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NATIONAL HEALTH INSURANCE

(Broad Assessment of American Health Status and the American Health Care Delivery and Financing Systems)

THURSDAY, JULY 10, 1975

U.S. HOUSE OF REPRESENTATIVES,

SUBCOMMITTEE ON HEALTH,
COMMITTEE ON WAYS AND MEANS,

Washington, D.O. The subcommittee met at 10 a.m., pursuant to notice, in the committee hearing room, Longworth House Office Building, Hon. Dan Rostenkowski (chairman of the subcommittee) presiding.

[The press releases announcing the hearings follow:]

[Press release No. 7 of Tuesday, June 24, 1975]

SUBCOMMITTEE CHAIRMAN DAN ROSTENKOWSKI (D., ILL.) SUBCOMMITTEE ON

HEALTH, COMMITTEE ON WAYS AND MEANS, ANNOUNCES PANEL DISCUSSIONS ON NATIONAL HEALTH INSURANCE BEGINNING JULY 10, 1975

Subcommittee Chairman Dan Rostenkowski (D. Ill.) of the Subcommittee on Health of the Committee on Ways and Means announced today the second stage in the Subcommittee's consideration of national health insurance. This stage will involve small panel discussions on the broad issues in national health insurance. The Subcommittee will form these small panels from members of the Advisory Panel on National Health Insurance, which it established earlier this year (see: Press Release Nos. 2, 3, and 5).

The panel discussions will begin on July 19, 1975 at 10:00 a.m. and are also scheduled for July 11, 17, and 24. The sessions will be conducted in the Main Hearing Room of the Ways and Means Committee in the Longworth House Office Building.

It is expected that public hearings and additional panel discussions will be scheduled later in the year on the subject of national health insurance.

In addition, on July 31, the Subcommittee will meet to consider which aspects of medicare it will want to address in public hearings to be held after the August recess. Included in the discussion will be possible action on recent Department of Health, Education, and Welfare medicare regulations which were the subject of a public oversight hearing on June 12, 1975 (see: Press Release No. 6).

[Press release No. 8 of Tuesday, July 1, 1975)

SUBCOMMITTEE CHAIRMAN DAN ROSTENKOWSKI (D., ILL.) SUBCOMMITTEE ON

HEALTH, COMMITTEE ON WAYS AND MEANS RELEASES ADDITIONAL INFORMATION ON NATIONAL HEALTH INSURANCE PANEL DISCUSSIONS FOR JULY

Subcommittee Chairman Dan Rostenkowski (D., Ill.) of the Subcommittee on Health of the Committee on Ways and Means today released additional information about the panel discussions on national health insurance scheduled for

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July, first announced on June 24, 1975 (see: Press Release #7). It is expected that the Subcommittee will schedule public hearings on this subject in the late summer or early fall. The membership and structure of each panel discussion is attached.

JULY 10, 1975

SUBJECT: BROAD ASSESSMENT OF AMERICAN HEALTH STATUS AND THE AMERICAN

HEALTH CARE DELIVERY AND FINANCING SYSTEMS

Panelists

1. E. L. Wynder, M.D., President, American Health Foundation. 2. John G. Freymann, M.D., President, National Fund for Medical Education. 3. Rashi Fein, Professor of the Economics of Medicine, Harvard University. 4. Uwe Reinhardt, Professor of Economics, Princeton University. 5. Kerr White, M.D., Professor of Health Care Organization, The Johns Hopkins

University.

The panel will begin its presentation to the Subcommittee at 10:00 a.m. on July 10, 1975, in the Main Hearing Room of the Committee on Ways and Means in the Longworth Building at New Jersey and Independence Avenue, S.E.

JULY 11, 1975

SUBJECT: THE ROLE OF GOVERNMENT IN AMERICAN HEALTH

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Panelists 1. Lewis H. Butler, Professor of Health Policy, University of California. 2. Pierre R. de Vise, Professor of Urban Science, University of Illinois at Chicago

Circle. 3. Richard Heim, Executive Director, Health and Social Services Department,

New Mexico. 4. Lowell Bellin, M.D., Commissioner of Health, New York City.

The panel will begin its presentation to the Subcommittee at 9:00 a.m. on July 11, 1975, in the Main Hearing Room of the Committee on Ways and Means in the Longworth House Office Building at New Jersey and Independence Avenue, S.E.

JULY 17, 1975

SUBJECT: PRIVATE SECTOR ROLE IN AMERICAN HEALTH

Panelists 1. Herman M. Somers, Professor of Politics and Public Affairs, Woodrow Wil

son School of Public and International Affairs. 2. Nathan J. Stark, President, University Health Center of Pittsburgh. 3. Robert G. England, M.D., Carlinville, Illinois. 4. Lawrence M. Cathles, Jr., Retired Senior Vice President, Aetna Life and

Casualty. 5. John Larkin Thompson, President, Blue Shield of Massachusetts.

The panel will begin its presentation to the Subcommittee at 10:00 a.m. on July 17, 1975, in the Main Hearing Room of the Committee on Ways and Means in the Longworth House Office Building at New Jersey and Independence Avenue, S.E.

JULY 24, 1975

SUBJECT: PROBLEMS AND ISSUES IN HEALTH CARE ORGANIZATION, DELIVERY AND

FINANCING

Panelists

1. Martin S. Feldstein, Professor of Economics, Harvard University. 2. Herbert E. Klarman, Professor of Economics, New York University. 3. Wilbur J. Cohen, Dean, School of Education, University of Michigan. 4. Charles A. Siegfried, Madison, New Jersey. 5. Avedis Donabedian, M.D., M.P.H., Professor of Medical Care Organization,

University of Michigan.

The panel will begin its presentation to the Subcommittee at 10:00 a.m. on July 24, 1975, in the Main Hearing Room of the Committee on Ways and Means in the Longworth House Office Building at New Jersey and Independence Avenue, S.E.

[Press release No. 9 of Wednesday, July 23, 1975)

SUBCOMMITTEE CHAIRMAN DAN ROSTENKOWSKI (D., ILL.) ANNOUNCES PANEL DIs

CUSSION ON NATIONAL HEALTH INSURANCE (WITH PANELISTS CCTED BY THE MINORITY) SEPTEMBER 12, 1975

Subcommittee Chairman Dan Rostenkowski (D., Ill.) of the Subcommittee on Health of the Committee on Ways and Means, today announced an additional panel on national health insurance, with panelists selected by the minority. The panel discussion will begin at 9:00 a.m. in the Main Hearing Room of the Ways and Means Committee in the Longworth House Office Building.

It is expected that public hearings on national health insurance will begin later in September or early October.

The list of panelists for September 12 will be released in a later announcement.

[Press release No. 12 of Wednesday, Aug. 20, 1975) SUBCOMMITTEE CHAIRMAN DAN ROSTENKOWSKI (D., ILL.), SUBCOMMITTEE ON

HEALTH, COMMITTEE ON WAYS AND MEANS RELEASES MEMBERSHIP OF PANEL DISCUSSION FOR SEPTEMBER 12, 1975 SELECTED BY THE MINORITY MEMBERS OF THE SUBCOMMITTEE

Subcommittee Chairman Dan Rostenkowski (D., Ill., ) of the Subcommittee on Health of the Committee on Ways and Means today released additional information about the panel discussion on national health insurance scheduled for September 12, 1975, first announced on July 23, 1975. (See: Press Release #9)

A list of the members of the Panel selected to represent the minority follows:

1

TENTATIVE LIST OF WITNESSES
Panel of Witnesses for 9:00 a.m. :

Dr. Max Gammon, London, England
Mr. Anthony Lejeune, Middlesex, England
Dr. Sigmund J. Lofstead, Chicago, Illinois
Dr. Reginald Murley, London, England

Dr. Bette Stephenson, Toronto, Canada
Panel of Witnesses for Afternoon Session :

Dr. John H. Burkhardt, Knoxville, Tennessee Dr. John Hamilton, Rochester, New York Dr. Marvin N. Lynberis, Charlotte, North Carolina Dr. Clinton S. McGill, Portland, Oregon Dr. David S. Masland, Carlisle, Pennsylvania Dr. Donald Quinlan, Northfield, Illinois Mr. ROSTENKOWSKI. The Subcommittee on Health will come to order.

Today the Subcommittee on Health begins active consideration of national health insurance. Instead of first receiving testimony on specific proposals from interested organizations and individuals, we thought it would be useful to begin by exploring, with a series of expert panels, the broad outlines of health care in the Uinted States and some of the major issues we will need to address as we frame a national health insurance bill. Later, probably in early fall, we will likely hold public hearings at which all interested parties can express their views.

At the beginning of this year the subcommittee invited individuals and organizations to submit written statements on the subject of na

1 Additions or changes may be announced at a later date.

tional health insurance. This permitted the updating of testimony presented during the extensive hearings on national health insurance the Committee on Ways and Means completed a year ago, and also offered a fresh opportunity for the expression of views by those who had not previously testified. These statements will soon be available in the form of a printed record thus furnishing the subcommittee the full benefit of the information and views presented before we begin consideration of specific national health insurance proposals.

The panels of experts who will be sharing their knowledge of the American health care system with us during this month were selected, like the larger advisory panel of which they are a part, not to represent the viewpoint of any organized group but rather to let us benefit from the fruits of their own individual studies and experiences in health care and health care financing. There will be ample opportunity later for the expression of official positions by organizations and individuals. Our objective for the moment is simply to learn and try to understand, so that the decisions we make later will be soundly based.

We begin our broad review of this subject with an exploration of American health status, our health care delivery system or systems, and how we finance the $100 billion or so being spent for personal health care. Tomorrow we will take a broad look at the role of Government at all levels in American health. On July 17, we will examine the private sector role. And on July 24, we will take up problems and issues in health care organization, delivery, and financing.

I believe that the subcommittee will agree with me that we should plan for additional sessions like the ones already scheduled with selected members of the subcommittee's advisory panel as we narrow our attention to more specific issues. I say this because one thing that has become clear to me in the months since I assumed chairmanship of this subcommittee is that the American health care system is extraordinarily complex. You cannot change any part of it without affecting other parts—perhaps in ways not able to be anticipated. We need to learn a great deal about the American system of health care, and we must approach the task of framing national health insurance legislation with a great deal of sensitivity and even humility.

I have been looking forward to beginning these panel sessions. We have a fine group of expert witnesses who have agreed to meet with us and I want to have every member participate in these sessions to the fullest.

We hope to proceed somewhat informally today, using a format that will promote understanding and the exchange of views. The panel members have been asked to make a brief opening statement, so as to leave adequate time for questioning and discussion among both panel and subcommittee members. I would like at this time to open for

any
comment that

any member of the subcommittee would like to make before I introduce the panel.

Mr. Duncan. Mr. Chairman, I apologize if you mentioned it in your statement; I didn't have it. I noticed today that we have a panel of people apparently who do not practice medicine and wouldn't have first-hand knowledge of such practice. Are we planning on a panel of actual physicians or people in the medical field who are actually out in the boondocks practicing medicine? I would say that the panel

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