The plan has three advantages. In the first place, it has been too often the case that persons receiving care at Government expense receive an inferior quality of care which has often been called charity care. By providing service cards to these people we avoid the necessity of identifying them as recipients of Government assistance at the time they need hospital care, and we provide that they receive the same high quality of care as is today available to persons who purchase prepayment protection.

The second advantage is that an individual may apply for prepayment protection for himself and his dependents at any time whether or not hospital and medical care is needed at the time. The determination of need is made easier and does not complicate an emergency situation. There is criticism of the "means test" because of the embarrassment and delay to an individual at the time he is ill.

The third advantage is that persons of limited income are encouraged to pay part of the cost of their hospital and medical care. Medical protection would be assured, however, through the State health insurance agency while the individual contributed to his protection within his own financial limits. It is important that we maintain this sense of individual responsibility. The independence of our people has been America's strength and this is one way to maintain and encourage that independence.

Another basic purpose of the bill is to stimulate and encourage every self-supporting citizen to protect himself and his family against the cost of hospital and medical care by voluntary enrollment in prepayment plans.

The most costly illness the average individual is likely to encounter is that requiring hospital care. The cost of hospital or medical care under existing prepayment plans runs about $5 a month for the worker and his family. The hidden costs of a Government program would in the end be a greater burden upon the average individual. We can only imagine the infinite and vexing details of control that would have to be established for operation of a cast compulsory system affecting the lives and health of all the American people.

About a third of the American people now have some form of health protection through voluntary health insurance plans. A recent survey shows that an estimated 52,500,000 people are protected by voluntary hospital coverage; more than 26,000,000 have voluntary surgical expense coverage, and nearly 9,000,000 have medical expense coverage. More than 31,000,000 of the Nation's 58,000,000 employed civilians are insured under some form of voluntary protection against loss of income due to sickness or accident.

Now, Mr. Chairman, these plans have been built up under which a third of the people have some form of coverage and there has not been, so far as I have been able to observe, any great campaign of any kind to build them up. I never hear anything about these plans on the radio, I do not see anything about them in the newspapers, there has not been any great effort to build up these plans.

Senator HUMPHREY. In fact, the American Medical Association fought them for a long time.

Senator HILL. I think the record will sustain that fact. There has been no effort to build up these plans. These plans can be built up. I can picture the acting chairman of this subcommittee, with all his power of eloquence and persuasion, addressing the people of the com

munities of Minnesota today challenging them, stimulating them, encouraging them to come in and build up this voluntary plan. Senator HUMPHREY. I may help you on it.

Senator HILL. And that is exactly what I want to see done. I want to see the American people do this job.

Let me say this, speaking of the people who join these plans: The fact that there has been very little or no encouragement, and certainly no campaigns on behalf of these plans, if there is a place in our American way of life for the voluntary system, here is a voluntary program that cannot be ignored.

With universal participation voluntary health plans can provide more comprehensive protection than they do now, that is self-evident. The more members they have, the more members are taken in, the more extensive can be the protection they give. The bill gives assistance to the States to survey the extent of enrollment and to develop methods of broadening protection and increasing the number of persons enrolled. The bill provides for pay-roll deduction of subscription charges for Federal employees who request it, and encourages similar voluntary deduction for State and local Government employees.

The greatest impetus, I think the life-insurance companies will tell us, that was ever given the life insurance in this country was when the United States Government extended war risk insurance during the World War. By that very act of the Government the people became insurance conscious and thousands of people bought life insurance who never bought it before. Whenever you provide for membership by your Federal employees and your State and city and county employees, you have given a tremendous impetus, you have given a great impact to this thing of voluntary prepaid insurance.

Senator HUMPHREY. The Social Security Act had that effect, too, did it not?

Senator HILL. Of course it did. When persons enrolled in prepayment plans become unemployed, subscription charges will be paid during the period of unemployment compensation.

In other words, when they are unemployed, these subscription charges will be carried for them just as though they were on some pay roll.

In its broadest effect the bill will stimulate the coordination and full use of the Nation's health resources. The bill does this by assisting the States to survey their needs and to integrate the use of their hospitals and medical facilities in order to provide the greatest possible service for the greatest number of people.

In this the voluntary health insurance bill follows the tested pattern of the Hospital and Health Center Construction Act. Before ground was broken or foundations laid for a single hospital, the first year under that act was spent taking inventory of hospital and health center needs in each State. Once the facts were in hand, the States were able to move promptly with a construction program suited to their particular needs.

The proposed surveys under the voluntary health insurance bill will, I am sure, reveal different needs for different areas. Some areas may find that the network of hospitals, health centers, diagnostic clinics, and the supply of doctors and nurses and skilled technicians can provide a well-rounded medical service. Other areas may need

additional services or facilities in order to provide proper care. Cooperative use of certain facilities may be desirable for some areas. All of these matters can best be determined by the people right on the

scene.

The bill provides that the Federal Government pay half of the cost of the following types of surveys by the States and the local communities:

Surveys of existing diagnostic facilities. Proper diagnosis is a necessary element of medical care and the growth and development of diagnostic clinics will be encouraged, especially in rural areas, so that such services will be available to everyone.

Surveys of existing facilities and services and financing for mental illness, tuberculosis, and chronic diseases. The surveys will provide the basis for programs to increase and improve these facilities, at present considered primarily a State responsibility.

Surveys of areas which at present do not have adequate medical care because of economic inability to support a medical practice, We know that many areas, especially rural sections, have not been able to attract the doctors they need and this is a matter of deep concern to all of us.

When the States have determined their needs, the States and the Federal Government then can and must take definite, intelligent action. From our experience with the Hospital and Health Center Construction Act we know that the surveys have led to specific programs to meet the deficiencies revealed.

It is the responsibility of this committe, as I said in the beginning, to submit legislation upon which the Senate and the Congress can act. The health needs of our people demand action.

S. 1456 is a bill that can be passed, and passed now.

The reaction to S. 1456 shows the people are ready for this program. It has general support and it has approval from the medical and hospital professions-whose aid and cooperation are essential to the success of any broad program of hospital and medical care.

The voluntary health insurance bill builds upon our traditional medical practices and makes use of our free American medical institutions.

Gentlemen, there can be no doubt about the fact that under these practices and under our free American medical institutions, our people have enjoyed the highest quality of medical care of, certainly, any comparable nation in the whole world. The bill enlists the voluntary prepayment health insurance plans which now serve a third of our people.

The program under the bill can be put into operation immediatelyput in operation now-to benefit those most in need of hospital and medical care. We have the doctors, nurses, and hospital facilities to proceed with the program. At the same time, the bill recognizes the practical limits to the medical care which can be immediately provided and does not precipitate the Nation into a program of universal medical care definitely beyond the capacities of our present health

resources.

The bill is flexible and fosters the growth of the national health program to meet new needs and new conditions. As present programs go forward and increase the number of doctors and nurses and pro

vide additional hospitals and clinics, we can provide in an orderly manner for expansion of the services which will be made available under the bill.

I have faith in the American people-their wisdom, their selfreliance. I have faith in their ability to do for themselves. The more we challenge and encourage and stimulate the people-the more they will respond, the more they will do for themselves.

The Hospital Survey and Construction Act has been inspiring proof of the ability and the desire of the people to act for themselves. Among the 48 States, Mississippi, Alabama, and North Carolina have perhaps the finest programs for hospital construction. Yet these are among the lowest States in the income of their people.

Through the voluntary health insurance bill the Federal Government will give financial aid and encouragement, leadership, and wise guidance to the medical-care program. But we rely upon the initiative and ability and resourcefulness of the people by placing full control and administration of the programs in the hands of the States and the local communities. The details of the programs will flow from the needs, the customs, and the determinations of the people. Democratic government must be government "by the people" as well as government "for the people."

This Eighty-first Congress has the opportunity to stand with the great Congresses of American history.

With the Sixty-third Congress of Woodrow Wilson's first term, which enacted the income-tax law, the antitrust law, created the Federal Trade Commission and the Federal Reserve Board, and provided for popular election of United States Senators.

With the Seventy-third Congress of the historic Hundred Days in 1933, which with bipartisan support enacted the many great laws that lifted our Nation from depression.

And with the Seventy-seventh Congress, which with bipartison support responded to Pearl Harbor with the laws that mobilized our Nation for global war.

Senator TAFT. What is the matter with the Eightieth Congress? Senator HILL. Well, since the Senator has asked the question, I would like to answer it off the record.

(Discussion off the record.)

Senator TAFT. The Seventy-ninth Congress passed the hospital bill. Senator HILL. Yes; the Seventy-ninth was outstanding, and bid for a great place in history because of the passage of the Hospital Construction Act.

The health of the people is the greatest resource of any nation. We can render no greater service to the people of America, and to the people of the world who look to a strong America for leadership to peace, than to enact this legislation for the health, the strength, the self-reliance, and the happiness of our Nation.

Let the Senate Committee on Labor and Public Welfare-our committee-give leadership and bring forth the legislation to make this Congress the great health Congress.

Senator TAFT. Are there any questions? Senator Donnell?
Senator DONNELL. No questions.

Senator TAFT. I am afraid we will not be able to wait for Senator Humphrey. We appreciate your statement.

Senator HILL. Thank you, sir. Mr. Bugbee is here, and is there anything you want to add, Mr. Bugbee?

Senator TAFT. I understood Mr. Bugbee would return at 10 o'clock tomorrow morning.

Mr. BUGBEE. Senator, the American Hospital Association is appearing later in support of S. 1456, so I think I need not appear now. Senator HILL. Unless there is some question, you will come back with them?

Mr. BUGBEE. Yes.

Senator TAFT. The committee will recess until 10 o'clock tomorrow morning.

(Whereupon, at 12:45 p. m., the subcommittee adjourned, to reconvene at 10 a. m. Wednesday, May 25, 1949.)