to how medicine should be carried out. I would look to them for advice. I feel that I am particularly fortunate in that I think Secretary Finch found me and that is where my allegiance is going to be and to anybody to whom he gives it.

Senator JAVITS. I agree with you that it is a great association of the doctors of the country and that it must be consulted, and that you will do your utmost to have them involved in your program. However, if you cannot would you have any hesitancy in your conscience, if the Secretary of Health, Education, and Welfare and the President are with you, in standing firm for what you believe, even though it is opposed by the American Medical Association?

Dr. EGEBERG. No, sir. I am sure that there will be a lot of opposition to many of the things that will come out of this administration. I would hope that with the proper help one can take a very realistic view of the problem that exists unhampered by the customs that exist and by the cliches and by the loyalty and slogans that exist and come forward with some new ideas.

Now, I am sure that when the ideas come an awful lot of people practicing medicine and an awful lot of people who are happy to see me proposed for this job are going to be thinking that I am ruthless, crazy, or something like that, but I do not have any doubt that if we work out a plan and that plan has to be sold that I will sell it. I do not think one can go ahead and alter a profession. I think one has to sell it. I think I have knowledge of those things you are talking about.

Senator JAVITS. The only thing I would like to know, Dr. Egeberg, is are you, this early, able to persevere in doing something to which the administration is committed, and in which you believe, notwithstanding any action of opposition of the American Medical Association?

Dr. EGEBERG. May I just quote from General MacArthur. I was General MacArthur's aide during the war. He said that there were three qualities that he would like to see in a person working for him and the first one was, and the most important one is, loyalty. The second one is courage and the third one is intelligence and good sense. He complimented me by saying that he thought I had those in that order. [Laughter.]

Senator JAVITS. Dr. Egeberg, I am not going to press you.

Dr. EGEBERG. I hope I answered your question.

Senator JAVITS. No, you did not. However, I do not intend to pressure you.

Dr. EGEBERG. I am prepared to answer any questions.

Senator JAVITS. I understand. I want you to succeed. I do not want you to say anything this morning that will, in your judgment, make it more difficult for you to succeed; therefore, if you would like me to accept the answer that you have given, I will accept it. But it is not answered.

Dr. EGEBERG. Yes. I would be glad to answer it as you have asked it. Senator JAVITS. Well, I will submit this to you again.

Dr. EGEBERG. Thank you.

Senator JAVITS. Please feel free to make the same answer. Please understand I do not want to pressure you to make a categorical answer. I will leave it to your judgment as to what will best equip you for this job. I should say: Not only what is the best for you, but for the

country. We are talking about both right now, and I trust that you would understand that although we might have a joke or two and all have a laugh, this is very serious business, and the whole country is listening to us. I just want to impress that upon you.

The question I asked was: Are you prepared in a situation where you are convinced and you are supported by the Secretary and the administration, to wit, the President-but to which the American Medical Association, the great organization of doctors of which you are a member is opposed, as they have been, could you persevere as Assistant Secretary of Health, Education, and Welfare?

Dr. EGEBERG. Yes, sir.

Senator JAVITS. All right. That shortens the questions considerably. To the extent that you wish, can you give us your view as to what you consider to be the major problems in the health field, in terms of inadequate facilities and high costs?

Dr. EGEBERG. The major problems in high costs?
Senator JAVITS. And inadequacies in facilities.

Dr. EGEBERG. Well, I think the major problems are due to the fact that recent legislation has given 30 million or more people the opportunity for good medical care and that in our own way of giving medical care we cannot rise to this occasion. I think chaos will come if we do not find new ways of providing medical care to all people.

In order to keep the costs within perspective that the taxpayer and that the Government will be willing to face, one has to find out how one can deliver good medical care to these people. This means the use of many people who were not used before. It means much greater use of the health profession and it means that we will probably have to develop new professions in the care of all people.

One would hope one can push the whole problem over to the right solution and take care of an increasing number of people and keep them from being too sick. This is what one would propose. This is what I would propose to study.

I think there is much efficiency that can be brought to the hospital. I think there are many, many people who are placed in the hospital to be taken care of when they could have been taken care of at home. We have shown that in Los Angeles.

I think there is a tremendous whole sum of areas in which one could start reducing the cost of medical care.

Senator JAVITS. It has been called to my attention that an article of yours, published in the November 1968 issue of the bulletin of the New York Academy of Medicine, discussing the education of medical students, describes group practice as one of the dramatic changes. This relates to the employment of prepaid insured group practice. Is this one of the changes you would have in mind, to accomplish?

Dr. EGEBERG. I think it is one of the changes. I think this is one of the changes that has helped. I think that the solution to this problem. is going to come in many directions. I think some people find that a doctor who is willing to work 80 hours a week is an efficient person just because he is working 80 hours a week, but we would hope that that person working alone or in a small group can also avail himself of the help that comes to a group doctor.

Senator JAVITS. Do you think that the proper national goal for the United States would be to make available to all its people, regardless of their economic status, the most effective medical care of which our society is technologically and scientifically capable?

Dr. EGEBERG. I certainly do, sir. I think this might be very different in different parts of the country and with different ethnic groups and with different groups as far as income is concerned because it will have to do with the educating of them. There are many areas where health is not being dealt with at all.

Senator JAVITS. Do you have any particular bias about obtaining this national goal through government, or the private sector, or a mix of the two?

Dr. EGEBERG. I have no bias, but I think it will have to be accomplished by a mix of the two.

Senator JAVITS. Your choice of the mix is, therefore, dictated by what is best, rather than by prejudices against it being all government if that is the way it is to be?

Dr. EGEBERG. Yes. My prejudices will come from the results of this study and I feel very deeply now that it will be a mix of the two.

Senator JAVITS. Well, it will interest you to know Doctor, that the President was one of the cosponsors of such a measure, 20 years ago, when he was a Member of the House of Representatives. It was a bill which I myself introduced. Many people have an incorrect idea about the President. Many of them do not understand the openmindedness of the President on this very issue. That is an illustration, going back a very long time ago. Of course, the State of California has been, has it not, one of the most progressive States in terms of universal health care?

Dr. EGEBERG. Yes, sir, it has.

Senator JAVITS. I just have one more question. I am very grateful to you for your patience with me.

I noticed with great interest that you have a very interesting idea as to the role of the medical student in the Government. In an article in the November 1968 issue of Medical Opinion and Review, you put forward the proposition that medical students view the health care in America as, and I quote, "insensitive and completely out of touch with the recipients of health care."

Can you give us some concept, as a medical school dean, of that whole complexion of issues; to wit, the view of the medical student on the existing state of health care; the way in which he might be tied into an activist role in improving the system, and the way in which the whole body of medical students needs to be expanded. I gather we have a very great shortage of space available in the medical schools in this country, for the number of qualified applicants.

Dr. EGEBERG. Yes, sir.

I think one has to realize that medical students form the spectrum from what one may call conservatism to outright radicalism and that they all connect with each other just like a copper wire. The radical ones are ones that it is difficult for me to understand. A majority of medical students-I would say probably 90 percent of them-are people who feel very fortunate to have come into the health profession. They are searching. They are taking very little for granted. They are

extremely critical of the generation ahead of them, and they feel that things that we do are things that we inherited the patterns for. If we can relate to them I think we will get some wonderful new ideas on how medical care can be distributed and how the population can be kept healthy. I would certainly hope that I would be able to talk with both students and resident students as far as their imaginative ideas on what can be done. That is probably enough about students per se. I am sure that we have to increase rather dramatically the number of physicians in this country and we shall probably be asking medical schools to do it.

It would seem to me that the most practical, the cheapest, and the surest way of increasing the output of physicians is to provide whatever medical schools are needed to increase the number of physicians. Our school, for instance, has gone from 68 to 72 to 84 to 96 first-year students in 4 years.

Senator JAVITS. Do you feel that the Government and governmental aid must have a role in that expansion?

Dr. EGEBERG. I think so because when it comes to the cost of educating a medical student it is difficult to pinpoint it. It is not merely as much as it costs to educate an aviator for the Air Force. It is about a quarter of that, but it costs an awful lost of money. I can assure you that people running medical schools have wondered why it costs so much and have tried to cut it down.

I think they are going to have to have help. I think they are going to need much help if they are going to be asked to increase the number of students that they graduate, but I cannot think of a better place to invest.

The CHAIRMAN. Will you yield?

Senator JAVITS. I will yield.

The CHAIRMAN. This goes along with the development of your chain of thought on this.

Dr. Egeberg, it seems to me that the medical schools have been remiss in their refusal to admit substantial numbers of additional students.

In my home State this past fall we found 1,300 young men to go into medicine. They have the proper character and proper grade to enter medical school.

There are four medical schools in my State. They admitted 400 only. The University of Mexico admitted 1,500 medical students this past fall. Six hundred of them are from the United States. Now, they do not admit anybody that wants to get in. I know, because I know of some people who were trying to get in and they appealed to me for accreditation of documents.

They were very careful to see that no one showed up with forgery of credentials and took all kinds of affidavits and documents.

The best medical schools in the world are right here in the United States. We find that there are many foreign students coming here because of that. We are glad to license them in the United States because we have so few doctors. Over 25 percent of our interns in hospitals, as you know, are graduates of foreign medical schools and over 35 percent of our residents are graduates of foreign medical schoolsand I think that the medical schools of America need much more help than they are getting. I think we need about 200 more medical schools.

We have got to get the doctors. We may have to go to South America or anywhere in the world to get them. We do not seem to be concentrating enough on educating our own.

I just wanted to put that in. I think that would illustrate what you were saying.

Senator JAVITS. Dr. Egeberg, I think that is a very proper interjection by the chairman.

Would you agree with us that it is the duty of the Federal Government to break any monopolistic ideas in the field of medicine which tend to limit, contrary to the national interest, the number of its doctors?

Dr. EGEBERG. I do not believe that the medical schools themselves have anything to do with that monopoly. I think that they have a sort of perfectionist attitude and the reason they educate people into specialties to such a degree is that so much information has become available.

I think they are ready for a new field where the knowledge will be spread across the board. I think they are ready to start and encourage people to become what one might call the family or general physician. That is a man who could probably take care of 90 percent of the problems that come into his office and this is what the public wants. This is what the public needs. I think there has been a great deal of distress about this. I am sure there are many educators who are distressed about it.

This is an area where I think talking and helping financially can get us out of a hole.

The medical school faculty is a conservative group on the whole. You know there is talk about liberalism and conservatism. There may be conservatism in one way and liberalism in another, but their aim has been to produce for this country outstandingly well-educated people. They look at the problem of educating a much larger number and still maintaining the level of competence that they aim at. Certainly, if one created a different type of degree-let's say we created different classes of physicians-at least at the present time, by philosophy, that would be bad. I think one can get the cooperation from the medical schools to meet the manpower problem satisfactorily and I can assure you that I will use whatever resources in my power to get such cooperation.

Senator JAVITS. In other words, you will not apologize for the existing system unless you think it is wrong, and you will not be an advocate, necessarily, of the status qou?

Dr. EGEBERG. Yes, sir.

Senator JAVITS. Well, Dr. Egeberg, thank you very much.

I am not a bit surprised. I thought you would be the kind of man you are, and I can only assure you, as one Senator, that I shall do everything I can to make your mission a successful one. I must say that I am very grateful that, notwithstanding the Knowles affair, which I think is monumental in our history and most deplorable, we have been able in our country to find a man of your quality and character to do the job-quite a difficult one just from the Knowles affair, itself.