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I think that is a very significant statement because the Administrator at that time, Paul V. McNutt, had told the Surgeon General to get on the band wagon for compulsory health insurance, in which the latter did not believe. I think that when you have a medical man, a distinguished physician and public-health man who had devoted his life to the health services of his country, when a man like that doesn't believe in a program, he should be free to say so. He offered some objection and was not quite as compliant as the Administrator thought he ought to be, and he was ultimately eased out, as you probably know.

The CHAIRMAN. In other words, what you are probably trying to emphasize is that if the Health Service is placed under a welfare department, a secretary of welfare, who may favor a socialized medical program or compulsory health program, whoever is at the head of that medical service, that medical agency, must be obedient to the will and the authority of the Welfare Secretary, or he could no longer hold his position.

Dr. SHEARON. That is correct. You have probably noticed that you have not heard from the Surgeon General of the Public Health Service regarding this plan which so strongly affects them. It wouldn't do you any good if you did hear, because the Surgeon General would not dare say anything against the administration's point of view. That is the unfortunate thing; that we lost a man who did oppose and we got a "yes" man who won't oppose. That is an unfortunate thing for the health of the country, and I don't think it is fair to say that this is merely medical opposition for selfish reasons. There is far more involved than the mere opposition of physicians because they have a vested interest in programs. I don't think it is on a selfish basis, not that there aren't certain selfish physicians. There are selfish persons in all professions. But I don't think their main objection is for a selfish reason. It is because they understand far better than most persons inside and outside of Congress understand just what is at stake in this kind of proposal. We have seen the Public Health Service dragged right down in the mud. At the present time it is really pathetic the things that are being done to that agency, and they can't say a word. This has happened within a decade since the Federal Security was organized. The people in the Public Health Service have less and less word.

The CHAIRMAN. It is your contention, then, that the Public Health Service is of that importance not only to the doctors from the standpoint of the vested interest that they may have in it, but to the people of the entire Nation that that service should not be subordinated to a welfare agency.

Dr. SHEARON. That is exactly my point of view, and I think it has been brought out very clearly with three successive Federal Security Administrators. We had Paul V. McNutt, then Mr. Watson Miller, and now Mr. Ewing. Each one who has come in as a political appointee, men who have not been in the health or the welfare field, but who did have political ambitions and who were using the post on a transient basis as a springboard, those men have come in and they have been sold in a very short time on the desirability of a compulsory health-insurance program. There isn't one of these three Administrators who really understands anything about what is involved in the administration of a compulsory health program.

The CHAIRMAN. You are saying something here that is important. On the face of it, it will arrest our attention and interest immediately. But what is the other alternative? Suppose we set up a Health Department, so long as the President of the United States wants a compulsory health-insurance program, and he has the appointing power of the Secretary of that Department as well as the Secretary of the Department of Welfare, is it not logical to assume that whoever he appoints as Secretary of the Health Department would be someone who would certainly advocate and sponsor his compulsory health program? Where is the advantage there? What can we do to prevent that?

Dr. SHEARON. You can't do too much except to change the administration.

The CHAIRMAN. We are getting involved in politics now.

Dr. SHEARON. We are involved in politics. We have been in politics since they introduced the first Wagner-Murray-Dingell bill, which said in effect, "Let's put health in politics."

The CHAIRMAN. I mean, how can Congress solve that problem? Dr. SHEARON. You have hit the nail on the head exactly. There is no question at all that, if you have the President wanting a compulsory health-insurance program, if he appoints the head of a Health Agency or a Health Department, he will probably appoint someone who thinks as he does, and you are in great jeopardy. I would say that if you had a separate Health and Medical Department, as has been proposed by the Hoover Commission, it does call for a physician. That is not entirely proof, either, against the possibility of control and of getting in a physician who, say, believes in compulsory health insurance. There are three or four thousand physicians in the United States who do so believe.

The CHAIRMAN. The only answer I know to that is that we might set it up on the same basis the Labor Department is set up to be an advocate of the interests of labor. We might set it up to be an advocate of the interests of the medical profession.

Dr. SHEARON. I think that would be very bad, too.

The CHAIRMAN. If it is bad, we set up the Labor Department charged with that responsibility. We have a precedent for it, at least. Dr. SHEARON. Yes. You might set up an agency that would be devoted to health and welfare-I don't like the word "welfare"-to health and medical care of the people. Such an agency devoted to those subjects would be very good, but I don't sponsor one for the interests of the medical profession alone.

I did want to bring out these points, though, because it is a very real thing and it is something that the people in the Public Health Service are very conscious of, but they do not dare to say a word, and that is a bad thing when the people who are in charge of our health programs do not dare to speak out frankly. I would suggest seriously

to

this committee that you call in two or three of the top Assistant Surgeons General-it wouldn't do any good to call the Surgeon General, but the Assistant Surgeons General, some of the men who have been there a long time, distinguished men like Dr. Dyer and Dr. Williams, call them in and ask them in executive session, with a promise of full protection to them, what their views are. I think you might find it very interesting.

The CHAIRMAN. Do you think they would feel free to talk in executive session?

Dr. SHEARON. The amount of fear inside the Public Health Service is a most unfortunate situation, and fear is rather rampant inside the whole Federal Security Agency at the present time. It is too bad.

The CHAIRMAN. The whole Congress has to pass on this program, and not just this committee. How could we give them assurance that their confidences would be protected; and, if we did protect them, the other Members of the Congress would not have the information: I do not see that an executive session to let them express their views in secret and in confidence would accomplish anything.

Dr. SHEARON. Is it not unfortunate for the United States that we have such a condition that Federal officials are afraid to speak out their true opinions, for fear they will lose their jobs if they so speak? I think it is unfortunate.

The CHAIRMAN. That is a matter of individual opinion. There are a lot of people who believe in a welfare state and a police state. Dr. SHEARON. Yes.

The CHAIRMAN. After all, it is a matter of individual opinion. That is something that addresses itself to the American people. Dr. SHEARON. That is correct.

I have a few scattered points here.

I might say that a Federal agency will not help to distribute medical personnel, whether it is headed by a physician or by a layman. We had an experience with War Manpower Commission during the war when surely everybody wanted to do his patriotic duty, and you just couldn't get physicians to go to certain parts of the country. They wouldn't go. Neither would you go and I wouldn't go. There are just parts of this country where nobody wants to go but the few people who live there. That is an unfortunate thing, and it can't be overcome by Federal fiat or compulsory health insurance. They found that in Germany. After 60 years of compulsory health insurance they were still clamoring that th they couldn't get physicians into

rural areas.

It is stated that what you need is a Department of Welfare, a tripartite one, headed by a good Administrator, and I ask if any of the three successive Administrators of the Federal Security Agency have had administrative experience. It has been some other kind, legal in the case of Mr. Ewing. He had not been in the welfare or health field until 1947 when he came down to Washington as a political appointee, with political ambitions. I am not saying that in any personal way, but I am trying to indicate that we have not so far in 10 years had men who were necessarily able Administrators with long administrative experience. It hasn't turned out that way.

I think that it is not a question of opposition by the medical profession. The thing is that it is wrong in principle to centralize in any single agency or department as much power as would be vested in this particular Department covering health, education, social security, and welfare. The social-security program last year cost approximately 2.5 billion dollars. That is a lot of money. It is dangerous for one man to control the expenditure of such sums and to control rules and regulations. As Mr. Ewing testified last year, under crossexamination in regard to the Wagner-Murray-Dingell bill, he said, "The final authority would be vested in me," in one person. He stated that himself.

So it is concentration of power in a single agency and a single individual that would be bad. It has been suggested that the President might even, after giving Mr. Ewing a 60-day appointment, might even appoint a physician to head the Welfare Department. I would say that that was just as bad as to appoint anyone else. I think a physician might well be vulnerable when it came to controlling so much money, so much power over everyone in the United States. It is just a bad proposition, it seems to me.

I should like to point out that part of the time there has been not a single physician in the Social Security Administration, and the rest of the time there has been one. Yet that lay agency has taken upon itself to attempt to control the Public Health Service and to write legislation. It is a very serious situation and that is the kind of thing which we have seen going on now for more than 10 years. Why shouldn't people be suspicious? They would be very stupid if they were not suspicious that it would be even worse if the Federal Security Agency were elevated to departmental status.

Now, if I may go back to my testimony, one of the things I pointed out last time was the fact that there has been this enormous increase in expenditure. It is an alarming increase, it seems to me. We have not had the savings that were promised. Near the top of page 2 of my testimony you will see a table which I think is very startling, namely, the increase in expenditures from 743 million dollars in 1946 up to 1.5 billions dollars at the present time, doubled in 5 years, and the proposed programs would increase that rate of expenditure very, very greatly.

If the education bill goes through, you start in with $300,000,000, and you know when you start in with $300,000,000, pretty soon you are up to $500,000,000, and so on up. There are increases in the Public Health Service expenditures, and great increases proposed for social security. That would then put one man in charge of those multibillion-dollar programs. I think it is too much.

Now I wish to point out that if you are going to make these transfers of functions out of the Federal Security Agency you had better make them in advance because it will be almost impossible to get health and medicine out of the Welfare Department afterward. It has been suggested that the present Welfare Department idea is all right as far as it goes, and later on we could take out health and medicine.

However, Mr. Ewing himself has stated that he is opposed to any such transfer, and of course the President also opposed it. So it doesn't seem as though there would be much likelihood of having the Hoover Commission recommendations carried out later on. I think it would be even harder to carry them out after the Department were set up.

What you are here called upon to decide is whether the health and medical services of this Nation are to be controlled by lay administrators and lay policy makers. The only way to protect our national health services is to place them in an independent agency beyond the reach of lay political control, under qualified medical supervision. Certainly the Hoover Commission proposal does call for medical supervision of these highly technical programs.

That becomes evident. If you work in the two agencies you see the difference in the type of personnel. In the Social Security Administration you have economists, statisticians, and analysts, many clerks, actuaries, and so forth, a totally different type of personnel from what you have in the Public Health Service, where you have physicians, dentists, nurses, sanitary engineers, and men who are engaged in pure science in the National Institutes of Health. When you attempt to put a lay person in charge of that scientific personnel, it simply doesn't work out. They don't talk the same language. They don't even know what the scientist is talking about.

During the past year and a half Mr. Ewing has demonstrated to what length he will go in fighting for the nationalization of medicine without having any understanding of what is involved administratively. Were he elevated to the Cabinet and allowed to keep the FSA virtually intact, I think we might expect a new drive in 1950 to nationalize medicine, and no one doubts that that is the political strategy.

It must be realized that the FSA is essentially an inflated Social Security Administration with a costly overloaded superstructure. Before 1939 the Social Security Board operated with a budget well under $1,000,000,000, but since the FSA has taken over the operating functions of society security much larger sums are being demanded from Congress. Of the total amount of specific appropriations for 1950, 82 percent is for social security. That indicates in itself how the welfare and social-security programs dominate by money alone, and also the number of personnel. In its 1950 budget the Social Security Administration asked for $1,226,863,000, or five times as much as the $273,000,000 requested for all other bureaus and divisions in the FSA, including the Public Health Service and the Office of Education. In other words, Social Security now takes five times as much as these smaller agencies.

This dominance of the welfare branch of the FSA has placed undue emphasis on the programs, personnel, and funds of welfare and socialsecurity bureaus. More than that, there has been a growing tendency to emphasize the welfare, rather than the scientific, approach to health and medical matters. The powerful social-security staff has lorded it over the Public Health Service. Nonmedical personnel have dictated to medical staff. The situation is absurd and dangerous, insofar as programs for improvement of national health is concerned. It has even been proposed to bring medical research, medical education, and hospital-construction programs within the purview of the social-security system. That was all written up in Senate Committee Print No. 5 of 1946 on medical-care insurance, and this committee should take a look at that report which actually stakes out what the Social Security Administration would do in fields that you might think were far afield from social security. These proposals have been made by lay administrators greedy for power and for the control of multibillion dollar Federal appropriations.

Since plan No. 1 proposes that a specific individual, the present Federal Security Administrator, be elevated on a temporary basis to the post of Secretary of Welfare, it is incumbent on this committee to pass on the qualifications of the official in question. I wish to file with the committee as part of my testimony to be incorporated at this point

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