Now, for the best schemes which have been evolved on that score which are in effect-I think of other schemes that have been and I will tell you about one in a minute-but the best scheme on that scope which we have is the group practice, or the enormous group practice like HIP plan in New York, to which Dr. Baehr will undoubtedly speak, and who is here today.

This is an illustration of what can be done in bringing down the cost of normal medical care, preventive medicine, the office costs, the homes costs, the outpatient care, by mutualizing the risk and the

cost.

Mutualization is one, a distribution of the risk in this field and second, and equally important, is the doctor and his facilities, that is, the diagnostic and treatment facilities, a base of permanent support, because he gets an established fee per year, or the group does, which they can absolutely rely on and thus enables them to discount the risks of a lot of business or a little business, or many people going to one doctor and making him very rich and too few people going to another doctor.

I think 7700 moves helpfully in that direction, because it is an established fact that in order to engage in this kind of practice, doctors who are going to club together for the purpose of performing these needed functions, in addition to that, as we all know, medicine is becoming a highly technical process with the machinery involvedand I do not say that disrespectfully-but it is a layman's way of saying it-becoming more and more expensive all of the time and this bill, H. R. 7700, is a recognition of that fact.

I think actually, and this has been testified to before this committee, that these loans are very sound loans. We are dealing in a field which is very much like housing, where we started off by thinking when the Federal Government helped to get mortgage money out around the country, it would run great risks and would cost the Federal Government a great deal of money and ended up by finding out that it was one of the very profitable activities of our Government.

I think this is the same thing, and I think that the same thing will be true in respect to this trial effort which is incorporated in H. R. 7700, and naturally the promise is a very modest one, just as the proposal for reinsurance is an extremely modest one.

I have a deep conviction that far more must be done, but certainly those of us who have been working in this field for so long-and the chairman has been working in this field longer than anyone-must recognize the objections and the opposition to it.

This committee knows very well what it will face on the floor from many people when it brings up either of these bills, and I am sure it is fully prepared to meet it. I am confident that they will carry, because I think that the country is back of it.

But, no one will contend that these are very elaborate steps. They are modest, very reasonable, first steps in the direction which our Federal Government must, in my opinion, inevitably pursue and it is for those reasons, Mr. Chairman, that I support H. R. 7700.

If the Chair will indulge me for just a moment, I would like to say as to a comprehensive national-health program, this is a very major question. I believe that despite all of the tub thumping which

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was done for the national health insurance scheme by the previous administration for such a long time, the idea that the Nation should be concerned and take a definite part in the solution of the national health problem has never been so deeply entertained by people, so generally, as it is today; much more so, in my opinion, than it was when it was a big political question or being used as a big political issue, and a great deal of tub thumping was being done about it.

I think that the people are very deeply convinced that the Nation and the people togther have to do something together to solve the national-health problem.

Now, when I say what I did about a fundamental approach by the committee, I think it would be extremely useful if the committee considers favorably these two bills—and I hope very much it willif it at the same time sought to outline an historical policy for the Federal Government's participation in this whole field of health. A beginning in that has already been taken in the bill which was passed by the House to broaden the idea that the Federal Government should participate only in the hospital construction program to include other phases of hospital treatment, or quasi-hospital treatment; nursing homes, rehabilitation centers, diagnostic centers, and so forth; but I think it would be extremely useful if the committee could lay down a final principle and I believe that the principle should be this, that the Federal Government should participate in dealing with the national-health problem, but it should participate as a backer and partner with the citizens, rather than to run it as an insurance scheme, or a social security scheme, which was a scheme of the previous administration.

I believe that it would be extremely valuable if this committee should, in addition to dealing with these specific measures, endeavor to chart a fundamental principle upon which the Federal Government would participate in the problems of dealing with the national health, and that the principles which I urge upon the committee are that the Federal Government be a partner with the citizens in helping the citizens to mutualize the risk and get greater facilities, and generally to deal with the problem, rather than to approach the matter from the insurance aspect, or social security aspect, which was the aspect recommended by the previous administration.

But I submit, if you adopt that principle, its application ultimately must be very much broader than is contained in the two measures about which I have been talking, which I know that the committee has before it, and I urge upon the committee as an expression of that principle, which I have just described, of a national-health program, which has been sponsored since 1949, by a group of Republican Members of the House and Senate and which is now incorporated in H. R. 3586, which happens to be my particular bill. The other bills are those of Representatives Scott of Pennsylvania and Hale of Maine, which are before this committee, and the fundamental basis for which is Federal backing for cooperative health plans, to the extent of taking up the slack in those plans which exist due to the needs for looking after people whose income is under par and who, therefore, cannot pay the full premium which would be involved in giving them optimum medical care under those plans, and would include the indigent, the aged, and other people.

I notice very interestingly that the criticism of the Committee for the National Health, which has for a long time, as we all know, been working for the health-insurance scheme, which I referred to a minute ago; the criticism of that group, of the reinsurance bill which is before this committee, is that it fails to take care of low-income, the rural population, the self-employed, and the retired.

Now, whether or not there is anything to that criticism, I do not think it is pertinent to our discussion. I think the point is that the Federal Government's interposition in this field has in some way to deal with those groups of people which represent a problem in terms of working out the national health situation. For example, when you get high-level civil service employees-I do not mean high-level employees in terms of policymaking but in terms of income, organizations like the HIP, as it has, can manage very successfully on a financial basis and give all kinds of care without any Government help except the employer participation, which happens to come from the city of New York, or could easily come from any other employer group. But, when you get to the people who have below-par income, and have other difficulties and have difficulties in meeting their premium requirements, then you do need governmental interposition to help those plans carry on, and as a matter of public policy, I would say that it is extremely important to the future of our country that the Government, if it is going to help in this field--and as I say I think there is a public consciousness that the need for help is very great, we should find a way for helping which would preserve the independence of the citizens and the independence of the doctors, and all of the other technicians concerned, and I believe that this program which a group of us got behind as far back as 1949, has the greatest promise on that score. Now, I realize that the committee is not prepared to undertake any such extensive program as we have recommended, but I do urge upon the committee, in addition to the consideration of both the measures, the reinsurance measure, and H. R. 7700, for loans to establish facilities for group practice, and so forth, that it consider in that connection, when it comes out with those bills, the enunciation of a principle upon which the future help from the Federal Government to deal with the national health may proceed, and I think if it does that, it will have made a very real contribution to this problem and put us on the road to a solution of what has been a highly and very controversial political issue in our country for a long time.

I hope too, Mr. Chairman, that the committee will feel emboldened to act now in this situation and that these two measures at least can be pased before we adjourn the 83d Congress. I thing if they are passed, they will indeed be a landmark in the record of this Congress. Thank you, Mr. Chairman.

The CHAIRMAN. Any questions, gentlemen?
Mr. YOUNGER. Mr. Chairman.

The CHAIRMAN. Mr. Younger.

Mr. YOUNGER. Mr. Javits, you had in mind a direct contribution on the part of the Federal Government to the premiums, so to speak, for the health insurance of the indigent and the low-income groups.

Mr. JAVITS Yes. The way this thing works under our bill is that where a cooperative health plan is established-and it can be established by a veterans' post, the church, a town-almost any entity

trade-union-and qualifies for that kind of aid by its facilities and its facilities pass muster-I cannot describe to you all of the details of it-then, to the extent that it falls short of giving the care, having met all of the standards, the Federal Government up to a maximum of $15 per person per year will help, in a division with the States, the division with the States being on the same basis as under the HillBurton Act, depending upon the per capita State income. But, there is an absolute limit of $15 per person per year. And, that is the general scheme in our bill. And, it has been very much debated, as I am sure you know, but that is the general idea.

I would reiterate that I hope very much that the committee cannot only come out with these bills, but can actually take the position this should be the national policy in this field, this enormously important field-we are taking these steps; other generations, or other Congresses, or perhaps tomorrow other steps will be taken; but at least we are laying out the chart along which the Federal Government ought to proceed in this field.

That, I think, Mr. Chairman, would be a great service.

The CHAIRMAN. Are there any further questions, gentlemen?
Mr. DEROUNIAN. Mr. Chairman.

The CHAIRMAN. Mr. Derounian.

Mr. DEROUNIAN. Mr. Javits, under your bill and under Mr. Scott's bill and under Mr. Hale's bill, how great a participation would the Federal Government have, beyond its contribution to the States on that formula?

Mr. JAVITS. None.

Mr. DEROUNIAN. No direct supervision?

Mr. JAVITS. None whatsoever. The regional boards, which are citizen boards set up for the purpose of administering it, and so on, on the basis of qualifications established by law.

Mr. DEROUNIAN. No further questions.

The CHAIRMAN. Any further questions, gentlemen?

The Chair expresses the appreciation of the committee for your appearance here today, Mr. Javits, and the encouragement that comes as a result of the statement you have made. We appreciate the views that you have with respect to governmental responsibility in the matter of the health of our people, and I am inclined to believe that before this session is over-I am hopeful-that we will have an opportunity to give some consideration to the bill to which you have referred as your bill. What number is it?

Mr. JAVITS. I think it is 3586.

The CHAIRMAN. Yes.

Mr. JAVITS. I would like to emphasize, Mr. Chairman, that my bill does not take precedence over Mr. Scott's or Mr. Hale's bill. I am sure that the committee would intend to consider them together.

The CHAIRMAN. Yes. We have in mind, from the standpoint of getting every possible viewpoint, and having in mind as you have indicated, that what the committee has already done and what it is now striving to do, are but steps in a forward movement that we hope ultimately will prove highly beneficial to the health of our people. Mr. JAVITS. Thank you very much.

Mr. HESELTON. Mr. Chairman, may I ask a question?
The CHAIRMAN. Mr. Heselton.

Mr. HESELTON. That a bill is identical with a bill filed in the preceding Congress?

Mr. JAVITS. I did not get the question, Mr. Heselton.

Mr. HESELTON. The bill that you have here is identical with a bill filed in a preceding Congress?

Mr. JAVITS. Yes; it originated in the 81st Congress, in 1949.

Mr. HESELTON. That bill was also filed by our former colleague, Mr. Herter.

Mr. JAVITS. Identical with the one in which he joined and the idea has been a developing one ever since the time.

Mr. HESELTON. I too want to join the chairman in commending you for the very worthwhile effort you have made to provide a solution of this very difficult problem.

Mr. JAVITS. Thank you very much.

The CHAIRMAN. I hope, Mr. Javits, that you will feel that you have the right and certainly we would appreciate your assuming the right, to speak to the committee at any time with reference to any phase of the matter which you think would be helpful to the committee in its consideration.

Mr. JAVITS. Thank you, Mr. Chairman. I consider the committee my friends. Thank you.

The CHAIRMAN. We have with us today several distinguished witnesses. Dr. George Baehr, president and medical director, Health Insurance Plan of Greater New York; Dr. R. E. Rothenberg, medical director, Central Group of Brooklyn, Health Insurance Plan of Greater New York; and Dr. Karl Pickard, Health Insurance Plan of Greater New York, and others, who are to present their viewpoints with respect to H. R. 7700.

STATEMENT OF DR. GEORGE BAEHR, PRESIDENT AND MEDICAL DIRECTOR, HEALTH INSURANCE PLAN OF GREATER NEW YORK, NEW YORK, N. Y.

The CHAIRMAN. Dr. George Baehr, who will be the first witness, is the president and medical director of the Health Insurance Plan of Greater New York. He was formerly clinical professor of medicine at Columbia University and chief of the first medical service and director of clinical research at Mount Sinai Hospital, New York. He is consulting physician to a number of New York hospitals. From 1945 to 1948, he was president of the New York Academy of Medicine. He is a member of the Public Health Council of the State of New York, the Board of Hospitals of the city of New York, and the scientific board of the Public Health Research Council.

On the completion of Dr. Baehr's statement, he will introduce three of his associates who have been actively engaged in the organization and administration of medical groups which provide prepaid comprehensive personal health services to persons insured under the Health Insurance Plan of Greater New York.

Dr. Robert E. Rothenberg is medical director of the Central Medical Goup of Brooklyn, one of the largest groups affiliated with the health insurance plan. He is also assistant professor of environmental medicine and community health at the State University Medical School in New York. He is a fellow of the American College of Surgeons and a diplomate of the American Board of Surgery.