Security Board in its annual report to Congress for the year 1946, pages 439-443.

In the present Federal Security Agency budget for 1947 we note that nearly 80 percent of the appropriations will go to the Social Security Administration and that only small amounts are made available for health and education. In the past this concentration of funds in the agency which disburses welfare and social insurance payments has resulted in obscuring the importance of health and medical programs and in giving a dominant administrative position to officials in charge of cash-benefits programs as compared to officials working in the highly technical fields of medicine and medical research. We doubt if an Under Secretary of Health would be any better able to resist the already powerful Security Agency, which under S. 140 would be headed by an Under Secretary of Security, than has the Surgeon General of the Public Health Service been able to resist the present Social Security Administration.

We believe that it is unwise to place medical and scientific personnel and programs under the administrative jurisdiction of a lay Secretary. It has already been amply indicated in the present Federal Security Agency, which is headed by Watson B. Miller, a layman, that a nonmedical administrator does not understand medical problems and cannot speak for medicine. Last year at the hearings on the WagnerMurray-Dingell bill, S. 1606, Mr. Miller stated:

Individually and as spokesman for the Federal Security Agency, I stand squarely behind this program. It is necessary. It is practicable. It is long

overdue.

We believe this statement made by Mr. Miller is clear indication of his lack of understanding of medical problems because, in the first place, the bill, S. 1606, proposes to place administration of the program for medical care of the needy under the Social Security Board, which lacks a medical staff, and is engaged primarily in administering various cash benefit programs. In the second place, that same bill, which Mr. Miller supported unequivocally, states that the Surgeon General, a medical administrator, may not write his rules and regulations for the health insurance program until after he has consulted the Social Security Board, a lay organization, and until he has obtained the approval of the Federal Security Administrator-a layman. Hearings before Senate Committee on Education and Labor, Seventyninth Congress, second session, on S. 1606, part 1, page 121, 1946.

It will be impossible to recruit outstanding physicians in the Federal Government if such men are expected to accept the policy decisions made by a lay Secretary. The Public Health Service is even now experiencing great difficulty in recruiting professional staff and in retaining their present staff. Part of the difficulty, we understand, is due to the fact that physicians object to the lay controls which have been imposed on the Public Health Service by the Administrator of the Federal Security Agency. Even worse controls might be imposed by a Cabinet officer who had statutory authority.

We note that S. 140 specifies-section 2 (a), page 2, line 19-that the Under Secretary of Health

shall perform such duties concerning health as may be prescribed by the Secretary or required by law.

We question whether a lay Secretary would be competent to specify duties in a technical field such as medicine.

We urge the Committee on Expenditures in the Executive Department to postpone making its decisions on S. 140 and S. 712 until after hearings have been held on S. 545 and on other important medical and scientific legislation. Further, we recommend that the committee's decisions be withheld on these two measures until this committee has held hearings on Senator Lodge's bill, S. 164, which is most laudable, for it proposes the establishment of a commission to study and investigate the present organization and methods of operation of all departments, agencies, bureaus, and so forth, of the executive branch of the Government to determine what changes are necessary and report its findings to the Eighty-first Congress.

Senator FERGUSON. Dr. Howard, we have had some hearings on the Lodge bill already, and the committee is greatly interested in that question of examining the executive branch of the Government.

Dr. HOWARD. I did not know that, Senator.

We believe the provisions of title I of S. 545, which call for creation of an independent National Health Agency, should be thoroughly studied before any decision is reached on S. 140.

There are numerous health and medical functions scattered through the Federal Government. If these were brought together into a single health agency, they would constitute a sizable group of activities dealing with related matters and requiring specialized technical and scientific personnel.

Administratively and professionally there is strong justification for bringing together in one agency-a health agency-all Federal activities relating to health and medicine and of authorizing the medical head of such an agency to report directly to the President. Ultimately the National Health Agency should be given departmental status.

Health and medical functions have been an accepted part of the Federal Government since 1798, and Congress has repeatedly added to the responsibilities of the agency in which the more important health programs have been lodged-namely, the Public Health Service. We question the wisdom of placing these well-established functions in an over-all welfare agency where the new and untried social-insurance programs are being experimented with.

We note with approval that Congress is preparing to make exhaustive studies of the entire social-security program-its administration, its expansion, and its cost. Pending the conclusion of such studies, it would hardly seem advisable to set up a Cabinet post for an over-all agency in which the security program would be 80 or 90 percent of the whole. It is possible Congress may decide to curtail the security program, but this would be difficult if, in advance of such study, Congress should create a new department primarily for the purpose of emphasizing the importance of security programs which many persons believe have already grown to alarming size.

In support of the plans of Congress to survey the entire socialsecurity structure we believe it is of vital importance to include a thorough investigation of social security, which should cover administration, lobbying activities, waste of taxpayers' money, and interference with State legislative programs. And of a certainty, this should be done before social seuurity is elevated to departmental status.

In relation to lobbying activities, I would like to call the attention of this committee to a publication called "The Principles of a Nationwide Health Program." This was adopted by 29 sponsors and published with the cooperation of the Committee on Research and Medical Economics. Through the committee, arrangements were made for meetings of the conference of subcommittees in the autumn of 1943 and 1944. Copies of this report may be obtained from the Committee on Research and Medical Economics, 1790 Broadway, New York 19, New York.

Senator FERGUSON. What is the date of that document ?

Dr. HOWARD. This is a publication which came out prior to the Murray-Wagner-Dingell bill, and it is a publication to which Senator Wagner referred when he introduced his bill on the floor of the Senate, and when Senator Wagner introduced the national health bill in 1945 he quoted in extenso from the principles of the Nationwide health program, without, however, identifying the authors or indicating the tie-in with the Federal official who had written the major portion of S. 1606.

Senator Wagner in referring to this conference report stated that it had been issued by 29 leading health experts, including 13 outstanding doctors. What he failed to state was that 7 of the 29 handpicked conferees were Federal officials who might reasonably expect to obtain lucrative and powerful position in the Government insurance system which they were advocating.

Senator FERGUSON. What are you reading from now?

Dr. HOWARD. I am reading now from a publication entitled "Blueprint for the Nationalization of Medicine.' The seven conferees who were Federal employees at the time the report was prepared were:

Isidore S. Falk, Director, Bureau of Research and Statistics, Social Security Board;

George St. J. Perrott, Chief, Division of Public Health Methods, USPHS, and official liaison between Parran and Altmeyer;

Dean A. Clark, M. D., USPHS, now on loan as Director of the Health Insurance Plan for Greater New York;

Frederick D. Mott, M. D., former reserve officer of the USPHS, on loan to the Farm Security Administration, now chairman, Health Services Planning Commission, Department of Public Health, Saskatchewan, Canada;

Barkev S. Sanders, statistician, Chief of Health Studies on Falk's staff, SSB; Kenneth E. Pohlmann, labor organizer, on Dr. Mott's staff, Department of Agriculture; and

William Haber, professor of economics, University of Michigan, formerly with National Resources Board, later with War Manpower Commission.

Senator FERGUSON. Did you want to put any more in the record from that other document that you read from first?

Dr. HOWARD. I just want to suggest this for reading on the part of the committee.

Senator FERGUSON. You do not want to make it part of the record? Dr. HOWARD. I just wanted to call your attention to that publication. I have one other matter here that I would like to introduce into the record. I have here a pamphlet which I shall hand in, which is entitled "Labor's Program to Socialize Medicine Internationally."

Senator FERGUSON. Did you want to make that entire pamphlet a part of the record?

Dr. HOWARD. Yes; I would like to make this entire pamphlet a part of the record.

Senator FERGUSON. It will be received at this point.

(The document referred to is as follows:)

LABOR'S PROGRAM TO SOCIALIZE MEDICINE INTERNATIONALLY

WAGNER BILL REVEALED AS A PRODUCT OF THE INTERNATIONAL LABOR ORGANIZATION The Wagner-Murray-Dingell bill (S. 1050) should not be considered an American-made piece of legislation. It is merely the latest action taken by a member state of the International Labor Organization, in this instance the United States. It is commonly believed that certain Senators and Representatives have sensed a public demand for the socialization of medicine and have drafted legislation to provide it. This is at best a half-truth. The majority of the American people have made no such demand. Those behind it are leaders in the labor movement in this country and abroad.

A good many people associate legislation to socialize medicine with the advent of the New Deal. But in this sphere, Franklin D. Roosevelt was no innovator; he was a follower. Plans for socializing medicine throughout the world-one nation at a time-had been drawn up by the International Labor Organization years before. Mr. Roosevelt was merely the agent who, it was hoped, would implement ILO aims in the United States. He made a good start.

But what is the ILO? How did it originate? When did this country become involved with it? What is it trying to do? How does it operate? What practical significance does it have for United States physicians?

The International Labor Organization began as a private agency with headquarters in Basel, Switzerland. In 1919, under part XIII of the Versailles Treaty, it achieved official status as a subsidiary of the League of Nations. Its main office, up until World War II, was in Geneva; now it is in Montreal. Branches are maintained in Washington, D. C., and in other major capitals.

Original founders of the ILO were the International Association for Labor Legislation and its various national affiliates (e. g., the American Association for Labor Legislation). Other international organizations, with interlocking directorates, lent needed assistance; among these was the International Association for Social Security, which openly advocated the socialization of all phases of human endeavor.

The United States Senate, in 1919, specifically withheld the assent of the United States from part XIII of the Versailles Treaty. Senators at that time were aware of the operation of organizations such as the International Association for Labor Legislation and the International Association for Social Security. They knew that Samuel Gompers, president of the American Federation of Labor, had withdrawn from the American Association for Labor Legislation and had denounced its objectives as un-American. Despite Senatorial skepticism about ILO aims, however, the first officially approved International Labor Conference was held in the Navy Building at Washington, D. C., that same year. Franklin D. Roosevelt, then Under Secretary of the Navy, made the necessary arrangements for the meeting.

From 1919 until 1934 United States participation in the International Labor Conference was through official observers. These observers were among the strategists and labor leaders responsible for the creation of the ILO. World socialization was their aim, socialized medicine being only a small factor in their plans at that time.

In 1934, through an unheralded joint resolution, passed by Congress, the United States became a "member State" of the International Labor Organization and accepted the ILO constitution. But only a small segment of the public knew about it.

Nor did many realize, as stated in the resolution, that the United States "took part in 1900 in establishing and for many years thereafter supported the International Association for Labor Legislation." Thus, world planning for compulsory social insurance is directed by the ILO with the approval of the governing but usually without the knowledge of the governed.

The International Labor Organization states its purpose as being "to promote social justice in all the countries of the world. To this end it collects facts about labor and social conditions, formulates minimum international standards, and supervises their national application." In seeking to supervise the national application of ILO standards, the ILO is obviously more than a mere factfinding group.

The governing body of the ILO is composed of 16 government representatives, 8 representatives of management, and 8 representatives of labor. "By accept

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ing the Constitution of the International Labor Organization the States [national governments] agree to the preparation of international rules for social insurance by a permanent body of experts in social matter, namely the International Labor Office, and to the elaboration of these rules by a permanent congress, namely the International Labor Conference, consisting of representatives, not only of governments, but also of the classes directly concerned, capital and labor."

The International Labor Office acts as a secretariat, an information center, and a publishing house. It is "staffed by experts drawn from many different countries, whose knowledge, experience, and advice are available to all the nations which are members of the organization."

It has branch offices and correspondents in many countries.

What Americans serve among these experts? For medical care planning, there are at least three (none of them physicians): Arthur J. Altmeyer, chairman of the Social Security Board; Isidore S. Falk, director of the SSB's Bureau of Research and Statistics; and Wilbur Cohen, its assistant director.

The International Labor Conference is described as "a world parliament for labor and social questions." Each national delegation to the annual meetings comprises four delegates, two representing the Nation's Government, one representing management, and one representing labor; each of these three sections "speaks and votes independently, so that all points of view find full expression." The United tates Government, like others, pays the expenses of its own delegates to the annual conferences. In addition, it pays dues to the ILO as a member state.

Few people have any conception of the influence the International Labor Organization exercises on their daily lives. A hint of this influence was given by Franklin D. Roosevelt in an address before ILO delegates on November 7, 1941. He credited the ILO with "shortening the hours of labor, protecting women and children in agriculture and industry, making life more bearable for the merchant seamen, and keeping the factories and mines of the world more safe and fit places for human beings to work in." He added that "Through the long years of depression, from 1929 on, it sought to bring about a measure of security to all workers by the establishment of things like unemployment insurance and oldage insurance systems. Again, it sought to set the wheels of industry in action through establishment of international public works, rational policies of migration of workers, and the opening of the channels of world trade."

The late President did not in that address mention the efforts made by the ILO to promote socialized medicine. He neglected to say that the ILO had included requirements relating to medical care in its Workmen's Compensation Convention of 1925 and in its Sickness Insurance Convention and Agricultural Convention of 1927. He omitted any reference to ILO work on public health and health insurance in periods of economic depression, on the economical administration of medical and pharmaceutical benefits under sickness insurance schemes, and on curative and preventive care for invalids, the superannuated, and widows and orphans.

These activities were small steps toward the larger goal. By means of them, doctors and patients would become accustomed to socialized medicine in its milder forms.

In 1943 and 1944 the ILO put finishing touches on 114 proposals for the “improvement and unification of medical care services." Many of these are embodied in the Wagner-Murray-Dingell bill (S. 1050) and in other proposals for social legislation.

The amount of effort being expended by the ILO in furthering these proposals is suggested by the size of the organization's 1945 budget, which is $2,702,655, or double the 1944 figure.

Following is the procedure used by the ILO to effect legislation amongs its member States:

The governing body or the International Labor Conference itself, by a twothirds majority vote, makes certain recommendations. These are discussed and refined in a series of consultations. The recommendations then receive a vote by the conference. A two-thirds majority vote by the delegates present means acceptance. The recommendations then become draft conventions, and copies of them are sent to every ILO member State. Such members-e.g., the United States must bring the draft conventions before their legislatures within a year.

1 Provisional Bulletin No. 5, Inter-American Committee on Social Security, (ILO), p. 29.