pediatricians practice. We learn, further, that 31,000 babies die needlessly each year during their first year of life in our country, and that 3,000 mothers die needlessly each year in childbirth.

It is estimated that one-half of all maternal deaths and one-third of infant deaths are preventable.

This committee has had ample occasion also to consider the tremendous cost to our Nation and its economy of the illness which could be prevented by a more universal and adequate system of medical care.

We are told that among industrial workers, 600,000,000 man-days of production are lost each year as a result of illness and accidents. Much of this could be prevented.

This committee has considered the fact also that much of the poverty within American families springs from sickness and the cost of medical care. It is striking indeed that the surveys made of the famed "Hundred Neediest Cases" of the New York Times revealed that 85 percent of these families are indigent because of illness and the cost of medical care.

This committee has had many opportunities to take note of the tragically uneven distribution of illness and the frequently sudden nature of its coming. As a chaplain in this recent war, I had much opportunity to see homes and families wrecked because of a sudden and unanticipated illness.

It has often been true that the mere cost of a suddenly necessary operation has destroyed and made invalid carefully laid family plans. These instances have brought much suffering both psychological and physical, to innocent family members.

VOLUNTARY PLANS INADEQUATE

The facts also seem to indicate very clearly that medical needs are not being met by the sum of the private or voluntary plans in existence in our country. Though there has been commendable progress in some of these plans, they still cover only a comparatively small percentage of the population, and meet only a small proportion of

the medical needs of those covered.

Of those covered under the voluntary plans, less than 4 percent receive complete prepaid medical care. The Blue Cross has taken in a large proportion of the recipients of benefits under private plans.

It is important to remember that the Blue Cross covers generally only the hospital bill during ordinary illness. But such hospital bills take only 13 cents of the patient's medical dollar.

The doctor's bill, which accounts for 40 cents of the patient's dollar, is not covered by the Blue Cross plans. Nor do those plans cover dental care and preventive medicine-medical check-ups, et cetera.

This latter point is most important, since many a hospital bill would be altogether prevented through early enough medical attention.

Most of the recipients of benefits under the various private plans participate in the so-called commercial plans. We need to remember that only 40 percent of the money paid by the participants in these commercial plans come back to them in the form of benefits. The remaining 60 percent go into the large company overhead expenses and profits.

The so-called medical society plans-another category of private plans are also limited, both in coverage-less than 2 percent of the population being covered by them in 1945-and in scope, usually covering only surgical care and obstetrical service after 10 months. Senator DONNELL. Pardon me, going back for a moment to your statement

We need to remember that only 40 percent of the money paid by the participars in these commercial plans come back to them in the form of benefitsare you speaking there of the Blue Cross plans?

Reverend MCMICHAEL. No; not the Blue Cross plans, but the private company plans.

Senator DONNELL. I wanted the record to be clear.

Reverend MCMICHAEL. Not the Blue Cross.

Senator DONNELL. Do you know what the percentage of expense for operation is in the Blue Cross?

Reverend McMICHAEL. I do not. I would be glad to learn, if yo know.

Substantially more adequate coverage of medical needs is found i the Kaiser plan and in similar group practice plans. Nevertheless, a. of the private or voluntary insurance plans put together do not beg to meet the vast need for medical and hospital care in our country. Awe have seen, the overwhelming proportion of the people are not covered by these plans.

In general, most of the medical and hospital needs are not provided There are certainly many people who cannot afford to join these planEven if there is some dispute as to the validity of this last point, cannot be denied that many people who need to join will not do so, b will prefer to gamble on the possibility that they will have no need f the benefits which the particular plan involved provides.

This probably helps to explain the high turn-over of membership private plans. The participants drop out at the end of the year which they put money in but did not receive. The succeeding y might well be the year when their tragic illness or enforced hospital z tion comes. This high turn-over may help explain the high pro tional and administrative costs of the private plans.

It is apparent that, as in any insurance system, wider coverage wo lead to reduced unit costs, and it has also been contended that those w tend to be most sickly are most eager to join these private plans. T. may lead to high cost for participation in the plan or, on the other har may produce such rigid eligibility requirements as to keep out thes most in need of the plan.

PRIVATE CHARITY CANNOT DO THE JOB

Nor can it be contended effectively that the medical and hospit. needs of the uncovered masses of the American people are met by t. generous and charitable practices of the doctors and hospitals. We s told, for example, that less than 7 percent of the poorest rural far. lies-those receiving less than $500 per family per year-receive a free medical care during the year. Certainly this does not mean t they can afford $100 per year, which a family needs on the average f minimum medical care. Nor does it mean that these particularly r poverished American families are not visited by illness. It simp means that they go without the care which they clearly need.

We have pointed out that those areas in which we find greatest shortage of doctors and need for hospital facilities are precisely those areas where the greatest needs are found. This is not a matter of hearsay with me, since I am from such an area, from the deep and predominantly rural South.

My grandfather was a doctor in central Georgia, and my father was a doctor in south Georgia. As a boy, I spent many hours with dad on calls in the country. We came to know the rural people, how much pride and self-respect they had. This meant, tragically, that they would often wait until too late to call the doctor.

My father knew the poverty of many of the people, black and white, to whom he ministered. He knew the inability of these rural people to pay for adequate medical care. He came to see the inadequacy of all private plans to meet the needs of these most impoverished folk.

This is why he became a firm suporter of the Wagner health bill. He brought his own life to a premature end by working night and day, year after year, in an area where there was always more work than any one man could handle. Time after time we saw him give up plans. for definitely needed vacations, to deliver a baby or to minister to an acute illness. Babies do not follow a doctor's vacation schedule.

Dad was trying to meet the medical needs of a people who were disproportionately sick and in an area with a disproportionate medical and hospital shortage.

The national health plan envisaged in S. 1606 would assure a decent annual income to doctors in impoverished areas. It would increase the number of doctors in these areas and make life less pressing and difficult for all of the doctors there. It would also bring a new medical era to the medically disadvantaged common people.

We in the South have much to gain by the passage of this important National Health Act. But the South's gain would be the Nation's. It is in these impoverished areas that the largest proportion of children are found, and it is from these areas that people migrate in the greatest numbers to other areas when they leave childhood and reach productive age. The whole Nation stands to lose if we send out from impoverished areas men and women stunted and blighted by childhood disease which could have been prevented.

HEALTH INSURANCE MUST BE NATIONAL

We have a solid basis, therefore, for our conviction that this committee's health subcommittee is sound in its contention that only a national plan in which the Federal Government participates can make medical care universally available in the United States.

We agree also that only such a national plan can bring us substantial progress in eliminating those inequities as to medical care between low- and high-income areas in our country.

Certainly the Federal Government has a legitimate and inevitable. concern in this matter. This would be so, even if we were thinking only within the narrowly conceived terms of national defense, as the Selective Service rejections during the last war make clear. It is a long-established part of the framework of the American democratic government that public funds are expended by public agencies responsive to the popular will.

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We now consider the right to an education as a basic right of an American citizenship. We must come to so consider the right to be born decently and to have adequate medical and hospital care ever available.

S. 1606 is to be commended for the fact that it does not provide what social workers know as a "means" test. This is a great step toward the conception that decent medical care should be available to all, not as a form of charity, but as a basic right.

We all know the psychological humiliation which often comes from the charitable approach to the dispensing of medical care.

When Gene Talmadge was Governor of Georgia, he attacked various Federal Government measures to expand social security. He took the position that these measures were inimical to the churches, which depended on the existence of human objects for their charity.

According to this conception, the churches would have a stake in the preservation of poverty and injustice. But Mr. Talmadge, fortunately does not speak for the awakened churchmen of America, who know that true religion is dedicated to the abolition of preventable poverty and to the attainment of genuine justice.

COVERAGE SHOULD BE EXTENDED

We congratulate the authors and proponents of S. 1606 for helping us to progress toward an America in which medical care will be considered a matter of justice and not a matter merely of charity. We are concerned, however, by the fact that the bill as now written does not cover all of the population in the benefits which it makes available. We agree with the position of the United States Public Health Service that 100 percent of the population ought to be covered. We fear that the proposal for a special category of "needy" cases may open the door to the kind of stigma which we are seeking to avoid. There may also be danger of the development of a double standard of medical care, a different standard for the so-called needy.

The bill is to be commended also for its inclusive approach to the medical needs which are to be met. This is very sound.

As suggested above, in our analysis of the shortcomings of most private plans, a medical check-up which comes in time might well save s hospital bill. Thus we see that the inclusive approach of S. 1606 is economically as well as morally sound.

DOCTOR-PATIENT RELATIONSHIP

All of us realize the close relationship between strictly physical and functional ills. We know that a happy interpersonal relationship between doctor and patient is of great importance both for doctor and patient. This often may be a real factor in speeding a cure.

It is commendable that S. 1606 provides free choice of patient to doctor and vice versa. Free choice is actually extended and doctorpatient relationship improved by eliminating present cost barriers.

S. 1606 WILL IMPROVE QUALITY OF MEDICAL CARE

S. 1606 will increase the quality of medical care by freeing doctors to use laboratory and other techniques now neglected often because of cost. The quality of medical care receives an additional boon by the

provisions encouraging research, basic medical training, and special graduate work.

I remember how my own dad longed for and finally secured for himself periods of special postgraduate study.

Nor does the act remove the doctor's incentive. A patient can choose his doctor freely. He can also abandon that doctor if his work becomes unsatisfactory. Naturally, one who has been a chaplain appreciates the provision in the bill to give priority to grants-in-aid to servicemen seeking postgraduate medical education.

As a chaplain who worked largely with the unsung heroes of the merchant marine, however, I hope that the act will be amended to include in its definition of "servicemen" those who served during the war in the United States Maritime Service or merchant marine.

DEMOCRATIC ADMINISTRATION OF THE BILL

Commendable also are provisions calling for maximum participation by local, State, and private agencies in the administration of the act and provisions for advisory councils, including representatives of the public as well as of the medical and other professions.

We ministers welcome this opportunity for qualified clergymen who work intimately with individuals in a community to serve in their behalf on advisory councils. We urge that specific representation be given on these important councils to Negro, Jewish, and other religious and racial minority groups, so as to assure to them an equitable role and share in the administration and benefits of the act.

We have been gratified by the interest recently shown by organized labor, not only in narrowly conceived trade-union problems, but in public affairs and in health problems. We are confident that representatives of organized labor will also have a great contribution to make on these advisory councils.

We have expressed some concern over the dangers in the so-called needy cases as distinguished from those otherwise covered. We are glad to note, however, that the possibility is left open for these needy cases to secure medical benefits "on the basis of equitable payments to the personal health services account established under title II." We hope this will enable the patient to receive treatment from a doctor without that doctor's knowing that he is dealing with a special category of patient.

AMENDMENTS TO TITLE I

Our primary concern is that the splendid medical and hospital benefits proposed in the act be in fact universally and completely available to all Americans. We support the amendments proposed by Senator Pepper to title I, part B of the act. We believe these amendments make more certain the universal availability of the special maternal and child-health services involved by adding further clarifying details rooted in S. 1318.

Human rights must come before "States' rights." The major task is to see that the people in all States receive the intended opportunity for adequate medical and hospital care.

We join with Senator Pepper in questioning the requirement for financial contribution by the States, since we do not want the slightest possibility to remain that the people in any State be denied benefits which ought to be the right of all Americans.