ample provision for utilizing existing services and actually encourage the establishment of new ones when they are able to meet standards of service.

FREEDOM OF CHOICE

One of the questions which workers always ask when these proposals are under discussion is: "Under the plan will we be able to choose our own doctor and our own hospital?" I am very sure that the proposal for the establishment of health insurance would not have received the widespread support that it has among our tradeunion people if they were not assured that the freedom of choice of physician would be preserved and actually improved. Our people are no different from others in that they cherish the personal relationship between doctor and patient and we have insisted that the provisions in this respect make doubly sure that free choice is protected. Actually, we feel that the bill, if adopted, would in a great many instances extend the principle of free choice as under our preent system of payment; the actual choice of physician on the part of those in dire need of service is limited to the number of doctors who are willing to render service in the face of the possibility or even probability that the patient will not be able to pay.

THE BILL PROVIDES FOR DEMOCRATIC ADMINISTRATION

Our membership is concerned about the degree to which any proposed legislation threatens to set up any centralized or autocratic control. Despite the contentions of the opposition, we are convinced that in S. 1606 there is established a fair balance between administrative responsibilities and democratic administration. Certainly officials of Government agencies are given duties to perform and they are properly given the necessary authority to carry out these duties, but their authority is limited through a system of checks and balances. The rights of insured persons and of persons and agencies rendering serv ices are carefully spelled out, and rights of appeal from decisions ar provided. In addition, the Surgeon General is specifically directed to decentralize the administration through the States and localitie A very important provision of the bill in our opinion is that directs the Surgeon General to establish a National Advisory Poly Council, which is to be made up from names submitted by profession: and other appropriate organizations and which is to include representatives of the consuming public. The Surgeon General is required to consult this body on all important questions of policy and adm.istration, and to include in a periodic report to Congress a record of such consultations. Provision is also made for the establishment of special advisory, technical, regional, and local committees to advi on general or special questions, professional and technical subject-. and other matters.

We have had considerable experience for many years with advisor councils. Some of them are only paper organizations and the advi and counsel of their members is almost meaningless. In other instances attempts have been made to give advisory councils so much power that there is a tendency to dilute administrative responsibility. The advisory council as set up in this bill avoids both those errors ani implements genuine democratic participation in the program.

While the entire program contemplated in this bill centers about title II, the provisions of title I are of vital importance. We heartily approve part A of this title providing increased grants to States forhealth services. The present system of grants-in-aid carried on cooperatively with the United States Public Health Service and the various State departments has been successful, but so limited in scope that it fails to meet the need.

MATERNAL AND CHILD HEALTH SERVICES

We are particularly interested in part B of this title which provides for increased grants to States for maternal and child health services. We feel that it is entirely appropriate that there be a special part for such a program, as we recognize that society has a special responsibility to make real the right of all children to good health.

Children and mothers today in many cities and towns do not get the kind or the amount of medical care or health services that they should have and that doctors know how to give, for three reasons: First, in many cases the facilities and the expert services that children need just do not exist where they live; second, many parents do not know what good care for children means, nor how to get it even if it is there; third, they do not have the money to pay for the care when. they need it.

This third lack will be taken care of under the personal healthservice provisions of title II and under the proposed amendments to section 121 of title I, part B, which together provide for payment of costs for care of all maternity patients and children. However, paying bills for care now available-or even for the additional care that we predict will become available when money to pay bills is in the insurance pool-will not of itself mean that maternity care and medical care for children are going to be of the kind and quality that are essential if children are to grow up really sound in mind and body and able to take their places effectively in our work-a-day world.

It is, therefore, of the greatest importance to the future of the workers and the Nation that an agency of the Federal Government whose primary concern is the health and welfare of children be given appropriate responsibility for planning ways and means for assuring that all mothers and children have access to care of the highest type that physicians and hospitals know how to give, and for setting the standards of care.

PROPOSED AMENDMENT TO TITLE I

In my letter to the chairman of this committee on March 12, 1946, I recommended an amendment providing that the Children's Bureau program under title I be basically directed toward community services, special research, demonstrations, training of personnel, and special educational programs to assure high standards of maternal and child care, and that any personal health services provided through the Children's Bureau be limited to those for persons not eligible for insurance benefits. Such an amendment has been recently proposed by Senator Pepper in his testimony before this committee.

The American Federation of Labor was one of the national organizations that sponsored the creation of the Children's Bureau. The position that the Children's Bureau has always taken with respect

to the welfare and health of children has been one activated only by a concern that the conditions under which children live and grow shall be the best. The Bureau has through the years shown courage and leadership in carrying out its functions in the interests of all children, and we do not want to see any steps taken that will weaken this ability to stand for the interests of children.

MEDICAL CARE FOR THE NEEDY

We further commend the provisions of part C of this title for grants to States for medical care of needy persons. No matter how carefully drawn may be the legislation providing for health insurance offering the widest possible coverage, there will be persons who are in need but who are not eligible for the benefits of the insurance system. The provision of this part for variable grants to the States depending upon the States' per capita income would make it possible to meet the needs of the distressed areas of the country in a practical way. This part therefore, serves to round out the entire structure of the national health program by providing medical care and service to those most in need.

SOURCE OF OPPOSITION FUNDS SHOULD BE INVESTIGATED

The members of this committee are aware that the proposal for national health insurance has been subject to serious attack from various quarters. We do not say that all of those who oppose this measure and who are in disagreement with us are dishonest men. We do say. however, that some of the organizations which have been busily stirring up opposition to this bill depending largely upon false and misleading slogans, and expending huge amounts of money, should be thoroughly investigated. I say quite frankly to the members of this committee that in our opinion you will not have fulfilled your responsibility to the public in these hearings unless the sources of the funds for some of these organizations have been thoroughly investigated and made known to the public. The people of the country have a right to know and they have a right to expect from this committee what individuals and what corporations have contributed to the misleading campaigns of such organizations as the National Physicians' Com mittee for the Extension of Medical Service and the Association of American Physicians and Surgeons, Inc. I have tried to make clear the reasons on which the American Federation of Labor bases its support of this bill. Our purposes and our records are open, and the basis of our support is common knowledge. We think that the reasons for the opposition of the organizations I have named and their allies should be made equally public.

CONSTITUTIONALITY OF S. 1606

There is one other question which I shall mention in closing since I understand it has been raised in the course of these hearings, and that is the question of the constitutionality of the bill under consideration. When this bill was being drafted we received various informal opinions on this matter from our general counsel and have now from him a formal opinion which indicates that the provisions of the bill are entirely in accordance with the Constitution. If the committee so desires I shall be glad to submit this for the record.

The CHAIRMAN. Mr. Green, this committee will be very glad to have that opinion, and will incorporate it in the record following your

statement.

Mr. GREEN. Very well; I shall be glad to include it in the record. The CHAIRMAN. Thank you.

(The document referred to is as follows:)

MEMORANDUM TO PRESIDENT GREEN ON THE CONSTITUTIONALITY OF S. 1606 NATIONAL HEALTH ACT OF 1945

Although there have been some questions raised as to the constitutionality of the National Health Act, notably by the American Bar Association in 1944, it is clear beyond doubt that this bill is within the constitutional power of Congress. It may be observed that the report of the American Bar Association merely assumes that the proposal is unconstitutional but cites no supporting authority. All constitutional aspects of S. 1606 have been conclusively settled by the Supreme Court of the United States (Steward Machine Company v. Davis, 301 U. S. 548, and Helvering v. Davis, 301 U. S. 619) when it upheld the Social Security Act. It is inconceivable, in the face of those decisions, that S. 1606 will be held unconstitutional.

In those cases the Supreme Court of the United States laid down the doctrine that article I, section 8, of the Federal Constitution empowers the Congress to provide for the general welfare of the United States; that Congress has a wide discretion in determining what is necessary for the general welfare, and that Congress' exercise of that discretion cannot be challenged in the courts unless it be shown that the Congress was clearly wrong and arbitrary. The following extracts from the Supreme Court's decision in the Helvering case fully apply to S. 1606.

*

"Congress may spend money in aid of the general welfare. * *There have been great statesmen in our history who have stood for other views. We will not resurrect the contest. It is now settled by decision * * There is a middle ground * * in which discretion is at large. The discretion, however, is not confided to the courts. The discretion belongs to Congress, unless the choice is clearly wrong, a display of arbitrary power, not an exercise of judgment. This is now familiar law. 'When such a contention comes here we naturally require a showing that by no reasonable possibility can the challenged legislation fall within the wide range of discretion permitted to the Congress.' Nor is the concept of the general welfare static. Needs that were narrow or parochial a century ago may be interwoven in our day with the well being of the Nation. What is critical or urgent changes with the times."

*

"The hope behind this statute is to save men and women from the rigors of the poorhouse as well as from the haunting fear that such a lot awaits them when journey's end is near."

*

"The problem is plainly national in area and dimensions. Moreover, laws of the separate States cannot deal with it effectively. Congress, at least, had a basis for that belief. States and local governments are often lacking in the resources that are necessary to finance an adequate program of security for the aged. This is brought out with a wealth of illustration in recent studies of the problem. Apart from the failure of resources, states and local governments are at times reluctant to increase so heavily the burden of taxation to be borne by their residents for fear of placing themselves in a position of economic disadvantage as compared with neighbors or competitors. We have seen this in our study of the problem or unemployment insurance."

"When money is spent to promote the general welfare, the concept of welfare or the opposite is shaped by Congress, not the States. So the concept be not arbitrary, the locality must yield."

Surely it cannot be suggested that it is constitutional for Congress to provide for unemployment insurance and old-age security, but unconstitutional to provide an insurance scheme for adequate medical care. The latter is as clearly for the

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"general welfare" of the people as the former and hence equally within the constitutional power of Congress.

So much for the basic underlying power of Congress to make provision for the medical care of the people of this country. As to the details of the plan embodied in S. 1606, they are, from a legal point of view, identical with those of the social security, workmen's compensation, and similar laws, all of which have been the subject of review by the Supreme Court, which upheld their constitutionality. Accordingly, it is our confident view that S. 1606 is in all respects constitutional. Respectfully submitted.

JOSEPH A. PADWAY, General Counsel, American Federation of Labor. The CHAIRMAN. Are there any questions the gentlemen wish to direct to Mr. Green?

Senator DONNELL. I should like to ask some questions.

The CHAIRMAN. You may proceed.

Senator DONNELL. Mr. Green, you referred to S. 1050, stating that the entire program for the development of a unified comprehensive social security program is contained in that bill?

Mr. GREEN. That is the Murray-Wagner-Dingell bill. Yes, sir.

FINANCING OF S. 1050

Senator DONNELL. I want to ask you, Mr. Green, whether or not you have investigated or caused to be investigated the question as to the probable cost under S. 1050, to which you have referred?

Mr. GREEN. Well, not the entire cost, because that would be very difficult, but we have gone into it in a quite extensive and practical way. Senator DONNELL. Would you be kind enough to tell us substantially the results of your inquiry as to the probable cost, and as to the portions of that program to which your figures apply?

Mr. GREEN. I will be glad to do it; but I do not have it with me now. Senator DONNELL. I have before me a document entitled, "Proposals for Health, Old-Age, and Unemployment Insurance," by Earl E. Muntz, New York University. He is comparing the 1945 bill, S. 1050. with the 1943 bill, which was S. 1161. And he is giving the revised figures as he gets them from the various sources as to the aggregate cost under S. 1050, the bill to which you referred in your testimony. Mr. GREEN. I see.

Senator DONNELL. This is on page 63. After referring to certain additional costs attributable to S. 1050 over and above the figures of S. 1161, he says:

This would raise the estimates previously given to the following totals:

1. Based on Senator Wagner's figures and remarks, $11,625,000,000.

2. Based on tax foundation study, $11,787,000,000.

3. Based on author's estimate, $13,405,000,000—

I take it that is Mr. Muntz' estimate

4. Based on Hirschfield's study, $14,625,000,000.

I understand that is Mr. Gerhard Hirschfield.

Do you recall whether or not the figures you have examined into would exceed the approximate somewhere between $11,625,000,000 and the $14,625,000,000 a year for these services under S. 1050?

Mr. GREEN. We have not made a comparison between our figures and those figures to which you have referred, so I could not at the moment say how they would measure up.