doctor assigned to him. Isn't that socialized medicine? And I am not defending socialized medicine.

Dr. MILLER. That could be regarded as socialized medicine. It certainly is medicine furnished by the state.

Senator FERGUSON. Is that separate in the Army and Navy so that it is under one head, the Surgeon General?

Dr. MILLER. The Surgeon General; yes, sir, in both services.

The CHAIRMAN. Would you say that the Veterans' Administration has socialized medicine?

Dr. MILLER. I think it could be defined as such; yes.

Senator MCCARTHY. Doctor, from the standpoint of the Veterans' Administration, would you care to register either an objection or a criticism or a suggestion as to whether that should be changed in the manner that we are now discussing?

Dr. MILLER. The present administration of the Veterans' Administration is receiving the utmost encouragement and support from the American Medical Association.

Senator MCCARTHY. That is what I thought. In the relationships that I have had with them that is what has always been more or less the feeling that I obtained insofar as the medical world and the veterans hospitals in the various States and the national administration are concerned.

Dr. MILLER. And that depends-that support depends entirely upon the effort that is being made by General Hawley, underwritten by General Bradley, to improve the quality of care that the boys get.

The CHAIRMAN. Doctor, is the report true that the American Medical Association helped prepare the rate schedules for services which the Veterans' Administration uses in the different States?

Dr. MILLER. The American Medical Association had nothing to do with rate schedules. The State society committees have had to do with that.

The CHAIRMAN. The report comes to me, which I find it very difficult to believe, and I will ask you if you can enlighten us on it, to the effect that the personnel on the boards in the States that are establishing rates for the Veterans' Administration are all members of the American Medical Association. Do you know as to the truth of that? Dr. MILLER. I would expect that that were true.

The CHAIRMAN. In other words, the American Medical Association members are fixing the rates for the veterans in the Veterans' hospitals? Dr. MILLER. I would rather put it that they are negotiating with the Veterans' Administration those rates. That has been the technique so far.

The CHAIRMAN. And is it true that the rates have recently increased over 100 percent in these institutions?

Dr. MILLER. I imagine that is correct.

The CHAIRMAN. And isn't it a fact also that the rates which are paid by the Veterans' Administration in the veterans' facilities are used generally for the purpose of establishing rates charged the civilian population in the same localities in the same States?

Dr. MILLER. I suppose that any rate schedule has its influence in that direction, and certainly the veterans' problem is large enough for that influence to extend.

The CHAIRMAN. Therefore the increase in rates which is agreed upon between the members of the American Medical Association and the

Veterans' Administration would also apply to all members of the veteran's family who employ doctors, as well as to the veteran himself who is treated at the expense of the Government?

Dr. MILLER. I think perhaps we are getting the cart before the horse a little, Senator.

The CHAIRMAN. I think probably we should ask these questions of the Veterans' Administration. It would seem very important to me that if the veterans' families are having to pay 100 or 200 percent more for medical treatment, perhaps the veteran himself is losing out, even though he may get his treatment from the facilities.

Dr. MILLER. It is my experience, as far as I have looked over these fee schedules, that they at long last have been brought up to what is current in the community. There may be variations here and there, but certainly in my community, in my State, that is so.

The CHAIRMAN. You have a very excellent community, one of the few communities in the country that have the very best of everything in the way of medical and surgical facilities, I believe.

Senator FERGUSON. Do you know the percentage of physicians, doctors, that belong to the American Medical Association?"

Dr. MILLER. Well, the percentage of practicing physicians—by that you do not mean to include those retired or those not practicing? Senator FERGUSON. No; I mean those practicing.

Dr. MILLER. Those who actually practice-I suppose there are 150,000, maybe 160,000 who are actively engaged in practice of one kind or another. About 130,000 are members of the Association. Those are my figures, approximately.

Senator FERGUSON. Do the States require that in order for a doctor to be admitted to practice he must belong to the American Medical Society?

Dr. MILLER. No, sir.

Senator FERGUSON. The same as the American Bar Association and lawyers. Is that correct?

Dr. MILLER. That is right.

The CHAIRMAN. The American Medical Association does have a say in establishing the qualifications for medical colleges, for instance, does it not?

Dr. MILLER, The American Medical Association has maintained for many years a Council on Medical Service in Hospitals.

The CHAIRMAN. But doesn't the American Medical Association grade various medical schools-I don't know whether they are A, B, C, or 1, 2, 3-and don't they set up requirements of facilities, hospitals, and clinical facilities for each grade of medical college, and also establish the number or limit the number of students which may attend each college and determine who may be admitted?

Dr. MILLER. The Council on Medical Service conducts surveys for rating both hospitals and medical schools, and has minimum requirements which it holds up, to satisfy which a given hospital or medical school must improve itself.

The CHAIRMAN. And are those ratings recognized by law?

Dr. MILLER. I am not certain that they are recognized by law. 1 know that laws have been passed in some States regarding either the American Medical Association or the American College of Surgeons. Whether they are constitutional or not in a given case I do not know.

The CHAIRMAN. But suppose the State set up qualifications which did not conform with the qualifications set up by the American Medical Association, then what would happen? Would the American. Medical Association oppose the graduates from that college being permitted to practice anywhere in the United States?

Dr. MILLER. The American Medical Association does not license in any way those who are able to practice in any State. That is a State function.

The CHAIRMAN. But you would be opposed to a State setting up their own qualifications or rates for medical colleges within the State, would you not?

Dr. MILLER. I think that would lead to a great deal of confusion. Students from Connecticut go elsewhere for their education and those from other states come to Connecticut.

The CHAIRMAN. You would be opposed to States setting up their own qualifications for medical colleges?

Dr. MILLER. Yes, I would.

Senator FERGUSON. Isn't it a fact, though, that they do set them up? Take the University of Michigan, the Medical Department, doesn't the State control that entirely?

· Dr. MILLER. Oh, yes.

Senator FERGUSON. Does the American Medical Association have anything to say about that to them except that they list it as one that is A or B or C? Isn't that correct?

Dr. MILLER. That is correct. They will inspect the State University Medical School, just as they do some others.

Senator FERGUSON. But they do not actually set down the rules and the State adopts those rules, do they?

Dr. MILLLER. No, sir; the State, so far as I know, adopts no rules set down by the American Medical Association.

The CHAIRMAN. But if the University of Michigan Medical College did not conform to the rating or the requirements set up by the American Medical Association, then the AMA would not recognize it as a first class college, and would not recommend that any students attend it, would they? Or do they just give it a lower school rating?

Dr. MILLER. Let me answer the question in this way. If such an impossible situation arose that the State of Michigan ran such a poor school that the AMA could not certify its graduates as having been sufficiently trained, that is a service that the AMA would serve to all other States in the Union, because we would not like to have graduates of that poor school come into our State to serve us.

Senator FERGUSON. We were talking here previously about the cost of medical service. Could you tell us now on the record how the present costs compare with, say, 1939?

Dr. MILLER. I believe the cost has gone up about in proportion to the cost of living, the cost of rent, every other cost that we are acquainted with, that has gone up.

Senator FERGUSON. Do you know about what the percentage increase is in the cost of medical care?

Dr. MILLER. That is a pretty big question to answer, Senator. I know hospitalization, for example, is one of the large costs of medical care that certainly has gone up, I suppose 50 to 100 per cent in some localities.

Senator FERGUSON. What about the ordinary physicians' visits to the home? How much has that gone up? Have you any figures on that?

Mr. MILLER. I have no figures on that. I imagine it must have gone up. It costs me more to maintain my office and pay my clerks and nurses than it did before.

Senator FERGUSON. Would you say that it has gone up more than the average of our inflation?

Dr. MILLER. I don't believe so. I think it has gone along with the general rise in prices.

Senator FERGUSON. Are there any States that restrict fees?
Dr. MILLER. So far as I know, there are not.

Senator FERGUSON. Has the American Medical Association fixed fees?

Dr. MILLER. No, sir. We recognize that the expenses that go into determining a fee vary so tremendously over the country that it would be impossible to set a uniform fee that would be applicable everywhere.

Senator FERGUSON. You do not have a minimum fee?

Dr. MILLER. No, sir.

The CHAIRMAN. You do not attempt to fix the fees of the country doctor in any way?

Dr. MILLER. No, sir.

The CHAIRMAN. Although sometimes the community practice fixes those fees, does it not?

Dr. MILLER. The patients themselves fix the fees if they are overcharged.

The CHAIRMAN. But you do have an interest in the fees which are allowed at veterans' facilities?

Dr. MILLER. Like any other group, we negotiate with the paymaster. That is what it amounts to.

Senator FERGUSON. Are you familiar with what they call the Michigan system in relation to the veterans?

Mr. MILLER. In a general way, yes, sir.

Senator FERGUSON. Does that fix the fees where they send them out to the doctor? Does the Veterans' Association fix the fee?

Dr. MILLER. The Veterans' Association and the Medical Society, I believe, have come to determine what the fees will be, just as they have in other places, and it is the method of collecting the fees and distributing the services which is a peculiarity.

Senator FERGUSON. Would you say that the fee is lower or higher than the general fee for similar services, that is, not connected with veterans?

Dr. MILLER. I am not familiar enough with the schedule in Michigan to answer that.

Senator FERGUSON. Any State? Your own State?

Dr. MILLER. I think it is about the average of the fees charged. Senator FERGUSON. So the Federal Government pays just about the average?

Dr. MILLER. In my opinion, yes, sir.

(Dr. Miller submitted the following paper:)

Re S. 140.

To the Senate Committee on Expenditures in the Executive Departments. GENTLEMEN: My name is James Raglan Miller. I am a practicing physician since 1915 in Hartford, Conn. I speak as a member of the board of trustees of the American Medical Association on behalf of the 130,000 physicians who are members of the American Medical Association.

While it is true that a poll of the sentiments of the members of our great association has not been taken concerning their attitude toward S. 140 or toward the assembling of the functions of health education and security in one Department of Cabinet rank, I do not hesitate to say that the attitude expressed in this statement conforms to the wishes of the vast majority of our members.

An examination of the minutes of the House of Delegates of the American Medical Association shows that considerable thought was given over a period of years to the formulation of a separate Federal health agency. References and records of action taken appear repeatedly in the minutes. As early as 1884 at the annual session it was urged that a separate Department of Health be established under a Cabinet officer. In 1891, a committee of 23 members was appointed to petition Congress on this matter. Further references appear in the minutes of the annual sessions each year from 1891 up to and including 1902. The subject apparently was not discussed during the three succeeding years, but reappears annually from 1906 to 1913, and from 1917 to 1930. After 5 years, a resolution was introduced into the special session of the house held in Chicago in 1935 urging the President of the United States to establish a separate Department of Health. At the session of the house of delegates in San Francisco in 1938, the house adopted the following recommendation of the reference committee on legislation and public relations: "* your committee recommends that the house of delegates reiterate its demand for a Federal executive department to be designated as the Department of Health, with a doctor of medicine at its head who shall have general supervision and direction of the affairs of the Federal Government pertaining to the health of the people." From the foregoing it will be seen that the American Medical Association has repeatedly gone on record as being desirous of seeing legislation passed leading to the formulation of a separate National Health Department. Current opinion in the association at the present time is to the effect that this Department should be an agency separated from other activities of the Government.

* *

Congress in 1879 passed legislation authorizing a National Board of Health. The functions and relations of this unit with other departments were very poorly defined in the law and no money was appropriated for its activities. The legislation remained on the statute books without any action until 1893 at which time it was repealed.

It has been estimated that educators are concerned in some manner with approximately 28,000,000 members of the population. Social security has contact with about 51,000,000 people including recipients as well as taxpayers. Medicine, on the other hand, has a much broader contact and in fact, enters into the lives of all of our people.

An examination of proposals to group all health activities of the Federal Government under one head may be accomplished in a number of ways. The most commonly considered conceptions are:

1. A separate Department of Health whose head has Cabinet status.

2. Combining all health activities of the Federal Government in a separate agency not of Cabinet status.

3. Combining health activities with other activities of the Federal Government in one Department.

While the American Medical Association is still of the opinion that the health of the Nation warrants a separate Department of Health with a Cabinet officer at its head, it realizes that it may be impractical to develop this at the present time.

Furthermore it is its opinion that if a separate Department of Health is not feasible it is possible to group health activities in a separate bureau. The association is opposed to having health activities grouped with other activities in a department with Cabinet status.