prise, believing that the voluntary system is the best system, the least expensive system and the most truly American system. There is no need for Federal medicine or its socialistic set-up, with low cost voluntary health insurance so widely available to the American public. In conclusion, we urge that your committee report unfavorably upon the Wagner-Murray-Dingell bill, S. 1606, in all particulars. Respectfully submitted. Attest: HOLMAN TAYLOR, M. D., Secretary. H. F. CONNALLY, M. D., President. NOTE-Attached, as exhibit A, in this submission is schedule of benefits provided by the Blue Cross plan in Texas, as referred to on pages 8 and 9 of this communication. (Exhibit A will be filed with the committee.) The CHAIRMAN. The statement of the State Medical Association of Texas refers to a schedule of benefits provided by the Blue Cross plan in Texas, and a copy of this document will be filed with the committee for the information of the committee. (The pamphlet, Blue Cross Comprehensive Service for the Whole Family, Dallas, Tex., is filed for the information of the committee.) The CHAIRMAN., There will also be inserted into the record at this point a statement from the New Mexico Medical Society, a statement from the Academy of Medicine of Cleveland, a statement from Dr. Franz Goldmann, associate clinical professor, of the Yale University School of Medicine, a statement from the Committee for the Nation's Health, and one from Alamance General Hospital, Burlington, N. C. (The statements are as follows:) STATEMENT OF CARL H. GELLENTHIEN, M. D., PRESIDENT OF THE NEW MEXICO MEDICAL SOCIETY, PRESENTED TO THE UNITED STATES SENATE COMMITTEE 05 EDUCATION AND LABOR, APRIL 17, 1946 Geographically, New Mexico is the fourth largest State in the Union. Only Texas, California, and Montana outrank it. It is a sparsely populated State, with roughly 3.5 people per square mile. The population in 1940 was 531,818 and the area 122,303 square miles, or approximately twice the combined area of all the New England States. It is divided into 31 counties, the smallest of which, Bernalillo, is as large as Rhode Island; and the largest, Socorro, has approximately the same area as Massachusetts. The major activities and Industries are agricultural; that is, ranching and farming. Sixty-six out of every hundred persons in 1940 lived in rural territory. Mora County, where I live, in northeastern New Mexico, has a population of 10,387, according to the 1940 census. The size of the average family is 4.5. The Spanish-American population in round numbers is 96 percent (and for New Mexico is about 40 percent). The area is 1,942 square miles. The majority of the population are small landowners, scattered in villages, in the canyons, or a ranches. According to the county extension agent, there are 54,000 acres of cultivated land, both dry and irrigated, and 1,120,000 acres of grazing land. There are no towns over 1,332 population in Mora County, no manufacturing of any type, no mining, and only a small amount of lumbering, which is mainly mine props or railroad ties. Only two towns, Mora and Wagon Mound, have electricity at present, but the Rural Electrification Administration is now building a power line in the county. There is opportunity for improvement in many things in New Mexico. There is need for improvement in the housing situation. While we do have a shortage of housing, it is due mostly to the migration from rural to urban centers as a result of increased annual incomes. In rural communities, they always have and can now build adobe and lumber buildings, shortage or shortage of building materials. The adobe and lumber are on the ranch and require only the physical effort to process and use them. Our biggest problem is to educate and sell the native New Mexican the pleasures of running water in the kitchen and an indoor toilet. The State public health department with the New Mexico Tuberculosis Association and the New Mexico Cancer Society, have struggled valiantly for several years for an improved educational program and enforcement of laws to better the public health and education of our people. The totally inadequate amount of money for public health and preventive medicine advancement in the 1945-46 Mora County budget was only $10,020, a per capita yearly expenditure of only 96 cents. The total assessed property valuation in the county for 1945 was $4,252,114. About half of this assessment was made against the Santa Fe Railroad, which is by far the largest taxpayer in the county. It has been very favorably inclined toward spending tax money for public health and we are very grateful for this support. Additional Federal appropriations for the advancement of the public health by preventive medical procedures for our people in New Mexico would be highly beneficial and much appreciated. There is great need for improvement in the venereal disease control program and clinics and the immunization program for the prevention of contagious diseases, such as smallpox, diphtheria, whooping cough, and typhoid fever among school children. The quality, type, and supply of clothing for all of us in the State can also be improved. There is still room for improvement in the quality and availability of good schooling for our children. The people of New Mexico, because of their geographic isolation, the wideopen spaces, and the peculiar requirements of ranch work, are resourceful individuals who do not like charity or hand-outs from the Government or anyone else. They like to stand on their own feet and pay their own way. The income per family from agricultural production has gone up markedly since the war and the income from other scurces last year was $1,500 to $2,200. The predicted combined income for New Mexico residents this year is expected to ammount to more than $390,000,000 or approximately $3,300 per family. If financial assistance were given to insure a better water supply for irrigation through the construction of small dams, production and the average annual income would rise tremendously. The medical profession of the State during the past year has organized a voluntary prepayment medical service program. Arrangements are being made with Veterans' Bureau to include the veterans living in New Mexico in this medical service plan. There are now 30,000 veterans in the State with a probable 50,000 by the end of the year. The medical profession intends to sell the voluntary prepayment medical service to the State department of public welfare. The department of public welfare will thus remove some of the stigma of charity and medical indigence from its clients by arranging with the State medical society to supply the medical service on the same basis as it does for the selfsupporting individual. It is also the plan of the medical society to incorporate the medical program of the Farm Security Administration and the Children's Bureau with its own. We in New Mexico feel that the quality of medical service will be enhanced by the small hospitals and medical facilities made available under the provisions of the Hill-Burton bill. We think this is a desirable piece of legislation and are planning to use its provisions to the best of our abilities. The cost of medical care to the people of New Mexico is adequately and economically taken care of by the voluntary medical service plan of the New Mexico physicians service now in operation. The middle-income bracket of our population can afford and is now buying this. The lower-income bracket, the medically indigent and so-called charity cases, will be better cared for than ever before, with the local and State political agencies buying this service for their clients. The New Mexico medical profession and the New Mexico hospitals have always taken care of the charity cases. We have never had a charity or county hospital in New Mexico. The higher-income bracket, the so-called rich, are not very numerous in the State, and are able to look out for themselves. Our greatest deficiency and most crying need in New Mexico is an adequate number of good, all-weather, ranch-to-market roads. That is the most important contribution to the welfare of the people of New Mexico that could be made. A glance at a map of New Mexico shows several large counties, sparsely populated, that have no doctor. They have never had a doctor or hospital, and no 85907-46-pt. 2- -5 doctor could afford to practice in these counties. If, instead of looking at political map, one looks at a topographical map, one immediately sees that the county is bisected by a mountain range or a canyon, thus making it impossible to get from one part of the county to another. In Rio Arriba County, the tow of Tierra Amerillo and Gobernador are 45 miles apart but one has to drive 345 miles to get from one town to the other. Sickness does not recognize political and artificial boundaries. There are two doctors of medicine in Mora County; one who is 73 years old and physically incapacitated, and myself. There is also one osteopath, an intelligent young man who realizes that he is inadequately trained to treat sick humans so is now doing pre-medical work and later plans to enter medical school. There are no general hospitals in the county, although we hope to build one at each end of the county under this Hill-Burton bill. If we had good roads so that a patient could be promptly taken to the nearest hospital, regardless of county or political lines, he would receive efficient medcal care, for there are two excellent hospitals in Las Vegas, 11 miles across the county line. It is common practice in the State for people to drive 50 or 00 miles to a movie or a hospital. To get to our county seat, some of us have to drive over 90 miles each way. The distances in the State are so great and the existing roads so straight and with so little traffic that we at Valmora, for instance, think nothing of driving 160 miles to Albuquerque, conducting our business, and driving back that evening. So, in summarizing, I express the sentiments of my fellow New Mexicans when I say, "We emphatically do not want more Government interference with our daily lives; we want less. We do not want more taxes; we want less. We defnitely do not want the provisions of Senate bill 1606 and its political regulation of our lives. We feel that if you must do something, then give us larger appropriations for the betterment of our public health and general welfare; give us good, all-weather, ranch-to-market roads and help us build small dams to insure ample water for irrigation so that we can raise bigger and better crops and get better prices for our ranch products. We New Mexicans feel that we have made satisfactory progress since 1540, when Coronado and his Spanish cohorts first arrived, and that we can continue t improve our housing, sanitation, clothing, schooling, and food supply according to the requirements of the times. You may rest assured we will continue to previde adequate and satisfactory medical care for our citizens. We want to do it on our own, however. We do not want to be regimented, socialized, communized. or regulated by Federal Government bureaus. If Congress feels that it must do something for the people of New Mexico, then help us to help ourselves, but dont try to make us wards of the Government. Hon. JAMES E. MURRAY, ACADEMY OF MEDICINE OF CLEVELAND AND CUYAHOGA COUNTY MEDICAL SOCIETY, 2009 Adelbert Road, March 15, 1946. United States Senate, Senate Office Building, Washington, D. C. DEAR SIR: The Academy of Medicine of Cleveland, comprising 2,000 doctors. wishes to submit this statement in objection to S. 1606-the Wagner-Murray bill-and respectfully ask that it be included and printed in the report of the hearings on this bill, scheduled to take place before the Committee on Labor and Education. American doctors-free men with free minds-unrestricted by Government directives and controls, have developed and given to the people of this country the most effective and widely distributed medical care that has ever been provided for any comparable number of people anywhere at any time. They have progressively provided a higher and higher quality of medical care for the people of the United States until this care is second to no other in the world. Through such voluntary agencies as the Blue Cross Hospital Plans, physician, sponsored medical service plans, employer-employee group insurance plans, all of which are growing at a remarkable rate, needed protections have been provided for more than 25,000,000 people. As of January 1, 1946, these voluntary prepar ment plans for hospital and medical care were in operation in 25 States of the Union, 4 States had plans ready to operate, and 4 other States had plans in the formative stage. The extension of these voluntary plans will provide other tens of millions of people with the means for the easier payment of the cost of medici! care. These voluntary methods will eventually provide every American with medicine and medical procedures of a higher quality than were ever before known or imagined. We object to S. 1606 because, if enacted into law, it would establish a health service completely socialistic in concept. It would establish the Surgeon General of the Public Health Service as medical dictator under the direction of the Administrator of the Social Security Board. It would regiment the doctors, dentists, specialists, nurses, and laboratory technicians; restrict the scope of a doctor's practice to limits set by law; fix the qualifications for specialists; determine what hospitals or clinics may provide service for patients and under what conditions; make a public record of the characteristics and most intimate and sacred personal relationship of each and every patient; and finally restrict the free choice of physicians in that only those physicians enrolled under the proposed plan can be chosen. We object to S. 1606 because this proposed program would entail the expenditure of billions of dollars more annually than the proponents of this bill estimate, and the recipients of any benefits under this program would be paying an inordinate price for such benefits as compared with similar benefits now available from private insurance companies or from voluntary prepayment plans already operating successfully. We object to S. 1606 because it is un-American. It regiments the medical profession and it regiments the American people under the dictates of a governmental bureau. The Constitution of the United States, the Bill of Rights, and the American way of life are diametrically opposed to regimentation. The basic tenet in a democracy is that the State is the creature of the citizen. Such revolutionary social planning as outlined in S. 1606 proposes that the citizen will become the creature of the State. This does mean the socialization of medicine and together with other similar un-American social plans will eventually lead to the complete socialization of American life. The Academy of Medicine hereby voices its unalterable opposition to the Wagner-Murray bill (S. 1606) and urges the complete defeat of this un-American proposed legislation. Very truly yours, FARRELL T. GALLAGHER, M. D., President. Senator JAMES E. MURRAY, YALE UNIVERSITY SCHOOL OF MEDICINE, Senate Office Building, Washington, D. C. DEAR SENATOR: AS Senate hearings about various health bills are about to start, I am taking the liberty of sending you herewith the transcript of excerpts from lectures of mine on the subject. Publication of the complete and edited text is scheduled for May issues of the New England Journal of Medicine. Very truly yours, FG/0 enc. FRANZ GOLDMANN, M. D., EXCERPTS FROM HEALTH BILLS PENDING IN CONGRESS, A SERIES OF LECTURES GIVEN AT THE HARVARD MEDICAL SCHOOL IN FEBRUARY 1946 BY FRANZ GOLDMANN, M. D., ASSOCIATE CLINICAL PROFESSOR OF PUBLIC HEALTH, YALE UNIVERSITY SCHOOL OF MEDICINE THE NATIONAL HEALTH BILL: DISCUSSION OF PROVISIONS Any plan for the improvement and extension of our health services must be judged strictly on the basis of merit. Unbiased analysis of the national health bill shows strong and weak points. The provisions of title I can be expected to exert a powerful and beneficial influence on the badly needed further extension and improvement of general public health, maternal, and child-health services. At long last the sound development of uniform medical care programs for the needy would be initiated. But there are weaknesses that should be eliminated. As it stands, the bill evades the undeniably intricate-problem of unification of the administration of health services at the State levels, thus continuing the policy of vesting authority in a multitude of State agencies. To give an example, 22 of the crippled children's programs at present are administered by agencies other the health departments. The measure requires the establishment of a single "public assistance agency" to administer or to supervise the State's medica care program for the needy. Thereby it would bring about a considerabi improvement but also perpetuate the old evil of dual administration, the publ assistant agencies being responsible for the medical care of the needy, and health agencies having authority for the medical care of self-supporting persons as well as preventive health services for all. At the Federal level not less thr: three agencies are charged with administrative responsibility, and cooperat and correlation, typical "Ersatz" products, are recommended. The sections dealing with medical care of the needy fail to eliminate the utterly inadequate method of making cash allowances to individuals for the pay ment of their bills and to require the use of the prepayment method for the support of services to the needy. Title II invites many comments on both strong and weak points. The "right to medical care" is established for all those covered by the program. wherever they live and whatever their income. With this we are nearing the realization of an old American dream-the dream of equality of opportunity for everybody to obtain good medical care. Fairly complete service is organized for the majority of the people under one program, in constrast to the old policy e offering more or less limited service under different programs. Broad coverag is essential from an actuarial point of view, as it makes for effective and ec nomical operation of a plan pooling the risks and resources. The scope of the service, fairly comprehensive as it is, compares favorably with that of very man voluntary health-insurance plans in operation. Continuation of the system f private practice of medicine, dentistry, and related professions and freedom choice, as proposed in the bill, are the very principles for which the professions have been fighting ever since there has been organized care of the sick. Thus, the professions are offered a unique opportunity to make the program work. The system of voluntary hospitals is maintained in conformity with the concepts and wishes of those who want scope and chance for voluntary effort and pallasthropy. Preventive medicine is encouraged through the combination of an organized program for the care of the sick with a system of services for the pre vention of illness and promotion of good health; the inclusion of diagnost laboratory services; the inclusion of “preventive" services and of “periodic phys ical examinations" or "periodic examinations" in the case of dental service; and easy access to early treatment. The quality of medical care is promoted by the comprehensiveness of the program; the exclusion from service of persons other than legally qualified på7sicians, dentists, and nurses; the encouragement of group practice; the availe bility of consultant and specialist services; the many provisions for the main tenance of professional and hospital standards; and the provision of funds for research and professional education. The proposed method of raising funds for the support of the program is sound and has a long and honorable record in this country as well as a score of foreign countries. It is superior to other methods finance, because it substitutes organized self-help for charity from the few to the many, eliminates application for aid and determination of eligibility on the bes of financial need, and relieves the administration of the cumbersome procedure inherent in any system utilizing the "means test." On the debit side of the ledger quite a few items have to be entered that deserve careful consideration. The success or failure of any health program, no matter how it is finance depends upon the willing and understanding cooperation of the members the various health professions. "Doctors can make or break it." The Wag Murray-Dingell bill gives the members of the professional groups importazi rights and defines them in detail. But it contains nothing about the duties the professions, except for the statement that the general practitioners in local areas who are participating in the program have a collective responsib to provide the general services. The question then is warranted whether a si isfactory operation of the program can be expected if the individual physicis have freedom of participation and the medical profession has no collective sponsibility for the availability of professional services. To quote from Carl Becker: "This is indeed the central problem of all political philosophy and praj tice, the problem of the one and the many-the difficulty being to reconelle desirable liberties of the individual with the necessary power of government |