can repeal the State laws, naturally, but by some means of disapproval indicate that such laws are inimical to the health of the Nation.

Mr. YOUNGER. Would you mean that whatever program the Federal Government might set up should be withheld from those States that have those laws?

Dr. BRAND. No.

Mr. YOUNGER. You would not recommend that?

Dr. BRAND. No. I think the Federal Government should make available to all persons whatever care is needed and the question of State involvement is a question that the Federal Government has to decide.

Mr. YOUNGER. You would not go so far as to recommend the withholding of the Federal benefits from States that have such laws in order to force them to repeal the laws?

Dr. BRAND. My answer would be no.

Mr. YOUNGER. On your seventh recommendation, you say:

By establishing a coordinated and integrated national health insurance program.

Now, most of the evidence that has been presented here has been to the effect that this program of group-health programs should be on a regional basis and will not be successful on a national basis. What is your comment on that?

Dr. BRAND. An overall national insurance program would be a means of collecting the moneys and distributing the moneys.

The actual services are rendered perhaps on a regional basis, if you want, that is the reintegration of various centers and clinics with the hospitals as probably the only way you can function properly in terms of services to the people.

I can see the Government establishing this insurance program and being the banker, you might say, for the whole thing and establishing standards for it.

Mr. YOUNGER. But your recommendation does not conceive of the Federal Government setting up a tremendous bureau to supervise all of these so-called local plans?

Dr. BRAND. No, only to the extent of setting up standards, for example, for comprehensive care, and that the doctors be selected by certain qualifications and that the actual services, the medical services, be supervised locally by the physicians.

I think that should be the proper answer.

Mr. YOUNGER. If I understand you correctly, what you are proposing is that the Federal Government set up standards by which those groups must operate if they receive Federal aid and that the Federal Government alone will collect the money and then disburse it through

the States.

Dr. BRAND. The States or any other regional arrangement.

Mr. YOUNGER. But you do not want a big Federal bureau setup? Dr. BRAND. Well, I am not in a position to say there should or should not be because I am not too well versed with methods of financing the collection of funds. I leave that to better authorities.

Mr. DEROUNIAN. You understand, of course, Dr. Brand, that under our law today the problem of health, safety, morals, is a State proposition? You understand that?

Dr. BRAND. A State proposition?

Mr. DEROUNIAN. Yes, every State makes its own rules and regulations.

In connection with Mr. Younger's inquiry along this line, I also would like to ask you whether or not you feel that the present system of State supervision of their own profession should be superseded by a Federal supervision?

Dr. BRAND. Are you talking about the profession?

Mr. DEROUNIAN. I am talking about the medical profession in each State. As it stands now each State is autonomous in that branch. You are asking for a national program. I just want to find out whether you feel that the present method is not to the best interests of the people of the country and you want a national supervision.

Dr. BRAND. No, I don't think there need be national supervision. I think the States can still function, determining which physicians are qualified to render services as they do today.

Mr. DOLLIVER. Will you repeat that?

Dr. BRAND. I say that the States can still serve as the screener to determine which physicians may or may not give services through their State boards of education, and so forth.

I do not think the Federal Government needs to step into that picture.

Mr. DEROUNIAN. As I want to point out, if there is going to be a complete turnover of jurisdiction here on medicine within each State, you are going to have a tough proposition getting this over. That is not the President's plan at all. His plan is to have private enterprise and nonprofit associations administer this thing as they have generally in the past with grants-in-aid from the Federal Government, like FHA. That is my understanding.

Dr. BRAND. If I may say, it would seem to me that if any banker were to give out funds on a loan or any other basis, he would like to see that the funds are used to good advantage. I think then he may set up standards, whether it is for a mortgage or anything else.

In medicine, of course, since we are all interested in making sure that our people in this Nation are healthy people, some standards should be developed to make certain that they get that type of vigor and health that they are entitled to receive.

Mr. YOUNGER. That brings up one more question.

In regard to the various health insurance plans, there are so many of them, there has been a great deal of evidence introduced by the various people who have testified that the plans are somewhat misleading at times and they do not cover what the people who carried the policies expected them to cover. You would expect the Federal Government before they entered into any reinsurance plan to set standards or possibly specify a standard policy like the fire policy that is issued all over the United States before there is any reinsurance; is that your idea?

Dr. BRAND. That is the idea.

Mr. EDELMAN. Might I venture to suggest to the Chair that possibly Dr. Brand could comment on his medical experience in these several comprehensive or partially comprehensive plans which he has operated, as to the effect on the actual health conditions which he observes among this group of workers.

Does the availability of these services reduce catastrophic illness? Does it raise general health levels?

It would seem to me that some comment from Dr. Brand along those lines will be useful to this committee.

The CHAIRMAN. We will be pleased to have any comment that the doctor wishes to make.

Dr. BRAND. I will try to draw on my experience.

When I was with the Health Insurance Plan it was quite obvious, as is obvious in all other insurance programs where they provide comprehensive service, that in the first few months in any new group that is involved you have a very high level of service demanded and as the conditions are cleaned up, of course, the health improves.

It is something you will find in practically every group that goes into a service program.

When I came to the Sidney Hillman Health Center in 1951, and we opened our doors for service, we were rather shocked, frankly, to see the amount of care that was necessary for people who were unable to afford medical care otherwise, for people who did not want to go to the outmoded clinics, even in New York City, and we have quite a busy job cleaning them up, medically speaking.

We also had overage groups. In a study of a thousand charts of the first year's membership, we found that better than 70 percent were people over 40 or 45 years of age and as a result we have a very high utilization of service even today because we find quite a number of chronic diseases among them.

I often wonder if these people had had medical attention all along the line that is, from the day they apparently needed it and perhaps before through preventive health examinations-whether some of these conditions would have been so acute at this time; whether they would have been a much healthier group even with their chronic ailment.

It has been rather a shocking affair, to say the least, to see how much care has been needed.

And here we have only touched on 19,000 out of a potential 40,000 members. We have been too busy to establish multifarious screening programs, as much as we wanted to do so, because we have so much care to give day to day to people who come in and seek it.

We hope to open our doors to the wives of members and eventually to the children of members. We have permitted some of the wives to come in, particularly the housewives of the male members of the union, and they are quite an experience, too.

I would say through the adverse selection that occurs under such circumstances that we probably see 98 percent of them and give them

care.

Of course, that is not good actually speaking, but we are willing to absorb the actual cost that arises from that condition.

The CHAIRMAN. Any further comment, or any further questions, gentlemen?

If not, Dr. Brand, that will conclude your testimony. I will examine these two books of reports that you have presented to ascertain by editing whether it will be possible to enter the important parts of those into our record.

That will take a little time to go through them. It contains a great deal of information and yet it could not all go into the record because of the way it is prepared.

So we will have to do a little editing.

Dr. BRAND. Thank you.

The CHAIRMAN. I want to impress upon you, as I have on the witnesses who preceded you, that we are greatly indebted to you for your attendance here today and for giving us the benefit of the experience which you have gained in these several important positions that you have occupied in the field of health in New York City.

I could not tell you how much we do appreciate the willingness of yourself and your associates to come and give to us the benefit of your knowledge. It will be very helpful to us and certainly will be considered by the committee in arriving at whatever may be its opinion with respect to legislation.

Dr. BRAND. The Amalgamated appreciates the opportunity to present its story. Thank you.

(Dr. Brand later submitted the following information for the record :)

TABLE 1.-Number of physicians' services provided, by department, Sidney Hillman Health Center of New York, April 1951¬Sept. 30, 1952

1 Based on average of 33,356 eligible persons during first 12 months of operation.

2 Based on average of 32,468 eligible persons during first 18 months of operation. Source: Brand, Morris, A., M. D., The Medical Service Program of the Sidney Hillman Health Center of New York. Presented at American Public Health Association annual meeting, October 1952.

TABLE 2.-Number of diagnostic and ancillary services provided, Sidney Hillman Health Center of New York, April 1951-Sept. 30, 1952

2 Based on average of 32,468 eligible persons during first 18 months.

Excludes electrocardiography and X-ray readings; these are included in physicians' services. 4 Services started October 1951.

Source: New York Joint Board, Amalgamated Clothing Workers of America: Health Security by Union Action. May 1952; Brand, Morris A., M. D., The Medical Service Program of the Sidney Hillman Health Center of New York. Presented at American Public Health Association Annual meeting, October 1952.

SIDNEY HILLMAN HEALTH CENTER,

Mr. CHARLES A. WOLVERTON,

New York 3, N. Y., March 4, 1954.

Chairman, Committee on Interstate and Foreign Commerce,
House of Representatives, Washington 25, D. C.

DEAR MR. WOLVERTON: In accordance with your request of February 5, you will find enclosed:

1. Two copies of the leaflet describing the prepayment medical care program provided in the Sidney Hillman Health Center to the 26 locals comprising the New York Joint Board of the Amalgamated Colthing Workers of American.

2. Two copies of the Handbook of Information on Group Life Insurance and Group Accident and Sickness Insurance.

3. Two copies of Information Regarding Retirement Benefits.

It is not possible to send any specimen contract between our center and the members because there is no written statement to cover that other than that found in the leaflet (enclosed). There is no contract between the center and members. Also, we do not have any contractual agreement with the physicians providing the services. The technicians providing the services in the center are on a salary basis.

The center serves about 30,000 members and about 1,500 wives of members who have voluntarily enrolled in the present fiscal year.

CHARACTERISTICS

Sponsorship: Labor-Management

Year established: 1951

Area served: Greater New York

Governing body:

Board of directors, 24, of whom 15 represent the New York joint board of the ACWA and 9 represent employer organizations.

Medical advisory council of 9 physicians, including 6 physicians who are not members of the staff, 2 physicians selected by the staff and the medical director.