We suggest the committee consider writing more explicit instructions to the Secretary into the bill.

Senator PURTELL. Mr. Biemiller, if you followed these hearingsand I assume you have from your discussion and also from your paper here you know this is an experimental plan, more or less. You realize, I am sure, that it would be impracticable and I would say. not even wise to attempt to spell out many things in that bill which we can spell out after a year or two of experience. It is a new venture into the health field and I would myself feel it was quite unwise to set this up in detail until we have gained more experience in its operation.

Mr. BIEMILLER. It is, however, Senator, in our opinion

Senator PURTELL. And that was so testified to by the Secretary, I may say. I will be glad to read to you her testimony, if you wish, but I am sure you have read it.

Mr. BIEMILLER. We have discussed this matter with the officials of the Department.

Senator PURTELL. Yes.

Mr. BIEMILLER. But it is frankly, in our opinion, a very unwise delegation of such complete authority. There are various manners in which this problem could be met. One, we suggest is writing more explicit instructions in. That is, for example, done in one of the bills now before the House committee, H. R. 6949. We think that offers one approach.

Another possible approach of a protective nature we should like to call to the committee's attention would be to adopt a formula something similar to the National Science Foundation, which provides there in the event of regulations governing various phases of that Government operation that the director goes into an advisory committee and presents his ideas.

He does not have to abide by the advice of that advisory committee, but he does have to report to the Congress both their proposals and any counterproposals, if there are such, of the National Science Foundation Advisory Council. So that the Congress is then aware of everything that is going on.

I am sure you are also, Senator, aware of the great controversy that went on on this question of the delegation of authority when there were proposals before the Congress for a national health insurance scheme, and one of the great protests that was made by the sponsor of that plan constantly was the question of the delegation of authority. We met some of those criticisms at that time and did try to be more restricted.

We think there is validity to that type of criticism, but are simply calling this matter to your attention and suggest you give it full attention as we know you are, because we have great respect for the very conscientious manner in which this committee always operated, and I say that quite sincerely.

Senator PURTELL. Of course, you know the advisory council is provided for in this bill.

Mr. BIEMILLER. Yes. And we want to make sure that the advisory council have the right to give advice and to give to the Congress an annual report, so that there is that check and balance.

Senator PURTELL, Yes.

Mr. BIEMILLER. It appears to us that S. 3114 contains a major inner contradiction in that it places two responsibilities on the Secretary; 1. To meet important social objectives; and

2. To operate a sound reinsurance system.

It seems to us that the reinsurance system can only be kept on a sound actuarial basis if the insurance is granted under conditions that make the social objectives unobtainable. Or if the social objectives are to be achieved, it can only be done by operating the reinsurance program at a consistent loss which would then convert the reinsurance program into a poorly disguised subsidy. We are not against a Government subsidy in this field, but we feel that if a program of subsidies to meet health needs is undertaken, it should be done directly and openly.

Senator PURTELL. Now, Mr. Biemiller, you have heard againand I am assuming that you followed this testimony here we had evidence presented to show that the coverage in 1939 under health insurance was about 9 million. The latest figures given to us by witnesses appearing here were that the present coverage is around 100 million.

Obviously this was not a need that had been created. A need for the coverage of the 91 million other people had not been created between 1939 and 1954. It existed perhaps to a lesser extent because we had a lesser number of people. I mean, it existed numerically to a lesser extent. But time was taken to seek out these fields and find out whether or not this coverage could be given at a rate that could be met by people. Do you not feel if perhaps there was some assurance at that time of a reinsurance program available to some of these companies, that they might have explored some of these fields quicker, and it could have accelerated that program a little more!

And do you not think if that were true, that by this reinsurance plan we might do this other thing now in other fields?

Mr. BIEMILLER. First may I comment in terms of the 1939 period. I think there were factors other than the lack of a reinsurance program. Senator PURTELL. I know there were.

Mr. BIEMILLER. For instance, I remember in those days I was 1 member of the Wisconsin State Legislature and a member of the W consin Assembly. We had a devil of a time passing a bill to make Blue Cross legal in the State of Wisconsin because the Wisconsin State Medical Society was fighting us on such a matter at that time. And it took us a long time to get any acceptance even of voluntary health insurance plans. We have not forgotten the American Medical Asso ciation blasted the Committee on the Costs of Medical Care, which urged experimentation with voluntary insurance plans, as incitement to revolution.

This was a real enough fight we had at that time, and I think it is something we have to remember.

In terms of reinsurance you will note as we go on here that wh we have criticism mainly of the shortcomings of the bill and mainly of the fact that the public is getting the impression it is a more farreaching measure than it is; still in terms of its having any value in spreading voluntary health insurance we are the last people to object to it on that score. We are trying to analyze with you ways of im proving it. And we have some concrete objections.

Senator PURTELL. I think your chief objection now is that it does not do enough. You think it ought to do more, but you do not object to its objectives and purposes and aims. Is that correct?

Mr. BIEMILLER. No. If someone thinks this is the way of strengthening things, it is all right. But we do not think you will get very far.

Senator PURTELL. Of course it has not been presented by anybody appearing here, Mr. Biemiller-and I am sure you will agree with me-from the Department, or representing any other group, or any individual-there has been nobody here that I know of who expressed the idea this is a cure-all. I do not think anyone attempted to make it appear that this is the answer to all health problems.

I agree with you some people may mistakenly think it is supposed to be, but it is not the intention of this committee so to represent it, if it finally brings it out as a measure to be considered by the Senate. Mr. BIEMILLER. I am sure Senator, you and your colleagues on the committee who are cognizant of the problems, and work with them day by day, realize this bill will not be any magic cure-all of anything. Senator PURTELL. I think the Department made it rather clear in its testimony, don't you?

Mr. BIEMILLER. In its testimony, but not in some of its other public

statements.

Senator PURTELL. I did not see the public statements you referred to but I think the statement you did refer to points it up very clearly. Mr. BIEMILLER. Yes. That is the testimony I am referring to there. Senator PURTELL. I thought you mentioned a speech too.

Mr. BIEMILLER. Yes.

Senator PURTELL. I think that pointed it up very clearly.

Mr. BIEMILLER. I think that particular statement from the Assistant Secretary Perkins is taken from his testimony before the House Committee if I am not mistaken.

Senator PURTELL. You do not state there. You say:

Contrast this with the following statement recently made by the Assistant Secretary of the Department of Health.

I did not know where it was made.

Mr. BIEMILLER. I think that is where it was made.

Senator PURTELL. But he points out that there were limitations. Mr. BIEMILLER. Right. Great limitations.

Senator PURTELL. They do not try to make it appear this is a

cure-all.

Mr. BIEMILLER. Now I want to come back to some other bills that are before us. In fact, bills which, in our opinion, more realistically approach the needs as outlined in the Secretary's testimony have been introduced by a group of distinguished Senators and Congressmen, who are all incidentally of the majority party. In fact, this measure, when first introduced, had as a cosponsor in the House the present Vice President of the United States. I refer to Senate bill 1153 and H. R. 3582, H. R. 3586, and H. R. 4128, introduced by Senators Ives and Flanders and by Representatives Javits, Hale, and Scott, The American Federation of Labor has never specifically endorsed this measure but it has by convention action noted the forward steps it represents in approaching the problem of providing adequate health insurance for the entire population.

This measure, in contrast to S. 3114, accepts the assumption that a public subsidy to voluntary insurance plans is the appropriate method for bringing most of the population under the coverage of such plans. The following specific constructive provisions of this measure commend themselves to all concerned with basic health needs.

1. It offers a nationwide scheme of insurance as a means of financing medical services.

2. The public charity principle involving a means test for lowerincome individuals and families is entirely excluded.

3. It provides that in order to qualify for Federal-State aid, the plans or a combination of plans, purchasable by a family, must offer comprehensive services, that is, at least hospitalization and the services of family physicians as well as specialists.

4. The membership charges in such plans cannot be flat rate, but must be based on a percentage of a subscriber's income (up to $5,000. 5. The majority of the governing board of every acceptable plan must represent those receiving medical care and services.

It appears to us that this bill represents a more realistic and straightforward approach to the needs than does S. 3114.

We note, however, that title II of S. 3114 contains provisions which authorize the Secretary to conduct studies and collect information concerning the organizational, actuarial, operational, and other prote lems of health service prepayment plans and their carriers. Th title provides that the information would be made available to the public and to sponsors of health service and prepayment plans with out charge. Such information which can only be collected and eval. ated adequately by a Government agency would be very useful to us as we continue to develop through collective-bargaining agreemer's providing protection for wage earners. It would be particular helpful to us as we continue to move into the newer area of provid direct-service plans for wage earners and the members of their families.

Senator PURTELL. May I interrupt?

Mr. BIEMILLER. Surely.

Senator PURTELL. A great honor has been paid me today by hav these visitors from the State of Connecticut from a junior hi school in Riverside, Conn., come in here and say hello. Mr. Ro of the history class there, is here. I apologize to you but I wanted to tell these young men that I appreciate very much your com over and I hope I shall have the opportunity of seeing you before you leave Washington. Thank you, and thank you, Mr. Biemille for permitting me to interrupt.

Mr. BIEMILLER. Certainly. Mr. Chairman, may I also call yo attention to the fact that out of our experience in this field we have observed that every example of a successful comprehensive hea service plan points to the importance of financial assistance in mee ing the heavy capital outlays that are necessary for constructing physical facilities necessary to such plans. We know of a num of areas today where comprehensive health service plans are about get underway, but where the lack of means for financing these fac fies constitutes a serious barrier. In this connection, we believe that the approach to this problem represented in S. 1052, introduced y Senator Humphrey, and another bill introduced in the House by Re resentative Wolverton, chairman of the Committee on Interstate ani

Foreign Commerce (H. R. 7700) constitutes a substantial contribution to meeting this need. The first of these authorizes direct Government loans for medical facilities. The latter bill would create a medical facilities mortgage insurance fund. We submit that this should be given serious consideration by this committee as you plan legislation in this broad field of health.

We support these bills in principle, although there are some changes, particularly relating to some of the deficiencies, which we believe would improve either of these measures. We should be glad to discuss these detailed changes with the staff members of this committee. We stress that we believe the enactment of either or both of these bills would have a most beneficial effect in promoting the most satisfactory types of prepaid health service plans.

Now, Mr. Chairman, I should like to present the views of the American Federation of Labor with respect to S. 2758, a bill designed to broaden the scope of what is popularly known as the Hill-Burton Hospital Survey and Construction Act.

I am sure that your committee has had presented to it the full record of the impressive progress that has been made in the field of hospital construction since you first had the original bill before you almost 8 years ago. As we look over this record and review the list of 2,000 hospitals, health centers and related facilities which have been approved, with nearly 1,400 of them completed, adding more than 100,000 hospital beds and nearly 450 public health centers to the Nation's health resources, we, too, are impressed with the remarkable job that has been done. We should like to take advantage of this opportunity to congratulate the members of this committee on the foresighted planning that entered into the original act passed in

1946.

The program conducted under the Hill-Burton Act represents not only a tremendous achievement in the physical facilities that have been brought into being under its provisions, but also has established a new pattern of cooperative relationships between the Federal Government and the State governments.

This construction program has also brought into being the most significant working relationship between State and Federal officials and the technicians, the representatives of the medical profession and the representatives of those groups which include in their membership the recipients of medical care and services. In evaluating the achievements of the program it is appropriate that these intangible assets should be weighed along with the network of substantial and beautifully efficient buildings that have been constructed by the joint efforts of community, State, and Nation. The cooperative contribution of all the groups concerned with this program has been clearly facilitated by the provision in the original act for truly representative advisory councils at all levels of administration.

Our organization takes, I believe, justifiable pride also in the fact that we supported this legislation vigorously from the date of its introduction, and for the last 7 years have vigorously supported the appropriations necessary for its implementation.

Likewise, in the first session of this Congress, we supported the measure to extend the act for 2 years, which President Eisenhower signed last July as Public Law 151.