NATIONAL HEALTH 10-POINT PROGRAM OF THE AMERICAN MEDICAL ASSOCIATION "1. The American Medical Association urges a minimum standard of nutrition, housing, clothing, and recreation as fundamental to good health and as an objective to be achieved in any suitable health program. The responsibility for attainment of this standard should be placed as fas as possible on the individual, but the application of community effort, compatible with the maintenance of free enterprise, should be encouraged with governmental aid where needed.

"2. The provision of preventive medical services through professionally competent health departments with sufficient staff and equipment to meet community needs is recognized as essential in a health program. The principle of Federal aid through provision of funds or personnel is recognized with the understanding that local areas shall control their own agencies as has been established in the field of education. Health departments should not assume the care of the sick as a function since administration of medical care under such auspices tends to a deterioration in the quality of the service rendered. Medical care to those unable to provide for themselves is best administered by local and private agencies with the aid of public funds when needed. This program for national health should include the administration of medical care including hospitalization to all those needing it but unable to pay, such medical care to be provided preferably by a physician of the patient's choice with funds provided by local agencies with the assistance of Federal funds when necessary. "3. The procedures established by modern medicine for advice to the prospective mother and for adequate care in childbirth should be made available to all at a price that they can afford to pay. When local funds are lacking for the care of those unable to pay, Federal aid should be supplied with the funds administered through local or State agencies.

"4. The child should have throughout infancy proper attention including scientific nutrition, immunization against preventable disease and other services included in infant welfare. Such services are best supplied by personal contact between the mother and the individual physician but may be provided through child care and infant welfare stations administered under local auspices with support by tax funds whenever the need can be shown.

"5. The provision of health and diagnostic centers and hospitals necessary to community needs is an essential of good medical care. Such facilities are preferably supplied by local agencies, including the community, church and trade agencies which have been responsible for the fine development of facilities for medical care in most American communities up to this time. Where such facilities are unavailable and cannot be supplied through local or State agencies, the Federal Government may aid, preferably under a plan which requires that the need be shown and that the community prove its ability to maintain such institutions once they are established (Hill-Burton bill).

"6. A program for medical care within the American system of individual initiative and freedom of enterprise includes the establishment of voluntary nonprofit prepayment plans for the costs of hospitalization (such as the Blue Cross plans) and voluntary nonprofit prepayment plans for medical care (such as those developed by many State and county medical societies). The principles of such insurance contracts should be acceptable to the Council on Medical Service of the American Medical Association and to the authoritative bodies of State medical associations. The evolution of voluntary prepayment insurance against the costs of sickness admits also the utilization of private sickness insurance plans which comply with State regulatory statutes and meet the standards of the Council on Medical Service of the American Medical Association. "7. A program for national health should include the administration of medical care, including hospitalization to all veterans, such medical care to be provided preferably by a physician of the veterans' choice with payment by the Veterans' Administration through a plan mutually agreed on between the State medical association and the Veterans' Administration.

"8. Research for the advancement of medical science is fundamental in any national health program. The inclusion of medical research in a national science foundation, such as proposed in pending Federal legislation, is endorsed.

9. The services rendered by volunteer philanthropic health agencies such as the American Cancer Society, the National Tuberculosis Association, the National Foundation for Infantile Paralysis, Inc., and by philanthropic agencies such as

the Commonwealth Fund and the Rockefeller Foundation, and similar bodies have been of vast benefit to the American people and are a natural growth of the system of free enterprise and democracy that prevail in the United States, Their participation in a national health program should be encouraged and the growth of such agencies when properly administered should be commended.

"10. Fundamental to the promotion of the public health and alleviation of illness are widespread education in the field of health and the widest possible dissemination of information regarding the prevention of disease and its treatment by authoritative agencies. Health education should be considered a necessary function of all departments of public health, medical associations, and school authorities."

At the meeting of the house of delegates held in Chicago, December 3-5, 1945, acting on several resolutions calling for the adoption of voluntary prepayment medical care plans, the house of delegates made the following report:

"All of these plans show a uniformity of desire for the immediate setting up of a national plan on a voluntary basis. In all of them the urgency of this being done is stressed. Accordingly your reference committee recommends that the house of delegates of the American Medical Association instruct the board of trustees and the council on medical service and public relations to proceed as promptly as possible with the development of a specific national health program, with emphasis on the Nation-wide organization of locally administered prepayment medical plans sponsored by medical societies."

In accordance with this action the council on medical service and public relstions of the American Medical Association and its board of trustees called a conference of representatives of the voluntary prepayment medical care plans of the invidual States. This conference, which was held in Chicago in February 1946, organized a corporation to be known as the Associated Medical Care Plans, a national nonprofit organization, which includes State and local medical care plans that comply with the minimum standards for medical care approved by the council on medical service and public relations and by the board of trustees of the American Medical Association.

The objects of the new corporation as set out in the articles of incorporation are broad. They embrace a variety of activities, which can be expanded as future experience and development may indicate. Specifically, the authority granted by the State of Illinois permits the new corporation "to promote establishment and operation of such nonprofit, voluntary medical care plans throughout the United States and Canada as will adequately meet the health needs of the public and preserve and advance scientific medicine and the high quality of medical care rendered by the medical profession of the two countries." Significantly, the corporation recognizes that "State and local medical care plans should be autono mous in their operation so that the needs, facilities, resources, and practices of their respective areas can be given due consideration, but that the health and welfare of the public is advanced by the coordination through the medium of this corporation of methods, coverages, operations and actuarial data."

The actual activities that are at present contemplated are indicated by the specific duties that the proposed bylaws impose on the commission of the corporation, which, in effect, is the corporation's board of directors. The commie sion is directed to undertake and promote:

(a) Research and compilation of statistics with special studies of experience and collection and distribution of financial and service data.

(b) Consultation and information services based on contacts with existing and contemplated plans concerning administrative policies and procedures, and the distribution of significant literature and information.

(c) Public education by interpreting the national scope and significance of the medical care plan movement under medical society auspices with publicity methods suitable to the various groups in the public and yet consonant with proper professional practices.

(a) Coordination and reciprocity among plans with reference to transference of subscribers and benefits in the development of national enrollment, among large enterprises and authoritative contacts with governmental or national agencies. such as Farm Security, welfare, and industrial groups.

The necessary details dealing with the manner in which these duties will be performed are matters that will evolve from future meetings of the commission and of members of the corporation. To expedite the initiation of corporate activities, a meeting of the commission has been called for April 26 and in Chicago from which will emerge considered operational plans. These wil

be presented for approval to the first meeting of the members of the corporation, now tentatively to be held in San Francisco the 2 days immediately preceding the annual session of the American Medical Association in July.

Among the more pressing of the matters on the agenda of the commission for its April meeting is the acceptance of applications for membership and the appointment of an executive director to administer the day-by-day activities of the corporation. Plans, at least temporarily, call for the establishment of an office, with necessary administrative and clerical staff, in the headquarters building of the American Medical Association, thus facilitating coordination of the activities of the new corporation and of the Council on Medical Service and Public Relations of the American Medical Association.

The following men are serving as indicated on an interim basis until the membership can elect officers at the corporation's first annual meeting:

President: F. E. Feierabend, M. D., of Surgical Care, Inc., Kansas City.

Vice president: William M. Bowman, of the California Physicians' Service, San Francisco.

Treasurer: Norman M. Scott, M. D., of the Medical Service Plan of New Jersey, Clinton..

Secretary: Jay C. Ketchum, of the Michigan Medical Service, Detroit. Commissioners: Willard C. Marshall, Oregon Physicians' Service, Portland; Edwin M. Kingery, Iowa Medical Service, Des Moines; Arthur J. Offerman, M. D., Nebraska Medical Service, Omaha; L. Howard Schriver, M. D., Ohio Medical Indemnity, Cincinnati; Lester H. Perry, Medical Service Association of Pennsylvania, Harrisburg; Herbert H. Bauckus, M. D., Council, Medical Society of State of New York, Buffalo; Raymond L. Zech, M. D., Seattle, Council on Medical Service and Public Relations of the American Medical Association; A. W. Adson, M. D., Rochester, Minn., Council on Medical Service and Public Relations of the American Medical Association, and Edward J. McCormick, M. D., Toledo, Council on Medical Service and Public Relations of the American Medical Association.

The council on medical service and public relations has established standards for prepayment medical care plans which propose to insure to the sick a high quality of medical care by incorporating the fundamental principles which the medical profession believes to be necessary in maintaining such medical service. These principles include free choice of physician, free choice of hospital, the maintenance of mutual responsibility between doctor and patient and the avoidance of political interference between doctor and patient. The text of the standards follows:

STANDARDS OF ACCEPTANCE FOR MEDICAL CARE PLANS APPROVED BY THE BOARD OF TRUSTEES AND BY THE COUNCIL ON MEDICAL SERVICE OF THE AMERICAN MEDICAL ASSOCIATION

Development of plans affecting the distribution of medical care, in accordance with the principles adopted by the house of delegates, is one of the principal functions of the council on medical service and public relations. First in importance in the development of plans affecting the provision of medical care is the utilization of the prepayment method to help spread medical and surgical costs.

The council on medical service and public relations suggests that special recognition be granted to plans organized and operated in accordance with standards which adequately protect the interest of the public and the medical profession.

In granting this recognition the council will consider each prepayment medical care plan in the light of established knowledge and authoritative opinion, and according to standards adopted from time to time by the council in the interest of the public. Plans that conform with the requirements thus formulated will be accepted by the council.

Under the conditions defined in the following paragraphs, the council grants the right to print its seal on all official papers of accepted plans and in any promotional literature or display material used by these plans.

This official seal should appear without comment on its significance unless such comment has been previously approved by the council. A statement proposed for such use follows: "The seal of acceptance denotes that (name of plan) has been accepted within the standards set forth by the council on medical service of the American Medical Association."

The acceptance of a plan and the seal of the council are intended to signify that the plan comforms with or meets the following standards or requirements: (1) The prepayment plan must have the approval of the State medical association or if local, of the county medical society in whose area it operates.

(2) The medical profession should assume responsibility for the medical services included in the benefits; the medical profession is qualified by education to accept responsibility for the character of the medical services rendered.

(3) Provision should be made for a medical director acceptable to the county or State medical society, or a committee appointed by either of these groups, to adjust difficulties and complaints. The medical director or committee members may be paid on a per diem basis for the time involved in handling such matters. (4) There should be no regulation which restricts free choice of a qualified doctor of medicine in the locality covered by the plan who is willing to give service under the conditions established.

(5) The method of giving the service must retain the personal, confidential relationship between the patient and the physician.

(6) The plan should be organized and operated to provide the greatest possible benefits in medical care to the subscriber. Honesty of purpose and sincere consideration of mutual interests on the part of the subscribers, the physicians and the plans are presupposed as necessary considerations for successful operation. (7) The duties from subscribers through premium rates should be adequate to provide for the benefits offered and the risks involved.

In determining such factors the council will utilize the experience of those plans that are and have been operating successfully, but will not discourage experiments in other types of coverage provided such experiments are limited in scope and capable of scientific evaluation.

(8) These benefits may be in terms of cash indemnity or service units. Where benefits are paid in cash to the subscriber it must be clearly stated that these benefits are for the purpose of assisting in paying the charges incurred for medical service and do not necessarily cover the entire cost of medical service, except under specified conditions.

(9) Subscribers' contracts must state clearly the benefits and conditions under which medical services will be provided or cash indemnities paid. All exclusions, waiting periods, and deductible provisions must be clearly indicated in the promotional literature and in the contracts.

(10) Promotional activities must be reasonable without extravagant or misleading statements concerning the benefits to the subscribers. In approving promotional material the council will endeavor to indicate the type of statements which are acceptable and the nature of those considered objectionable. It is not the function of the council to edit all copy word for word and sentence for sentence, but rather to indicate the general type of revision required in any given piece of literature. It expects the spirit and intent of such objections to be observed in the remainder of the copy not specifically criticized. Promotional activities will include any devices for informing the public or the profession. (11) Enrollment practices shall be based on sound actuarial principles such as will not expose the plan to adverse selection. Group enrollment is recommended until further experience warrants the acceptance of individuals.

(12) It is understood that the plan of organization will conform with State statutes and that the plan will operate on an insurance accounting basis with due consideration for earned and unearned premiums, administrative costs, and reserves for contingencies and unanticipated losses. Supervision should be under the appropriate State authority.

(13) Each accepted plan must submit periodic reports of financial and enrollment experience in the manner prescribed by the council.

Acceptance of plans by the council will be for a period of 2 years or until revoked (provided they comply with the standards during this period) at the end of which all contracts and financial statements be reexamined. A shorter period of approval may be granted at the discretion of the council. Any changes in contracts or literature during the period of acceptance must be submitted to the council for review.

The representatives of the American Medical Association have reviewed the statements made to the Senate Committee on Education and Labor by the Senators and Congressmen who present this legislation and by representatives of Federal Government agencies that support it. We should like to answer speckfically some of the points made by those who support this legislation and to cite the evidence in support of our statements.

Regimentation.-Senator Wagner has said, "There is no foundation for the charges that a compulsory health-insurance program would involve regimentation of doctors and patients, lowered standards, or political medicine." Nevertheless, physicians in countries which have compulsory health-insurance systems have been regimented. The standards of medical care in all such countries, we contend, are lower than those that prevail in the United States, which at this time does not have any such system. This was admitted by Mr. Altmeyer and there is evidence submitted which will prove it.

Senator Wagner has asserted that, “Under the bill patients are guaranteed free choice of doctors, doctors are guaranteed the right to accept or reject patients, and hospitals are guaranteed freedom to manage their affairs." Under questioning of Senators Donnell and Ellender, Mr. Altmeyer, of the Social Security Board, and Dr. Joseph Mountin, of the United States Public Health Service, admitted that the choice of doctor is not free choice but is a restricted choice. The bill itself indicates that the administrator of medical care under this bill would have the right to designate hospitals and specialists entitled to cooperate under the act.

The National Physicians Committee.-In his testimony before this hearing, Congressman John D. Dingell characterized the National Physicians Committee as a satellite organization of the American Medical Association. The National Physicians Committee is not connected with the American Medical Association. The American Medical Association does not exercise any supervision over its financing or its operations. The house of delegates has voiced approval of its work.

Congressman John D. Dingell asserts that the National Physicians Committee was "formed specifically to preserve the American Medical Association's taxexempt status under the income-tax laws." The representatives of the American Medical Association wish to say that the American Medical Association did not organize the National Physicians Committee; rather that the National Physicians Committee was organized by a group of physicians independently and without the sponsorship of the American Medical Association.

Congressman John D. Dingell asserted that the American Medical Association has a "monopoly which it exercises over the health of the American people." The questioning of Mr. Altmeyer by Senator Ellender brought out that there are more than 60,000 physicians in practice who are not members of the American Medical Association. This is true. Furthermore, the American Medical Association does not exercise any type of control over physicians or over the health of the American people, other than the will of either to follow voluntarily advice which the American Medical Association may give in the pages of its publications. The councils of the association set up standards of medical education, hospitals, drugs, foods, and physical devices. Those who wish to do so voluntarily may accept these standards.

British health-insurance plan.-Congressman Dingell referred to alleged false information which the American Medical Association issued concerning the British health-insurance system and which he stated "has been repudiated by the secretary of the British Medical Association." The secretary, Dr. Anderson, to whom he refers has been dead for several years. The present secretary of the British Medical Association, Dr. Charles Hill, has issued a statement to the effect that the presently proposed expansion of compulsory sickness insurance in England will be opposed by the medical profession, since the proposals would "lead sooner rather than later to doctors becoming whole-time salaried servants of the state.

The health of the Nation.-In his statement to the Senate committee, Senator Pepper presented what he called a series of facts showing the gravity of the Nation's health problem. The Nation's health problem is not grave, since the United States now has the lowest sickness and death rates of any large nation in the world. Here are the statistics, as published in the Encyclopaedia Britannica Book of the Year (1943), of the comparative death rates of the large nations: United States___

10. 5 Sweden.
12.9 Chile____

12. 3 Japan---.

11.2

19.8

17.6

9.8

12.5 New Zealand-European_-_

The rate for the United States is lower than that of any other great nation. New Zealand, which is not a large nation but which has a lower death rate, limits Its sickness and death statistics to its European population.