their opinion is in the public interest in helping the people preserve their health? Dr. SENSENICH. That is right. Senator PEPPER. And this is not a matter that the people have elected the doctors to decide for them. We have got a perfect right to draw up any data that we think is relevant to the subject and to legislate in this field as in other fields? That is correct, is it not? Dr. SENSENICH. Correct, if I may answer one thing: I think they would expect that you would get the best advice you could get in the preparation of that legislation. I do not think any legislator with nonmedical experience is competent to judge. That is with all due respect. Senator PEPPER. But you will have to admit that in the trial of a case at law if a witness has a personal interest in the matter, the jury is entitled to know that the witness has a personal interest in the advice he is giving? Dr. SENSENICH. That is right, sir. Senator PEPPER. All right. Dr. SENSENICH. But we must also know that the public has an interest. Senator PEPPER. The difference of it is that we Senators do not make any more money if we pass a good health bill, but a doctor may make more if we do not. Dr. SENSENICHI. That is not the fact. Senator DONNELL. Well, Mr. Chairman, I think it is only proper to state at this time that the testimony adduced up to this point by the proponents of the bill has been to the effect that the installation of S. 1606 and the plan thereunder will actually prove more beneficial to the doctors, as Dr. Butler indicated in his testimony. The CHAIRMAN. To the great majority of the medical profession. Senator DONNELL. Yes, sir. The CHAIRMAN. But not to those at the top of the medical profession. Senator DONNELL. Well, I think, Mr. Chairman, the fact is that the American Medical Association is constituted of over 125,000 practitioners who are physicians all over the United States. Dr. SENSENICH. That is right. Senator DONNELL. They are representative, do you not consider, of the views of the medical profession taken by and large over the country? Dr. SENSENICH. That is right, sir. Senator DONNELL. And the house of delegates has expressed its opposition to compulsory health insurance? Dr. SENSENICH. That is right, sir. The CHAIRMAN. And the house of delegates, according to some critics of the American Medical Association, is far behind the times in this field? Dr. SENSENICH. I should not say that that was factual. The delegates are elected for a 2-year term, and I have never known any democratic institution in which its governing body or policy-making body did not reflect the attitude and belief of its membership, when they are elected every 2 years. Senator DONNELL. Is it your judgment that the house of delegates does reflect the present, up-to-date opinion of the medical profession? Dr. SENSENICH. There is no question about it. Dr. SENSENICH. Beyond question. The CHAIRMAN. Well, thank you for your testimony, doctor. I think you have given us a lot of inspiration here to study this problem very carefully, and we are glad to have you, and I am sure we will benefit from the discussion. Dr. SENSENICH. Thank you very much for having heard us. We have other witnesses. The CHAIRMAN. Well, now I think we will recess until 2 o'clock. Dr. SENSENICH. That will be fine, sir. The CHAIRMAN. 2 o'clock. Dr. SENSENICH. Thank you very much. (Whereupon, at 12: 15 p. m., Wednesday, April 17, 1946, adjourned to meet at 2 p. m., Wednesday, April 17, 1946.) AFTERNOON SESSION (The hearing was resumed at 2 p. m.) The CHAIRMAN. The committee will come to order. Senator Donnell, this morning there was some question raised with reference to the question as to whether or not the bill, the pending bill, had any provision for preventive medicine. I wish to call attention at this time to the section 213 of the bill on page 63, which provides as follows: SEC. 213. For the purpose of encouraging and aiding the advancement and dissemination of knowledge and skill in providing benefits under this act and in preventing illness, disability, and premature death, etc. Again over on page 65, subdivision (b) of section 214 provides as follows: (b) The term "general medical benefit” means services furnished by a legally qualified physician or by a group of such physicians, including all necessary services such as can be furnished by a physician engaged in the general or family practice of medicine, at the office, home, hospital, or elsewhere, including preventive, diagnostic, and therapeutic treatment and care, and periodic physica. examination. I believe there is reference also to preventive medicine in some other parts. All through title I, in the grants to States you will find references to preventive medicine. Senator DONNELL. Yes, sir. The CHAIRMAN. The first witness this afternoon is Dr. Lowell S. Goin. Before we call on Dr. Goin, I wish to have inserted into the record at this point a statement that has been filed by the State Mediical Association of Texas. (The statement is as follows:) Hon. JAMES E. MURRAY. STATE MEDICAL ASSOCIATION OF TEXAS, OFFICE OF THE SECRETARY, Fort Worth, Tex.. April 15, 1946. Chairman, Committee on Education and Labor, United States Senate, Washington, D. C. DEAR SENATOR MURRAY: The State Medical Association of Texas, with a membership of 6,000 practicing physicians appreciates your courtesy in permitting us to go on record as being opposed to the enactment of Senate bill 1606-the Wagner-Murray-Dingell bill. Our investigations show us that not only the physicians of Texas but the citizens of Texas by an overwhelming majority are definitely opposed to the Wagner-Murray-Dingell bill, inasmuch as it constitutes compulsory prepaid health insurance under Federal control. As evidence of this definite State-wide opposition on the part of the people of Texas, we point to the fact that a large section of the Texas press, including both large daily newspapers and small country weeklies, have placed themselves editorially on record in opposition to this proposed legislation. We also would respectfully call your attention to the fact that the representatives of the State of Texas in the Congress have, by a large majority, gone publicly on record as being opposed to this Federal legislation. Texas is a pioneer State, a vigorous, fast growing commonwealth. The average Texan thinks and speaks for himself, and above all things jealously guards his freedom of choice in matters which effect his personal liberty and pursuit of happiness. Texans gained their liberty by fighting for it and it is not thinkable that a citizenry which holds such a pride in their State as do Texans, will willingly agree to the regimentation of themselves and their affairs, during peacetime, by any Federal agency. We venture to say, judging from the expressed attitudes of the press of Texas and its duly elected representatives in Congress, that should the matter of compulsory Federal health insurance be put to a vote of the people of Texas it would be defeated at the polls by an overwhelming vote. The people of Texas do not want Federal medicine. They wish to retain their full liberty to select and patronize the physicians of their choice without being handicapped in even the smallest way by any Federal law or directive. As to Senate bill 1606 and its many complicated details, we wish you to know that a majority of the State Medical Association of Texas, all its officials and all its committees, have read this bill and studied it in detail. In fact, special group meetings of doctors have been called for the purpose of reading_the_bill in full and discussing its multitudinous and complicated provisions. In these considerations of the Wagner-Murray-Dingell bill the members of the State Medical Association of Texas have attempted to consider the measure impartially and quite unselfishly. Their attempt has been to reach a very simple conclusionwould the Wagner-Murray-Dingell bill be helpful to the health, welfare, and happiness of the 7 million people who live in the State of Texas? Our considered conclusion is that this bill would not better public health in Texas. On the contrary, it would tend to destroy the present system of Americanized medicine in our State by substituting Federal control, and the wealth, welfare, and happiness of Texas generally would soon be seriously and adversely affected. In regard to title I of S. 1606, the State Medical Association of Texas certainly stands in full approval of Federal grants-in-aid to the States for establishing and maintaining adequate measures for the prevention, treatment, and control of venereal disease and tuberculosis, the extension of the Public Health Service, and the extending of maternal and child-health care to all mothers and children where personal payment for such service would constitute a hardship. Similarly, the State Medical Association most certainly favors Federal grants-inaid for the purpose of providing full medical care and hospitalization for the indigent. One section of the bill which would seem objectionable is the provision for training thousands of employees in public health work in some central Federal educational set-up in Washington. We believe that such training should be decentralized, and that training of public-health employees could more efficiently be carried out in the hospitals, universities, and other centers of medical education distributed throughout the United States. In such a manner the trainees could more readily become acquainted first-hand with widely varying health problems than they could if they were forced to secure such training in the highly political atmosphere of Washington, D. C. As to the provisions for Federal aid in the prevention and control of venereal diseases and tuberculosis, it is our opinion that laws already on the Federal statute books make ample and sufficient provisions for these activities. As to the construction of hospitals in locations where they are needed, we believe that this important matter is fully covered by the Hill-Burton (S. 191) bill which has already passed the United States Senate and is now under consideration by the House of Representatives. This bill, which depends upon the various States to make surveys as to where hospitals are most needed and where they would be self-supporting by the contiguous population appears to us to be the full and complete answer to the hospital construction problem. The Hill Burton bill has been endorsed as to principle by the legislative committee of the State Medical Association, and has the full endorsement of the America" Medical Association.' In regard to scientific and medical research, it seems to us that this is adequately taken care of in the amended Magnuson bill, S. 1850, which measure meets with the hearty approval of the American Medical Association and which undoubtedly will be endorsed by the State Medical Association at the earliest opportunity. The State Medical Association of Texas is opposed in every particular to title I of the Wagner-Murray-Dingell bill, which provides for prepaid personal health service benefits, and we believe that the people of Texas are similarly oppose No matter what any person, however exalted his position, might say in th regard, we are fully convinced that compulsory prepaid health insurance a definitely socialistic. When the Government goes into business, establishes a system of insurance to which everyone must contribute; when it regulates Lprovision of medical service through Washington; when it regulates fees th doctors are to receive when they participate in the system; when it regulates consultations and determines when consultants are to be consulted, we resper fully submit that this is very definite socialized medicine. We believe tha such a system, which interposes great groups of nonmedical Federal employees between the public and their doctors, would constitute a medical system both undemocratic and un-American. We believe that no universal plan of compulsory prepayment health insurance could ever be successful, or be operated efficiently unless the medical profession is thoroughly in accord with such plan and wholeheartedly cooperates in its administration. On the face of it, so far as Texas is concerned, hardly a doctor gives compulsory health insurance his approval. The State Medical Association of Texas and the many county medical societies representing the 254 counties of this State, are all on record as opposing this compulsory medical insurance plan. Their reasons are many and cogent. The feel that so far as Texas is concerned, with its wide-open spaces and vast areas which are thinly populated, such a complicated insurance system could b operated only under extreme difficulties. It is repugnant to the doctors of Texas that this proposed law, if forced upon them, would compel them to devote mary hours of their valuable time, which might be used in caring for the sick, to the making of voluminous reports, in triplicate, to Federal bureaus in Austin and Washington. The State Medical Association further feels that the Wagner-Murray-Dinge bill, which puts into the hands of one man, the Surgeon General of the United States Public Health Service, a tremendous power which could be wielded throug one vast central agency in Washington present political implications both elec and dangerous. While it is true that an advisory council of 16 members is provided for, yet it should be noted that such council would be appointed by ??Surgeon General himself, with the approval of the Federal Security Administra tor. Such a council, widely scattered throughout the United Sates, would "ke consist of members fully in accord with the political policy of the Surgeon G.9%. and like so many other councils of an advisory nature would, in effect, N innocuous and more or less a figure head. The State Medical Association believes that there would be definite danger of absolute dictatorship under any law whi would give the Surgeon General practically the sole authority to employ doctors and specialists, establish fee schedules for physicians, fix the qualification specialists, determine how many patients any doctor might have, designate an regulate hospital and clinics to provide service and negotiate contracts w public agencies, nonprofit groups and individuals for providing full medi benefits. It is our firm belief that such stringent Federal regulation affecting med* would definitely destroy the private practice of medicine in the United States Americanized medicine, under Federal control, would forever lose the time honored relationship between physician and patient and patient and physi in which is the base of its entire structure. The initiative of every doctor restricted and regulated by Federal law would be seriously handicapped and medi research and scientific progress on the part of individual doctors would soon d» come a thing of the past. The quality of medical care would deteriorate an the independence and self-respect of every practicing physician would corre spondingly suffer. The original Wagner-Murray-Dingell bill, S. 1050, which was referred to the finance committee of the Senate, did give some indication of the tremendous financial burden which it would impose upon the American public. The new Wagner-Murray-Dingell bill, S. 1606, is being considered without a single definite figure to indicate its cost or its terrific tax burden. The people of Texas, as well as the physicians of this State, realize quite well that the matter of dodging the financial requisites was not without a political bearing. However, since in this world nobody ever gets something for nothing, the American public eventually will have to foot this bill, and we believe that every worker and every employer will be surprised and shocked at what they will have to pay for compulsory health insurance if instituted by the Congress. Such payments, if estimated on the financial figures of the first Wagner-Murray-Dingell bill, would mean the collection by the Federal Government of between 3 and 4 billion dollars annually from the people of America for this single purpose. It would seem only fair to the people of the United States that a more definite figure of the cost of the Wagner-Murray-Dingell bill should be made public. Under the present circumstances the people are being asked to accept an additional tremendous financial burden, whether it is called contributions or taxes, the import of which the average citizen is at present unsuspecting and unaware. With Federal, State, and local taxation practically at an all-time high this additionl demand would make the present grievous tax burden almost impossible to bear. We believe that if the American public was thoroughly cognizant of what this proposed legislation would cost them, both workers and employers would demand the Wagner-Murray-Dingell bill die in your committee. The State Medical Association of Texas strongly advocates widespread prepaid health insurance to cover every family and every individual in the State, but it wishes such insurance to be voluntary and not compulsory upon the individual. Furthermore, the doctors of Texas favor the expansion of such insurance as offered by private enterprise rather than through Federal direction and control. Voluntary prepaid health insurance can be provided, and is provided, at a far less cost than contemplated in this proposed Federal legislation. The State Medical Association of Texas is actively upholding and sponsoring worthy programs for prepaid hospitalization and medical and surgical care. The State association has gone on record as approving both nonprofit and commercial prepaid health insurance plans, provided only that such plans are financially sound, give free choice of doctors and do not destroy the relationship between physician and patient. In particular, the State Medical Association of Texas has approved the Blue Cross group medical and surgical service in Texas, a nonprofit organization. Similarly it will approve other nonprofit plans, and by approval it means that the doctors of Texas are actively supporting such plans. Estimating from the provisions of the former Wagner-Murray-Dingell bill, S. 1050, that every worker would have to pay 3 percent of his earnings for compulsory health insurance, we wish to compare such payments with the cost of voluntary hospitalization and essential medical and surgical care as provided by Blue Cross plan in Texas. Taking the average worker, earning the annual wage of $2,600, 3 percent of such wage paid for compulsory health insurance would amount to $78 annually. This would cover the worker alone. The Blue Cross plan, when both hospitalization and essential medical and surgical care are included, would cost this worker and his whole family, no matter how many children. $4.10 a month or $49.20 a year. This would be a saving of $28 80 in actual cash expended by the individual worker. Full hospital, and essential medical and surgical care is offered to the unmarried person for $1.65 a month by the Blue Cross in Texas, with a corresponding saving, when compared with the exhorbitant rate likely for compulsory Federal coverage. Under the provisions of the first Wagner-Murray-Dingel bill, S. 1050, which is our only possible yardstick for estimating Federal health insurance cost, an unmarried worker earning $3,600 a year-the top bracket under the proposed law-would have to pay $108 annually to the Government for this compulsory protection. A combined hospital, medical, and surgical policy with the Blue Cross in Texas could he bought by this unmarried worker for $19.80 a year, a saving of $88.20 a year. The essential health insurance coverage under the Blue Cross plan would have the approval of the State Medical Association of Texas, and is as broad and as efficient as any plan which could be offered by the Federal Government. The State Medical Association of Texas will continue to use every effort in support of voluntary prepaid health insurance provided through private enter |