there and investigate them. A man does not need to be a doctor to investigate to see whether a man is rich or poor, does he?

Dr. MONFORT. No, sir; that, of course, is like anything else. There are good politicians and there are bad politicians; there are good welfare workers and there are bad welfare workers.

For example, one of the hospitals in town turned down a welfare patient because she happened to be a doctor's sister. I say, the patient happened to be a doctor's sister, and had no more business being a welfare patient than the man in the moon. As I say, the hospital turned down the patient.

Senator LONG. You see, Doctor, you have two problems with regard to better medical care. One is the matter of administering. Certainly, nobody but a doctor or nurse or intern is competent to administer the care. You have another problem, which is that of paying for it. That is not a problem for those who are well to do and who have money of their own. They can afford to pay, and we expect them to. But with regard to those who cannot afford to pay, there is the problem of how we can help them out. I do not believe that the doctor is the only one who has an idea as to who can or cannot afford to pay for medical care. I believe anybody familiar with the problem knows about that.

Dr. MONFORT. Senator, we are going into socialized medicine again, but Blue Cross and Blue Shield can protect a family for the price of a pack of cigarettes a week; and a little more than that for most of the commercial plans, which take care of the emergencies.

Senator LONG. Yes, and a very good plan.

Dr. MONFORT. Senator, if a man cannot afford that, how in the world can he afford the tax plan? He cannot do it.

The CHAIRMAN. Senator Taylor, do you have a question? Senator TAYLOR. Doctor, your testimony boils down to this. In your estimation, the question of better medical care depends on many factors-better roads, better sewage facilities in small communities, or maybe if you cannot get the better sewage facilities, it is a matter of educating the brides of young doctors to be more self-sacrificing? Dr. MONFORT. That is a good way to put it; yes, sir.

The CHAIRMAN. Thank you very much, Doctor. I wish you would extend my greetings to my constituents in your community when you get home, please, sir.

Dr. MONFORT. I will, Mr. Chairman. Thank you.

The CHAIRMAN. Dr. Young, will you come around, please?

STATEMENT OF DR. ROBERT YOUNG,1 PRESIDENT, AMERICAN ASSOCIATION OF PHYSICIANS AND SURGEONS, CHICAGO, ILL.

Dr. YOUNG. Gentlemen, I would like to read a prepared statement, with your permission, and after reading this, if you care to, I would be glad to answer any questions that I am capable of.

The CHAIRMAN. How long will it take you to read this statement, Doctor?

Dr. YOUNG. Not very long, Mr. Chairman.

The CHAIRMAN. All right, proceed. We will expedite it as much

as we can.

1 See letter and supplemental statement filed by Dr. Young, p. 97.

Dr. YOUNG. The Association of American Physicians and Surgeons, which I represent as president, appreciate this opportunity of presenting its views on Reorganization Plan No. 1.

For the record, I should like to state that I was born at Columbus, Ohio. I received my college training at the Ohio State University and was graduated in medicine from Harvard Medical School in 1934. Since 1938, I have been engaged in the private practice of surgery in Columbus, Ohio; and also I carry on, in an administrative capacity, a practice of industrial medicine. I am an assistant professor in surgery and an assistant professor in preventive medicine at Ohio State University.

The Association of American Physicians and Surgeons is national in scope and has members in every State and in the Territories. The purposes of the association 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. 1-Department of Welfare. 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 more than 85 percent of the approximately 189,000 physiians 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 the 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. 1.

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, and H. R. 782. 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 proposal, honestly reflect the views of disapproval of the vast majority of the association's members to this measure.

Therefore, I believe it is reasonable to assume that the association's stand on Reorganization Plan No. 1 represents the convictions of a great majority of American physicians, and also, a considerable fraction of the thinking citizenry.

Reorganization Plan No. 1 proposes to constitute the Federal Security Agency a Department of Welfare, 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, and so forth. 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 heads of such groups 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, supplemental 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 Persident'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 lodged-namely, 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. 1 would be a backward stepone 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.

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 these 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 research, 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 upwards of 6 or 7 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; pp. 79-80, lines 24, 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 and an Under Secretary, and three Assistant Secretaries are rapidly increasing in importance so that the power that would be conferred would not be static.

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 popution, larger social-security benefits for the aged and unemployed, and so forth, 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 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. 1-at least until after legislation has been introduced, 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. 1 becomes law, control of the Nation's health activities will be vested in a lay Secretary of the Department of Welfare. Once in, we fear that health will never escape the ever expanding, 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. 1. 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. (Page 1; paragraph 3, Task Force Report-supplement to appendix 0.)

The CHAIRMAN. Senator Taylor, do you have any questions?
Senator TAYLOR. No, I have none, Mr. Chairman.

The CHAIRMAN. Senator Smith, do you have any questions?

Senator SMITH. I would like to repeat the question I asked of Dr. Miller, Dr. Young:

Would this separate medical agency or department include the military health facilities as well?

Dr. YOUNG. As has been pointed out, that is undergoing considerable reorganization. I would say that it would be best to include it, except for the active military organizations.

Senator SMITH. How would you separate it?

Dr. YOUNG. There should be an integration between the Army, Navy and Air Force hospitals and personnel, and the Federal medical organizations in the other 44 departments and agencies. There is a considerable overlap which is wasteful, of both personnel and matériel. Senator SMITH. Would you nnclude the veterans hospitals' facilities in the medical agency?

Dr. YOUNG. It should be included. In addition to that, the veterans' facilities should be integrated with our private hospitals, be-cause under the Hill-Burton bill, we are spending approximately $75,000,000 a year of Federal money for private hospitals, which are in direct competition with the veterans' hospitals, which is again a waste of money and matérial.

Senator SMITH. Thank you.

The CHAIRMAN. Senator Schoeppel? Do you have any questions? Senator SCHOEPPEL. I have no questions, Mr. Chairman.

The CHAIRMAN. Thank you very much, Dr. Young. We are glad to hear your testimony.

Dr. YOUNG. Thank you, Mr. Chairman.

The CHAIRMAN. The next witness is Miss Elizabeth Wickenden, Washington representative of the American Public Welfare Association.