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three nurses day and night. But if I have to pay 20 percent of those three nurses, a little different answer comes.

Mr. CURTIS. I can see the reason.

Mr. MARSHALL. It comes in these cases.

That is one of the very difficult features of this health insurance program.

It is possible to malinger and chisel, and not meaning to do it. You do it honestly. You need three if you don't have to pay for them. It is the old profit motive in reverse.

Mr. CURTIS. We can put it the other way around and make your statement affirmative when we look at rehabilitation which in my judgment is one of the greatest programs that has been really blooming in recent years. The psychological factor in rehabilitation, they tell is so darn important that we can hurt that if we do not provide the proper incentive to want to be rehabilitated and get well. Mr. MARSHALL. That is right.

Mr. CURTIS. I thank your for contributing to my thinking on this subject.

Just one final remark to my good friend, Congressman Forand, whom I admire and enjoy discussing this problem with.

I think that we need to be a little bit patient. Human beings have been on this earth for many, many centuries and we are coming as close as any society in history that I ever heard of or any present society to even be able to talk about solving these problems, and as long as we can show a good rate of progress, I think that is the key thing.

I do believe that the rate of progress in the past few years has been encouraging and I want to say this: That I think part of that rate of progress comes from the stimulation that Mr. Forand provides in these kinds of suggestions, so I think this is all for the good, although I am against your bill.

The CHAIRMAN. Are there any further questions?

Mr. FORAND. Will Mr. Curtis yield?

Mr. CURTIS. Certainly.

Mr. FORAND. You may be interested to know, if you do not already know it, that people getting over the age of 65 are increasing at the rate of 1,000 a day.

Mr. CURTIS. Just because our doctors and hospitals are doing such a swell job, so let's not criticize them that they are not interested in the people's welfare.

Mr. MARSHALL. People are spending their money for vitamins perhaps instead of doctors.

The CHAIRMAN. Mr. Alger will inquire.

Mr. ALGER. Mr. Marshall, I will not ask further questions.

I thought your statement was rather complete. You heard the earlier testimony. I have felt that the previous witness, Mr. Cruikshank, did not present the case clearly. The problem is obvious to us all. He did not present the case clearly, as I see it, where these medical needs occur, other than isolated cases.

Whether it would be the suicide that was mentioned, human beings. do strange things. A few isolated cases do not think mean we immediately need a vast national program, but I may be wrong.

Mr. Cruikshank agreed that he would give me a documentation for the record here of places where people are not getting medical care, period.

You have just made the statement that in your area the people are not turned away from hospital care because they could not pay the bill.

What area is that?

Mr. MARSHALL. That was the city of Schenectady, N.Y., where for 25 years we have had a very definite policy of never asking when a doctor sent a patient to a hospital how much money the patient had or whether or not he would pay the bill. He was admitted immediately. We inquired later about his means.

Mr. ALGER. I just wanted you to know that Mr. Cruikshank is going to offer this committee, I judge, a list of areas, or situations, or cases, however he chooses to do it, where people have been turned away because they could not pay. I think you should be apprised of that because I believe that we need to further develop that and possibly, Mr. Chairman, leave the record open so that if a witness wants to give us additional information on that score, he may, should it become a matter of contention here where we are seeking information.

Thank you.

(Letters of Mr. Rabaut follow :)

HOUSE OF REPRESENTATIVES,
Washington, D.C., July 10, 1959.

Hon. AIME J. FORAND,

Chairman, Subcommittee on Administration of the Social Security Law, 1107 New House Office Building.

DEAR AIME: Earlier this year I discussed the case of Mr. Raymond G. Jenkins, 5767 Iroquois, Detroit 13, Mich. with you because I thought the bill presented to him by Harper Hospital was exorbitant.

I have made copies of some of the pertinent letters in the case and they are herewith attached. This is a pitiful case and the suffering of the parents is tremendous without the added burden of a hospital bill they cannot afford. Yesterday I wrote the director of Harper Hospital and asked him to consider cancellation of the bill as Mr. Jenkins is an average working man, completely dependent upon his wages for the support of his family. The enclosures are being presented in support of your bill, H.R. 4700, which I understand will be called up for hearing next week.

With best regards, I am,
Sincerely yours,

LOUIS C. RABAUT,
Member of Congress.

DETROIT, MICH., June 9, 1959.

Mr. GEORGE E. CARTMILL,

Director, Harper Hospital,

Detroit, Mich.

DEAR SIR: I am writing in regard to my hospital bill No. 683616. At the present time I am totally unable to pay this bill.

Since my baby has been sick, I have already spent more than $800 for doctor bills, wheelchair, medical prescription, etc. My little girl is still not well. Consequently, my expenses are still accumulating. Naturally other financial obligations have arisen due to her illness.

I have always paid my bills promptly in the past when requiring the services of your hospital. If you check your records you can see that August 3, 1952, and October 1, 1954, my bills were paid promptly and in full by me.

Due to the fact that Harper Hospital is supposedly a nonprofit hospital and also the fact that I have lost a completely healthy and normal child to the ravages of malpractice, why not cancel this bill completely?

I don't think that I am asking an unfair request. After all my loss is far greater than yours.

The extent of damage this tragedy has done to me and my family is incomprehensible. My wife is teetering on the verge of a nervous breakdown and I have lost the will to go on. My son, who is only 4 years old, has been greatly affected by this episode. He cannot understand why his sister who left home on that January day, laughing, running, playing, enjoying television, and relating enthusiastically all of her experiences at school can no longer see or walk. My confidence in mankind is completely annihilated.

My child often asks me to take her to Belle Isle, which was her favorite park before she lost her health. As soon as she gets to this park she begins to cry because she cannot see the swings, slide, horses, or the beauty of the merry-goround.

I ask you, is it fair for a completely innocent child to be deprived of the joy of walking, the excitement of seeing the comics on television, the beauty of colors, and the many wonders of everyday life? The pathetic part of this case is the fact that she has experienced these things.

It is indubitably most piteous to see this child groping in the darkness to which she can never adjust.

Yours sincerely,

Mr. RAYMOND C. JENKINS,
Detroit, Mich.

RAYMOND C. JENKINS.

HARPER HOSPITAL,

Detroit, Mich., June 23, 1959.

DEAR MR. JENKINS: This is in reply to your letter of June 9 regarding your Harper Hospital bill.

I do not agree with you that there exists any evidence of malpractice or negligence in your daughter's care. All aspects of her care preceding, during and following surgery have been thoroughly investigated. I am satisfied that not only was there no negligence whatsoever on the part of those attending your daughter, but that truly heroic emergency treatment was undertaken in her behalf.

It is true that Harper Hospital is a nonprofit institution. As such our charges to patients are set at our costs. The days when civic minded individuals gave large donations to hospitals for free care of the less fortunate are over. Therefore, it is imperative that we make every effort to collect the amount of our costs from patients, their families, or their insurance companies. Inasmuch as the agencies to which you have applied for financial assistance have rejected your application because of certain assets, I cannot honor your request that your indebtedness to us be forgiven.

Our credit office will be glad to accept your application for long-term credit arrangements should it be necessary for you to handle your account in this way. Please feel free to contact our credit office at your convenience.

Sincerely yours,

Hon. Louis C. RABAUT,

GEORGE E. CARTMILL, Director.

HARPER HOSPITAL, Detroit, Mich., March 24, 1959.

House of Representatives, Washington, D.C. DEAR SIR: This is in reply to your letter of March 5 in which you enclosed a letter from Mr. Raymond C. Jenkins, 5767 Iroquois, Detroit, Mich.

LaJuana Jenkins, 6 years old, was admitted on January 2, 1959, for a tonsillectomy and adenoidectomy. The surgeon who operated was selected by the family. He is a member of the Harper Hospital attending staff and a specialist certified by the American Academy of Otolaryngology. The surgery was performed on January 2. There were no complications during the surgery, but immediately postoperative the child nearly expired due to cardiac arrest. It is a tribute to the medical staff who attended the patient during this crisis that the patient was restored to life. Most regrettably, the child sustained severe brain damage during the cardiac arrest. I have investigated the incident thoroughly and I am satisfied that not only was there no negligence whatsoever on the part of those attending the patient, but truly heroic emergency treatment was undertaken.

LaJuana Jenkins was discharged to the family home on February 28, 1959. Every test and treatment known to our specialists were tried to restore the child to good health but all failed. It is the unanimous opinion of all that the brain damage is too severe for full recovery. Institutionalization was recommended and the parents made application for the child's commitment to a State institution.

The Jenkins' family was accorded every consideration throughout the period of the child's hospitalization. At no time did they indicate full realization or acceptance of their child's condition and prognosis. The family was allowed free medical supervision following surgery to relieve the financial strain.

Of the total hospital bill of $1,988, the Jenkins have paid $368 to date. The several official and voluntary agencies to which Mr. Jenkins applied for financial assistance rejected his application because of the family's financial resources. Mr. Jenkins has not applied directly to Harper Hospital for assistance. Certainly we will consider his request for long-term credit arrangements if he should make such a request.

Should you have additional questions which I may answer, please let me know. Sincerely yours,

Representative LOUIS C. RABAUT,

1232 House Office, Washington, D.C.

GEORGE E. CARTMILL, Director.

DETROIT, MICH., February 28, 1959.

DEAR SIR: I think the proposed bill of socialized medicine is good for this country. I do hope that you will support Representative Dingell in getting this bill passed.

Doctors and hospitals in this country are just plain robbers. The prices they charge people are definitely getting out of hand. Not only do they rob people, but they wreck their health also.

Following is a typical example:

On January 2, 1959, I took my little 6-year-old daughter to Harper Hospital for a simple tonsillectomy. They told me she would be able to go home the same day. I was informed that the charges would be approximately $135, which would cover the complete charges. How wrong they were. At the present time my daughter is still in the hospital. I am being charged approximately $400 a week. (I don't have Blue Cross. I was priced out of it by their high rate several months ago.) Not only is all of my money gone, but her health is gone as well.

Since I am unable to pay these exorbitant rates they are making every effort to discharge my daughter from the hospital.

The doctors at Harper Hospital, after extensive examination, have informed me that my baby will never be normal again, and also stated that she should be institutionalized.

Sir, how in the name of God can something like this happen in a State which is supposed to be up to date and civilized? I am being charged for something for which they were the cause.

When I brought my child to this hospital, she was a picture of health-smiling, happy, and joyful. You should see her now. What a difference. How cruel can this world be?

I have been to various agencies around the city. No one will give me any type of assistance-medically, spiritually, or financially. The crippled children's commission refused me aid because I am a property owner. I applied at the veterans' trust fund which has $50,000 to aid veterans who need financial assistance. They refused to give me any assistance because they feel that my case is not an emergency.

In view of the above-mentioned facts, you can readily see why we need some type of socialized medicine in order that this vicious thing will not happen to some other unfortunate person.

Democratically yours,

RAYMOND C. JENKINS, Democratic Delegate, Ward 17, Precinct 25.

The CHAIRMAN. Are there any further questions of Mr. Marshall! If not, again, Mr. Marshall, we thank you, sir, for coming to the committee and giving us the thinking of the Chamber of Commerce of the United States.

Without objection, the committee will now recess until 1:30 this afternoon.

(Thereupon, at 12:15 p.m., the committee recessed, to reconvene at 1:30 p.m., same day.)

AFTERNOON SESSION

The CHAIRMAN. The committee will please be in order.
Our next witnesses are Mr. Lourie and Dr. Schottland.
Mr. Lourie, are you to make the presentation?

STATEMENTS OF NORMAN V. LOURIE, VICE PRESIDENT, NATIONAL
ASSOCIATION OF SOCIAL WORKERS, AND CHAIRMAN, COMMIS-
SION ON SOCIAL POLICY AND ACTION; AND DR. CHARLES I.
SCHOTTLAND, DEAN, FLORENCE HELLER SCHOOL FOR ADVANCED
STUDIES IN SOCIAL WELFARE, BRANDEIS UNIVERSITY, REPRE-
SENTING NATIONAL ASSOCIATION OF SOCIAL WORKERS

Mr. LOURIE. I will make a presentation and Mr. Schottland will also make a presentation. We will divide the time, sir.

The CHAIRMAN. Do you want to be notified at a certain point? Mr. LOURIE. I think between us we will take about 30 minutes. We will take 30 minutes, totally.

The CHAIRMAN. Do you want 20 minutes, and then 10 minutes for Mr. Schottland?

Mr. LOURIE. We will each take about 10.

The CHAIRMAN. Do you want me to notify you at any point?
Mr. LOURIE. At the end of the 30 minutes, sir.

The CHAIRMAN. You will watch your division.

Mr. UTT. Mr. Chairman, I would like to welcome Mr. Schottland to the witness table. He has a long and enviable record of serving California for many, many years before he came to HEW. He had retired and now is back at work again.

Mr. SCHOTTLAND. Thank you, sir.

The CHAIRMAN. Will you identify yourself for the record.

Mr. LOURIE. I am Norman V. Lourie, vice president of the National Association of Social Workers, and chairman of the commission on social policy and action. I am accompanied today by Dr. Charles I. Schottland, dean, Florence Heller School for Advanced Studies in Social Welfare, Brandeis University, who will also make a statement for the association immediately following the completion of my remarks.

The CHAIRMAN. You are recognized for 30 minutes.

Mr. LOURIE. I would like to identify myself further by indicating that I am deputy secretary of the Department of Public Welfare of the Commonwealth of Pennsylvania.

The National Association of Social Workers is the professional association representing 23,000 social workers in the United States. Our members work in public and private social welfare and health organizations. We work for every State government, the Federal Government, in most counties in the country, and for practically every sectarian and nonsectarian philanthropy.

The concern and leadership of the Committee on Ways and Means for improving the health and welfare of all Americans is well known

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