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The most recent action of the American Federation of Labor in this respect was taken by our 720 convention, meeting in St. Louis, MO September 21-25, 1953. A declaration unanimously passed by that convention stated, in part:

The need for a greater number of hospitals, doctors, and other trained medical personnel, clinics and other medical-care facilities, and for a more satistactory method of financing the cost of medical care is urgent, and becomes more urgent every day (Official Proceedings, 720 convention, AFL, p. 641). The convention also adopted the report of the executive council

, which included in its recommendations:

Continuance and expansion of the Hill-Burton hospital-construction program, including the construction of health centers. (Ibid., p. 310.)

It is in no sense a detraction from the achievements of the present program to point out that it falls short of meeting the total need, both quantitatively and qualitatively.

Speaking to the qualitative point, it is apparent that with the rerg progress that has been made with respect to general hospital bed construction, the specialized needs with respect to facilities for chronic disease, nursing homes, diagnostic and treatment centers for ambulatory patients, and rehabilitation facilities have fallen behind. Special appropriations whose authorization is contemplated in this bill for surveying these needs and making grants to the States and localities are designed to meet these deficiencies.

I recall that the very inception of the program grew out of a comprehensive plan for the establishment of a network of integrated facilities, including the fully equipped urban centers, the teaching hospitals and what might be described as the feeder facilities, which would include the health centers and clinics where no attempt would be made to provide all of the specialized services necessary in the larger centers, The program has, in part, met that need, but in one sense our whole health facility construction program has gotten out of balance. The construction of the type of specialized facility that is contemplatel in this measure will help to restore this balance.

Many of the members of this committee have also over the years expressed an interest in the amount of funds available for the entire program. While I am aware that appropriations as such do not full within the area of your responsibility as a committee, I cannot refrain from expressing our concern over what appears to its as an insufficient amount of funds scheduled for the entire program for the coming fiscal year. In this connection, I am speaking to the quantitative shortcomings of the present program.

The original survey's made by the states following the enactment of the Hill Burton Act indicated that there was a shortage of

app 11 mately 900.000 hospital beds in the entire country. That was i veurs ago. While under the program about 105,000 beds have been aihed, our population has grown in that time by more than 18 million people. I am informed that current State survers indicate total need of nearly 2 million beds, with a leticiency of at least 800.000. So we are barely keeping pace with our expanding needs.

The S60 million authorization for the specialized projects contem plated in the bill now before you, together with the additional million for research and survey, appears sufficient to get this part: 1lar program underway. However, it is with deep concern that we note the reference in the budget proposed for fiscal year 1955 to an amount of only $50 million for the continuation of the basic HillBurton program. This, as you know, represents a reduction of $15

million from the amount authorized for the current fiscal year. In prin fact, only in the year 1950 was the full $150 million authorized in

the original act appropriated.

While there may have been some justification in reducing the appropriations during the height of the Korean conflict, when there

was a shortage of both manpower and materials, it does seem particu2: Jarly inappropriate at the present time, in view of the backlog of

accumulated needs and in view of threatened unemployment in the building and construction trades, that the amount appropriated for this program should be reduced to the lowest point in its history-to an amount representing one-third of the annual appropriation authorized in 1946. The construction of facilities both of the type contemplated in S. 2758 and of that authorized in the original act represent the most useful types of public works projects.

We are aware of the fact that the construction of the specialized facilities for chronic disease hospitals, nursing homes, and other treatment centers and facilities would make possible a number of significant economies in providing services to these classes of patients. I would like to point out, however, that the problem of meeting the costs of medical care by individuals is still with us. It will still be with us in the event this bill is enacted into law. I am sure you are aware that its enactment will take us into an area of need where the provisions of presently existing insurance programs are the least adequate. This is not an argument against the bill. It is to point out once again that there remains the necessity to undertake overall comprehensive planning to meet the essential health needs of the Nation.

Good as these proposals are, they leave unmiet the important problems of aid for medical education and aid in establishing local publichealth units. And the question of how the patients are to meet the cost of the services and facilities made available by the construction program remains largely unanswered. We support this program as one link in a chain of defense against disease. We hope the Congress will forge the other links without delay.

May I again, Mr. Chairman, express to you and the members of this subcommittee the appreciation of the American Federation of Labor for the opportunity of presenting our views on these important proposals.

Senator PURTELL. I want to thank you, Mr. Biemiller, for coming here and giving us the advantage of knowing your views and the views of the association that you represent,

The testimony this morning concludes our schedule of witnesses on the President's health recommendations and proposals. The record, however, will be left open for 10 days, during which time admissible testimony may be filed and included in the record.

These particular hearings are, therefore, concluded and the subcommittee will stand in recess until further call by the chairman.

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(By direction of the chairman, the following is made a part of the record :)

DEARBORN, MICH., April 25, 1954 Hon. WILLIAM A. PURTELL, Chairman, Subcommittee on Health of Senate Public Welfare Committee,

Senate Office Building. MY DEAR SENATOR PURTELL: I am writing to express my view's on the proposed Health Service Prepayment-Plan Reinsurance Act, H. R. 8376 and S. 3114. which are now under study by the appropriate committees of the Congress | have been personally interested in the development of voluntary health pre payment plans for many years as a member of the American Hospital Asse ciation's original hospital service plan commission, later the Blue Cross (oth mission. I have been directly associated with the development of the Bine Cross movement in the United States and Canada since its inception: I was closely associated with the Philadelphia Blue Cross plan, and I am at present a member of the board of trustees of the Michigan Blue Cross plan.

I believe that it is necessary and desirable for government at local, State, and Federal levels actively to encourage the extension of voluntary bealth insurance. I have not understood, for example, why the Federal Government has not long ago made it possible for Federal employees to participate in Riue Cross and other voluntary health-insurance plans by extending the advantar of payroll deduction for this purpose as private industry has done for maut years. I believe that the Federal Government should take the initiative in helping the States to develop methods for the coverage of certain segment of the population, such as the aged and the low-income groups, many of whoca cannot afford to purchase adequate protection, but who could pay part of the cost of such protection. The continued solveney of our voluntary hosptal system and the maintenance of quality of care combine to demand a solution to these problems.

I have reviewed the proposed Health Service Prepayment Plan Reinsurador Act and I have read some of the testimony which has been presented to be Congress in connection with it. I do not pretend to be an expert on insuramme matters and particularly not on reinsurance: I am. therefore, not qualis to judge the technical aspects of the bill. It does seem to me, however tha! the bill should help to induce both nonprofit plans and commercial instråd companies to more widespread experimentation in this field. The announce objectives of the administration and the stated purposes of the bill lead me to believe that the Congress would be well advised to take this first step to encourage the voluntary plans to widen the scope of their benefits and their area of coverage.

As one who has been interested in the development and one who has been interested in the operation of the Hill-Burton bill, it would appear to me that the Congress would be well advised to protect the Secretary of Health, Faling: tion, and Welfare and the insurance carriers by giving the proposed Adli mite Council some authority to approve regulations and standards. I make t'i suggestion for amendment which I believe would strengthen the bill and well! draw support for it from some who might fear that the present Hofl.2% concentrates too much power in one individual. Very truly yours,

HENRY Foro Hospitat.

ROBIN C. BUERKI, JI. D. Erecutive Director, Detroit, Mind


Senate Office Building, Washington, D. C.: This message is sent with deepest concern to protest the passage of Senato bill 3114. It is felt that it is not necessary for the Government to get into the operation of the insurance business through the reinsurance program. The mixta expense of Government in meeting its necessary functions renders performans of expensive and unnecessary functions inadvisible at this time. This is ance proposal should be carefully reconsidered because it is not necessary at

time to meet the public need. I am sure that the American tradition of freedom of choice and the freedom of enterprise would be greatly endangered by the Government's entry into the health and accident insurance field.



Senate Ofice Building, Washington, D. ('.: Request you investigate and work to defeat H. R. 8356, which is Senate bill 3114, which appears being railroaded through committees Passage will regiment one branch of insurance, hamstring all State insurance commissions, be a step toward socialized medicine. Let's keep what State rights we still have. This request is solidly backed by Nevada State Insurance Agents' Associations.


Senator W. MALONE,

Senate Office Building, Washington, D. C.: Definitely advise to kill Senate bill 3114. Does not accomplish what it was intended for. Definite step toward socialism for medical and insurance field.


LAS VEGAS, NEV. Senator GEORGE W. MALONE, United States Senator for Nevada,

Washington, D. C.: Believe Senate bill S. 3114 and House bill 8356 may be very detrimental to the insurance business and may have much wider aspects than appear on the surface. Please investigate these thoroughly, as general opinion here of insurance men is opposed.

JAMES C. Young.


Senate Building, Washington, D. C. Regarding legislation S. 3114, definitely against public interests and detrimental to insurance industry. Would remove all State control of insurance, Please vote no.



United States Senate, Washington, D. C. Understand S. 3114 has been introduced which will in effect put Government into insurance business. Know you realize that electorate in last election desired less, not more, socialization, so you are therefore urged to oppose this bill.



Senate Office Building, Washington, D. C. Nevada State Insurance Agents Association wishes to express strong opposition passage, S. 3114, accident and health reinsurance. It does not achieve purpose of improving public welfare, permits socialization of insurance, and takes control of insurance out of various States substituting Federal control.

D. E. MATTSON, Secretary.


Senate Building. Urge your careful study and opposition to Senate bill s. 3114 which sets up reinsurance plan under Federal control, as this plan takes away State control and regulation and is not necessary as it does not improve the health or benefit of


the public. Firmly believe that the regulation of insurance can be handled better by States than from the Government level.


Las Vegas, Nevada, Hon. GEORGE W. MALONE,

Senate Office Building, Washington, D. C. Request your serious consideration to opposing passage S. 3114. Bill will accomplish objective of improving public health. Bill grants suflicient authority to Secretary of Health, Education, and Welfare, to enable Secretary to completely regulate insurance, control State insurance departments, and eventually result in socialization of medicine and insurance. Letter follows.

PAUL A. HAMMEL, Insurance Commissioner, State of Nerada.


I have just read over the summary of the insurance bills H. R. 8336 and S. 3114.

It looks to me like this is an attempt to control the insurance business. The bill is supposed to provide reinsurance, but my company does not need te 1). surance and there is plenty of reinsurance available for those that do. The bill would place very broad regulatory power over all health and accident insur: ance in the United States with the Secretary of Health, Education, and Welfare. This we do not want to happen. Please give this your attention and read this bill over carefully. Respectfully,



Reno, Nev., April 17, 1954 Re S. 3114. Hon. GEORGE W. MALONE, Senate Office Building,

Washington, D. C. DEAR SENATOR MALONE: We greatly appreciated your recent communication

Just at the moment there seems to be a rather serious problem in your buulliwick relative to the above-mentioned bill. In studying some of the conditions forth in that item it appears to us this is a detinite attempt on the part of a portion of the Federal Government to take over State's richs insofar as the several insurance departments of the States are concerned. It furthermore appears this is an attempt to set up a dictatorship under the Secretary of Health, Education, and Welfare. to tell insurance companies what premi'ne they can charge, what benefits they can provide, etc.,all of which we detiritely conclude would not be in the public interest.

During the past several years different ideas have been suggested from Wach. ington indicating an attempt by some factions back there to develop an ofenall Federal control of the insurance business in the United States, We are at fident you recognize that such an arrangement would wreck the finest business in our estimation, that operates in the United States today in behalf of the twipals. tion. The immense growth of the health and accident protecton business during the past few years detinitely shows many companies in this field are capable of handling any and all requirements of this nature and also that more and more peoule each year are protecting their families and themselves throuch this medium.

Not only would the requirements of this bill enacted into law encialize the insurance business in the United States but it would also be a long step toward social zation of medicine, also.

We sincerely hope you will exert your usual good energies in again preservisa the right of the States in looking after their own business. Yours very truly,

D. L. ACREA, Manager.

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