will be very glad to get it and submit it for the record. Senator DONNELL. The figure which you have given of 40 percent - refers to private companies, which are issuing policies of health insurance, does it not? Dr. FOREMAN. Yes. Senator DONNELL. And in other words, 60 percent of the premiums paid into private companies, according to your statement do not come back as benefits, but you are not undertaking to say that any such ratio prevails in connection with Blue Cross enterprises, are you? Dr. FOREMAN. I am not implying that that is the same. Senator DONNELL. Do you know, Doctor, whether or not the figure of from 122 to 15 percent as regards administrative and acquisition costs under Blue Cross plans is approximately the experience that we have had thus far? Do you know that to be true or not? Dr. FOREMAN. Senator, I would hesitate to say that because I cannot give that with any accuracy. Senator DONNELL. Going back for a moment to the method of financing of this type proposition, and referring particularly to the section to which I called your attention, in title II, you will observe there that the only reference to the 3 percent is to the fact, and that is on page 61, that there should be credited from appropriations made by Congress to the public health services' account, amounts equivalent to 3 percent of the wages paid after June 30, 1946, and so forth, and that is all that that provides. Dr. FOREMAN. Yes. Senator DONNELL. You do not find anything indicating where these funds "equivalent to 3 percent" are to come from, whether they are to come from taxes upon employers and employees or not, do you? 85907-46-pt. 1- -25 Dr. FOREMAN. Well, it calls for the definition over here in 217 (a). I was looking to see that. Senator DONNELL. That is 217 (a) and (b). Dr. FOREMAN. Yes, it means all remuneration. Senator DONNELL. And 217 (b) defines the term "employment." There is nothing in either of these sections 212 or 227 that states from what source the amounts equivalent to 3 percent of the wages shall be derived, whether those amounts, shall come from pay-roll taxes or whether they shall come from especially earmarked income taxes, or other sources, is there? Dr. FOREMAN. I am not able to put my finger on it; it was my definite impression that half of the employees was to be furnished by the employer. Senator DONNELL. Doctor, just how thoroughly would you say that you have studied this title II, have you gone through it with the utmost care? Dr. FOREMAN. Senator, I have a great many other things that I : am doing, and it was several weeks ago when I went through it, and so I have not got it at my finger tips as perhaps I should have. I did not realize that I was going to be questioned on the bill. Senator DONNELL. You realize in coming before our committee. that you did so with this quotation, "We unequivocably endorse the Wagner-Murray-Dingell National Health Bill, the main measure to carry it out"? "You understood, Doctor, that you were going to come here and discuss this bill? Dr. FOREMAN. I am prepared to stand behind that statement. Senator DONNELL. And furthermore, on page 5 of your statement. you say: Specifically, our organization wants to see the Wagner-Murray-Dingell Nations Health Bill, S. 1606, become law. Dr. FOREMAN. That is right. Senator DONNELL. And as you have indicated, your conclusion to that effect has not been based on resolutions adopted by either the membership or by resolutions adopted by the board of directors or representatives of your organization, is that correct? Dr. FOREMAN. Well, resolutions specifically referring to this bill' Senator DONNELL. Or to compulsory health insurance? Dr. FOREMAN. There were resolutions authorizing me. Senator DONNELL. There is no resolution to which you have calle: attention this morning of either your membership or of your board of representatives which endorses specifically compulsory Federa health insurance, am I correct in that? Dr. FOREMAN. I think that you are. Senator DONNELL. Now, Doctor, on page 4 of this statement, at line 7. you say: Yet doctors' services alone take three times as much in the average medica dollar. I do not understand the meaning of that sentence. Would you kindly elucidate that? Dr. FOREMAN. The average dollar spent for medical service is what I meant by the medical dollar. |