(a) Hospitalization 1. There are 135,000 members of our organization who are covered by a hospitalization program providing for full payment of semiprivate room accommodations for 120 days. All other hospital charges while confined during this 120 days are paid. The dependents of these 135,000 members, approximately 315,000 additional individuals, are also covered by this program, making a total of 450,000 individuals covered by this program. 2. There are 12,200 members who receive full payment for room charges (semiprivate or ward) for less than 120 days, and payment for only part of the hospital charges over and above room and board. Of this group, 9,500 also have coverage for their dependents for the specific program in effect. 3. There are 8,200 members who have hospital coverage providing for $10 or more per day, with a specified maximum for other hospital charges. Of this group, 4,000 also have coverage for their dependents in the same amounts. 4. There are 12,300 members who have hospitalization coverage providing $10 or less per day for room and board, with a specified maximum amount for other hospital charges. Of this group, 11,400 also have the same coverage for their dependents. (b) Surgical care There are 139,600 members who have surgical coverage providing for a maximum fee of $250 or higher. Of this group all but a small group of about 550 have the same coverage for their dependents. There is another group of 24,700 of our members who have surgical coverage providing for a maximum fee of less than $250. Of this group, 19,200 also have coverage for their dependents. (c) Medical care, inhospital There are 148,500 of our members who, under their hospitalization and surgical program, have some form of inhospital medical care. These programs usually amount to an allowance of approximately $3 a day for each day of confinement, which is paid for doctors' visits for nonsurgical purposes. Of this group, 144,600 have similad inhospital medical care coverage for their dependents. (d) Medical care in o (d) Medical care in office or home There are 5,300 members who have insurance covering medical care for office or home visits. Of this number, 1,700 have similar coverages for their dependents. (e) Diagnostic X-ray and laboratory Diagnostic X-ray or diagnostic X-ray and laboratory benefits are provided for 126,500 members. At least 80 percent of these members receive the diagnostic X-ray only; diagnostic X-ray or diagnostic laboratory and X-ray benefits are provided for the dependents of 2,500 members. It should be noted that in almost every case the same programs which are in effect for our membership have been extended to other employees of the companies. This would mean an increase of about 15 to 20 percent in all the above figures to arrive at an accurate tally of all persons covered by the programs described. If we can be of any help to you further, please do not hesitate to let us know. With best wishes, I am, Sincerely yours, JOSEPH W. CHILDS, The CHAIRMAN. Are there any further questions, gentleman? If not, we will adjourn until 2 o'clock when the remaining witnesses will be heard. (Whereupon, at 12:30 p. m., a recess was taken until 2 p. m., the same day.) AFTERNOON SESSION The committee reconvened at 2 p. m., upon the expiration of the re cess. The CHAIRMAN. The meeting will come to order, please. Our first witness will be Dr. Morris Brand, medical director of Sidney Hillman Health Center in New York, and for 7 years acting medical director and associate medical director of Health Insurance Plan of Greater New York. We are very pleased, Doctor, to have you present today. We anticipate out of your experience you will be able to give us some worthwhile information. You may proceed. STATEMENT OF MORRIS BRAND, M. D., MEDICAL DIRECTOR, SIDNEY HILLMAN HEALTH CENTER, NEW YORK, N. Y. Dr. BRAND. The ACWA principles for a nationwide health pro gram: The Amalgamated Clothing Workers of America at its annual meeting in 1952 reaffirmed the following principles for a nationwide health program it had adopted at its convention in 1950. These principles called for 1. Establishment of a coordinated and integrated national health program, including national health insurance which will give all Americans, in health as well as sickness, access to the highest quality of medical care. 2. Aid to the professional schools through grants for training health personnel, including scholarships to students. 3. Aid in the building of hospitals and group medical practice clinics with a minimum of State and local matching funds. 4. Aid for the extension and expansion of State and local publichealth services. 5. Aid to maternal and child health services and expansion of programs for physically handicapped children. 6. Development of a mental-health program to improve our mental hospitals and for the training of psychiatrists and other mentalhealth personnel. 7. Aid in the understanding and prevention of chronic diseases and in increasing facilities and services for care of the mentally ill. 8. Extension of rehabilitation services to provide aid for those who become disabled each year. Similar principles for legislative action have been adopted by the Congress of Industrial Organizations, American Federation of Labor, and the International Association of Machinists. The Amalgamated Clothing Workers of America adopted these principles because it believes that the unmet health needs of its members reflect those of labor in particular and the Nation's population in general. And today, in anticipation of its 1954 meeting, the ACWA maintains that a healthier America cannot be hoped for unless the above principles are adopted and implemented. In 1951 a report by Senator Lehman's Committee on Labor and Public Welfare stated that about 50 percent of the population had some form of medical insurance and of this percentage only 3 to 4 percent had comprehensive type of coverage, that 15 percent had hospital insurance benefits, 21 percent had both hospital and surgical insurance, and only 11 percent had hospital, surgical, and some form of limited medical coverage. Last week Dr. Magnuson revised the overall figure when he stated that 90 million Americans are enrolled in some form of voluntary medical or hospital plans. In all probability there has been very little change in the percentage breakdown as given in Senator Lehman's report. However, in spite of the fact that 60 percent of the population have insurance coverage, Dr. Magnuson stated that only about 15 percent of private expenditures for medical care is covered by these insurance programs. Furthermore, the Amalgamated believes that the lack of any positive action in this direction, coupled with the recent trend of government to avoid expenditures in the health field, will spell continued hardships to a large number of the people in need of medical care now out of their reach both because of a lack of sufficient facilities and personnel and the everfiring economic barrier. The Amalgamated, therefore, views with some skepticism any stopgap legislation because such measures do not provide the necessary solution to a vital problem. Although labor has been aware of its unmet medical needs for some time, its primary concern was to improve the standards for living. Working hours had to be decreased and wages increased. As the workers unionized to become coherent vocal forces, labor sought and obtained labor-management grievance machinery, workmen's compensation legislation, child-labor laws, unemployment, retirement, and social-security benefits. Recently the trend in the labor movement is to obtain hospital and medical-care benefits not only for the worker but for the dependents. also. The workers want to provide themselves and their families with a medical security which will make available when needed, and unhindered by the specter of unpredictable high medical costs, the knowledge and skills of the American medical profession. Mr. Louis Hollander, cochairman of the New York joint board of the ACWA, has said: Labor views the whole matter of a worker's health fundamentally as an economic problem. The efficacy of even the most perfectly planned and most perfectly administered system of [industrial] medicine and hygiene is necessarily limited by the economic level of men and women who are potential patients of the [industrial] physician. I need not cite the statistics showing the coincidence of a high rate of morbidity with a low income level. Deeply aware of and driven by the need for medical care, labor has decided that it cannot and must not wait for legislative action and the medical profession to give it a practical solution for its medical care needs. Mr. Jacob Potofsky, president of the Amalgamated Clothing Workers of America, said: Since government is not ready to assume this responsibility [the health of the Nation], then enlightened industry and labor must do for themselves what the Government will not do for them. Also, Mr. A. J. Hayes, president of the International Association of Machinists, recently stated: It appears that labor unions must carry the ball as far as possible and prove by concrete example and experience the necessity for a much more adequate national policy. 39087-54-pt. 6- -34 Labor is taking such steps as it deems necessary to improve its health status. It has included in its negotiations demands for hospital and medical care benefits for the workers and, in some instances, has also obtained coverage for the workers' dependents. Management has acknowledged that the medical programs to which they are contributing have been instrumental in reducing the amount of illness in workers, decreasing their length and incidence of absenteeism, prolonged the working years of their workers, decreased labor turnover, improved plant efficiency, and improved labor-management relationship. Industry agrees that it is a good business practice to provide the workers with health maintenance, health repair and preventive services, as well as to their equipment and buildings. The skilled worker is worthy of management's investment in his health. The cost of providing medical-care benefits is offset by the lessened demand on community resources and a decrease in costs to the community. This investment has given a good dividend return to the workers, to the industrialists, and to the Nation. In the last few years that labor has become an organized purchaser and consumer of medical care, it has learned that when possible the following features should be incorporated in all medical plans it purchases or establishes: 1. Service: Medical and hospital service, rather than cash indemnification, should be a primary feature regardless of the scope of benefits rendered. This permits members to seek medical attention when needed without fear of unpredictable additional costs and without the necessity of an immediate cash outlay to meet the doctor's bills which, although reimbursable in part, create a large hole in the savings accounts and daily budgets. Studies have shown that most indemnification programs are inadequate, for on the average patients with catastrophic conditions have had to pay about 50 percent of the medical expenses incurred. Thus, the financial barrier is dented, but not removed. Labor, therefore, wants service, not only to avoid the fees above and beyond the indemnification, but also to permit persons to obtain early diag nosis and treatment rather than to wait until such time as the accentutation and multiplication of symptoms and signs of illness force them to seek medical attention. Delayed action because of the lack of sufficient funds to meet the high cost of modern medical care has all the potential destructiveness of a delayed action bomb-it can cause a great deal of damage. 2. Scope: The medical service must include a health maintenance program and preventive, diagnostic and therapeutic services. These should be provided by general physicians and specialists in the home, hospital, or the office. The services should also include dental care, psychotherapy, ambulance services, rehabilitation, social services and public health nursing. The services should come as close to the meaning of "comprehensive medical care" as is possible. Medication can be dispensed as part of the benefits or at a marked reduction of cost from a pharmacy in the center. Surgical and orthopedic appliances and eyeglasses can be provided at very reasonable costs by cooperative and nonprofit organizations. 3. Group medical practice: The organization of professional knowledge and skills, equipment and personnel in a single facility is in the best interests of both the patients and the physicians. Group practice assures the patients of the integration and coordination of professional opinions and a personal relationship not only with one physician, but a team of physicians. The group physicians derive certain economic, social and professional benefits inherent in group, but not possible in solo practice. 4. Control of policies: Consumers should have representation on the policymaking level. David J. McDonald, president of the United Steel Workers of America, recently stated: In order to succeed, the plans (Blue Shield and Blue Cross) must become community organizations based on wide public representation on your governing boards. Also, the CIO convention in 1952 included in its resolution the following statement: We support more effective representation of labor and other consumer groups on the governing boards of voluntary health insurance plans, of hospitals and similar organizations. Professional policies should be the responsibility of a medical board which may act in an advisory capacity to the board of directors or may be responsible also for the carrying out of the adopted policies. 5. Limitations: There should be no limitation because of preexisting disease or conditions, age, sex, creed, color, number and extent of services in the provision of medical care, whether in the home, center, or hospital. All active and retired members of the union should be eligible, and, also, if possible, the spouse and unmarried dependent children. Sufficient reserves should be established to provide service during periods of unemployment. 6. The medical staff: The staff should be selected in accordance with the professional standards adopted by a medical advisory board. The physicians' standards of living must not be encroached upon, but must be maintained always at a level which will permit them to maintain their dignity and responsibility in their communities. This would include appropriate payment for their services, tenure, and such social insurance benefits which labor enjoys for itself. 7. Quality of medical services. The quality and adequacy of medical care should be under the constant review of the administrative physician and the medical board. These are the fundamentals of a good medical plan. However, since legislative action is remote, labor is attempting to achieve better health either by the purchase of existing medical plans or by establishing its own direct service medical plans. The trend toward the latter is evident from the following: In St. Louis, the Labor Health Institute provides comprehensive medical care to about 14,000 persons. In New York City, the ILGWU Health Center, which is an AFL group, which has been in existence for 32 years, serves 200,000 persons, and in the past 3 years the Sidney Hillman Health Center was opened in the heart of the men's and boys' clothing industry to serve its 40,000 members; the Hotel Workers opened a center in the midtown area to serve 40,000 members; the Amalgamated Laundry Workers Union is building a center in Manhattan to serve 18,000 mem |