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 them— because 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

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,1 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 Welfare 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 refused 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.

3

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? 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.

Senator IVES. Thank you.

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.