Dr. PARROTT. Well, I don't know that I have any data on Russia and China. We have quite a bit of historical information on Western Europe.

Unfortunately it's hard to compare Western Europe to the United States. First off, they are divided up into small homogeneous coun

tries.

Mr. ROGERS. I was not saying which necessarily would be best for us. I was saying, where do you think the system has worked the best? Dr. PARROTT. In the world?

Mr. ROGERS. Yes.

Dr. PARROTT. Right here.

Mr. ROGERS. But we don't have universal health care here.

Dr. PARROTT. Well, obviously it didn't work too well in Britain on the long haul, and it didn't work. The problem that I see in Western Europe is that every medical society I have talked to in Western Europe is a syndicate, they are a labor union, and certainly we do not propose to try to get into that kind of a problem here.

We may have to negotiate with Government agencies and governments, but I would hate to see anything resembling a universal type of job action in this country.

Mr. CARTER. Mr. Chairman, would you yield on that.

Actually aren't the people being taken care of? Or are they being turned away from our hospitals?

Dr. PARROTT. You mean our hospitals?

Mr. CARTER. Yes.

Dr. PARROTT. No, I don't think they are.

Mr. CARTER. Are the poor being taken care of? What about youngsters who have dreaded diseases such as cancer, for instance? Isn't it true that there is a plan even now by which they can get into the cancer clinics throughout our country and have their treatment taken care of and assisted by the Cancer Society?

Isn't that quite true?

Dr. PARROTT. That is true.

Mr. CARTER. Yes, sir.

Dr. PARROTT. I would like to add to that, you know, Dr. Carter, the same as I do that a person in this country can walk into any emergency room and be taken care of even if he goes on bad paper, and that is a form of charity.

But the problem is, our big problem on access is a cultural problem of getting into the system, not a financial problem, it's a cultural problem. Its inability to know how to get into the system or thinking that finance is going to cause a turndown or a turnaway.

They may be referred away from some physicians offices, that may be true, but I don't know of any major community hospital in the United States where a sick person walks into the emergency room that they are not taken care of.

Mr. CARTER. Would you turn down a maternity case, if a woman came into the hospital without funds and you were there?

Dr. PARROTT. We never have. If we are called on to take care of the patient, we never have turned them down.

Mr. CARTER. I don't think that any self-respecting doctor would. Perhaps the same percentage, 3 percent of our profession, is like 3 percent of almost all other professions. None of us is perfect. The only perfect man was crucified.

Thank you, Mr. Chairman.

Mr. ROGERS. Well, then, evidently we don't have any problem except an education problem. Is that what you are saying?

Dr. PARROTT. Well, when you are talking about access, of course we have lots of problems. But

Mr. ROGERS. I got that from the colloquy, that we don't have any problems at all. I wasn't sure that is what you meant.

Dr. PARROTT. The big problem in access, Congressman, is a cultural problem, and I think we have put too much emphasis on the horror stories. When the CBS story came out we found out the girl was well taken care of through agencies in existence.

Mr. ROGERS. I have in my personal experience people who have not been able to get it because of funding and so forth.

Mr. SCHEUER. Mr. Chairman.

Mr. ROGERS. I yield.

Mr. SCHEUER. Several times in your testimony you described our health care delivery system as the best in the world. I would like to question you about that.

I would presume that the best of our health care is equal to the best elsewhere in the world, and it may be better than the best in the world.

But there seems to be considerable evidence from morbidity and mortality statistics available that the average health care actually delivered through the system and enjoyed by the consumer is not as good as other countries that have health care systems. I am sure you are familiar with the morbidity and mortality statistics on health in Scandinavian countries and England and Canada.

I think in infant mortality we are way down 12th or 14th, and in heart disease, strokes, and other ailments we are far from the top. I think our life expectancy is not first in the world.

Now I am not attributing this entirely to defaults of the health service delivery system. It may be that some of the behavioral characteristics that you point out on page 16, as I recall of your testimony, have major impact there and that is one of the reasons I am so concerned with asking each of the witnesses what they think that we in this committee can do to impact behavior.

Having said all that, is there really any statistical evidence that will stand up that from the point of view of health outcome we are No. 1 in the world.

Dr. PARROTT. If you took the Swedes in the United States and compared them to the Swedes in Sweden you would find that the statistics are totally different.

The Swedes in Minnesota live longer than the Swedes in Sweden. Now, let me go to one other point.

You made a point of the paranatal mortality figures and people have done this often. You have to look at the way the statistics are reported.

In my State I have to describe anything that twitches at 18 weeks, abortions or miscarriages at 18 weeks, anything that moves or makes a movement is a live birth. This is not done in Sweden. Their home deliveries in Sweden are reported in the family. They have a totally different system of gathering statistics.

So what you are really comparing are apples and oranges. That doesn't deny the fact that the Swedish system in certain areas works

very well. It does. Their research for example. The people in Britain that do the best work are very very good doctors. But even during the second World War-I spent 4 years in Britain before the health service there. I felt that we had more and better doctors per capita in this country than they had in Britain.

Nobody is taking on those countries as being backward or anything else. What we are trying to do is to avoid falling into traps that intelligent people fall into, and I think that is the most I can say. Mr. ROGERS. May I ask this.

I would agree that our doctors are well trained for the most part. Our care where people are getting it, our care is I would think the best in the world.

What we are looking at now is the system; how the delivery system works and how people serve it and who falls through the cracks, soto-speak, and who doesn't.

I still would like you to answer, if you can, what nation do you feel has best organized itself to deliver health care in a universal care approach.

Dr. PARROTT. I don't think I can answer the question, Congressman. I have never been in Sweden. I understand that they have an excellent system there from the people who have gone through but they have a lot of fault.

Mr. ROGERS. I have never been there.

Dr. PARROTT. Of what I saw in Germany, Munich, recently, they have two systems of insurance in Germany. I know the professor of obstetrics very well in Munich, and he took me to see his hospital. Those that purchase government insurance got care in one waiting room with a certain type of equipment and those in another that had private insurance got different care.

They had American power tables. I don't think they are that good but they are expensive. They have two systems, like the old system in the South where they took care of the blacks and whites. I told my friend that I didn't think you can sell this in the United States, and that we are just getting over that. He said he agreed.

He knows the United States very well, he is a world-known academician. But he didn't pussyfoot about it. He said they discriminate. I don't think we want to go for that kind of system. The French. I visited the French. The French have a very big labor negotiation problem between their medical societies and their government.

You talk to the government people, and they say there is no problem. You talk to the medical societies, and they say there are all kinds of problems, and they didn't speak English so I didn't get all the over

tones.

Mr. ROGERS. What do the people say there?

Dr. PARROTT. Well. I can't answer that either because I don't speak French. I think the Dutch have a very complicated system but I will tell you this. As to the economics position in the negotiating countries, the Dutch, the Belgians and French, they have protected the economies of their dollars probably better than the rest of Europe, but that isn't what I think we are after either.

Mr. ROGERS. What about Canada?

1. GOVERNMENT CANNOT GUARANTEE HEALTH CARE

Neither the government, physicians, nor anyone else can guarantee health or provide health care in unlimited quantities. This is a fact. According to Stanford University economist Victor R. Fuchs, all of the decisions about medical care, such as producing more doctors, building more hospitals, having more sophisticated equipment and even having National Health Insurance, will have far less impact on the nation's health than will the personal decisions made by American citizens. This view has recently been echoed by Theodore Cooper, M.D., Assistant Secretary of Health of the Department of Health, Education and Welfare. National Health Insurance will not lower many of the leading causes of death, such as accidents, suicides, homicides, coronary heart disease, etc. These causes of death and poor health care are results of individual decisions regarding personal life styles, such as whether to smoke, lose weight, control high blood pressure or consume less alcohol.

Economist Fuchs says that many statements about the "right to health" are misleading because they "suggest that society has a supply of 'health' stored away which it can give to individuals and that it is only the niggardliness of the Administration or the ineptitude of Congress or the selfishness of physicians that prevents this from happening."

Fuchs further emphasizes the view that all people cannot have everything they would like to have. He reasons that there simply are not enough natural and man-made resources available to satisfy all human wants from education to social justice. He states that although there are inefficiencies and wastes in the present system, that even if there were eliminated that this nation's resources would still be short of meeting such unlimited demands. While we do not agree with everything Fuchs states in his book, entitled "Who Shall Live," we feel that it demonstrates that even the most lavish use of medical care will not make a great difference in the nation's mortality rate, but will only lead to national bankruptcy.

II. LEGISLATION

There were more than a dozen major NHI proposals introduced in the last Congress. Many of these proposals have been revised and introduced in the 94th Congress and undoubtedly more can be expected.

Those considered to be "major" NHI proposals are:

H.R. 6222 (Reps. Fulton, Carter, Duncan (Tenn.) and Murphy (N.Y.)), "The Comprehensive Health Care Insurance Act of 1975" (the AMA Plan).

H.R. 1 (Rep. Ullman), "The National Health Care Services Reorganization and Financing Act" (the AHAA Plan).

H.R. 5990 (Rep. Burleson); S. 1438 (Sen. McIntyre), "The National Health Financing Act" (the AHA Plan).

H.R. 21 (Rep. Corman); S. 3 (Sen. Kennedy), "The Health Security Act" (Committee for National Health Insurance Plan).

S. 2470 (Sens. Long & Ribicoff), "Catastrophic Health Insurance and Medical Assistance Reform Act."

III. COST

All of the above NHI plans would have the government provide health care for the non-needy and would cost untold billions. The authors and sponsors of each proposal have submitted cost estimates which we will not go into. We will only point out what has happened with estimated costs in the past and what realistically can be expected with any NHI plan.

In the early 1960's when Medicare was being debated in the Congress, its proponents estimated the cost would be $900 million for 1965 and gradually build up to $1.7 billion in 1975. Those who opposed Medicare estimated it would cost several times what the proponents said it would. The actual figures show that the cost of Medicare for 1965 was $3.5 billion and rose to $14.9 billion for 1975, a 900 percent cost overrun!

If a 900 percent cost overrun on a limited program like Medicare and Medicaid resulted, we can only look to our English cousins for a realistic prediction of what would happen here if we enacted NHI. The actual figures show that NHI in Great Britain is costing 1,700 percent more than its proponents said it would when it was enacted in 1948.

Dr. PARROTT. I think it's coming. It's an expensive ambulance, but it's changed the patient care.

Mr. SCHEUER. Mr. Chairman, I take it we are about to close this session?

Mr. ROGERS. Unless the gentleman has further questions.

Mr. SCHEUER. I want to thank the witnesses.

We have given them very much of a going over in depth and I would say the only other group that we have honored in this way was Leonard Woodcock of the AFL-CIO. He came here with two experts and I think it's a tribute to their ability to challenge us and stimulate us that we have had this long and indepth exchange and I appreciate it very much. You have been very patient and very informative.

Dr. PARROTT. Thank you, sir, and I hope anything we have said is not misunderstood.

Mr. ROGERS. We appreciate very much your being here and your very helpful testimony. As we go into further hearings at the beginning of next year we probably will want to come back and go into specific details.

We are trying now to get a broad brush feeling of the various significant proposals. Then we want to zero in on payments, zero in on benefits, zero in on delivery systems, by subject matter, and then we would like to get you to help us at that time.

Dr. PARROTT. Čongressman Rogers, I would like to take this opportunity to offer to you and your committee the available resources of the American Medical Association. We have one of the best medical libraries. We have a good system of statistics and I would like to offer any of the resources that we have to your committee. We would be glad to supply information on request.

Mr. ROGERS. You are very kind. I am sure we will call on you. Incidentally, we also wish to express the committee's appreciation for your help with the staff in preparing the dictionary of terms. We are grateful to you for that.

Dr. PARROTT. Thank you.

Mr. ROGERS. Thank you for being here.

The committee stands adjourned.

[The following statements and letters were received for the record:]

STATEMENT OF THE LOUISIANA STATE MEDICAL SOCIETY

Mr. Chairman and members of the Subcommittee on Public Health and Environment of the House Interstate and Foreign Commerce Committee, the Louisiana State Medical Society is happy to have this opportunity to present its views on National Health Insurance.

The Louisiana State Medical Society has been, since its founding in 1878, an organization dedicated to bringing the best medical care possible to all citizens regardless of ther ability to pay. The Louisiana State Medical Society has been and remains equally dedicated to the concept of medical service as a proper function of the private sector.

The more than 3,500 members of our Society believe that the ony way that we can continue to provide adequate, high quality health care for all citizens is by practicing our profession within the framework of the American free enterprise system with the least possible interference by government. We present our statement in OPPOSITION to any and all of the National Health Insurance proposals that have to date been put forth.