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tion are to represent physicians in the fields of medical economics, public relations, and legislation. The ultimate test of all of its actions is the public interest. It is supported by the direct memberships of individual physicians.
On March 27, 1947, the association presented testimony before the Senate Committee on Expenditures in the Executive Departments on Senate bills S. 140 and S. 712. These measures proposed to accomplish virtually the same objectives which are proposed in Reorganization Plan No. 27, Department of Health, Education, and Security. At the time of presenting testimony on S. 140 and S. 712 in 1947, the association's opposition to these two measures was supported unanimously by telegrams from the association's State delegates. Also, the American Medical Association, which has a membership of about 80 percent of the approximately 200,000 physicians in active practice in this country, presented testimony at that time which concurred with our association's testimony of opposition to S. 140 and S. 712.
Again on February 15, 1949, at the request of the association, I appeared before the House Committee on Expenditures in the Executive Departments to oppose enactment of H. R. 782, a bill very similar to S. 712 and S. 140, and one that would accomplish almost the same objectives as those proposed in Reorganization Plan No. 27.
Also, it was my privilege to appear before this committee on July 22, 1949, and submit a statement opposing Reorganization Plan No. 1, of 1949, another proposal having virtually the same provisions as plan No. 27.
During the past 2 years at two different meetings, the delegates of the Association of American Physicians and Surgeons voted unanimously to adopt resolutions disapproving S. 140, S. 712, H. R. 782, and Reorganization Plan No. 1. Since the members of each State elect their own delegates to represent them it is my belief that these resolutions of opposition to measures like the President's latest proposal, honestly reflect the views of disapproval of the vast majority of the association's members.
Therefore, I believe it is reasonable to assume that the association's stand on Reorganization Plan No. 27 represents the convictions of a great majority of American physicians, and also, a considerable faction of the thinking citizenry.
Reorganization Plan No. 27 proposes to constitute the Federal Security Agency a Department of Health, Education, and Security, which would include the administration of the Nation's health, education, and social-security activities. We are opposed to it for the following reasons:
1. We believe such a department would not be in the public interest.
The health of the Nation is far too important to be eclipsed by, or to become embroiled in, matters of welfare, education, social security-cash benefits, etc. In this regard the Hoover Commission supplemental report on an independent medical agency states: "The health agency, if submerged within a multipurpose department, would be more likely to find its health functions impeded by collateral considerations pertaining to welfare and insurance."
There are numerous health and medical functions scattered through the Federal Government. If these were brought together into a single health agency, they would constitute a sizable group of activities dealing with related matters and requiring specialized technical and scientific personnel.
Administratively and professionally, there is strong justification for bringing together in one agency or department-headed by a doctor of medicine, all Federal activities relating to health and medicine and of authorizing the medical head of such group to report directly to the President as an agency administrator or a department Secretary.
The Hoover Commission supports this contention. In its task force report on Federal medical services, supplement to appendix O, recommendations are made for a "United Medical Service organization as an independent administration reporting to the President, instead of as a bureau of a department of health, education, and security."
You will note that the last half of the quoted sentence, "instead of as a bureau of a department of health, education, and security," places the President's proposed reform in direct conflict with the stated recommendations of the nonpartisan Hoover Commission.
Health and medical functions have been an accepted part of the Federal Government since 1798, and Congress has repeatedly added to the responsibilities of the agency in which the more important health programs have been lodgednamely the Public Health Service. We question the wisdom of placing these well established functions in an over-all welfare agency where the new and untried social insurance programs are being proposed.
The health of this great Nation is of vital importance. Every American recognizes that indisputable fact. Its importance has been stressed many times by President Truman. During the past year, the Federal Security Administrator in the press and on the radio, has emphasized the importance of the health of the American people. With this in mind, it seems to the members of this Association, that enactment of Reorganization Plan No. 27 would be a backward step, one that would endanger the health of the Nation because the plan would place control of the Nation's health activities in the inexperienced and unskilled hands of social or welfare workers. The Hoover Commission recommends: "The agency (United Medical Service) should be headed by a professional career director general" * * * "and (he) should be the highest ranking physician in the Government."
It will be impossible to recruit outstanding physicians for service in the Federal Government if such men are expected to accept the policy decisions made by a lay Secretary who has no professional training or experience in the professional field of health. (Reorganization Plan No. 27 states: "The Surgeon General shall be the head of the Public Health Service and shall perform such other duties concerning health as may be required by law or as the Secretary may prescribe pursuant to law.")
From time to time in the past and at the present time the Federal medical services (Public Health Service, Veterans' Administration, Indian Affairs, Army, Navy, and Air Forces) have experienced extreme difficulty in recruiting professional staffs. This difficulty stems from the fact that physicians object to the lack of appreciation of medical problems and the unfortunate results of lay controls previously experienced in those situations (Analysis of the Replies to the Postwar Questionnaire-A Report to the Committee on National Emergency Medical Service, by Frank G. Dickinson, Ph. D., director of medical economic recearch, Chicago, American Medical Association, June 4, 1947). Controls which might be imposed by a Cabinet officer who has statutory authority would know no limits.
2. Recalling the political uses made of WPA funds, we believe there would be far greater temptation and danger if large sums not only for relief but for health and education and social insurance were all placed under one-man control. The Hoover Commission says: 'Appropriations for health should, if possible, be clearly identified as such and not confused with those for social security, welfare, or other social programs."
There would be particular danger if all the health and medical-care funds of the Nation, amounting to upward of six or seven billion dollars a year under the President's compulsory sickness insurance program, were to be added to all the other funds which the new Secretary would administer.
The manner in which the Federal Security Administration proposed to dominate medical activities is a matter of record (Murray-Wagner-Dingell bill, S. 5, 81st Cong., p. 39, lines 23, 24, and 25; p. 79, line 24; p. 80, lines 1 and 2). It is only reasonable to assume that the various reorganizations that already have been made or are now being proposed are designed to pave the way for creation of a vast system of national social insurance in which medical functions will be absorbed under a scheme of compulsory health insurance as advocated by President Truman in his message to Congress on January 5, 1949.
The Federal activities that would be placed under the jurisdiction of a Secretary with Cabinet rank are rapidly increasing in importance so that the power that would be conferred would not be static. An example of the ever-expanding and widening influences of the proposed Department is the social-security bill, H. R. 6000, approved by the House last year and passed by the Senate on June 20, 1950. It immensely expands the tax-collecting and tax-spending powers of the recommended Department of Health, Education, and Security.
Congress is now considering bills that would inaugurate large new Federal programs through grants-in-aid to education, grants-in-aid for medical care, compulsory sickness insurance for the entire population, etc., all of which would confer far larger powers on the proposed Secretary than are now enjoyed by the Administrator of the Federal Security Agency. The prospect of such expanding power in the hands of one person is alarming.
The temptation, regardless of which party was in power, to use the vast health, education, and security funds to enhance political power and prestige is only human when placed in the hands of men of the past record.
The channeling of all of the "natural propaganda appeal outlets," namely health, education, welfare, and social security, into the hands of one man and providing him with a budget second only to the Department of Defense, would give him a potential second only to that of the President.
We recommend and urge the members of this committee to reject the President's Reorganization Plan No. 27—at least until after legislation has been passed and signed by the President, to create an "independent medical agency,' as recommended by the Hoover Commission. Unless this is done, and plan No. 27 becomes law, control of the Nation's health activities will be vested in a lay Secretary of the Department. Once in, we fear that health will never escape the everexpanding, self-perpetuating, and power-gaining web of the welfare bureaucracy. The Hoover Commission studied this whole problem and considered the President's suggestion as embodied in Reorganization Plan No. 27. After exhaustive research, investigation, and careful deliberations, the Hoover Commission concluded: "* * * we have reached the conclusion that such an independent organization (independent medical agency) would be preferable to placing this function in a larger department, as the Commission originally proposed" (p. 1, par. 3, task force report-supplement to appendix O).
Mr. Chairman and members of the committee, I desire to express our appreciation for this opportunity again to present the views of the Association of American Physicians and Surgeons.
Dr. YOUNG. I am Dr. Robert E. S. Young of Columbus, Ohio, chairman of the legislative committee of the Association of American Physicians and Surgeons, and I appear here today in support of Senate Resolution 302, and against Reorganization Plan No. 27.
The Association of American Physicians and Surgeons, which is national in scope with members in every State, and in the territories, has consistently opposed legislation very similar to Reorganization Plan No. 27. The association presented testimony against S. 140, S. 712 in 1947, H. R. 782 in 1949, and also Reorganization Plan No. 1 in 1949.
We oppose Reorganization Plan No. 27 for the following reasons: 1. Plan No. 27 has all of the objections which Plan No. 1 had last
2. The creation of a Department of Health, Education, and Security would not be in the public interest because the health of the Nation is too important to become eclipsed by, or to become embroiled in, matters of welfare, education, social security, cash benefits, and so forth.
3. Plan No. 27 is directly contrary to the recommendations of the Hoover Commission. The Hoover Commission's supplemental report on an independent medical agency statės:
The health agency, if submerged within a multipurpose department, would be more likely to find its health functions impeded by collateral considerations pertaining to welfare and insurance.
The CHAIRMAN. If that is taken from the report of the Hoover Commission, if you will, I wish you would cite the number of the report and the page from which you quote.
Dr. YOUNG. It is the task force report on Federal medical services, supplement to appendix O, prepared for the Commission on Organization of the Executive Branch of the Government, March 1949.
The CHAIRMAN. That is what I wanted to clarify now. referred to it as the Hoover Commission report. There is a difference in the Hoover Commission report and that task force report. So, if you want to be accurate, I think you had better amend your statement. There are a lot of recommendations of the task force that the Hoover Commission did not accept and, in fact, rejected. We have quite often witnesses coming in referring to the Hoover Commission's recommendations when in fact they are quoting from task force reports and they do not mean to be inaccurate, but it is inaccurate and can be misleading.
DR. YOUNG. I will then amend this to make the reference as I have indicated, page 1, subtitle A.
The CHAIRMAN. Doctor, that is why I asked you and called it to your attention. I know you did not mean to submit any misleading statements, but I thought you were a bit confused.
Dr. YOUNG. Thank you, sir.
Continuing with the reasons for our opposition:
4. It would be a backward step to place the Nation's health activities in the inexperienced and unskilled hands of social or welfare workers. Again referring to the task force report on Federal medical services, the same reference, page 2, subheading E, paragraph (2), the task force recommends:
United Medical Service
should be headed by a professional career director general * * * and (e) should be the highest ranking physician in the Government.
5. We fear the elevation of Mr. Oscar Ewing, who, because of his public declarations, has been referred to as Mr. Socialized Medicine, would contribute greatly to creating the machinery for obtaining and administering socialized medicine.
The CHAIRMAN. May I inquire there, you name Mr. Ewing?
The CHAIRMAN. Assuming he were eliminated from the picture entirely, what hope would you have that the President who has urged the Congress to enact a compulsory health-insurance plan would appoint someone as head of this Department who is not in accord with his views? It is not a question, as I see it, of Mr. Ewing personally. He is entitled to his views and he expresses them, and I have no quarrel with him about that. But I do not see how he as an individual particularly is involved, because even if he were eliminated, I think whomever the President might nominate for Secretary of the Department would be some individual who certainly would be in accord with the President's program.
Dr. YOUNG. If I may enlarge upon that for a moment, the budget of the proposed Department would be second only to that of the Department of Defense. The natural propaganda sources inherent in a Department of Health, Education, and Social Security is so tremendous that it would be only natural for any individual, regardless of his opinion, to use this tremendous power to further his own ends, whether they were moral or otherwise.
The report of the Harness committee-that is House Report 786, Eightieth Congress-would indicate that men of the past have so used their powers. A more recent report of the Subcommittee on Overstaffing in the Executive Departments and Agencies submitted to the Committee on Post Office and Civil Service would indicate that this attitude is still continuing.
I believe that the Secretary of the new Department would take over all of the duties of the present Administrator of the Federal Security Agency, and would direct to a considerable extent the affairs of education and health, would tend to make it appear that health would suffer very greatly and be delegated to a very minor role in the new Department.
Further, the title "Secretary of Health, Education, and Security" is rather cumbersome. It would be probably shortened to Secretary of Health. Health then would become synonymous with social security and again the tremendous opening for socialized medicine would be quite apparent.
It is for those reasons that we are opposed to the combination of these agencies in one department.
The CHAIRMAN. Very well; you may proceed with your statement. Dr. YOUNG. Continuing with the reasons for our opposition:
6. Because the channeling of all of the "natural propaganda outlets," namely health, education, and social security, into the hands of one man and providing him with a budget second only to the Department of Defense, would give him a potential second only to that of the President. The prospect of such expanding power in the hands of one person is alarming.
We recommend and urge the members of this committee to reject the President's Reorganization Plan No. 27, at least until after legislation has been passed and signed by the President, to create an independent medical agency.
Mr. Chairman, and members of the committee, I desire to express our appreciation for the opportunity again to present the views of the Association of American Physicians and Surgeons.
The CHAIRMAN. Dr. Young, may I ask if in the membership of the Association of American Physicians and Surgeons there is a duplication or overlapping of membership in the American Medical Association?
Dr. YOUNG. To become a member of the association of American Physicians and Surgeons it is necessary that a man belong to his county medical society.
The CHAIRMAN. So there is a complete overlapping as to membership?
Dr. YOUNG. There is a complete overlapping.
The CHAIRMAN. And this is sort of a top organization of the medical profession in a sense; is it?
Dr. YOUNG. It is an organization which deals only with medical economics, public relations, and legislation.
The CHAIRMAN. So, in other words, we have had the expression of the members of your association through the American Medical Association when Dr. Bauer testified?
Dr. YOUNG. That is true.
The CHAIRMAN. You are simply saying that as an independent association of physicians and surgeons, they also oppose it?
Dr. YOUNG. There is a complete duplication of membership in our organization, but the American Medical Association is not responsible for our views.
The CHAIRMAN. I understand that, and so you do express your independent views, the independent views of your association. Dr. YOUNG. That is correct.
The CHAIRMAN. Did you hear Dr. Bauer's testimony?
Dr. YOUNG. I did.
The CHAIRMAN. Are the views of his association and your association absolutely in accord as expressed as the views of the medical association this morning?