I would like to say again parenthetically here, the problem to date has been heavily in the recognition area; but it is absolutely inevitable that if enough contracts are arrived at this will result in impasse type of proceedings becoming predominant in this field. It is only a matter of where we are in the history of labor relations in the hospital field that says that recognition strikes are dominant.

The act has no provision for effectively resolving such impasses. The association believes that the problem of bargaining impasses in health care institutions must be resolved because strikes in such institutions are intolerable.

This committee should carefully weigh the serious implications for the public of work stoppages in the health care field whether occurring in a single institution or on a widespread basis.

Those who support coverage of all health care institutions under the National Labor Relations Act argue that the problems of strikes and work stoppages in health-care institutions have not really materialized where coverage already exists.

They cite as an example the National Labor Relations Board's jurisdiction over investor-owned health care institutions.

There have been instances of strikes in such institutions and we would further point out that there has been very limited experience in this area in that the extension of jurisdiction over these institutions is relatively recent.

If collective bargaining were to become more widespread in the hospital field as a consequence of enactment of H.R. 11357, the potential for more strikes and for strikes involving all hospitals in a broad geographic area would clearly exist.

And, parenthetically again, I don't know what you do with patients if all of the hospitals in an area are hit with a strike.

FRAGMENTATION OF BARGAINING UNITS

The National Labor Relations Act also fails to deal adequately with the problem of multiple bargaining units within a health-care institution.

There are over 100 separate occupational classifications in the health care field with an overwhelming percentage of these classifications being critical to the efficient operation of hospitals.

The health care institutions of this country would face major difficulties in attempting to provide coordinated patient care services if forced to bargain separately with many different employee groups within an institution.

More and more of the allied health professional groups have been obtaining licensure through State legislation. This problem of fragmentation has reached such a magnitude that this Association, as well as others, including the American Medical Association, the American Nurses' Association, and the U.S. Department of Health, Education, and Welfare, have called for a national moratorium on licensure of additional categories of health care personnel.

Under the provisions of the National Labor Relations Act, employees of health care institutions would be further fragmented into numerous small bargaining units.

The National Labor Relations Board, for example, has already recognized separate bargaining units for pharmacists, laboratory technologists, registered nurses, and licensed practical or licensed vocational nurses.

Additional bargaining units can be projected for many other professional and paraprofessional groups as well as for the many crafts which are vital to the functioning of health care institutions such as engineers, carpenters, plumbers, electricians, and maintenance workers. This proliferation of bargaining units within an institution would have the following adverse effects:

First, any one of these many bargaining units, even a very small bargaining unit within the institution, could close down the entire facility because of the general practice of all bargaining units to respect the picketing efforts of others.

As an example, a small unit of four stationary engineers could effectively disrupt the total operations of a hospital by establishing a picket line that would be honored by other employees.

Second, the existence of numerous bargaining units could lead to many jurisdictional disputes. Rigid craft lines could be imposed on hospitals, similar to those that exist in the construction industry.

These rigid craft lines create problems both because of overlapping responsibilities as well as interference with patient care when employees refuse to perform tasks outside of those defined by their bargaining unit.

This would seriously impair efforts to provide efficient, coordinated and high quality patient care services.

Third, the various bargaining units within the health-care institution would each fiercely compete for the most favorable wages, hours, and working conditions. Such continuing competition would interfere with the necessary team work which is critical in providing quality patient services.

Fourth, dealing with many bargaining units in a hospital would result in an excessive and unnecessary cost in terms of administrative and legal time and expense.

It is difficult to justify these additional costs, which must of course be borne by the patient, at a time when vigorous efforts are being directed by hospitals and by the Government at controlling rising health care costs.

In conclusion, Mr. Chairman, we reiterate our strong belief that enactment of H.R. 11357 which would subject nonprofit hospitals to the provisions of the National Labor Relations Act, with all of its significant limitations and shortcomings as it applies to the health field, would seriously impair the delivery of patient care services and would not be in the best interest of the public. We urge the committee to reject this bill.

We thank you for the opportunity of presenting the views of the American Hospital Association to the committee.

I wonder if I could say just one additional word.

The issue has been raised that within the groups that are striving for recognition, that their choice is submission or conflict, that they either submit to not being recognized, or

We would submit that because of the public pressures on a hospital to maintain service in spite of whatever demands might be made, and our own concern for patients, that this would be our choice, once the union is recognized, that our choice would be submission to whatever demands have been made, essentially, or conflict.

The CHAIRMAN. Are you sure you want to put that on the public record?

Mr. HITT. This is the nature of the concern that faces the hospital field that it has to maintain a continuity of service.

The CHAIRMAN. Let me ask you this: do you see a qualititative difference between the situations of an employee in a profit hospital and a nonprofit hospital?

Mr. HITT. No, sir; I do not.

The CHAIRMAN. Now, is there anything else in conclusion gentlemen? Dr. GEHRIG. Senator, if I may, I think Mr. Hitt hit very closely onthe real concerns that must center on the patient; and I think that the problem of stoppages and impasses that are related to the bargaining unit again brings out the fact that hospital people, physicians and others, must show a first concern for the patient.

I would like to add another thought here, and that is, as was just indicated, the vulnerability of health care institutions to demands to which many institutions will have to accede. This is going to be reflected also in costs. As you know, hospitals are under tremendous pressure, both by our own efforts and those of our Government, to control hospital costs.

I predict that with this sort of action, we are going to see further inflation in hospital costs. In the past increased costs have been reflected in increasing salaries, which we are pleased to have been able to give, but nonetheless, while salaries of hospital employees have been improved during this period, we are in between-by Government and public-because of increasing hospital costs-costs which are related to personnel salaries, to the tune of about 60 percent. Mr. HITT. Senator, from your reaction to what I said, maybe you misunderstood the point I was trying to make.

The point I was trying to make is that we who are responsible for delivering hospital services and working out whatever arrangements are necessary, will be under such great pressure at the time of a threat of a strike, that we will-we would have to give in to demands that under other circumstances might be resisted, or considered completely out of the question.

Our ability to resist these comes from the nature and the purpose of hospitals and the public pressures for services, as well as from our own concerns for the patient. We cannot back off of bargaining as though we were bargaining over just dollars.

Thank you very much.

The CHAIRMAN. Thank you very much.

Mr. Frederick K. Alderson, vice president and director of Legislative Liaison of the National Right to Work Committee.

I have read your paper, Mr. Alderson, if you want to just summarize it; I am the only one that happens to be here; so if you want to simplify it for yourself, it is all right with me.

STATEMENT OF FREDERICK K. ALDERSON, VICE PRESIDENT AND DIRECTOR OF LEGISLATIVE LIAISON, NATIONAL RIGHT TO WORK COMMITTEE

Mr. ALDERSON. I would be very happy to do that, Mr. Chairman; and I will submit the whole statement for the record at the end of my testimony.

The National Right to Work Committee is a single-purpose citizens organization dedicated to the principle that union membership should be voluntary, not compulsory.

Our principal concern today is not with the broad aspects of the bill, H.R. 11357, but with one vital facet: the impact it would have in extending to hospital employees that provision of the National Labor Relations Act which sanctions compulsory unionism.

This provision of the NLRA is objectionable to the overwhelming majority of the American people. Their attitude is reflected by the findings of a recent nationwide public opinion survey.

When H.R. 11357 was reported out, it was argued that this legislation, and I quote, "will result in greater labor stability by largely eliminating the recognition strike by providing access to the election procedures of the NLRB."

Witnesses today have also mentioned this.

The supporters of this bill however seem to be unfamiliar with the impact of the existing law which authorizes the forced unionization of workers. Recent history indicates clearly that much industrial unrest has been generated by disputes between union officials and employers over the issue of compulsory unionism.

AFL-CIO President George Meany himself, during an appearance before a House subcommittee several years ago, acknowledged this fact by saying, "Disputes over union security have been a frequent cause of industrial strife."

The Bureau of Labor Statistics published fiscal data which tended to confirm Mr. Meany's statement.

Mr. Chairman, with bills now pending in Congress that would extend the horizons of compulsory unionism to embrace farmworkers and the millions of employees in the public sector, we feel the enactment of this legislation, which you are considering today, could set a very dangerous precedent. It could serve to intensify the demands of officials of public employee unions for the same extraordinary privileges now granted union officials in the private sector. And we submit that the Nation would be on the road to ruin when and if Congress should legalize the forced unionization of agricultural and public employees.

In conclusion, Mr. Chairman, if it should be decided to report favorably this bill to the Senate for consideration, we strongly urge this committee to include a provision that would guarantee to employees of nonprofit hospitals freedom of choice with respect to union membership.

Such a provision would most certainly be hailed by rank and file workers throughout the country as a hallmark decision-a decision breaking with the current Federal policy which forces employees in the private sector to pay money to a labor organization in order to hold a job.

Thank you very much.

The CHAIRMAN. Thank you very much.

(The prepared statement of Mr. Alderson follows:)