contributions for all social insurance programs. This bill was drafted on the assumption that 3 percent of pay rolls (up to $3,600 per year) would be allocated for health insurance, of which one-half would be paid by employers and the other half by employees. In other words, 12 percent of pay rolls would be contributed by employers and 111⁄2 percent by employees. The bill also provides that the additional cost above 3 percent due to the gradual introduction of dental and home nursing services would be financed out of general revenues.

I have been asked many times why the premiums for health insurance were not included in the national health bill, S. 1606, and I should like to clarify the situation for the record.

Under the Constitution, all revenue bills must originate in the House of Representatives. This means that the House must consider and pass revenue legislation before the Senate. In order that the health insurance legislation can be considered and passed by the Senate without waiting first for House action, it was necessary to consider the benefit and revenue provisions separately.

This separation of legislation between the revenue and benefit aspects is in keeping with previous practice. In both 1935 and 1937 legisla tion relating to railroad retirement was considered and enacted in this way. I was one of the authors of that bill, too.

Another reason for separating the benefit and revenue provisions is that under present arrangements in Congress different committees are concerned with these two matters. In the Senate, for instance, the Committee on Education and Labor handles all health legislation such as the hospital survey and construction bill, and the Public Health. Service Act. The many technical problems involved in revenue legislation are handled by the Senate Committee on Finance. Similarly, in the House of Representatives, health matters are handled by the House Committee on Interstate and Foreign Commerce, but reve nue matters are handled by the House Committee on Ways and Means The financial details relating to the raising of the revenue for the plan raises many special problems which have a bearing on existing income taxes and pay-roll contributions and should be considered i relation to these laws.

In terms of priority, it is essential that the benefits should be given consideration first. If the Congress thinks that health insurance benefits should be provided, then the method of financing can be worke out in terms of the scope and character of the medical care provided

Now as to my summary, during the course of the hearings befor your committee you will hear from experts who will testify on th technical aspects of the bill. I hope that the committee will incorporate in the bill any constructive suggestion that will come out of the hearings so that we can have a comprehensive health insurance plat that will meet the needs of the American people.

(The summary is as follows:)

SUMMARY OF WAGNER-MURRAY DINGELL NATIONAL HEALTH BILL S. 1606; H. R. 475

The bill provides for a national health program, including

I. Community-wide health services

Federal grants-in-aid to States for (1) expanded public health services, ( expanded maternal and child health services, and (3) medical care of need persons. Federal Government will pay between 50 and 75 percent of what

State spends for such programs, with poorest States getting the largest percentage of Federal aid. Administration of these programs will be coordinated with— II. A Nation-wide system of prepaid personal health service benefits

1. What will benefits include?—All needed preventive, diagnostic, and curative services by a general practitioner, specialists' and laboratory services, special medicines and appliances, and hospital care up to 60 days, or 120 days if funds permit; dental and nursing services are provided but may be limited at the outset of the plan if personnel is unavailable.

2. Who will be eligible for the benefits?-All employees in industry and commerce (except railroad workers), agricultural and domestic workers, employees of nonprofit institutions, farmers, small businessmen, and other self-employed persons, and recipients of old-age or survivor's benefits will be covered. So will wives of employees and self-employed persons, their children under 18 (or over 18 if disabled), disabled husbands, and dependent parents. Other persons may qualify if contributions are paid on their behalf by a public agency.

3. Will there be free choice of doctor, dentist, nurse, or hospital?—Yes. Every eligible person will be allowed to choose his doctor, group clinic, dentist, nurse, or hospital from among those participating in the plan. Every licensed physician, dentist, or nurse, and every qualified hospital is guaranteed the right to participate. No practitioner or institution will be required to participate.

4. How will the plan be financed?-Through a special "Health services account" in the United States Treasury. To this account will be credited an amount equal to 3 percent of earnings up to $3,600 a year in covered employment, and other sums to cover specified items of service and care for special groups such as needy persons and others on whose behalf premiums are paid by public agencies.

5. How will the physician be paid?—According to the method (fee-for-service, salary or per capita basis, or combinations) chosen by a majority of physicians in an area. Individual physicians or organized groups may be paid by a method other than that chosen by the majority, under mutual agreements between them and the insurance administrators.

6. How will the plan be administered?—Through the United States Public Health Service, with decentralized administration. Special provision is made to utilize State and local agencies. A National Advisory Council, with professional and public representatives, will advise the Surgeon General who must include their recommendations in his report to Congress. Local advisory councils are also to be set up.

7. Provision is made for assuring high-quality care, and for medical research, and training of doctors and other health workers, with priority being given to projects for training of men and women returning from the armed forces. PERSONAL HEALTH SERVICE BENEFITS AVAILABLE UNDER THE NATIONAL HEALTH ACT

The National Health Act (S. 1606; H. R. 4720) provides for comprehensive medical care for workers and their dependents and for other insured persons. Care would be provided by the physicians, dentists and hospitals chosen by the patients from among all in the area who participate in the plan.

The following services would be provided:

Medical care. All needed services that can be furnished by the family physician or general practitioner at the office, home, or hospital.

Specialist care.-Services from a specialist or consultant, when recommended by the family physician or general practitioner or by another specialist who is attending the patient.

Surgical care.-Major and minor surgery available immediately. No limit on number of surgical cases per year.

Maternity care.-Available immediately.

Preventive care. All types of preventive services, including health examinations.

Hospital care.-Up to 60 days per person in each year (or 120 days when funds permit). Up to $7 per day, for basic accommodations, for the first 30 days; up to $4.50 per day thereafter. The insured person may use more expensive room accommodations and pay the hospital the extra cost. Provided in a general or special hospital.

Dental care.-At least: examinations, cleansings and (if the physician also advises) extractions. More complete dental services, especially for children, will be provided insofar as dentists and other nersonnel are available.

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Nursing care.-Necessary nursing services will be provided for hospitalized cases. Also, when requested by the physician, for cases at home, up to the limits of available nursing personnel.

Eye care-Eye examinations and glasses provided, when prescribed by the physician or optometrist.

X-ray, etc.-X-rays for diagnosis and treatment, electrocardiograms, basal metabolism tests, and all other diagnostic tests provided, when requested by the physician.

Laboratory services.-These services provided, when requested by the physician. They include blood tests, urine analyses, tissue examinations, etc. Physiotherapy.-These services provided, when requested by the physician. Medicines. Expensive drugs and medicines will be provided when prescribed by the physician.

No illnesses excluded.-None. Hospital care, however, will not be provided for more than 30 days following the diagnosis of tuberculosis or a psychosis. Also, since special institutional arrangements are needed for tuberculosis and for mental or nervous diseases, and, in large measure there already are arrangements for such cases in tax-supported hospitals, care in such special hospitals is excluded.

WHY VOLUNTARY HEALTH-INSURANCE PLANS CAN'T DO THE JOB

The National Health Act (S. 1606, H. R. 4730) provides among other things for comprehensive prepaid personal health services for gainfully employed workers and their dependents. Physician's care in the office, home and hospital. and hospital care would be provided by physicians and hospitals of the patient's choice. X-ray and laboratory services, and related services, certain medicines and appliances, and (possibly limited) dental and home-nursing care would also be provided.

Some of the services provided under this bill are now available to some people through voluntary prepayment plans. The questions are raised, "Why can't voluntary plans do the whole job? Why have a compulsory insurance system?" Why voluntary plans can't do the job. The reasons are found in the experiences of the voluntary plans themselves.

1. Complete coverage unattainable.-No type of voluntary plan, here or abroad, has succeeded in including all of the population in a region or has even approximated this goal. As a rule, those who are most in need of protection are not covered. Experience the world over has shown that only through social insurance can complete coverage, and certainly coverage of those most in need of protection, be assured.

2. Membership restricted.-Most or all existing voluntary plans have restrictions; some will not enroll persons above or below a specified age, or persons not enrolled in groups, or persons above a specified income. Some are limited to particular occupational or other groups.

3. Services limited.-Service provided in voluntary plans is usually limited, and such plans are tending to narrow the scope of services offered instead of broadening it. With only a few exceptions, the only plans with substantial membership are those providing only hospital care or care while the patient is in the hospital. In most of the plans with any considerable membership. care is not available until the patient is already seriously ill and needs hos pital, surgical, or obstetrical care. Most plans will not give care for preexisting conditions or chronic illness and many exclude care for various specified conditions.

4. Patients charged extra.-Many plans that give more extensive care limit the total money value of care that will be provided in a year; or they require the patient to pay regular fees for the first one or two calls in each illness. thereby discouraging the patient from seeking care early in an illness.

5. Costs are high.-Because voluntary plans tend to attract those whe expect to need medical or hospital care, the premium costs are necessarily higher than with comprehensive coverage. Enrollment costs, and the con stant turn-over in membership, contribute to increase the overhead costs of voluntary plans.

6. Contributions not related to ability to pay.-Usually in voluntary pla contributions are not related to income; under the National Health Act pas ments would be related to ability to pay.

7. Consumer not represented in management.-Voluntary plans owned by groups of physicians or sponsored by medical societies exclude the consumer from planning and management.

The passage of this bill will not interfere with the continuance of existing voluntary organizations or agencies that provide medical or hospital services. On the contrary, the health insurance system would provide new opportunities for them to provide more service. An insured person may choose such an organized group, rather than an individual physician, if he prefers, and be entitled to receive all the insurance benefits which the organized group is equipped to provide.

WHAT THE NATIONAL HEALTH ACT WOULD MEAN TO THE MEDICAL PROFESSION

The National Health Act (S. 1606 and H. R. 4730) provides for a system of prepaid personal health service for gainfully employed workers and their families. Medical benefits provided through the bill include all needed service-preventive, diagnostic, and curative-furnished by a general practitioner of the individual's choice (from among all doctors in the area participating in the program), specialst and consultant services, laboratory and related services, and necessary hospital care up to 60 days a year for each member of the family, or 120 days if funds permit. Dental and home-nursing services are also provided, although these may be limited in scope at the outset of the program if there is insufficient personnel. All licensed physicians are guaranteed the right to participate in the plan if they wish to do so.

Aside from the benefits which the worker and his family would derive from this program, the plan would be of great benefit to the medical profession

1. Best possible care for his patient.-The physician would be able to use for his patient the full resources of medicine. All too often this is not possible at present, because the patient cannot afford the necessary expense. The physician would have the advantage of consultant, specialist, laboratory, and diagnostic services for his patient, hospital care, and expensive medicines and appliances. In other words, health insurance would make it increasingly possible for the physician to practice medicine in the way he thinks it should be practiced.

2. Improved relationships between patient and physician, with wider freedom of choice.-Under health insurance, the physician does not charge the patient; the strain of financial relationship between the physician and his patient is removed. By eliminating the financial relationship between physician and patient, there is wider freedom of choice; the fee no longer stands between the patient and the doctor. Under the bill, freedom of choice on the part of the patient and the physician is guaranteed; the patient is free to choose his own physician and the physician has the right to accept or reject a patient who chooses him.

3. Assurance of prompt payment of doctor's bills.-Physicians would be professionally independent, as they now are practicing as they now do. In addition, they would be sure of being paid for all services rendered to insured persons. The present burden of providing care, free of charge, for the poor would be eliminated in the case of all who are insured.

4. More adequate incomes.-Under this plan, most physicians would receive more adequate and more stable incomes. With the removal of the economic barrier between patient and doctor, there would be maximum utilization of the time of all available medical personnel. Under these conditions, a situation such as that in 1941, when more than one-fourth of the country's physicians had incomes below $1,200, is not likely to recur. 5. Increased opportunity to practice in the community of his choice.-By making money available to pay for medical care, regardless of any particular patient's income, physicians who wish to practice in low-income or rural areas may do so without the customary financial worry.

6. Opportunities for increasing his skill and knowledge.—The bill provides for professional and financial incentives for the professional advancement of physiicans. Funds would be provided for "refresher" and postgraduate work.

7. Advancement of the science of medicine.—Through the bill, funds would be provided for medical research and physicians would be informed of new and improved medical techniques.

WHAT THE NATIONAL HEALTH ACT WOULD MEAN TO HOSPITALS

The National Health Act of 1945 (S. 1606 and H. R. 4730) includes a plan for a national prepaid personal health service for gainfully employed workers and their families. In addition to general practitioner, specialist, and laboratory and related services (and dental and home-nursing services), the bill provides for necessary hospital care up to 60 days a year for each family member; if funds permit, hospitalization may be extended up to 120 days. All hospitals may participate in the program if they meet general standards set up by the Surgeon General after consultation with an advisory council.

Under the bill, each hospital may choose how it is paid. It can be paid directly from the insurance fund. Or else it can submit its bill to the patient and the patient will receive a reimbursement from the fund.

The bill provides that the Surgeon General shall exercise no supervision or control over a participating hospital and that requirements for participation shall not prescribe the adininistration, personnel, or operation of any nonFederal hospital. For the participating hospitals, the provisions of the bill would mean

1. Relief from the strain of meeting operating costs and balancing bud gets. Even in the period of wartime prosperity, with its increased demand for hospital care accompanied by increased ability to pay on the part of the public, the strain of keeping "out of the red" persisted for many hospitals. Assurance of payment for the hospital care of many patients who are unable to pay, would mean greater assurance of balancing the hospital budget. A contingency fund, such as that which would be established under a health insurance system, would assure stability of income to hospitals during the ups and downs of the business cycle. Since higher occupancy rates would result from the insurance program, hospital income would be increased.

2. Relief from the burden of providing free or part-free care to patients.— Hospitals would be guaranteed payment for essential care for insured patients, regardless of the patients' ability to pay. If public welfare agencies bring "needy persons" into the program, free or part-free care would no longer be a burden to be borne by the hospital.

3. Encouragement in the construction, expansion, and improvement of hospital facilities.-In many communities, capital funds can be found to construct needed hospitals if future financial means are in sight to support the institution and its personnel. By providing payment for necessary hospital care, the bill would enable hospitals to meet their operating costs and, as a result, give them the needed financial encouragement to improve and expand their facilities. Through the Hospital Survey and Construction Act (S. 191), already passed by the Senate and now before the House, grants are to be made available for the construction of needed hospitals.

4. The assurance of competent hospital personnel.--With prompt and adequate payments to hospitals, they will be able to afford the competent, high-calibered personnel necessary for their efficient operation and the provision of high-quality care.

Moreover, hospitals will have increased opportunities to further improve and extend the training of interns and student nurses. This, in turn, will result in higher standards of service within the hospital.

WHAT THE NATIONAL HEALTH ACT WOULD MEAN TO VETERANS

Passage of the National Health Act (Senate bill 1606; House bill 4730) would put into effect most of the national health program called for by President Truman. It includes a plan of prepaid personal health insurance, as a part of the social security system. Gainfully employed workers and their families could get needed medical and hospital care, from the doctor or hospital of their choice, and have the bills for such services paid from the insurance funds.

The National Health Act leaves open the question as to how the costs of the health insurance benefits are to be divided among workers, employers, and the Government, all of whom already spend money for medical care. The total costs of the insurance benefits are estimated at about 3 percent of earnings, up to $3,600 a year, at the beginning; they might be as much as 4 percent later. Congress will, no doubt, want to hear from the public how these costs should be met.