with 4,000 people on his panel, but the average doctor needs that many in order to come out with a few dollars saved at the end of the year. Of course, in this country I think the situation we have is one doctor to 1,500 people.

Senator MURRAY. Those are matters that all adjust themselves in time, it seems to me. I don't know what the situation in England is with reference to the number of doctors or whether they have sufficient medical personnel, but it seems to me at the commencement of the program naturally people who have been unable to seek medical care before would no doubt flock in, especially people who needed dental care, for example.

Mr. HAYES. Of course, my own opinion is Britain has been taking too great a stride at one time. That is what this bill does, it seems to me. Over the last few years I have testified for the Taft bill, and we believe in these slow steps. As Senator Hill stated yesterday, the services are necessary. We have to determine what the next best step is as we go along, not this tremendous stride which will completely change the complexion of medical and hospital care all at one time with no assurance it is going to make it better. We cannot provide more medical care than we have without having more people. We in the hospital groups in the various States are always careful to see that hospitals are not going to be put up somewhere without help to run them.

Senator DONNELL. Mr. Hays, there is one place on page 11 that I don't quite understand in your testimony, and I was going to ask you if you would amplify it. You quote from section 705 (a) of S. 1679, the compulsory health insurance proposal.

Mr. HAYES. Yes, sir.

Senator DONNELL. Then you say:

Do you notice that under this provision the Federal Government would provide no assistance whatever in financing care to these unfortunate people for whom the need is greatest? The entire burden for the indigent would be left upon the States and local communities under the compulsory health insurance program, plus the added costs of Federal administration. If the States and local communities did not pay premiums into the Federal Government, these needy individuals would receive no protection.

Now, the question that arises in my mind and in your mind arises at lines 21 and 22 of 705 (a); and that is the use of the term "by public agencies of the United States, the several States, or any of them," and so forth. Do you think it is clear that under section 705 (a) the Federal Government would provide no assistance whatever, or do you think the language I have read "public agencies in the United States," would mean the United States Government would provide some of the assistance?

Mr. HAYES. Well, it is not clearly stated that the Federal Government-Senator Murray, I spoke about that a few minutes ago-to my mind it is not clear that the Federal Government is going to do this immediately under this bill. It might as the need arose and as this act might come into effect, but to my mind it doesn't show we would do any more than we would be doing today, taking care of it locally and statewise.

Senator DONNELL. I think that is all, Mr. Hayes. Thank you very much.

Senator MURRAY. Thank you, Mr. Hayes.

Mr. HAYES. Thank you, gentlemen.

Senator MURRAY. Now, Mr. John H. Olsen.

STATEMENT OF JOHN H. OLSEN, PAST PRESIDENT OF THE
AMERICAN PROTESTANT HOSPITAL ASSOCIATION

Senator MURRAY. You may state your full name and the organization you represent, your residence, and so forth.

Mr. OLSEN. For the record, my name is Olsen, Senator, John H. I am past president of the American Protestant Hospital Association, which I have the honor to represent at this hearing. I am also a past president of the Hospital Council of Brooklyn, a life member of the American Hospital Association, and a member of the American College of Hospital Administrators, the Hospital Association of the State of New York, and the Greater New York Hospital Association, and also serve as a member of the advisory editorial board of Hospital Management.

I am the administrator of the Richmond Memorial Hospital, Dreyfus Foundation, Prince Bay, Staten Island, N. Y., serving my twentieth year in that capacity, and 5 years longer as a member of its board of directors.

Senator MURRAY. Are you active in all those organizations?

Mr. OLSEN. Yes, sir. For over 30 years. My health has been good, and I haven't missed a meeting of the American Protestant Hospital Association in 29 years.

The members of the American Protestant Hospital Association are greatly interested in matters now before you and the serious manner in which they may concern our sick.

Rev. Chester C. Marshall, D. D., president of the American Protestant Hospital Association, has said:

There is no doubt in my mind that our association would vote unanimously its disapproval of bill S. 1679, introduced by Senator Thomas and others, providing for compulsory health insurance; nor do I have any doubt that strong approval would be forthcoming for either the Hill bill or the Taft bill, S. 1581. Dr. Marshall further states:

As president of the American Protestant Hospital Association I signed a statement a few weeks ago endorsing the main provisions of a bill then in the course of preparation and which subsequently was introduced in the Senate by Senators Hill, O'Conor, Withers, Aiken, and Morse—

Senators Lister D. Hill, of Alabama; Herbert R. O'Conor, of Maryland; Garrett L. Withers, of Kentucky; George D. Aiken, of Vermont; and Wayne Morse, of Oregon.

The provisions of this bill seem to be completely consistent with the official position of the American Protestant Hospital Association as stated in the resolution adopted on September 18, 1948, at its twenty-seventh annual convention at Atlantic City, N. J.

REPORT OF RESOLUTIONS COMMITTEE AT THE AMERICAN PROTESTANT HOSPITAL ASSOCIATION TWENTY-SEVENTH ANNUAL CONVENTION

The resolutions committee views with alarm the reported activities re compulsory health insurance, health aid, control of medical care of our people, and the discussion over the extent of Federal control of State and local health organizations versus noncontrol, and the committee expressed the hope that matters relating to health and facilities to provide the necessary care for the sick may

be approached from high humanitarian broad economic levels and not from a partisan political one.

The committee hopes that this vital matter of the health of our people may not become a political football to be bandied about by political parties. The committee welcomes the discussion by the press and the reports of the pros and Icons by different individuals, groups, organizations, and governmental agencies of proposed governmental health programs.

Without prejudice to plans which have been under discussion during the past years, the committee is of the opinion that no plan or policy should be adopted until the plan has been explored and approved by the joint committee of the American Hospital Association, the Catholic Hospital Association, and the American Protestant Hospital Association in conjunction with the American Medical Association, health agencies, Government agencies, the combined findings of these organizations to be presented and made available to committees of the House of Representatives, the Congress, the President of the United States, and governmental departments.

Whereas the good health of the men, women, and children of our several communities is the goal of our health agencies, including hospitals; and

Whereas studies and surveys of recent date have indicated the necessity for concerted action in providing increased facilities, personnel, and finances in order to cope with the problems which confront hospitals; and

Whereas in this democracy burdens are spread among the many, and the strong support the weak; and

Whereas great institutions of merciful help for the afflicted have multiplied in the land by reason of philanthropically minded men and women; and

Whereas our democratic customs emphasize freedom with liberality: It is therefore

Resolved, That the American Protestant Hospital Association record its approval of its officers and representatives in their efforts to effect and improve the systems of voluntary prepayment plans for the care of hospital patients and urges them to cooperate with other associations for the care of the sick wherein the people of our communities may freely choose the agencies for their care and the organized vehicles for periodic payments such as represented by Blue Cross plans for financing their care.

The president of the American Hospital Association, Joseph G. Norby, speaking at Peoria, Ill., December 8, 1948, said:

The aim of the announced Government policy regarding the health of the Nation's citizens and that of the American Hospital Association are the same * * * but compulsory health insurance is not the way.

In addition to being unnecessary, Mr. Norby continued:

Compulsory health insurance would destroy the quality of medical service in the United States.

Mr. Chairman, I have a copy here of Mr. Kenneth C. Crain's brief on compulsory health insurance under Federal legislation, appearing in Hospital Management, January 1949. With your permission, sir, I would like to make that part of the record.

Senator MURRAY. It may be made a part of the record.

(The brief above referred to follows:)

TO, THE CONGRESS OF THE UNITED STATES-A BRIEF ON COMPULSORY HEALTH INSURANCE UNDER FEDERAL LEGISLATION

(By Kenneth C. Crain. Reprinted from Hospital Management, January 1949) It is proposed to examine in this discussion, in such detail as may be necessary the following points:

1. The reasons advanced in support of the proposal for a compulsory healthinsurance system, and their fallacy, including the matter of rejections for selective service.

2. The fashion in which the present system of individual health care operates as to both medical and hospital services, the care of those who cannot pay for such services, and the methods of arranging prepayment.

3. The record of government-controlled health care in this country and in others, including Germany, Great Britain, and New Zealand.

4. The cost of a compulsory health-insurance system under social security and the difficulties already confronting social security and the taxpayer without this added burden.

The above outline indicates that this is an attempt to place before the Congress, fully but as briefly as possible, all of the considerations involved in the proposal to adopt by Federal legislation a compulsory system of health insurance. The reasons advanced in support of these proposals will be examined, as well as the arguments against them. The subject not only deserves, but demands, the most serious attention of this Congress, because the Federal plan transcends partisan political considerations and approaches the revolutionary in its theory and its probable effect upon American life.

It should be emphasized at the outset, especially in the light of the necessity for the most careful examination of the whole matter strictly on its merits, that it was in no accurate sense subjected to a referendum of the people in the recent election. While health insurance was mentioned in the Democratic national platform and in the campaign, the 21-point legislative program submitted to Congress by the President in his message of September 6, 1945, which on November 16, 1948, he indicated still to contain what he termed the "main bearings" of the course of his new administration, conspicuously omits the subject. It might reasonably be inferred that some of the serious difficulties involved, financial, administrative, and ethical, led to this omission.

It is pertinent in this connection, moreover, without any attempt at detailed and controversial analysis, to refer to the fact that, out of a total of around 95,000,000 possible voters, only 48,690,075 actually did vote, and that of this total about 24,100,000, or less than one-fourth of the possible grand total, voted for the winning national ticket. Under the American constitutional system, this decided the result; but it conferred no mandate for any purpose, and it would be the gravest injustice to the country to press for passage a compulsory health-insurance plan on the plea, so obviously ill-founded, that the people demand it.

Let us therefore examine the concept of a Federal compulsory system of healthcare insurance to see whether it should for sound reasons be enacted into law or whether it should for sound reasons be rejected. This is the responsibility of the Congress to the whole people, as well as to the professional groups who have as their personal and professional responsibility the care of the people's health.

THE ARGUMENTS FOR A FEDERAL PLAN

The reasons advanced in support of the idea of taking all individual health care under permanent Federal control have become so well known that it is necessary to refer to them only briefly. They rest upon the general assertion that the American system of care, with the free practice of medicine, dentistry, and nursing, and various types of hospital care, including especially the voluntary nonprofit community hospitals used by most people, while good in many respects, has become inadequate. They refer particularly to the fact that many people are unable because of limited resources to pay the costs of their health care, and therefore propose a compulsory insurance system to be paid for by Federal taxes levied upon all who work and their employers. They compliment the present extensive and rapidly expanding nonprofit and commercial prepayment plans, but again condemn them as inadequate. They appear to agree that the utmost possible degree of freedom, except the freedom not to be taxed for it, should under a Federal system be left to the individual citizen as well as to those who must render the required services, and promise that no real deprivation of liberty will result, whereas on the other hand they confidently assume a great improvement in individual health care.

An enormous mass of conflicting evidence, of statements pro and con, has been accumulated in the course of the attempts of Congress for several years to examine this subject in connection with the several bills which have been introduced relating to it; and undoubtedly many conscientious Members of both Houses have mined this mass for information. Eight volumes of reports of the hearings on the general subject of the so-called national health program before committees of the Seventy-ninth and Eightieth Congresses alone offer nearly 5,000 pages of material to the investigator, and search will produce valuable results. Some reference will be made later to specific material in these volumes.

The total is mentioned only to show how extensive and earnest the investigation has been. It is also true that a large part of the material consists of material from Government employees in the offices which would be greatly expanded in authority and power by the enactment of such a law, and there are also extensive contributions by some of the legislators strongly in favor of it. ous organizations with no actual knowledge of the subject have recorded their views, as well as representatives of organized labor and of the medical, hospital, and other professional and technical groups interested.

Numer

The scope of the proposal is virtually unlimited, in view of the present plan, which will have to be examined and converted into legislation in advance of the health-insurance idea, to extend the coverage of the social-security system to all who work, including the self-employed such as farmers, professional, and smallbusiness men, and members of the armed forces. Directly connected with this extension of social security is the conceded necessity for increasing the present painfully inadequate benefits under the old-age and survivors' insurance set-up The costs which at present comprises a major part of the social-security system. which this will involve are very large, and this and other aspects of the extension plan will be considered later in some detail. The scope of the health-insurance plan, in this light, would add to the social-security problem the individual health needs of the entire present population of about 147,000,000 persons, and the plan must be thought of in that light.

THE PRESENT SYSTEM OF INDIVIDUAL HEALTH CARE

How do Americans, for the most part self-supporting and self-respecting, see to their own and their families' health as things now are? Well, they must in the first place always use some judgment as to what to do, notably as to whether to visit or to call in the doctor, with such factors involved, stressed by the advocates of Federal care, as the nature of the illness, the accessibility of facilities, and the cost. Under a national health-insurance scheme the matter of cost would not be a deterrent, since the bill would go to the Government, with certain results which will be examined later. Accessible facilities would not automatically follow Government insurance and control, either, though this has been lightly assumed.

While it is true in some cases necessary care is at present not sought because of the cost, it is certainly also true that virtually everywhere a serious need is attended to by doctors and hospitals, regardless of the patient's ability to pay. This fact is not challenged. A survey conducted by Hospital Management in 1943 revealed no instance where a hospital would refuse to care for a person needing care, regardless of his lack of money. The free work done by most doctors as a part of their professional duty to the community is extensive but unadvertised, and is accepted as a matter of course.

Medical Care

The medical needs of the country are served by the largest and best-trained corps of physicians and surgeons in the world of whom the great majority, about 140,000, are members of the American Medical Association, which is strongly opposed to working under a Federal compulsory health-insurance system. Other practitioners of the healing art, including dentists, may produce a grand total of 250,000, while registered nurses number about 435,000. These men and women are scattered all over the country, roughly in proportion to the population.

Some of them work for hospitals or other institutions, governmental or otherwise; but the majority of the physicians and dentists are engaged in private practice under what is known as the fee-for-service system. That is, they treat the patient according to his needs, and charge him as a rule according to his ability to pay; which means that in some cases he pays little or nothing, while in others he pays too much. The latter kind of case has impressed the average cautious citizen with the desirability of negotiating in advance in case of the danger of an excessive bill.

In general, it may be asserted that the system works. In defense of it, it may be stated with emphasis that it is a great deal better, both in the availability and in the quality of the services rendered than any other system in the world, and that it shines with special brilliance by comparison with the systems of care operated by Government, here or anywhere else. One important point is that, contrary to the assertions which have been made by the advocates of Federal