lieve the Federal Government of a financial obligation that would run into billions of dollars and expenditure annually. It would maintain the independence of the medical profession and insure to all the highest possible quality of medical care.

Part C, titled, "Grants to States for Medical Care of Needy Persons," page 26 of the bill; it is our studied opinion that by the addition of some 12 or 15 words in section 181 of part C of S. 1606, provision could be made for the achievement of the avowed objectives of all the protagonists of compulsory health insurance in this country. The changes would be:

Line 5, inserting the words "including hospitalization" after the word "care," and deleting in line 6 the word "needy" and inserting after the word "persons" the words "to whom the payment for such services would be a hardship." This vital paragraph would then read as follows:

For the purpose of enabling each State to provide medical care including hospitalization as far as practicable under the conditions in such State, for persons to whom the payment for such services would be a hardship there is hereby authorized to be appropriated for the fiscal year ending June 30, 1946, the sum of $10,000,000 and there is hereby authorized to be appropriated for each fiscal year thereafter a sum sufficient to carry out the purposes of this part. The sums made available under this section shall be used for making payments to States which have submitted and had approved by the Social Security Board (hereinafter referred to as the "Board") State plans for medical care of needy persons. End of the suggestion for amending that subsection.

Thus, modified section B of S. 1606 would create the machinery for establishing State agencies which would be provided with funds to insure full medical care through local groups to every man, woman, and child in the United States.

Under such provisions, all the objectives so extensively detailed under title II of S. 1606 would be provided, but would require the "matching" of all Federal funds with State funds for the accomplishment of the purpose. This would eliminate the necessity for the limitlessly cumbersome machinery that would be entailed under the provisions of title II of this proposed legislation, and let us set about the task of providing medical care on a basis that is:

First, actually preferred by the people of the United States.
Second, wholly acceptable to the medical profession.

Third, that would insure the continuation and further improvement of the most effective medical service that has ever been provided.

ENDORSEMENT OF S. 191

In addition to approval, as qualified, of clauses A, B, and C of S. 1606, we are wholeheartedly in favor of the Hill-Burton bill, S. 191, which on December 11, 1945, was passed by the Senate and now is awaiting action by the House. Due largely to concentration on essential war efforts and the resulting lag in construction of health facilities, there is an urgent need for health center and hospital buildings. This need is universally recognized.

The Hill-Burton bill, S. 191, would make available Federal funds for surveys of hospital needs and grants-in-aid to States, and grants to political subdivisions and nonprofit agencies to supplement local funds to insure the building of adequate facilities. It has our unqualified approval.

OPPOSITION TO TITLE II

The PM stated that the main bulk of the National Physicians Committee literature is filled with an all-out attack of the bill's vita: provision-one establishing a national compulsory health insurance system. It is obvious that if the actual purpose of this legislation is to provide full medical care for all persons to whom payment would be a hardship, full and adequate provision will have been made by enacting into legislation the first three sections of S. 1606, with the safeguards that have been indicated, and Senate bill 191.

Our opposition to title II of S. 1606 is based on:

First, our conviction that the establishment of this kind of a system would lead to a serious deterioration in the quality of medical care for all people, rich and poor alike.

Second, it would establish a core of centralized control, applying to the most sacred and vital wants of every human being, which one established would require a miracle for free enterprise in any of its forms to survive.

HEALTH INSURANCE A REVOLUTIONARY CONCEPT

Title II of this legislation is truly and limitlessly revolutionary in its purpose and scope.

First, it would introduce an actually revolutionary concept in social security, as we know it in the United States. Under existing law. employment offices are maintained, under Federal and State control. to find jobs for the unemployed. Provisions are made for aid to the aged, the blind, and for dependent children. Payments are made it cash. To beneficiaries under the Social Security Act, compensation is paid during period of unemployment. Payments are made in cash. Retirement benefits, death benefits for surviving relatives, monthly allotments for widows and dependent children are provided. The payments are made in cash. The new Wagner-Murray-Dingell bills would place in the hands of the Federal Government responsibility for providing medical care and hospitalization for all social security beneficiaries and their dependents. Authority is given a single poltcal appointee to hire doctors and establish rates of pay; to control and operate hospitals and actually dispense medical care to 110.00 people. No cash payments are involved. Assuming that at leas 100,000 physicians would be needed to service the plan, then in effet the Federal Government would establish 100,000 retail medical outlets. man them, and conduct the business of providing medical care, to say nothing of dental, hospital, and nursing services provided for in the bill.

Second, such a move would represent a revolutionary change in our whole concept of the distribution of medical care and of medical care as such. It presupposes standardization and mechanization of administering medical care. Such procedure would involve making the doctor subordinate to the bureaucrat. It would mean the regi mentation of the medical profession. Consummation of the plans inevitably would result in absolute regimentation of the people as far as medical care is concerned. They would be forced by law to accept such medical care as could be provided by the politically ap pointed administrator, or pay twice for the same service.

MEDICAL CARE WOULD DETERIORATE UNDER S. 1606

There are few people in this or any other country, even among the supporters of this revolutionary legislation, who do not acknowledge the actual superiority and effectiveness of the type of medical care that is provided by our free and independent medical profession. There are some factors in this situation that are somewhat difficult to understand, but they are vital to an intelligent solution of the problem which is generally recognized.

This vital quality of American medicine is aptly described in an editorial in a recent issue of the Journal of the American Medical Association, which quotes as follows from Sir Lionel Whitby in his inaugural lecture as regius professor of physics in Cambridge University:

The simple facts are that medicine is both a science and an art. It is true that medicine will never be an exact science, because the normal variations in individuals have such a wide range that automatic and mechanical treatment is prohibited, while every patient requires a different method of approach according to his psychology. But one of the attractions of the profession is the personal and individual character of its practice: the latitude with which a qualified doctor may exercise his own judgment, expres his own opinions, and practice his own art. This, indeed, is one of the strongest objections to nationalization and standardization. If the profession of medicine be robbed of its scope for individuality, the soul will go out of it.

This can all be simply covered by the statement that medical care such as has been provided the American people, cannot be measured by the hour, piece, or pound. The National Physicians' Committee has been and will continue to be in vigorous and uncompromising opposition to entrusting to any centralized authority the responsibility for the distribution of medical care and hospitalization for 110,000,000 people. The proponents of this legislation attempt to make the public believe that more people would secure better medical care. On the basis of every experience, the reverse is the inevitable result.

During the course of these hearings some statements have been nade which may or may not actually contribute to the factual infornation that should lead to a satisfactory solution of the problem of he idstribution of medical care. In the course of his remarks before he committee, Senator Claude Pepper departed from the normal practice with the following statement, which I quote:

I have no doubt that the opponents are quite sincere, but it is difficult not to tress that many of them simply parrot unsubstantiated slogans issued by a Propaganda organization, financed to a great extent by certain patent-medicine anufacturers, namely, the National Physicians Committee.

I am the chairman of the board of trustees of the National Phyicians Committee, and have been since the committee was organized n October 1939. I think it essential that it be known that the Naional Physicians Committee for the Extension of Medical Service is xactly what its name implies. It is strictly an independent commitee, representing physicians throughout the United States. It has any local and State groups that support its point of view.

SUPPORT OF THE COMMITTEE BY THE DRUG MANUFACTURERS

The term "patent-medicine manufacturers," used by Senator Peper, was apparently one of disdain, intended to discredit the institu

tion of which I am a part. For the record, may I say that during its more than 6 years of operation, not one of these so-called patent-medicine manufacturers has endeavored to influence the policies or point of view of the committee, or exert any influence in the expenditure of its funds. Actually, these firms to which Senator Pepper has referred are almost exclusively manufacturing pharmasists. These are the institutions that gave to us for war use the sulfa drugs, atrabine, and penicillin. These are the firms which, with mass-production techniques, became a deciding factor in the saving of lives within our armed services. Of them, Col. Parren H. Long said less than a week ago:

Their genius for organization and production should receive the highest praise from a grateful people.

A bulletin recently received from the British Medical Society stated. "Their genius for mass production"-referring to atrabine, the sulfa drugs, and penicillin-"became a vital factor in the winning of the

war.'

I want to place myself on record as being proud of having as supporters these men of the pharmaceutical manufacturing industry, who have so valiently contributed both in times of war and peace.

We do not have to go far afield for actual examples of the resultof the political distribution of medical care in the United States. Les than a year ago, the discovered abuses within the Veterans' Administration provided irrefutable evidence of nepotism and patronage dispensing, that led to carelessness and a lack of effectiveness in action that actually startled the United States. This was of such a nature and of such proportions that General Bradley, the new Administrator of Veterans' Affairs, has approached the solution of care for the veterans on a wholly different basis, decentralizing the control. and attempting in every case, as nearly as possible, to provide veterans with the type of medical care that is available to the civiliar population.

In September of last year, the National Physicians Committee engaged the services of Dr. Herbert D. Simpson, professor emeritus of economics of Northwestern University, to make a study of the inc dence, development, progress, and prospects of physician-sponsored medical-care plans throughout the United States. In the text of this prepared study, now in the hands of the publishers, Dr. Simpso points out that physical revolutions always follow in the wake of scientific discovery and revolution; that there must always be a lag between the scientific development and its universal application.

Approximately 150 years ago, the steam engine was invented. It led to what is now known as the industrial revolution. Fifty years ago, the internal combustion engine was developed. Certainly, i has revolutionized transportation throughout the world, making pos sible the automobile and the airplane. Yet nearly half a century passed before 20,000,000 automobiles dotted our highways. Scientists have discovered the principles, applied them, and invented the atomic bomb. The repercussions from this development will be visible concentric circle form for all of the remaining generations of men. During the last 150 years, the progress in the scientific development of medicine has been without parallel in the annals of history. During the last 50 years, the range of knowledge has so expanded and the

discoveries have been of such import, that it amounts to an actual revolution. Dr. Simpson points out that we are in the process of applying this new knowledge on a universal basis. Given time, we can, without sacrificing our birthright of independence and freedom, continue to provide the American people with the most effective medical care ever imagined in this world, made available to an ever greater and greater number of people. I, personally, am not afraid of revolutionary change, if the change represents progress. The proposals under title II of this bill represent revolutionary change that could not mean anything other than retrogression and deterioration of our medical care and the loss, eventually, of our freedom.

The CHAIRMAN. Doctor, are you a practicing physician?

Dr. CARY. Yes, sir.

The CHAIRMAN. Where do you practice?

Dr. CARY. In Dallas, Tex.

The CHAIRMAN. Dallas, Tex. Are you a member of the American Medical Association?

Dr. CARY. Yes, sir.

The CHAIRMAN. How long have you been a member of that Association?

Dr. CARY. Since 1901, I think.

The CHAIRMAN. And the American Medical Association is the important association of the medical profession of the United States, is it not?

Dr. CARY. It represents the doctors in this country.

The CHAIRMAN. It is a well-organized and well-managed organization?

Dr. CARY. The most wonderfully democratic organization you know anything about, or, we know anything about.

The CHAIRMAN. And it has among its members the ablest members of the profession?

Dr. CARY. I would feel sorry for anyone interested in the profession who did not belong to it. There is no barrier; just a question of whether he is considered eligible in his home town.

The CHAIRMAN. Now, are the members of this National Physicians' Committee members of the American Medical Association, also? Dr. CARY. Yes, sir.

ORIGIN OF THE NATIONAL PHYSICIANS' COMMITTEE

The CHAIRMAN. Why was it necessary for the National Physicians' Committee to take on the task of opposing this legislation? Weren't he members of the American Medical Association competent to handle hat task?

Dr. CARY. I can answer that, I think, to your satisfaction, Senator. I am sure you remember the President of the United States appointed n 1935 an interdepartmental committee for study of medical care. And n 1938, in July, there was a meeting in Washington, to which very few loctors were invited. A great many so-called social workers, and welfare workers, and do-gooders were there in great shape; and to our consternation, the medical profession generally throughout the United States, we woke up and recognized that the greatest proparanda organization we had ever known or heard of was attempting to change the whole practice of medicine.