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bers, the Joint Electrical Board, a lithographers' local, and a butchers union have opened centers to provide partial services with the expectation of expanding the scope at later dates.

In Philadelphia there are the ILGWU Health Center, the Sidney Hillman Medical Center, and the AFL union centers, serving about 50,000 members.

In Chicago the Amalgamated Clothing Workers and the Janitors Union are opening centers to serve about 18,000 members.

The San Francisco Labor Council of the AFL is surveying the needs of its members with the hope of organizing a direct medical service program in one or more centers.

The Amalgamated Clothing Workers of Rochester, Los Angeles, and Allentown, Pa., have also taken steps to determine ways of organizing medical services.

The United Mine Workers Hospital and Medical program is making great progress.

There are many other medical centers throughout the country serving union members. All of these are manifestations of labor's restiveness with the lack of a proper solution to its unmet health needs. Labor has established many of their programs as expedient measures with the hope that they will be supplanted or integrated in a national comprehensive health plan.

As an example of what can be accomplished, the experiences of the Sidney Hillman Health Center in New York City will be cited. The center has been open for services since April 1951. It provides the following services in the center only:

Allergy, cardiology, chest, clinical laboratory, dermatology, diabetes, electrocardiography, gastroenterology, general medicine, general surgery, gynecology, internal medicine, neurology, ophthalmology, orthopedics, urology, social hygiene, deep therapy, superficial therapy, diagnostic, radiology, psychiatry (diagnosis only) proctology, physical medicine and rehabilitation, peripheral-vascular, otolaryngology.

A staff of 24 general physicians and 50 qualified specialists, plus qualified technical assistants, registered nurses and therapists have provided the following services for the 32-month period ending December 31, 1953:

18,959 members used the service.

87,691 services by general physicians (including health examinations, emergency care, and revisits).

106,072 services by specialists. 15,603 radiographic examinations. 142,958 laboratory procedures. 39,310 physical and rehabilitative treatments. 9.561 other therapeutic services provided by paramedical personnel.

86,611 prescriptions dispensed in the center at cost of pharmaceutical plus the container.

The costs of the services in the center are borne both by the members and the employers.

Mr. Chairman, may I introduce for the record two annual reports, one from the Sidney Hillman Health Center, and one from the Philadelphia Sidney Hillman Health Center?

The CHAIRMAN. How long are they?

Dr. BRAND. There are quite a number of pictures in each. That makes the reading time. very short.

The CHAIRMAN. If you will hand them to the clerk, he will look at them and see if it will be possible to put them in the record.

Dr. BRAND. The above impressive record of services in the Sidney Hillman Health Center of New York is paralleled in the other labormanagement-sponsored medical centers.

This humanitarian activity can neither be weighed nor measured, but the labor leaders and industrialists who have been instrumental in making these services possible are more than rewarded when they witness the number of members who avail themselves of services which are there as a matter of earned right and are provided in modern centers on a personal level in a pleasant atmosphere and surrounding far removed from the outdated cheerless outpatient departments many have been forced to use in the past.

Rare is there a union member who does not voice his or her appre. ciation for a degree of medical security which otherwise they could not begin to purchase.

At the first anniversary of the Sidney Hillman Health Center, Mr. Isidore Grossman, president of the New York Clothing Manufacturers’ Exchange, said:

The ill face their lot with erect self-respect knowing that they will receive the best that medical service can provide and that is their due. I am glad to have lived and witnessed this change, and to have participated, to a slight degree, in forwarding such a progressive step.

Since home and hospital care are not included in its services the center provides family physicians who provide home and occasional office care to the members with diagnostic procedures and consultations they may need to assist them in the care of members outside the center.

In addition, the Amalgamated Clothing Workers of America includes in its nationwide social-insurance program hospital, surgical, and maternity benefits; life insurance, sickness disability, and retirement benefits.

There is one more interesting aspect to this direct-action program, and that is the research program. Labor, like industry, believes that it has a responsibility not only to its members, but to the community in general.

At the Sidney Hillman Health Center in New York City, $250,000 was allocated to a research fund and the Sidney Hillman Foundation added another $50,000.

At the present time a study is being made in the center by a special research team of the relationship of diet and ethnic background to the development of arterioscleroris. Another research program is in progress at the Philadelphia Sidney Hillman Medical Center, and a special study is in progress at the Hotel Workers Center in New York.

Labor's interest in this field of direct medical-service plans has made it aware of the need to establish a central agency which would collect and maintain information from existing plans on a current basis and analyze the statistics and other pertinent information, recommend the establishment of uniformity in cost and service accounting, make the information available to interested persons and also perhaps provide actual assistance toward the organization and establishment of plans and facilities.

At a meeting in 1952 of union officers and administrators of labor and management, direct-service programs, a committee was appointed to draft the bylaws for an organization which will have for its functions the above-mentioned purposes. It is expected that by making such information available to labor-management health and welfare trustees and to the administrators of medical-care plans, it will demonstrate the feasibility and practicability of direct-service plans, indicate how the consumer dollar can be used most efficiently, and provide a forum for discussion of problems encountered in the operation of their programs.

The Sidney Hillman Health Centers of New York, Philadelphia, and Chicago, and the Amalgamated Laundry Workers Center and all the other programs mentioned, are part of a significant movement which seems to be gaining momentum. The attack on health problems will not wait for legislators or organized medicine to join with labor, the consumer.

Dr. Allan Gregg, of the Rockefeller Foundation, wrote:

One of the most heartening and to me significant forces intluencing the practice of medicine today is the intelligence and the conviction with which health is being helped by the labor unions.

The Federal Government can be of further assistance in this progressive movement:

1. By passing legislation which will provide loans to labor-management health and welfare funds, to consumer-sponsored plans, hospitals, and other nonprofit organizations for the establishment of group-practice medical centers.

2. By urging the repeal of State laws which have been obstructing the establishment of nonprofit consumer-sponsored group-practice medical plans.

3. By taking appropriate action to convince the officers and leaders in the medical profession to cease their constant and more recently accelerated campaign of harrassment of voluntary medical-insurance plans sponsored by consumer groups.

4. By establishing a method of providing funds to purchase from existing community nonprofit plans prepaid comprehensive medical and hospitalization services for the unemployed workers and their families.

5. By making grants to schools so that sufficient physicians, dentists, and other professional and technical personnel could be trained.

6. By increasing the facilities to provide medical and rehabilitative services to persons with mental and chronic ailments.

7. By establishing a coordinated and integrated national program.

A vigorous health-minded legislative program is a positive measure which will result in a vigorous healthy America.

The CHAIRMAN. Are there any questions, gentlemen ?
Mr. HESELTON. Doctor, at the bottom of page 2 of your statement,

you state:

The Amalgamated therefore views with some skepticism any stopgap legislation because such measures do not provide the necessary solution to a vita) problem.

Would you care to elaborate on what you mean by stopgap legislation?

Dr. BRAND. Any legislation which will not provide the population with comprehensive medical care where preventive service is included, where means for early diagnosis and treatment is included.

I think that is what they have in mind.

Mr. HESELTON. Have you had an opportunity to examine any of the three bills that were introduced, I believe on the 6th of January, by the chairman of this committee?

Dr. BRAND. No, I have not.

Mr. HESELTON. Yesterday he introduced a quite comprehensive bill carrying out, I believe, specifically, the recommendations of the President in his message covering grants to States to survey their need for constructive diagnostic centers, chronic disease hospitals, rehabilitation facilities, nurses' homes, and also grants to States to assist public and nonprofit agencies in the construction of such facilities.

I take it you would not want to leave the impression that that type of approach is objectionable?

Dr. BRAND. No, I don't think we would consider it objectionable at all, as long as some standards are developed whereby all programs that would be beneficiary of such loans had a comprehensive program that would permit people to have early care, which is part of the program that is very necessary.

Mr. HESELTON. Of course, if I understood you correctly, the comprehensive program you have in mind is the ideal program. While anyone with good will would look forward to that, you have to crawl before you can walk, and to make some of these constructive starts would be advantageous, it seems to me, in the overall effort. Do you agree with me? Dr. BRAND. I would tend to agree.

Mr. HESELTON. You mentioned several times in the course of your statement I think the opposition that you had encountered from the medical societies; has your staff in New York been proceeded against in any way?

Dr. BRAND. Not at the Sidney Hillman Health Center, but when I was affiliated with the HIP, Health Insurance Branch of Greater New York, we at that time had the same pressures that Dr. Baehr mentioned in his testimony the other day.

Of course, throughout the country there have been various forms of pressure applied against physicians working with consumer-sponsored programs.

I believe the Cooperative Health Federation of America has a very good summary of that in one of their publications.

Mr. HESELTON. Do you find the situation differs in New York and Philadelphia and Chicago?

Dr. BRAND. Yes, it does differ. I believe there is a difference between New York and Philadelphia. In New York we have very little difficulty getting the physicians we need, but in Philadelphia they had to curtail their

program somewhat because of some medical society reaction.

I understand most recently that in Allentown, Pa., where the Amalgamated has tried to set up a diagnostic and the therapeutic service, they have met with some resistance and the program is now lagging.

We also know that various other consumer groups, of course, have had difficulty. There was the Elk City program and then there was the San Diego program, the Puget Sound program.

At the present time I think Twin Harbors, Minn., is in the throes of a legal battle with the society.

HIP, of course, is having its problem.

Mr. HESELTON. What has been your general experience as to the turnover of staff?

Dr. BRAND. In the Sidney Hillman Health Center, we have not had much turnover of staff. I would say about 70 percent of the physicians who were there at the end of the first year are still with me.

Mr. HESELTON. Are they, generally speaking, yomger physicians?

Dr. BRAND. No. At the end of 18 months of service I made a study of it and I found them somewhere in the middle forties.

Mr. HESELTON. I think that is all, Mr. Chairman.
The CHAIRMAN. Are there any further questions, gentlemen?
Mr. Derounian?

Mr. DEROUNIAX. Dr. Brand, what is the average compensation your doctors receive for their share of the work at the health center

Dr. BRAND. $6.35 per hour up to the end of 1953. We gave a slight increase as of January 1. So I don't know what the average will be for this month.

But prior to this month it was $6.35 because the general physicians receive $5 per hour and the specialists $7.50.

Mr. DEROUNIAN. Is that part time?
Dr. BRAND. Yes.
Mr. DEROUNIAN. Part-time practice for them?

Dr. BRAND. Yes. On an hourly basis we have a man for a 2-hour session, but it can be extended to 3 or 4 hours at a time. Practically every general physician has quite a number of hours during the course of the week. Specialists may be less.

Mr. DEROUNIAN. How much does you union member pay per month for the present plan?

Dr. BRAND. On an annual basis, $10 a year for each member is paid by the member, and the employer is contributing one-quarter percent of the annual wage. That contribution has only been since April 1, 1953.

Mr. DEROUNIAN. On page 10 you state that you do not provide home care and yet you say that you provide physicians who provide home and occasional office care to the members. Is that free to them, or must they pay a fee?

Dr. BRAND. That should be family physicians and the correction was made in the presentation. They don't get any reimbursement at all in the home care. They do get some reimbursement from the national organization for surgical care and in the hospital.

Mr. DEROUNIAN. They make their visits on their own?
Dr. BRAND. Yes.
Mr. DEROUNIAN. And they do not expect to receive a fee for it?
Dr. BRAND. That is right.
The CHAIRMAN. Mr. Younger.

Mr. YOUNGER. On page 12 you recommend that the Federal Government urge the repeal of State laws which have been obstructing the establishment of nonprofit consumer sponsored group practice medical plans; what do you mean by having the Federal Government urge the repeal of State laws?

Dr. BRAND. I am not a good legislator. I just beg for something that I think will be useful. It is not that the Federal Government

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