ing this for fear that Oscar Ewing might be elevated a little bit; when, if you really get down to it, if you had a red hot doctor leading the fight for compulsory health insurance you would be in a lot more trouble than you are in today.

Mr. GARVEY. We have no complaint, Senator Long, about Administrator Ewing. Whether Mr. Ewing would be the Secretary on a permanent basis, or John Doe, or Dr. Smith, unless he held that position by virtue of a political accident and not by virtue of training we would have no complaint. We have no complaint about the way Mr. Ewing has administered his department. That is his affair. He has been appointed by the President and confirmed by the Senate. We are not dealing in personalities. We are dealing with the theory, the basic underlying set-up. Even if, let us say, Commissioner McNutt were still in charge of the Department, or his successor, Watson Miller, we would still have the same basic objection. It is an objection in principle. It is not an objection to a personality. Because no matter who was there, you would have the lay training and the lay administration.

Senator LONG. It occurs to me that if your thinking was followed through, here, with this absolute insistence on having a doctor over this health thing, you might wind up jumping out of the frying pan into the fire. That is the impression I gain.

The CHAIRMAN. Senator Smith?

Senator SMITH. No questions.

The CHAIRMAN. Senator Schoeppel?

Senator SCHOEPPEL. No questions.

The CHAIRMAN. Thank you very much, Doctor.

Dr. GALE. Thank you.

The CHAIRMAN. Dr. Monfort? Will you come around and have a seat, Doctor?

The Chair might advise the other members of the committee that I am about to hear from one of my own constituents, and I expect this is about to be rather impressive, to the Chair at least.

Doctor, we are very happy to have you.

STATEMENT OF J. J. MONFORT, M. D., BATESVILLE, ARK., COUNCILOR, ARKANSAS MEDICAL SOCIETY, AND PRACTICING SURGEON

Dr. MONFORT. Thank you.

I should like to read a part of this prepared statement and then digress a little, if I might, please.

The CHAIRMAN. All right.

Dr. MONFORT. I am Dr. J. J. Monfort of Batesville, Ark. I am a councilor of the Arkansas Medical Society and am a practicing surgeon in a large rural community.

I might digress here to say that I am representing the Arkansas Medical Society at this time. The part of Arkansas that I live in is the part that social welfare workers seem to be crying the most about when they speak of the poor medical care that our part of the country is getting. And I would like to enlarge upon that a little more later.

94651-49

Reasons for appearing: 1. To urge that the recommendations of the Hoover Commission creating a United Medical Administration be accepted. 2. To oppose the inclusion of a Bureau of Health in the proposed Department of Welfare. 3. And in public interest to request that the present Federal Security Agency be thoroughly investigated before its Administrator automatically be transferred to a Cabinet post.

1. The task force report on Federal medical services prepared for the Commission on Organization of the Executive Branch of the Government clearly recommends a United Medical Administration as an independent agency and not a bureau of a department of health, education, and security. Such an agency would be headed by the ablest physician administrator whose services could be obtained by the Government. This administrator would report to the President of the United States.

You will find that in the supplement to appendix O, task force report on Federal medical services.

We concur with this recommendation and believe that the health needs of our people can be better met by an independent health agency. Now I would like to digress from the statement to say that my interest in being here is in getting better medical care for my people. I would like to state that we live in a poor part of Arkansas, in the rocks. I do not believe that other people, who have not been there, can tell me what is best for those people with whom I work every day. I think that those of us who work there are a little bit better qualified to suggest solution. I am not competent to say what should be done in New York or in San Francisco for better medical care, except that as a doctor I think there are certain lines of reasoning which the A. M. A. has already taken up and which you have heard before and which the American Dental Association representative has given you.

Generally speaking, we are more or less educated men, and we realize that there are some things that we can take part in as citizens. But as to this interest in better medical care for the people of my part of Arkansas, this reorganization seems to affect it.

The CHAIRMAN. Seems to what?

Dr. MONFORT. Seems to affect that better medical care. It seems that the people of Arkansas have not cried for a compulsory health bill. What they are crying for is better education and better roads. That is what they need, in our opinion, in order to get better medical

care.

I can illustrate with a story about education. Of course, as you know, we are having a little polio epidemic down there. A colored boy who answered the phone at our clinic at night asked one of the doctors, when one of the polio patients came out the other night, if polio was a venereal disease. He said, "Why, no, Raymond. It isn't a venereal disease. It is an infectious disease, but it is not a contagious disease." Of course, that was over Raymond's head. It is over most people's heads if they have not had medical training, but there is a difference. The doctor went on the explain about it, and the boy just shook his head and said, "What is everybody afraid of it for, then?". So there needs to be some education-"if it isn't a venereal disease, why is anybody afraid of it."

The matter of roads is important. In the part of Arkansas where I live, it is 120 miles to a hospital in two directions, and it is 31 miles to the east and 52 miles to the south. Thirty-one miles north of me there is a community that has built a little hospital by giving bonds for it locally-not getting money from the Federal Government but by a local bond issue. They have not opened it yet; they do not have a doctor. And why don't they have a doctor? It is a town of seven or eight hundred people, but it is in a location in which it would take care of many more patients than that, just as we do a little farther south.

Now, a doctor is not going to move into a small town of seven or eight hundred people which does not even have a sewerage system and raise his family there, any more than any of you would go there to practice law or whatever your profession may be. I don't think you would do it, and I don't think you would expect a doctor to do it, unless there are certain changes, and unless there are certain inducements made. And then you probably won't get the better type of doctor.

That is why I say that we need better roads. If an accident occurs 60 of 70 miles from home, for example 55 miles from there in the Silica Products Co. sand mine, which produces sand for Corning Glass, and so on, if a man gets knocked off an electric pole they have a good road down there and in about 60 minutes he is under care. That is about as fast as if he got knocked off a pole 40 miles from Washington. He could get into a hospital and get care almost as fast. But they had a good road.

Of course, he is going to lose part of his hand, from 15,000 volts. It is a wonder he didn't lose his life.

We have lots of problems in sanitation and hygiene-lots of thembecause of the educational status of our people. And nobody that I know of, or no worth-while doctor, is going to turn down a patient for the lack of money. About a third of our work is charity work. And we are glad to do it, and we don't label it as charity work either. We don't tell the people that it is charity work. It is just marked off the books, because we know they can't pay. We don't object to that. We expect to do that. That is part of our work. But we do want to solve the problem of getting those people to the doctor as best we can.

There are two educational fields that I believe will get a doctor for a small town. And remember, we are talking about this reorganization plan as it affects us in Arkansas. I can't say how it will affect those in Connecticut or in San Francisco.

There are many doctors who would not even have gone to college if they could not go to college in the small town where they live, near home; and unless they can get through with their college work and can find finances in some way or other, they are unable to go on to medical school. That is true in our part of Arkansas..

We got together six doctors in a clinic. We went together because we felt we could do better work, give better service to people, by being together. We could hire better technicians, get better equipment, than we could do by ourselves as individuals. We also have more time for study, and we can eventually, by working in that way, give better

service.

If one of those young people coming up in our community wants to become a doctor, he has got to go to college first, and he can't go to

college if he is living very far from home, if he comes of a poor family. So I think that one of the long-run plans in getting more doctors in rural places is to have a college in the very small towns in these areas. The CHAIRMAN. What about the plan envisioned in this compulsory health insurance program, where the Government provides additional facilities and also helps to finance young doctors?

Dr. MONFORT. I am getting behind that. He has got to go through college first. We have two young brothers in our group, neither of whom would have ever gone to college if they had not lived within walking distance of the college. They did not have the money.

Senator LONG. Well, can you find the proper type facilities to educate doctors at those small colleges all over the country? It is my impression that the best medical schools are centered around the most enormous hospitals in America. We have had a great number of people trying to get into L. S. U. or Tulane Medical School at New Orleans because that is right next to that enormous charity hospital

there.

Dr. MONFORT. That is true, sir; and the best answer to that I can give you is the one that my old family doctor gave to me when I was in college and asked him about which medical school to go to. He said, "Son, they can all teach you more than you will ever learn." And it is true.

That is one problem, one point of view, from a country surgeon, about how to get doctors in small towns. And that is what I am interested in: Getting better medical care for my people.

All right. The second solution is this: It is clear to me that we can get doctors in small towns. There was one plan started by Oklahoma in their medical school this year. I don't know how it is going to work out, but it sounds reasonable to me. In an effort to get medical students in small towns, to see how the small-town problem was, they put junior and senior medical students into small towns to work for a period of 11 weeks. That was started by the State medical association. They worked with doctors on a certain course, having so many weeks of medicine and obstetrics and surgery, under men who have been alumni of Oklahoma or their partners. They are not allowed to go to the two larger towns in the State, because the purpose of this program is to get students to locate in the smaller towns by getting them to like it. Now, that is a plan that I think makes common sense. As to whether it will work out, it is like a suit; you have to try it on before you know whether it fits or not.

Of course, as the Senator has indicated in questioning other people here, there are some things about the compulsory health plan which are practically taken right out of the A. M. A.'s plan and have been in it for a hundred years, which is something that no one can argue about. But I think that a patient of mine who was in my office recently had the right_idea. Let's see; this is Friday. That was Wednesday morning. It was old man Laster, 75 years old, who came in for a little postoperative treatment and said that he had heard that I was interested in this socialized medicine thing. And I said, "I certainly am." He said, "Do you know, it is just getting to a point where this welfare-state idea is ruining my family life?"

I said, "Well, Mr. Laster, that is the first time I ever heard anybody make a statement like that. I would like to have you tell a little bit more about it.”

He said, "When I was sick, four of my nine children came down to be at the hospital with me. And do you know that two of those people wanted me to apply for welfare help?"

The State of Arkansas has a welfare act which pays so much on the hospital bill if the patient cannot pay and if he is properly eligible for that treatment. It is a good plan.

He said, "I can pay my own bills. I don't want to apply for welfare." He said, "One of them went up to the welfare director, and he said, 'Yes, I guess we can get him in. He is a pretty influential man up there. I think maybe we could get welfare help for him.' And they came back and told me about it, and I wouldn't take it."

"But," he said, "you know, I told that boy he ought to be ashamed of himself. He should have put up the money for my hospital care. He is my son. But instead he tries to get someone else to do it. That is why it is ruining my family life."

Now, those are not his exact words, but that is a condensation of what he said.

So from the standpoint of this man wanting to take care of himself, I think it is important.

There is another angle to the Federal Security Agency which alarms me, personally, a little bit, and that is the matter of taxation. Economy in government is what you gentlemen make it, what you decide to do or not to do. But I can tell you it is getting to be a burden already. And if you will pardon a personal illustration, I can show you how it will work.

This June I forgot that my quarterly income tax payment was due. I thought it was in July. It was just an oversight on my part. But it came when I didn't have the bank account to meet it. And I had to make some arrangements to do it, and it made me mad. So, because I happen to be in a group which has a policy of taking care of doctors for 2 or 3 years if something happens to them, which is patterned after a commercial health insurance plan, I gave up some of my accident and health insurance. Well, when I did that, there was an insurance man in town who receives a monthly premium on that, and with the renewal of that policy he does not get quite as much money. It isn't very much, but he doesn't get as much. But it was because that tax bill was too high. And it is getting to the place where I guess, like Mr. Cripps of England says, the national health plan "is a splendid thing for helping redistribute the wealth, but there is no more wealth in England.'

May I answer any questions, if I can?

The CHAIRMAN. I may say, Doctor, your full, prepared statement may be printed in the record at this point.

(The prepared statement referred to is as follows:)

STATEMENT CONCERNING REORGANIZATION PLAN NO. 1 OF 1949, PROVIDING FOR A DEPARTMENT OF WELFARE, BEFORE SENATE COMMITTEE ON EXPENDITURES IN THE EXECUTIVE DEPARTMENTS

(By J. J. Monfort, M. D.)

I am Dr. J. J. Monfort of Batesville, Ark. I am councilor of the Arkansas Medical Society and am a practicing surgeon in a large rural community.

Reasons for appearing: (1) To urge that the recommendations of the Hoover Commission creating a United Medical Administration be accepted. (2) To oppose the inclusion of a Bureau of Health in the proposed Department of Welfare. (3) And in public interest to request that the present Federal Security Agency