and together we shall move the medical world and achieve the reforms that are so desperately needed. The CHAIRMAN. Thank you, Senator Kennedy. Next we call on the distinguished Senator from Ohio, Senator Saxbe who is one of the cosponsors of this bill. He is respected for his independent thinking, is an able and distinguished Senator, and we are happy to have him with us. Senator SAXBE. I am always humbled by your introductions. Thank you. In joining as a sponsor on this, it is not with enthusiasm that I might have but rather with the recognition that something must be done to change our present system of distribution of medicine in this country. I wish that it could be done at the local level. I wish it could be done at the State level, but I do not believe it is going to be. I think it is something that is only going to be done by some type of comprehensive health insurance through financial means of a bill such as this and a national organization. At the present time, in most of our States, adequate coverage to all of the people is just not there, and added to that is the burden that inflation has put on our older people. Inflation has created a situation where people just do not have the savings for severe illness anymore, where they do not have the means, and medicare does not fill the gap altogether. People are proud. They like to feel that this is something to which they were entitled. They do not even have the $50 to go into that doctor's office, to go on to the hospital for treatment, They go once, they don't like the treatment they received so they do not go back even though they should. One of the discouraging things that we see is the general practitioner's office filled with people sitting there with crying children all afternoon because the doctor is so busy or he is out on an emergency, and he cannot handle this number of people. We can put more money into medical programs as they are; that is, medicare, medicaid. We can make more money for the doctor, but we cannot increase the number of doctors or their method of treatment by that manner. We have about 175,000 practicing physicians in this country. We have a total of 200,000 doctors, but 25,000 of these are not available because of research, because of involvement in other areas, and 175,000 physicians will just not do the job under our present set-up of private practice. There are a number of suggestions that will emerge from this bill and other suggestions, from the doctors themselves, how to spread them in a more equitable manner. We hear about paramedical help and some say it will work and some say it will not, but we must be able to spread these doctors more efficiently over a greater number of people. We must be sure that people will have the assistance of specialists and that there will be the money to pay for these specialists. One of the things I like about this bill that we are introducing is that it does recognize the existence of the referral system to specialists and the fact that they are the ones who will have to do the serious work and the more highly trained work. One of the areas that I do not like in the bill, but recognize it has to be there, is the question of the cost. At the present time, it is esti mated it will cost $37 billion. There are others who say it will cost more. It is true a great deal of this money is presently going into some type of health plan-Blue Cross, Blue Shield, individual plans. Everybody in this room, I dare say, is covered by some type of a program now. It is not as though we are breaking new ground as to coverage because all of us have some type of coverage to some degree at the present time. It only means it extends it to those who do not now belong, which is not a great many, and it expands the coverage. You are not limited to a certain dollar amount either at the bottom or at the top. It extends it to eyeglasses and various other devices that are part of our medical treatment. This cost would mean that the Federal Government itself would have to pay $5 or $6 additional billions a year. When you think that the war cost us last year $18 billion, I don't believe that this is too much to ask that we pay this for health coverage for all the people in the country. I do not want to mislead anybody. It does not mean there is going to be a doctor on every street corner; that we are going to have almost overnight adequate numbers of physicians. We need at least 40,000 more. There is no question about that. Some of my friends who are physicians and I have a great many and my son is a physician-say this in itself would cure all the ills, and I am sure we are going to hear this type of testimony, and we should hear it. Simply 40,000 more physicians are going to cure all these ills? I don't believe it will. I want 40,000 more physicians and I join with the chairman today in bills to advance the cause of general practitioners and others and to help the medical schools because we do need 40,000 more physicians, but I think just supplying 40,000 more is not going to, by economic pressures, drive physicians to the outposts where they are needed. It has to be done by other means, and I believe this bill is one of those means. Neither do I expect that this bill overnight is going to become popular and is going to be voted on and is going to be passed. It has a rough road ahead. I think the chairman, Senator Kennedy and Senator Cooper recognized it has a rough road ahead because it is revolutionary. But at least we are going to start talking about this program. We are not going to be adverse to changing in this system. as the evidence discloses that we can do it in a different way. I have half a dozen changes that have been presented to me already that sound good. So what comes out is probably going to be different from this bill that we introduced. I only hope that we and the other sponsors and people interested will be openminded enough to recognize in a revolutionary type of program such as this, we are going to welcome any corrections or any improvements to this bill. I am happy to be a part of it and I look forward to working with the doctors, with the health system of our Government and with the health system of our States in trying to work out a better program for general health for all our people. The CHAIRMAN. Thank you, Senator Saxbe, for your contribution to this opening session. I know from my conversations with the Senator, that his 2 years in the Senate is preceeded by a wide breadth of experience as attorney general for the State of Ohio, and that he has traveled in every county in his State and knows the health need of his State. I will place in the record at this time a statement by Senator Javits to be printed at this point in the record. I also order printed in the record Senator Javits' bills S. 3830 and S. 3711, with his statements and explanations of the bills. I also place in the record at this point the statement of Senator Claiborne Pell who is chairman of the Education Subcommittee who is very much interested in this subject. He could not be here today. (The statement of Senator Javits, a copy of S. 3830 and S. 3711, and explanation of the bills follow:) STATEMENT OF HON. JACOB K. JAVITS, A U.S. SENATOR FROM THE STATE OF NEW YORK Senator JAVITS. I congratulate the chairman for initiating these hearings on national health insurance. I have long urged that we begin an extensive examination of mandatory prepaid health care for all our citizens an idea whose time has been too long in coming-and transfer the national health insurance debate from university lecture halls to congressional hearing rooms. It is a tragic fact that although the United States leads the world in many branches of medical service, there is a national disparity in health services between the rich and the poor, between black and white. The poor suffer six times as many death from pregnancy complications, three and one-half times more deaths from diseases in early infancy, four times more deaths from TB, five times more deaths from syphilis, one and one-half times more deaths from cervical cancer, three times as much heart disease, seven times as many eye defects, and five times as much mental retardation. The life expectancy of a nonwhite American is 7 years less than his white counterpart, infant mortality rates are twice as great for nonwhites as for whites, and nonwhite maternal mortality is four times as great as the rate for whites. There is one doctor in private practice per 740 persons in New York State. Yet in Harlem, with a population of 185,000 persons, there are but 30 physicians in private practice relating to the local population. We are dealing here with the lives and welfare of all Americans. The issue of adequate and accessible health care, therefore, has become an imperative of social justice. Now it is for us to take that imperative and see that it becomes an idea whose time has come. To assure all Americans-whatever their economic status-accessible, quality health care and to provide form and direction to change the dangerously haphazard organization of health care in America, I introduced the National Health Insurance and Health Services Improvement Act of 1970, S. 3711. Since the health insurance would be financed by a tax on employers, employees and the self-employed rather than general revenues-although the health benefit costs for public assistance recipients and the unemployed would be underwritten by the Government-this measure was referred to the finance committee. To implement a national health insurance system, it is vital to proceed immediately with the rationalization of medical care services and facilities. To accomplish that end and put into motion initiatives that ultimately will reshape the inequities and hardships of our presently anachronistic national health-care system-a system aggravated by duplication, waste, overlap and poor coordination, I also introduced the Local Comprehensive Health Services Systems Act of 1970, S. 3830. This measure has been referred to this committee for consid eration and is, I am pleased to note, part of the subject of these hearings. I ask unanimous consent, Mr. chairman, that a copy of the bills, S. 3711 and S. 3830, together with a section-by-section analysis prepared by the Legislative Reference Service of the Library of Congress inay be made part of my remarks. My own relationship to national health insurance goes back a very long time; 21 years ago, in 1949, I introduced H.R. 4919 in the 81st Congress, a bill for a system of national health insurance. One of its cosponsors, was then Congressman, now President Richard M. Nixon, and others included the late very distinguished Secretary of State, Christian Herter, and former National Republican Chairman Thruston Morton, who served with such distinction in this body. Since then, along with many Members of the Senate, I have been actively engaged in the long struggle to provide health insurance to the aged. The landmark medicare legislation, finally enacted in 1965, was the culmination of an effort in which I had been engaged from the time I entered Congress. However, neither title XVIII-medicare program-nor the then little noticed title XIX enacted at the same time-medicaid-has proven adequate to meet an exploding demand for quality health care or—and this is critically important-to control a rapid and inflationary escalation of health care costs. The national health insurance bills I have introduced Mr. Chairman-and the other bills that have been and will be introduced-are symbolic of the recognition by our country of the great social needs of our people, which have developed over the decades. Almost 40 years ago President Herbert Hoover equated the right to public health with public education. In his inaugural address he said: Public health service should be as fully organized and as universally incorporated into our governmental system as is public education. The returns are a thousand-fold in economic benefits, and infinitely more in reduction of suffering and promotion of human happiness. I quote President Herbert Hoover, Mr. Chairman, because he was no wild-eyed radical. I believe our committee's study through these hearings of national health insurance legislative proposals will help arouse the conscience of the Nation to the urgent need for the development of a better system of health care-more readily accessible, more economical and more equitably distributed. I sincerely believe these hearings will stir the Congress to action in the enactment of legislation that takes a comprehensive and rational approach to the problems of health care. Not only must we increase purchasing power and therefore equalize access, but we must use those funds and the power of reimbursement to improve the delivery and availability of health care. In view of the acute stage the health care crisis has already reached, the ensuing premium on time, the need to implement a national health insurance system and garner all the concurrent advantages of emphasizing health care rather than disease care, it is essential to proceed immediately with the rationalization of medical care services and facilities, including the provision for health surveillance. I urge this committee to enact S. 3830 or similar legislation. We must begin a process of revolutionary change in medical care systems and stimulate the delivery of comprehensive health care to every American in need. 91ST CONGRESS 2D SESSION S. 3830 IN THE SENATE OF THE UNITED STATES MAY 13, 1970 Mr. JAVITS introduced the following bill; which was read twice and referred to the Committee on Labor and Public Welfare A BILL To amend the Public Health Service Act by establishing a new title X to such Act to provide Federal assistance to develop local comprehensive health service systems, and for other purposes. 1 Be it enacted by the Senate and House of Representa 2 tives of the United States of America in Congress assembled, 3 4 SHORT TITLE SECTION 1. This Act may be cited as the "Local Com 5 prehensive Health Services Systems Act of 1970". AMENDMENTS TO PUBLIC HEALTH SERVICE ACT 6 7 SEC. 2. (a) The Public Health Service Act is amended 8 by adding at the end thereof the following new title: |