(b) It will cause deterioration of dental service and lower the level of health.

(c) The necessary administrative procedures will delay treatment. (d) It will become a tax burden.

(e) It will eventually require regimentation, which it not the American way of life.

3. It is not good legislation for the profession because—

(a) It will destroy competition, inhibit ambition and industry. (b) It will result in mediocrity in the profession.

(c) Excessive paper work will reduce the number of chairside hours which a dentists may devote to his patients.

The profession needs ethical competition, the private relation to and direct responsibility for the health of the patient, to attain its highest achievements.

CONCLUSION

The American Dental Association and the dental profession always have been and always will be interested in the health, and particularly the dental health, and welfare of the American people. It will conscientiously scrutinize any programs offered which relate to its legitimate field of interest, and it will comment fairly and without prejudice or selfish motives on such programs.

The dental profession opposes the enactment of the National Health Insurance and Public Health Act because it is not good health legislation for the people of the United States of America.

Senator MURRAY. Does that conclude your statement?

Dr. FLAGSTAD. Yes, sir, Senator.

Senator MURRAY. I think you have been here with us before many times.

Dr. FLAGSTAD. We are old friends together.

Senator MURRAY. I want to express my approval of your program of objectives. It sounds very much like you took it out of our bill, S. 1679, and I want to congratulate you.

Your association, of course, is on friendly relations and cooperates with the American Medical Association, does it not?

Dr. FLAGSTAD. Yes, sir.

Senator MURRAY. I notice in your statement here you say that the health professions have frequently been criticized for not presenting a positive approach to the solution of health problems of our people. However, this criticism is not justified in regard to the American Dental Association, for it has long recognized that there are certain weaknesses in the distribution of our dental health services and has repeatedly appeared before the Congress to solicit its aid in the enactment of legislation which would in some degree help overcome these shortcomings. You also say that the association has on former appearances been before the congressional committees and presented for the record a dental health program, and so forth.

I notice in another part of your statement you say that the successful dentistry that is practiced in this country has conributed tremendously to the health and welfare of the American people and has been one of the great factors in making America one of the healthiest nations in the world. That is true, is it not?

Dr. FLAGSTAD. That is true.

Senator MURRAY. You have not always been given credit for that. It seems to me the medical profession claims they are the sole ones who have made America such a great healthy nation. Do you agree with them on that?

Dr. FLAGSTAD. That the American Medical Association-I think the American Medical Association has done, indeed, a great deal to improve the health of the people, and we have, also.

Senator MURRAY. But do you think the dentists have contributed something to that?

Dr. FLAGSTAD. Yes; and I think even the Congress has contributed some to that.

Senator MURRAY. Yes; we have made vast contributions.

Dr. FLAGSTAD. That is right.

Senator MURRAY. Do you not think the contributions made by our Government with reference to hygienic conditions and various other activities have had a very important bearing in making the United States a very healthy nation?

Dr. FLAGSTAD. Yes; I believe the Government has a very important place in the health of the Nation, Senator, but there is a certain place where we differ as to how far you should go. Certainly, the Government is responsible for sanitation and many other things. Public health is necessary.

Senator MURRAY. Now, you recognize, of course, that there is a large proportion of our population that is unable to pay for the best modern medical care in this country, do you not?

Dr. FLAGSTAD. I would say there are certain portions of the population that are not able to pay.

Senator MURRAY. The American Medical Association at one time said people earning less than $3,000 a year would be unable to pay for a serious illness, and that statement was made some years ago, so that if you applied it to the present time, people earning less than $5,000 a year, which represents something like 80 percent of the population, would be unable to pay for modern medical care in any serious illness. Dr. FLAGSTAD. I cannot vouch for the statistics of the American Medical Association, Senator, but I think I can say that there is a place where government needs to come in and help take care of them, and we have sponsored bills for that particular purpose, grants-in-aid, bills of different kinds. We are on record as favoring grants-in-aid of the Government in support of health programs.

The American Dental Association is for that.

Senator MURRAY. Of course, the testimony of the other witness here this morning points out that the income of the medical profession in this country is pretty high, that some of them earn as high as $186,000 a year. You do not think they need any assistance from the Government in paying them for their services, do you?

Dr. FLAGSTAD. I would hardly think so with that income.

Senator MURRAY. In the dental profession, do you not find also that there are a lot of people who cannot afford to pay for the best kind of American dentistry?

Dr. FLAGSTAD. They are being fairly well taken care of by other programs in the States and in the communities. We have programs in operation in practically every community and State to take care of these people; perhaps not to the extent we should like to, however.

- Senator MURRAY. Notwithstanding that, there is a great part of our population that have not had any dentistry at all, and if we undertook at this present moment to give them complete dentistry the dental profession would not be able to do it; is that right?

Dr. FLAGSTAD. I think if we were to rehabilitate all the mouths and put them in perfect condition, all within a very short time, I think it would be quite a task-impossible. However, many of these people who have not had dental service-it is not due to the fact particularly that it is not available, but because they have not taken advantage of the availability of the service.

Senator MURRAY. It is due to the fact that they did not receive the care they should have in early life, is it not?

Dr. FLAGSTAD. That is true, and we are in favor of a program of concentration on children.

Senator MURRAY. And the Congress is in sympathy with that program and intends to go forward in the establishment of a program that would have a tremendous effect on the future dental health as well as the physical health of the people of this country.

Dr. FLAGSTAD. That is right.

Senator MURRAY. Do you have any questions?
Senator DONNELL. I have a few questions.

Doctor, do you know very many dentists or doctors of medicine or surgery who make $186,000 a year or near that?

Dr. FLAGSTAD. I am not familiar with the medical income. I am somewhat familiar with the dental income, and I know of nobody who receives anywhere near that amount of money.

Senator DONNELL. You mentioned being in favor of grants-in-aid. Dr. FLAGSTAD. Yes, sir.

Senator DONNELL. Are you familiar, generally speaking, with the Taft bill, S. 1581?

Dr. FLAGSTAD. Yes, sir.

Senator DONNELL. Have you studied that bill, Doctor?

Dr. FLAGSTAD. We have not passed upon it. We have studied it

some.

Senator DONNELL. Have you personally studied the bill?
Dr. FLAGSTAD. Yes; I have looked it over.

Senator DONNELL. Would you tell us, please, just in a nutshell whether or not you favor that bill or whether you are opposed to it?

Dr. FLAGSTAD. We favor the philosophy of the bill and the grantin-aid system, and the taking care of those who are unable to pay and those who are only able to pay in part, and the subsidy of States and local communities by grants-in-aid to set up a health program.

There is another part of the bill there on which no policy has been set and which we will not pass judgment on at this time.

Senator DONNELL. Which is that?

Dr. FLAGSTAD. The same as title I of S. 1679, the matter of subsidy and grants to dental schools, and so forth.

Senator DONNELL. But this matter of grants-in-aid and the matter of assisting States by grants-in-aid to bring about treatment for persons who are unable to pay for the treatment themselves, either in whole or in part, that meets with your approval?

Dr. FLAGSTAD. That has been passed by the house of delegates of the American Dental Association. They are in favor of grants-in-aid as a system to support dental-health programs in communities and States under the complete supervision of the State and the community, not

the Federal Government, and they also favor service to those who are unable to pay and those who can only pay in part.

Senator DONNELL. And those policies to which you have just referred, to which the house of delegates has addressed itself, are among the fundamental policies set forth in S. 1581?

Dr. FLAGSTAD. That is right, and there are some details in the bill which our testimony of last year covers, which I think we are not in accord with.

Senator DONNELL. That is all, Mr. Chairman.

Senator MURRAY. Thank you, Doctor.

I have a request to call Dr. Bauer at this time so that we may complete his testimony this morning, and also Dr. Sensenich.

Dr. SENSENICH. Mr. Chairman, we appreciate the opportunity to come before your committee, and we feel we have a public responsibility in so doing, just as the committee, no doubt, feels it has a responsibility in hearing us.

There are four of us here this morning, but we are going to limit the statement to two and will do the best we can to conserve your time because we know you have much to do.

Senator MURRAY. Thank you very much.

Dr. SENSENICH. I would like to introduce the witnesses. Dr. Harvey Stone, who is professor of surgery at Johns Hopkins and also a member of the council on medical education and hospitals of the AMA. I might mention that we are all practicing physicians.

Next is Dr. Louis Bauer, who will give a statement in a moment. Dr. Bauer is chairman of the executive committee of the board of the American Medical Association. He specializes in internal medicine and is from Hempstead, N. Y.

Next is Dr. Lowell S. Goin of Los Angeles, Calif., who specializes in radiology and is past president of the California State Medical Association and the president of the California Physicians Service and a member of the house of delegates of the American Medical Association.

I am making these introductions now so we could go right along with our statements. Dr. Bauer, by the way, is a past president of the New York State Association and, I think, every other association in New York that I know anything about. Dr. Bauer will make his statement first and then Dr. Goin, and we will all be available for questions if we can be of any help.

Senator MURRAY. Thank you, sir. We are all becoming well acquainted with these doctors you have introduced. I have met them before and am very glad to have them here.

Dr. SENSENICH. We have had some very interesting meetings from time to time. I would like to say this off the record. (Discussion off the record.)

Senator MURRAY. You may proceed, Dr. Bauer.

STATEMENT OF DR. LOUIS H. BAUER, HEMPSTEAD, N. Y., ON BEHALF OF THE AMERICAN MEDICAL ASSOCIATION, ACCOMPANIED BY DR. ROSCOE SENSENICH, SOUTH BEND, IND.

Dr. BAUER. Mr. Chairman and members of the committee, my name is Dr. Louis H. Bauer. I am a physician and appear as a member of the board of trustees of the American Medical Association which had

a membership as of May 1, 1949, of 142,882 physicans. My home is in Rockville Center, N. Y., and my office is in Hempstead, N. Y.

It is my understanding that today detailed consideration will not be given to the proposals contained in the four bills on which hearings are being held, S. 1106, introduced by Senator Lodge, to provide assistance to the States in furnishing certain medical aid to needy and other individuals; S. 1456, introduced by Senator Hill, for himself and Senators O'Conor, Withers, Aiken, and Morse, to authorize grants to enable the States to survey, coordinate, supplement, and strengthen their existing health resources so that hospital and medical care may be obtained by all persons; S. 1581, introduced by Senator Taft, for himself and Senators Smith of New Jersey and Donnell to enact a National Health Act of 1949; and S. 1679, introduced by Senator Thomas of Utah for himself and Senators Murray, Wagner, Pepper, Chavez, Taylor, McGrath, and Humphrey, to provide a program of national health insurance and public health and to assist in increasing the number of adequately trained professional and other health personnel.

Acting on this information, the statement that I will present to the committee will be general in character, but the association does desire the opportunity to submit at a later date comments on some of the suggestions contained in these bills. Representatives of the association have appeared a number of times before your committee in connection with previous bills which have suggested the enactment of a compulsory sickness-insurance program under Federal supervision.

We would like to reiterate some of the viewpoints that we have previously stated with respect to this particular proposal and would like to offer additional comments on the Lodge bill, the Taft bill, and the Hill bill and on some of the other titles contained in S. 1679 which is, I believe, referred to as the administration bill.

There is little disagreement as to the desirability of the widest possible distribution and availability of the best quality of medical care. The differences of opinion arise as to the best way to attain this objective. It is the belief of the medical profession generally that the primary responsibility for the health of individual citizens rests on the individual citizen and on his immediate family. Where the requirements of a particular situation exceed the ability of the individual or his family to meet them, the local community, by the American tradition, comes to his aid. Should the resources of the local community prove inadequate to deal with the volume of demand for assistance in the health field, the problem then becomes the responsibility of the State.

It is only when the State in its turn is unable to cope with these demands that there should be recourse to Federal assistance. We believe that this procedure is in accordance with sound American tradition, with the intent of our political principles, and with the maintenance of self-reliance and independence of each of these levels of relationship, from the citizen to the National Government.

It follows that the local community or the State should make provision for the supplying of medical care to those of its citizens who find themselves financially unable to procure needed services. It is customary to speak of such economic groups as the indigent or medically indigent. It is believed that a simple system can be set up by