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. We concur with this recommendation and believe that the health needs of our people can be better met by an independent health agency. There would be less opportunity for confusing health functions with those of welfare and social insurance as would likely happen if the health agency were submerged in a multipurpose department. The American Medical Association over a period of years has urged a single Department of Health in the Federal Government. The President of the United States in submitting his Reorganization Plan No. 1 of 1949 has completely ignored the request of the highest ranking medical organization in this country to create an independent health agency, and has also ignored the findings and recommendations of the highest ranking nonpartisan commission. Since health is foremost in the thinking of many individuals at this time, it seems the obligation of the Government to put its house in order and coordinate all medical and hospital services into one administration headed by a physician. We believe a physician-administrator can more efficiently direct the activities of his department than can a nonprofessional person. 2. There is great danger in attempting to bring the Nation's health and medical functions under the control of welfare workers. There are those in Federal Government who have long planned to bring the entire population under the Federal control through a system of national compulsory social security embracing finally compulsory social security medicine. The United States Public Health Service was formerly the important agency concerned with the health problems of our Nation. That once-proud organization has lost its identity in the Federal Security Agency and pronouncements on the health needs of our people no longer appear over the signature of the Surgeon-General but over that of a political administrator. We oppose any plan which would perpetuate the present effort to bring together into one department, functions, programs, and personnel which do not belong together. One can see the growing tendency to emphasize the welfare approach to health and medical problems. As has been pointed out elsewhere,' public health functions deal with scientific programs, research, and medical and engineering problems. A public-health staff consists of physicians, dentists, scientists, and engineers. Social security deals with cash benefit programs. The personnel of such a bureau consists of social workers, statisticians; economists, and analysts. These two staffs do not harmoniously mix in work. Data have been presented to show that in the Federal Security Agency there do not now exist three coordinate bureaus of health, education, and social security, but one vast welfare agency. It is not likely that health functions will be given the importance they deserve in the Department of Welfare but will be engulfed by dole considerations. The Reorganization Plan No. 1 of 1949 does not define the health functions of this Department of Welfare but hastily states that the Federal Security Agency will become the Department of Welfare. We cannot accept such a flimsy change when among other considerations the health of our Nation is at stake. The powers given the Federal Security Administrator are broad and indefinite. Certainly the inclusion of health in a Department of Welfare is unsound. 3. Before the present Federal Security Agency is changed to the Department of We'fare and its present Administrator made Secretary of Welfare, a thorough investigation of the Agency and the Administrator should be made. We call attention to the fact that the 19472 report of the Committee on Expenditures in Executive Departments on "The Participation of Federal Officials in the Formation and Operation of Health Work Shops" indicts certain present officials of the Federal Security Agency. Apparently that report has been hidden and these violators are still operating. The present Administrator has not taken action against these offenders cited in the report but has retained them on his staff. 1 Shearon, testimony on H. R. 782, February 15, 1949. 2 H. Rept. No. 786, 80th Cong., 1st sess., 1947. The National Health Assembly of 1948 supposedly created to ascertain the health needs of the Nation failed to invite grass-roots physicians who grapple daily with the health problems of our people. We ask why Mr. Ewing retused invitations to physicians of Arkansas, Louisiana, and other States in the South, Rocky Mountain area, and Far West. The Administrator did invite 49 delegates from New York, 41 from Washington, D. C., 18 from Pennsylvania, and 14 from Massachusetts. It is said that at least 17 invited guests were members of nongovernmental lobbies working to nationalize medicine. It is further said that well-known Communist sympathizers were invited and present. The omission of physicians from areas of low economic level certainly clouds the appearance of Mr. Ewing's intent to honestly evaluate the Nation's health. Recently Representative Keefe in a speech before the House brought out much information about the socialistic philosophy advanced by Mr. J. Donald Kingsley, Assistant Administrator of the Federal Security Agency. The questions are: Why does the Federal Security Administrator have as his assistant, a man of known Communist and Socialist pronouncements? Why has he favored Communist-front organizations at the National Health Assembly? Why does he advocate compulsory health insurance schemes against the advice of the American Medical Association and other high-ranking medical organizations? Why does he take the advice of theorists in his department, who write legislation on the basis of European and International Labor Organization ideology and not upon the basis of American needs? 5 These questions need investigation before the health of the Nation is handed over to such an administrator. CONCLUSION 1. I herewith plead for an independent United Medical Administration headed by a physician responsible to the President of the United States. This administration would coordinate all governmental health functions. 2. I strongly urge that the Bureau of Health be removed from the Federal Security Agency and not included in the proposed Department of Welfare. 3. Before a Department of Welfare be created, I urge a thorough investigation of the record of activities of the Federal Security Administrator. The CHAIRMAN. Are there any questions? Senator IVES. I have just one question, Mr. Chairman. I believe, Doctor, that one of the basic fears you have is that you suspect, to some extent at least, that a proposal such as plan No. 1— once in effect-might serve as a medium for the propagation of various and sundry activities in behalf of socialized medicine? Dr. MONFORT. Yes, sir, that is a fear, Senator. You cannot expect a man to give up an idea in which he thoroughly believes. Senator IVES. I am not disputing your point at all, Doctor. I am just asking you that question. Dr. MONFORT. Yes, sir; I think that is a fair question. The CHAIRMAN. Senator Schoeppel? Senator SCHOEPPEL. Doctor, you made some reference to the plan that was being followed in the State of Oklahoma. Dr. MONFORT. Yes, sir. Senator SCHOEPPEL. I am wondering if you are conversant with the plan that has been worked out by the State of Kansas, wherein there has been an encouraging factor submitted and worked out, making it possible for young doctors to go out in rural communities, where the communities are establishing hospitals, and establishing an opportunity for internships in various rural areas in the State of Kansas, and wherein the very problem that you have been talking about down 3 Hearings of Subcommittee on Labor and Public Welfare, 80th Cong., pt. 5. p. 2416. 4 Congressional Record, 81st Cong., 1st sess., speech of Hon. Frank B. Keefe, Thursday, June 2, 1949. 5 I. L. O. bulletin, June 1, 1944, vol. XXVI, No. 1, p. 30. in your State might not be aggravated in ours; but it does give those communities an opportunity for medical service, and an opportunity to the young men who are interested in the medical profession. I wondered if you followed some reports in Kansas on that? Dr. MONFORT. I have personal experience in one relation to that plan. My home was originally in northwestern Oklahoma, about 16 miles from the Kansas line. Right across the State line is a little town of Hardtner, which has a hospital which was endowed by a very wealthy and eccentric farmer. He started out with one doctor in this hospital; and, according to this plan in Kansas, they have had four there, but none of them has stayed for more than a year. He has three doctors now, two of them are in this plan that you speak of, because it serves rather a wide community. The other doctor has been there for a number of years, a very fine surgeon. I have known him for a long time. Senator SCHOEPPEL. The big problem is to make facilities available in the rural areas wherein it will attract young men of the medical profession to go into the communities and remain there. Dr. MONFORT. Yes, sir. Senator, here is the thing. Is law your profession, Senator? Senator SCHOEPPEL. Yes, sir. Dr. MONFORT. If you, in your career as a student in law, married either as a student or in the first year or two that you were practicing, probably with someone else, in a large town, which happens to a doctor who has internship in a large hospital, and your wife was accustomed to living in a large town, do you think that your wife would want you to go to a small town and raise your family, where they did not even have sewage? Senator SCHOEPPEL. Well, we did that, and we would be happy to go back to it. Dr. MONFORT. I do not think a lot of them will, and the proof is that they have not. It is a hard problem. Usually the doctors who locate in a small town are the boys I mentioned in this plan a while ago, that I thought was right, with reference to the small colleges; that is, he came from a small town. Senator SCHOEPPEL. But the main proposition that should be worked out effectively, preferably on a State level, should be to encourage greater hospitalization facilities in the rural areas, and then greater opportunities for trained medical men who may have some inducement to go out in those areas and be of service. Is that not the main problem? Dr. MONFORT. Yes, sir. Senator, there is just this about it. With better roads, those people will have better medical care available. You cannot have a doctor in each "section" to take care of the people who live in a section of a square mile. There has to be a concentration some place, and the quicker you can get them there, the easier it is for them to get there, and the better medical care they are gong to have. Senator SCHOEPPEL. To carry this a little further, I might say that the medical group in my own State, that is, the hospital association groups, divided our State into a number of districts; that is, they grouped one or two counties into a district, and then they tried to work out some progressive relationship for the establishment of hospitals on a community stimulated basis in each of those districts. Then the medical school cooperated to the extent of sending interns out into each of those areas for a certain designated period of time. It has worked very satisfactorily, I might say. Dr. MONFORT. I believe it would. Senator SCHOEPPEL. That has, I think, in our State, which may be different, of course, in other States, stimulated a desire for those young men going into the rural areas to remain there. They have done quite well on the financial side, and rendered a great service. Dr. MONFORT. Senator, there comes a matter in our State that has not been brought out, and that is the fact that in this tremendous area in which there is a small medical center, we have 8,000 people and 3 hospitals, and 10 doctors because we serve over 100,000 people. Those people are not people who use the doctor very often. They are rather hardy hill folk, and they are honest, and so on and so forth, and hard working. Of course, we have the "WPA type," as everybody has, but these hospitals are privately owned. The people of the community have not yet come to an educational point where they could any more than think that a community hospital is a good thing, yes, but that is as far as they go. The people have been taught for 60 or 100 years that when they need medical care seriously, they get it just like they get a pair of pants when their pants wear out, and they pay for it. They may have to wait for a while to pay for it, perhaps, depending on the cotton crop, and so forth and so on. But, I might say, the hospital problem is not a problem as far as getting patients into the hospital is concerned. We have the beds, and they are full. Senator SCHOEPPEL. Do you find your medical profession generally, in your section of the State, cooperating to the extent of trying to get a greater dissemination of medical care out into all of the areas, and do you think that they by themselves can do the job? Dr. MONFORT. We can do it as far as humanly possible, and I might say that we work on an average of 14 to 16 hours a day. You cannot work much longer than that and retain your health. Senator, I would like to throw in this suggestion, which has worked out pretty well in our community. As I say, this is a local thing, and some of you gentlemen may not be interested in it, but in that part of the country there are burial associations by the dozen. Every community has them. A bunch of these funeral directors decided they would implement the income of their salesmen by letting them sell commercial accident and health insurance, hospital insurance if you want to call it that, because primarily that is what it is, and they have done a marvelous job of covering those people up there; but they also sell them an ambulance clause with it, and that has been the greatest boon to us. I have one patient 68 miles away that comes to see me every 3 or 4 weeks in an ambulance. She could not come in a bus, but she has ambulance insurance, and she uses it. It has been a boon, as I say. I do not know that that would work anywhere else, but in our community it has helped. Senator SCHOEPPEL. Doctor, do you not think that there is some program that has to be worked out there in greater assistance, or in a greater degree of assistance which can be given to those who are making the medical profession their chosen profession, in order to get more doctors to supply the demand? Dr. MONFORT. Senator, you are right, except that at this time we are limited in facilities. For example, in Arkansas, there were 90 students accepted for the freshman class. Last year the State legislature decided instead of selecting them strictly on a basis of academic qualifications and recommendations, that they would take so many from each district. There has been quite a howl about that, strange as it may seem. They thought the idea was to spread the distribution of medical students in the smaller areas a little better, but it also lowered the qualifications of the next year's entrance class. The CHAIRMAN. I might say that an editorial on that has appeared in one of the leading Arkansas newspapers. I did not read it, I just saw it this morning as I came in, but I believe that editorial is in criticism of that plan. Dr. MONFORT. Yes, sir. This is kind of far-fetched to say, but you can say, "Why allow more students to get in, if they are not going to be as good doctors as you can get?" It will not help the situation very much. Senator SCHOEPPEL. Doctor, I agree with you that the men who are chosen for entrance into those medical schools should be of the highest possible type, both in understanding and ability, and when we throw down the bars and machine them through, the general public is going to suffer. I am very much interested in your testimony, doctor, because you come from a local cross section of probably the rural areas of America, and I just personally happen to be from a small town. My home town in Kansas was a town of 1,600 people, and I can well envision and understand some of the very problems you have mentioned here. But something has to be worked out, whether it is on a local State level with certain assistance from the Federal Government, or otherwise, that will enable greater facilities in the medical schools to turn out better and greater numbers of these people and get them out in the rural areas if we are going to sell this demand for public health. Dr. MONFORT. Yes, sir; you are right, Senator. I would like to make somewhat a boasting statement, but I do not really mean it that way, about the character and quality of service that we try to give. Because we went in as a group to start with, and our group is just typical of the other groups, it is a boasting statement, but I am trying to get away from that idea. There are two of us in our group who do surgery, one female surgery, and the other general surgery. The other member is a member of the International College of Surgeons and I am a member of the American College of Surgeons. That would not have been possible had we not grouped together to give us time to specialize, or semispecialize which, incidentally, of course, is giving through increased knowledge better care to our patients. Senator SCHOEPPEL. Thank you, doctor. That is all, Mr. Chairman. The CHAIRMAN. Senator Long? Senator LONG. Doctor, in my State we have almost half the hospital days spent in State-owned hospitals at the State's expense, and we do find that although you say you do not want to have welfare workers connected with this problem, in order to separate those people who are eligible for free hospital care by reason of their poverty from those who can well afford to pay, we have to have somebody to go out |