1 knew Samuel Gompers as a progressive leader-one willing and ready to change his views with the changing times. True to this tradition, the American Federation of Labor, which he founded, has changed its position regarding health insurance to meet the changed conditions of our times.

I shall not attempt to offer in support of the bill exhaustive statistical material. Such data are important and very necessary to an understanding of the problem, but they have already been presented by those who are particularly expert in this field. I am not here to present figures and statistics, but I am here representing the working people of America, who have expressed themselves as most earnestly desiring that legislation be enacted which will make it possible for them to obtain the services and have available the facilities that are essential to the achievement of good health. It is my purpose to present the reasons on which they base their conclusions.

WORKERS DISSATISFIED WITH PRESENT HEALTH LEVELS

Now, the working people of America are not satisfied with present levels of health in this country. This is not to say that they do not appreciate the notable achievements of modern medical science or that they do not share a sense of pride in the standards and attainments of our great medical centers and universities. They recognize that the span of life has been materially increased over the last half century, and that, generally, the health level of our people compares favorably with most other nations. They know this general picture tends to conceal the highly unsatisfactory conditions prevailing in the poorer agricultural States, in the rural sections of the wealthiest States, and in the low income areas of our great metropolitan centers.

SELECTIVE SERVICE REJECTION FIGURES

Working people were shocked, just as other people were, by the extent of physical unfitness that was revealed by the selective-service examinations. With the whole record now before us, these figures are more shocking than appeared at first. Where we have been saying that a third of our young men were found physically unfit for the "duties of citizens in wartime"-to use General Hershey's phraseactually it is now revealed that fully a half of the young men failed to meet the Army's standards. This was true even in the latter stages of the war, when in times of manpower stringency the standards were substantially lowered.

We do not feel that a nation can be secure and we do not feel that we can be proud of our achievement in the field of health as long as this condition prevails. We do not think that our achievements in medicine can be measured in terms of scientific progress alone, no matter how brilliant may be our discoveries. Our medical progress must be measured by the degree of health enjoyed by our people, and in this we do not at present measure up. Even if our general health were the best in the world-which it is not-we should not be satisfied until it is as good as it is possible for it to be in America, and until the last laggard areas have caught up with the more advanced sections. While working people are deeply concerned with the general health

conditions of the country, their demand for improvement arise mostly from their own personal experience with the inadequacies of the present system. Wage earners are no different from other people in their desire for good health for themselves and their families. They want, therefore, to know that adequate, modern medical care will be available when it is needed. They have, over the years, come to a realization that the services of the doctor, hospital, nurse, and laboratory must find a place in the family budget before a family can court itself secure.

Our people do not minimize the importance of the maintenance of satisfactory healthful conditions as they affect their life on the job and at home. They know that good housing, adequate nutrition, and other environmental factors contribute materially toward good health To listen to some of the opponents of health insurance, however, yo might conclude that if workers had these things they would not need doctors, nurses, or hospitals. They should know better, especially the doctors among them. Workers apparently have more faith in the value of the services furnished by the medical profession than som members of the profession seem to have. In a layman's manner they could tell you what the professional people appearing before this committee can tell you in more scientific terms. They knew that delay in getting medical care in many cases means the difference between life and death or between disability and recovery. They know how important it may be for the family doctor to be able to call in specialists or to utilize modern diagnostic aids-how important and how costly. They have been hearing for years about the great progress of scientific methods, especially when practiced by well-organized groups. They have been reading of the wonderful medical advances made during the war and they want now to include this modern medical care in their standard of living. As they ponder these things they realize that the health goals to which they aspire for their families are far from being attained, and increasingly they are coming to realize that under the system of distributing medical care and service based on the ability of the individual to pay for it, they are too frequently unattainable.

UNPREDICTABILITY OF ILLNESS

Out of their own family experiences working people have come to realize that the methods of meeting the costs of medical care have a direct and practical relationship to the availability of that care. They know that, generally, individual savings do not provide a pra tical way of meeting these costs for the very simple reason that neither the time nor the amount of savings needed can be predicted. They can budget every other major item of family expenditure; housing. food, clothing, education, and recreation. But they cannot anticipate the frequency or the extent of the cost of the medical care and service that will be required for a family. The number of family plans, and hopes and aspiration for the children that have been upset by a com pletely unpredictable case of illness can never be counted. We do know that the most frequent single cause of dependency is sickness. And we know that the desperate resort to the "loan shark" often arises from the necessity of paying the cost attendant upon sickness and that the largest single reason for the cashing of War Savings bonds is illness.

While workers, like other people, cannot predict the frequency or the severity of illness in their individual families, they do know that for any major segment of the population these factors can be accurately forecast and the cost for larger groups of the population can therefore accurately be determined. They are convinced therefore that an extension of their present social insurance system can make possible, through setting aside small amounts of their income. regularly, a means of meeting the cost of medical care for all. They see nothing socialistic or revolutionary about a proposal to extend the century-old, thoroughly American principle of insurance to meet these needs.

Our people are quite convinced, too, that it is entirely appropriate to use the instrumentality of their Government to collect these insurance contributions and to administer the program, provided that proper safeguards are included in the legislation establishing the system to guarantee that the authorities granted government agencies are limited to the degree necessary to carry out their responsibilities. In coming to our present position of vigorous support of the principle of health insurance we have studied the practical alternatives and found them wanting.

NEGLECT OF ILLNESS

In consideration of such alternatives it has to be realized that doing without medical care is one of those to which families are frequently forced to resort. This often takes the form of postponement of examination or calling on the physician when the first symptoms of an ailment appear. To some this might appear as inexcusable improvidence on the part of workers, but this is in most cases an unjustifiable judgment. Who is to label as "improvident" the decision of a breadwinner sharing all the natural human desires to do the best for his family when he postpones taking care of his own physical needs or even concealing them because he fears what an examination migh disclose or what adequate treatment might cost? But the records of family physicians are filled with instances where serious and costly illness could have been avoided by an early visit from the patient. The records that have been placed before your committee give you in statistical form what we receive by way of letters and direct communication from the members of our unions and from the testimony of friendly doctors with whom we work. Health insurance, by making available to all workers the means of paying the cost of medical care, would remove the fear that stands in the way of modern and effective preventive treatment.

VOLUNTARY INSURANCE PLANS

There are many sincere people who earnestly put forward as an alternative to compulsory health insurance the desirability of the further extension of voluntary insurance plans.

I should like to comment on the confusion that has been introduced into public discussion of the problem before you resulting from misunderstanding of the terms "voluntary" and "compulsory" as used in this connection. We in the American Federation of Labor have on occasions been charged with inconsistency because we have opposed

compulsory arbitration and other forms of compulsion and adhered to our traditional principle of voluntarism while at the same time embracing compulsory health insurance. We do not feel that our posi tion is in the least in violation of our traditional principle, as the element of compulsion in health insurance is confined to the matter of coverage and to the payment of contributions. In other forms of compulsory legislation there are embodied compulsions that seriously limit the basic freedoms of citizens. The compulsory feature of health insurance is identical with the compulsory features of our public education system, where our children are required to attend school, and all property owners are required to support the system. To carry over into a discussion of this problem the usual connotations associated w the word "compulsory" as opposed to "voluntary" confuses rather than clarifies the issue. As a matter of fact, the plans of some of the voluntary programs have demonstrated that they can be quite undemocratic Those, for example, now being advocated so vigorously by some of the medical societies, place complete control of the plan, including the expenditure of the funds, in the hands of a single group whose members have a direct pecuniary interest in their operation. They are completely devoid of any standards to govern the quality of service to be provided, and provide for no representation on the part of those who are to pay their costs.

It is not necessary for me to go into an extended analysis of the deficiencies of voluntary plans, since testimony that has already bee: presented to this committee is thoroughly adequate for that purpose The analysis which Senator Pepper presented on the opening day of the hearings on this bill, which was based on the exhaustive study of hSubcommittee on Wartime Health and Education, said all that nee to be said on this subject; and we subscribe to his conclusions. We can only add that the experiences of our people point up the accuracy of his observations in that these plans are not reaching the low-incon people and they are the ones who most need the protection of heal insurance. We know, too, that the coverage provided under plans that give only partial protection is rapidly reaching the saturation poir: The Blue Cross plan, for example, which is among the better of suc plans, is now having to sign up four new subscribers for every thre who remain on the rolls for any appreciable length of time. As th number of people covered under their plans increases, this rate. turn-over will undoubtedly continue to increase, adding to the cofor which the subscribers get no return. This feature is in additi to the fact that those who stay in the plan will always tend to includ the poorer insurance risks.

It is possible that voluntary health insurance providing comple: medical care and service would be a good thing for those persons w could get it and who could afford to pay for it, but it has been four impractical for the great masses of people.

I have spoken of the needs for health insurance for which our peop are acutely aware and out of which has developed our support for. change in the method of meeting the cost of medical care. I shou like now to comment on the specific proposal before you in its relatio to those needs.

The heart of S. 1606 is in title II, which establishes a comprehensystem of prepaid medical care. This provision is so designed tha

it can readily be incorporated in a system of contributory health insurance. To this, as to any other proposal, we apply certain tests. There are specific questions which working people ask about any such plan.

COVERAGE OF S. 1606 IS ADEQUATE

First, they ask: "Is the system sufficiently comprehensive in its coverage?" We estimate that under the provisions of this bill coverage would include between 80 and 90 percent of the entire popula tion in a medical care program, and that its coverage is adequate and as nearly complete as is practicable. We favor the broad coverage provided, both because it represents a sound principle for insurance, and because it provides the care to all including the lowincome groups who are in need of such care.

Workers are likewise concerned with the nature of the benefits. On this point too it is our opinion that the bill is adequate, since it provides that all insured persons and their dependents are entitled to the services of a general practitioner of their own choice in home, office, or hospital; services of specialists and consultants; complete laboratory services including X-ray and physiotherapy; special appliances; hospitalization; general and special dental and home nursing services. We feel also that the provisions of the bill which allow for limitation on these benefits in terms of specified situations are practical and sound.

QUALITY OF MEDICAL CARE WOULD BE IMPROVED BY S. 1606

Past experience of workers, particularly with certain types of con tract care, have led them to be cautious about any proposal which might affect the quality of service. In our opinion, the passage of this bill would definitely encourage high-quality medical care. Doctors with whom we have consulted have informed us that when the ability of the individual patient to pay is a factor in his prescription of treatment, as it is under the present system, the best quality of service is often denied. Under the contemplated program this barrier would be removed. Patients would also be encouraged to visit the doctor in the early stages of illness. Moreover, when taken in conjunction with a program for construction of hospitals and health centers in areas of need, there would undoubtedly result from this program a vast improvement in the type of care available to our general population. The impetus given to group practice will also contribute substantially to this end and the provisions of the bill for the encouragement of research would aid tremendously in the development of better medical care.

EXISTING SERVICES WOULD BE UTILIZED

Especially during the past several years many of our unions have developed medical care programs for their members. Our people naturally want to know whether the adoption of a national health program would permit the continuance of these cooperative endeavors. During the preparation of this legislation we insisted upon provision for the continuance of these plans being included, and we are satisfied that the provision is adequate. We are convinced that the bill makes