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Now, I was very much interested in the chairman's statement and his effort to find out what objection there would be to advertising these various groups. And while I was sitting there, thinking about the question, I felt that the chairman was talking about something that probably should be advertised, and that was that there existed this type of insurance medical protection. Dr. Loos, from his medical standpoint, could think of nothing except personal advertising of the medical profession. Now, they are two separate and distinct things. I don't think the chairman has any idea that he wants a group of doctors to go out and advertise that they are prepared to take care of people for a certain sum and that they are the best doctors to do this. But certainly there is an awful lot of education to be done with people in general, who don't know-and education is a slow process always, and, besides that, by the time you get one group well educated they die and you have got to start on another. I have been educating young men for 40 years in medicine, or trying to, and it always distresses me because the class I am teaching now doesn't understand anything about what I taught the class last year. And that is the way with the human race in general.

Advertising, it seems to me, is a very legitimate thing when it comes to putting before the people the advantages that can be gained from a certain arrangement giving medical services. But who the men are in those groups makes the difference as to whether they are successful or whether they are not; whether they are honest, whether they are conscientious, whether they have the equipment and the brains to do what they say they are willing to do.

The business part of this thing should be managed by people who know how to manage it, because, as I said before, medical men are notoriously poor businessmen. They are trained in and interested in taking care of sick people.

On the other hand, they don't want to be controlled in their efforts to take care of sick people by men who don't know anything about taking care of sick people.

So that here is a nice balance between a group who, like the Kaiser people, have gotten into selling medical services. Now they go out and hire doctors for a sum. The doctors don't have to work for them if they don't want to. But a young man coming out of medical college, who has had 4 years of college, 4 years of medical school, an internship, and a residency, is busted. He is probably 30 years of age and needs a job. Kaiser will pay him $6,000 a year. Now, if he loses his identity in going to work for Kaiser and being submerged in something like what the old VA Department was, they are not practicing good medicine. And he can become submerged if he is overcome and overpowered and overruled by a group of men who know business but don't know medicine. And our hospitals are the same way. Just consider that in a hospital a doctor, who is the supporting part of the hospital, with his patients, has no authority in that hospital at all. He can't hire anybody. He can't fire anybody. The superintendent and the board of trustees do that. And yet those doctors have to have certain things for their patients.

If they have a wise manager, and the staff complains about the dietitian, the wise manager doesn't say, "Well, that is the only one we can have, because she is working for so much, and we won't pay any more."

The wise manager says, "Well, now, if you fellows know a better dietitian who will give your patients better service, and we can afford to have her, you go out and look for her."

So they go out and look for her. And they may get 2 or 3 that they will recommend. To whom? To themselves. Yes; from the standpoint of whether that dietitian can give good service to their patients or not, they will look at that. But they send her to the


Now, the staff has said, "Any one of these three will suit us. Leave it up to the manager to hire the one that he thinks will fit into his organization best."

Then he has fulfilled his obligation to the staff. The staff have fulfilled their obligation to the board of trustees and the manager. And there is no friction.

But some managers want to tell the staff what they can have and what they can't have when they feel as though they needed something for their patients.

On the other hand, there are many of the staff who want to tell the manager how to run the hospital.

So, you have got two parts of an organization, neither of which can superimpose their will on the other one and have the whole institution a smooth-running institution.

That is the trouble, as I see it, with something like the Kaisers. It may be run the best in the world. I don't know anything about it personally. I have never been in one of their institutions.

There are certain people who think they are getting good service from Kaiser. There are certain people who think they are getting good service from a lot of doctors. Some of them, I think, are. Others I don't think are.

The chairman also spoke of the iniquities in the medical profession, this morning. We all know them. The medical profession knows them better than anybody else, and the medical profession has been trying to clean them up, all the way from the AMA and the College of Surgeons, both ways. They are the ones that have given the publicity to them, Mr. Chairman. We are the ones that have been writing the articles telling the iniquities. And we have made some of the profession very peeved by it. But all right. We are trying to clean some of those things up ourselves.

I don't want anybody to think the medical profession hasn't done a good job on trying to take care of sick people. But you will have to remember that inherently the medical profession is not a good group of organizers. They are suspicious of anybody when they talk about organizing a group of doctors, because to them that is regimentation, and that is, in their term, socialized medicine. I don't know what the term means, because there has been so much loose talk, and it has been used unfavorably so often, that I don't think anybody knows what you mean when you say "socialized medicine" unless you take a jump across the pond to England.

Mr. ROGERS. Well, whatever socialized medicine is, you are agin' it?
Dr. MAGNUSON. I would like to have someone define it first.
There are a lot of things I am not "agin"."

Some of my views might be described as a little socialistic, although I don't think there is anything socialistic in that report.

Mr. HALE. Doctor, just one other question. I suppose it is a fact that there are very few people in the United States who don't know they can buy life insurance. For one reason or another, they may not buy it. But there are certainly millions of people in this country who do not know that they can buy any kind of health insurance, whether of the ordinary commercial type or the Blue Cross type. Is that not true?

Dr. MAGNUSON. I don't know whether that is true or not..

I can't imagine anyone that has a radio not knowing that there is health insurance these days. Because every time you turn your radio on, somebody tries to sell you health insurance.

Mr. HALE. Be that as it may, I had the same reaction this morning as the chairman to the testimony about advertising the existence of this group-insurance plan. And I take it you agree that there is a difference between advertising the skill of an individual doctor and advertising the existence of a health-insurance program.

Dr. MAGNUSON. I certainly do agree with that. There is a great difference.

Mr. HALE. That is all.

Dr. MAGNUSON. One is education, and the other is pure professional advertising.

Mr. HALE. Quite.

The CHAIRMAN. Mr. Heselton?

Mr. HESELTON. In listening to your responses to Mr. Hale's questioning, particularly with respect to actuarial experience, if I recall correctly, last fall we had witnesses here from insurance companies. I recall in particular an individual from the Massachusetts Mutual.

I have been trying to find it in the record but have not been able to locate it.

But he certainly left me with the impression that there had been quite considerable experimentation and study undertaken by companies, that a good many of them are offering more and more insurance, group policies in particular. And I recall that a United Aircraft representative described in some detail a group program that they were putting into effect for their 15,000 or 17,000 employees, which covered catastrophic illness.

When your Commission was working on this phase of the problem, did you have any assistance from the insurance companies themselves, or from people who have undertaken this type of a program?

Dr. MAGNUSON. Yes, sir. We had one whole day devoted to the financing of various kinds of medical care. And there was one thing that was brought out there. These group-insurance policies, most of them, don't include families. The aviation industry has a group of comparatively young men. It isn't hard for an insurance company to cover that group of young men and older men doing certain types of work, not exposed to any undue health hazards and what not, in a particular part of the country, where there were epidemics once in a while but they don't follow a catastrophic trend. And that is quite different than covering the wives and children and the old people. As I said, you can get actuarial statistics on small groups, certain industries, and that sort of thing, but there are no statistics on the whole population.

Mr. HESELTON. Doctor, while Mr. Dolliver was questioning you, as to two or more recommendations you could not get into the report,

you said you would like to discuss them with the committee. I would like to offer you the opportunity.

Dr. MAGNUSON. Thank you very much.

In the first place, when we were going through this group of statistics, I asked how many school children there were in this country, and I got the answer: 31 million, approximately.

Now, from the draft records, I would say that there had been almost 30 percent of our young men turned down on one basis or another for the draft, because of some physical disability of one kind or another.

Mr. HESELTON. Was that during the war, or afterward?
Dr. MAGNUSON. That was before the Korean war.

Now, it is a good bet, from what we know, that these 31 million children between the ages of 5 and 18 don't have a competent examination once between the ages of 5 and 18 unless they are sick.

There are all kinds of disabilities that are incipient in children. For instance, in my own field, curvature of the spine, the thing comes on slowly, doesn't give any pain symptoms at all, and usually starts at a time when the mother is no longer dressing the child and giving the child a bath and that sort of thing. So all of a sudden when the child is 12 years old, she comes in and says, "Mary has a curvature of the spine that just developed last week." The doctor knows that has been coming on for 3 or 4 years and never was noticed until it got so bad the mother couldn't help seeing it.

Weak feet, one of the favorite causes of turndowns in the draft, is another thing. Posture, which has a great effect on health-these children with adenoids, pinched noses, mouth breathers, and hollowchested, potbellied individuals, can't be healthy. They have no vital capacity inside them, and their digestion isn't good. Their respiratory supply isn't good.

Those three things I have been talking about could all be taken care of in the school gymnasium if they were found.

In connection with that, and several years before, as a matter of fact in 1949, I came out with a plan on the establishment of diagnostic clinics in the smaller towns or smaller cities.

We have plenty of them that are not organized so far as the general community is concerned, but there are plenty of them in the cities, especially where there are medical schools. But most of the population doesn't live near a medical school.

Take a town of 10,000 or 15,000. Most of them have a hospital these days, and most of them have doctors, in the community. There is no reason why the doctors in that community can't center around a hospital and establish a diagnostic clinic, first taking the children of the community.

Now, the Government ought to be interested in an examination of children, because that is the future citizen, and that is where the start of the health

Mr. HESELTON. Can I interrupt you there, so that you will cover what I want covered? In my State of Massachusetts, so far as I know, we have a rather extensive number of clinics set up for the children. The one I am particularly familiar with in my own area has a local school doctor paid by the community, a local school nurse, and also a school dentist. They hold regular clinical sessions. They hold them all over the county in each community. And some of these

communities are very small communities, running only a few hundred people. In discussing the problems we have been studying with the chairman, I said we were missing a point, in that the Government has the Federal, State, and local commission studying the relationships and the duties and responsibilities of the various units of Government in the various fields.

The longer I have listened to the very excellent testimony that has come in here, and the more I study the problem, the more I realize that the Federal Government simply cannot, by itself, do a full job, or even a competent job, in this field. It has to be a partnership proposition.

Do you mean to suggest that if Massachusetts is doing that, they are way ahead of many of the other States?

Dr. MAGNUSON. Yes; they are ahead.

And on the other hand, I think they are fooling themselves more or less. You have one school doctor. How many patients is that school doctor responsible for?

Mr. HESELTON. Well, I could not tell you. It would vary, of course, upon the size of the community. But I can say that the doctor who handles most of that is one of the most competent pediatricians in Massachusetts. I have no doubt of that.

Dr. MAGNUSON. I don't doubt it. Massachusetts has done a grand job. But if the community would say, "Let's have a clinic once a week from the time school is out until half-past 6 at night," most of the doctors in that community, whether pediatricians, eye-ear-nose-andthroat men, general practitioners, or what, if they would form themselves into an examining line and pass that child on, 1 an orthopedic surgeon, 1 a nose and throat man, 1 a pediatrician, maybe 2 or 3 pediatricians, and a few specialists and general practitioners, most of those things can be picked up, if a man has his mind centered on one group of things. But by the time the pediatrician gets through making a competent examination, he has spent too much time on one child to give the other 969, or however many he is responsible for, a decent examination.

On the other hand, if you had a group associated at your local hospital, you could have a diagnostic clinic and run these children through and then put your discards in the hole for further reference, and then once a month or every 6 weeks have a group of specialists come down from Boston or the nearest town where you have specialists and have those calls come in for special examinations and special prescriptions. In that way the doctors in the community would learn, and the men from the larger towns, the specialists, would be able to devote time to the people who need their particular services, and you could do it for just as little money, I think, as you could with a few, a comparatively few, good pediatricians acting as school physicians. The school physician is certainly an important thing, and Massachusetts has done a grand job in it.

Mr. HESELTON. Do not misunderstand me, Doctor, I did not want to give you the impression I thought it was being done adequately. I think most of those intimately connected with it would agree with you, and I think your suggestion is undoubtedly an extremely valuable one, particularly in terms of what is in this record, as to the terrific losses, actual money losses, in wages and that sort of thing, for many

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