Do you have some pretty

Mr. SPRINGER. I see what you mean. substantial evidence that that has taken place?

Mr. CRUIKSHANK. Yes, sir; we hear a lot from our members that that is the kind of thing that is taking place.

Mr. SPRINGER. Under your plan, Mr. Cruikshank, would you propose to fix the fees of the doctors?

Mr. CRUIKSHANK. No, sir. Our plan provides that the doctors themselves would agree to appropriate fees, and then if those fees were approved locally in the State-and finally within the field nationally— but if they were approved locally in the State as an appropriate set of fees that would be the schedule that would be in effect.

Mr. SPRINGER. Going over to page 4 of your statement, if you will turn over to that, paragraph 3, the first sentence of that reads:

A satisfactory health program should at the very least provide a means of making possible the full prepayment of the costs of the services offered.

Is it your plan to get sufficient from the worker to make possible the full payment of these medical services?

Mr. CRUIKSHANK. Our plan is that the employer and employee contribution should be the basis of the payment, but we recognize that it is appropriate for the Government to make contributions out of the general revenues of Government to supplement it.

Mr. SPRINGER. That is the point I want to come to. How much do you think the Government ought to pay?

Mr. CRUIKSHANK. I think it is appropriate that they bear an equal portion, a third.

Mr. SPRINGER. Have you any estimate as to what the Government's portion would be?

Mr. CRUIKSHANK. I don't have an up-to-date one. I said, in response to a question by Congressman Priest while you were away, that I would submit an up-to-date estimate of the cost on the whole program.

Mr. SPRINGER. Have you made any preliminary survey of that?

Mr. CRUIKSHANK. Some 2 years ago before I left for Europe we had quite extensive surveys. I don't think they would be up to date now and I confess at the moment we did not anticipate the hearings on the health insurance bill at this time, and we were not prepared for those cost estimates up to date.

Mr. SPRINGER. Would you estimate that the Government share would be 2 billion? 3 billion? 4 billion dollars a year?

Mr. CRUIKSHANK. I just would not say now, Congressman. I will be glad to submit it.

Mr. SPRINGER. In Europe here is what we found, Mr. Cruikshank, that it became an impossibility to do the job which you are talking about in Britain. I am not saying it is impossible to do it in the United States. But here is what they were doing. The Minister of Health, the administrative civil servant by whom we were briefed on this thing, told us that they were not attempting to do it any more; that all they did at the first of the year was to allocate so much. For instance, if the budget of Britain was $37 billion for the year and they allotted $4 billion for health costs, they just set that off and said, "This is what we will allot this year." And then they just took it up and divided it down a line, and it came out in a lot of places short. But that is all that was done there, as they found it to be a prohibitive question of

costs.

In Sweden they just had not done that. In other words, they were doing pretty much full coverage of what they had gone into, but they were doing it differently from Britain, who was trying to do the whole thing and then found out they could not do it, and just allotted so much money, and that had to stretch, whether you got care or did not get it. That is the reason I raise this question of how much you think it is going to cost, because I think that is going to become one of your important items in this thing.

In the next paragraph I notice you say:

While 56.6 percent of all families in the United States have some form of insurance protection, the record shows that only 15.2 percent of all medical costs are paid by such insurance.

Well, that is largely due, is it not, to the fact that the people who are under these plans are people like me, who have taken this type of insurance, who are really the healthy part of the population, aren't they?

Mr. CRUIKSHANK. Well, sir, I do not believe that that is correct. But if it were correct it would be quite a serious indictment of these plans because it would show that they were just taking the cream of the risk and leaving the real bad risk unprotected. But what it really means is this: You see there is a great disparity. If the plans were comprehensive and 56.6 percent of the population were covered under them, then 56.6 of the total medical bill of the United States would be paid by insurance. But the medical societies and the insurance companies are saying you do not need to do anything. They come to you gentlemen and say, "You don't need to do anything more than we are doing now. The insurance companies can take care of this problem." You see they are not taking care of it. And they allege, in support of that, that they have 80 million-and just the other day I saw a higher figure, 90 million people insured. But if there are only 15.2 percent of the medical costs that are being paid by those insurance companies it shows that they are inadequate.

Mr. SPRINGER. You may be right on that, Mr. Cruikshank, but I think that the figures are deceiving in this. There is not any insurance policy that I know of that is going to cover everybody for everything, without quite an enormous premium. For instance, the two policies I have make no attempt to make it cover, and I do not understand they are going to cover everything. In many instances they would only cover a fraction if I have a catastrophic illness. They only cover 30 days under Blue Cross, and the other policy is only going to cover the maximum.

Mr. CRUIKSHANK. Suppose some fire insurance company in the District of Columbia would say, "We have written fire insurance on 50 percent of the real estate in this town," and then it showed that only 10 or 15 percent of the fire loss was paid by that company. You would say that there is something the matter with their policy.

Mr. SPRINGER. No, I do not think there is any comparison because actually the policies written are not full-coverage policies.

Mr. CRUIKSHANK. No; but they run about 80 percent or so.
Mr. SPRINGER. Full coverage?

Mr. CRUIKSHANK. And they are allowed to approach that.
Mr. SPRINGER. I have never seen a policy that is full coverage.
Mr. CRUIKSHANK. Now we are talking about the health insurance
policies, and one of the troubles with them is that they do not cover

the things that are most likely to happen, and do not provide full protection. They take out so many of the things; there is so much in the fine print that takes them out.

Mr. SPRINGER. That is very true, but that is what you are getting paid on, the basis of what your possibility of being sick is, isn't it? Now I think that a company could cover you if you chose to pay the premium that is necessary for that, could it not?

Mr. CRUIKSHANK. No. Many companies will not even attempt to write a full-coverage policy. We have tried in some of our group activities, our collective bargaining, to get full coverage, and actually the companies resist the attempt. Even with higher premiums offered, they resist the risks, they don't want to cover them.

Mr. SPRINGER. The only full policy I know is the ordinary polio that you get for $10 a year for a family. That is full coverage. Mr. CRUIKSHANK. Against that one contingency.

Mr. SPRINGER. Against that one contingency, that is very true in buying an insurance policy you are paying for just about what you get. If there was any better way of doing it I think some insurance company would have done it.

Mr. CRUIKSHANK. I am not making the point that the people are getting gypped on what they are paying for-I think many of them are-but that is not the point of this paragraph. I am saying that these two figures show that the commercial insurance companies and the other voluntary plans are not providing full protection for the people that they have covered. If they were providing full protection those two figures would be more nearly alike.

Mr. SPRINGER. Just to come back to one more question, Mr. Cruikshank, and I am through, in your union health plan, such as the St. Louis plan, what kind of coverage do you have for people above 60 years of age?

Mr. CRUIKSHANK. The people above 60 years of age are covered, completely covered. Now, of course, as primary beneficiaries, that is in a general workers' union, in a way, it is truckdrivers and warehouse people and some clerks and others, and there are probably very few people over 60 that are actually there, but they have parents, they have dependent parents and others who are covered, and they get the full coverage of protection.

Mr. SPRINGER. For how long?

Mr. CRUIKSHANK. As far as I know, there is no limitation.

Mr. SPRINGER. Suppose that person above 60 years of age has cancer, long term, requiring hospitalization for a period of 2 years. What is your coverage on that?

Mr. CRUIKSHANK. To my knowledge, there is no limitation there, but that would, in that group, probably be protected by the fact that there would be very few of them.

Mr. SPRINGER. What would be your situation with a longtime heart situation? The same?

Mr. CRUIKSHANK. The same, I believe.

Mr. SPRINGER. Including hospital care?

Mr. CRUIKSHANK. Yes, sir.

Mr. SPRINGER. That would be true of tuberculosis?

Mr. CRUIKSHANK. No, I think there are exemptions in the plan for the type of thing which the State has always taken, the tubercular patient and mental patient, primarily.

You see, the only exemptions are exemptions covered by other things. For example, an accident to a worker where he is covered by workmen's compensation; they don't duplicate that. And they don't attempt to duplicate the mental care that the State provides through its mental institutions, nor tubercular. But the heart and cancer, for which there is no other provision, they do provide for.

Mr. SPRINGER. I believe that is all, Mr. Chairman.

The CHAIRMAN. Mr. Cruikshank, we certainly thank you for the opportunity that you have given to us to benefit by the wide experience that you have had in this subject, and the manner in which you have treated it, and the manner in which you have answered questions leaves no doubt that you are a qualified witness in a matter of this kind. We are certainly hopeful that as the hearing progresses and as the deliberation the committee is giving to the type of legislation that it will recommend progresses that we will have the benefit of such advice and counsel as you would care to give and that we would need in the drawing of legislation of this character.

Mr. CRUIKSHANK. Thank you, Mr. Chairman, and I want to thank you and the members of the committee for the courtesies you have extended me.

(The following additional information was later submitted by Mr. Cruikshank :).

TABLE 1.—National and international unions, United States, by affiliation and size of membership, January 19521

Includes at least 2 unions known by the Bureau to have been organized late in 1952. Although exact membership data are not available for all unions listed in this Directory, sufficient information is available to place all the unions within the groups in this table.

Source: U. S. Department of Labor, Bureau of Labor Statistics: Directory of Labor Unions in the United States 1953, (Bulletin No. 1127), Washington, U. S. Government Printing Office, 1953. p. 4.

TABLE 2.-Distribution of 9,000 labor-management agreements and workers covered, by size of agreement of coverage, 1950

Source: Bortz. Nelson M. and Moros, Alexander: Characteristics of 12,000 Labor-Management Con tracts, Monthly Labor Review, 73:34 (July) 1951.

TABLE 3.-Workers covered by employee-benefit plans under collective-bargaining agreements, by type of benefit and union affiliation, mid-19501

51

.6

248,000

3.5

85

9

595,000

8.3

55

800,000

11.1

25

3

942, 000

13.1

6

474,000

6.6

5

1,019, 000

14.2

1 Data based on information for 71 AFL unions, 29 CIO unions, and 31 unaffiliated unions. Also includes scattered AFL Federal labor unions and CIO local industrial unions and unaffiliated unions confined to a single plant or establishment.

2 Includes 1 or more of the following types of benefits: life insurance or death; accidental death and dismemberment; accident and sickness (but not sick leave or workmen's compensation); cash or servicses covering hospital, surgical, maternity, and medical care.

Source: U. S. Department of Labor, Bureau of Labor Statistics: Empire Benefit Plans Under Collective Bargaining, Mid-1950 (Bulletin No. 1017). Washington, U. S. Government Printing Office, 1951. 7 pp.