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The C. P. S. schedules list removal of an appendix at $125. (The Heller group of doctors charged upper-bracket families from $200 to $350 for this operation, with most charges $250.)

The C. P. S. fee for removal of the gallbladder is $200. (' (The group of doctors surveyed by the Heller committee charged their patients from $325 to $500 for this.)

C. P. S. charges for various kinds of gastric ulcer operations range from $50 to $200. Other C. P. S. charges: Removal of the thyroid gland, $175. (Mrs. M. you will recall, was charged $500.) Psychiatric examination, $15. (Actual charges in this field range from nothing, in some free clinics, to $25 an hour for wealthy neurotics.) Chest X-ray, $10. (The Heller group of doctors charged $10 to $15.) More complicated X-ray series-such as gastro-intestinal with opaque barium enema-cost up to $40.

The C. P. S. plan does not provide for eye examination or glasses, but the Heller committee surveyed a group of dispensing optometrists who charged $8.50 to $10 for lens and the same amount for frames.

The Industrial Accident Commission of California pays $15 for a complete examination of eyesight under present fee schedules. The California Medical Association has asked that this be increased to $22.50, to bring it more in line with average charges in the State. (One member of the News staff paid $20 for an examination recently; another paid $25.)

It is apparent that many doctors feel the C. P. S. fees are too low, and charge nonmembers whatever they please. At a recent meeting of the California Medical Association in southern California one physician complained that C. P. S. was "no better than socialized medicine" and said it has cost California physicians $10,000,000 in the decade since it was started.

It should probably, therefore, be interpreted as a minimum fee schedule rather than one physicians agree is fair for middle-income families.

[From the San Francisco News, June 17, 1949]

WHAT DOES IT COST TO BE SICK?-COST OF MEDICAL CARE UNPREDICTABLE FACTOR

(By George Dusheck)

How much does it cost to be sick? How can an American family, regardless of means, budget for sickness? Is it a private problem-or a public problem?

Mr. D., a 53-year-old accountant, earned $500 a month, working for a contractor on Guam. Living costs were high, however, and he and his wife had saved little when, last year, it was discovered he had cancer of the throat.

They returned to San Francisco and sought medical care for Mr. D. Here's how the bills added up at the end of 9 month's illness:

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This doesn't include the special foods that Mr. D. had to eat-nor the rent, utilities, and other family living expenses which continue whether a man is sick or well.

At the end of last month Mr. D. died—and on Memorial Day his widow added to her inheritance of medical bills the expenses of his funeral.

ANOTHER CASE

Mr. O. is a newspaperman, aged 37, who earns a monthly wage similar to Mr. D's. Last fall he felt tired and sluggish for a week or 10 days on end. "You probably need some vitamins," his wife told him, so he stopped in a drug store near the office and bought a bottle. It cost $2.37, including tax.

He took them for a few days and then forgot. His tiredness disappeared, possibly because of the vitamins or possibly because he got a full night's sleep several days in a row.

As far as Mr. O. can remember, $2.37 was the total of his medical expenses during the past 12 months.

EXTREMES IN RANGE

The respective illnesses of Mr. D. and Mr. O.-if Mr. O. could be said to have been sick, are extremes of the medical care cost range. But perhaps Mr. O. next year may be in a situation similar to Mr. D's. How can he prepare for it? Must his family face the same expensive and tragic prospect as did the widow of Mr. D.? The answer to this question is in the problem No. 1 category today before the American people and the medical profession. The answer is being sought by Government, by doctors-and in every household.

Those who support the traditional method of paying for medical care (as exemplified by the experiences of D. and O.) like to point out that Americans spend less for medical and dental service than for tobacco, cosmetics, liquor or movies.

COST ESTIMATED

This is undoubtedly true, although the best figures are only intelligent guesses. In 1948, for example, the total income in California amounted to 16.7 billion dollars, according to the State chamber of commerce. If the average expenditure for all medical care with 4 percent of each family's income (as indicated by several surveys during the past 20 years) then California's out-of-pocket medical care bill was $668,000,000.

If each of the State's 10,264,000 men, women and children (population estimate by the California Taxpayers Association at the beginning of 1949) paid his share of this bill, it would cost each person a little over $65.

UNCERTAIN LIABILITY

A man who smokes a pack of cigarettes a day, at 18 cents a pack, spends $67.70 a year. The per capita expenditure for alcoholic beverages in California is more than $119 each year, according to a 1947 survey by the Wholesale Liquor Distributors Association of northern California.

Measured against figures like these, the per capita expenditure for medical care looks reasonable enough.

The population does not consist of Mr. Per Capitas, however. It consists of Mr. D's and Mr. O's.

The cost of medical care is not only expensive-it is unpredictable and usually unbudgetable, chiefly because it is an indefinite and intangible liability to the average family. Who knows when illness will strike, how long it will last, what treatment and care will be needed?

It is true that almost any person can budget $65. Even a man with a wife and two children, if he is steadily employed at a living wage, could pay $260 out of his annual income for medical care, including dentistry and hospitalization. If California's annual 668 million dollar bill were really spread equally over the population and everyone was compelled to pay his share

PROGRAM CREATED

The State would have compulsory, Statewide health insurance! Gov. Earl Warren has three times proposed this plan-on a much lessthan-comprehensive scale-to the State legislature. It has been defeated each time. California Medical Association calls it "socialized medicine."

A similiar struggle is under way in the Congress. The United States equivalent of the Warren health insurance bill (although more comprehensive) is that extension of the social-security program which has been urged by President Truman and Oscar Ewing, Federal Security Administrator, and has been introduced into the Senate as S. 1679. There are many other suggestions.

Those who lead the opposition to the Truman and Warren health insurance proposals-chiefly the members of the medical societies-are themselves revolutionists, however. Almost all doctors freely admit that Mr. D. and the thousands of other persons similarly overwhelmed with catastrophic illness each year cannot bear this burden all by themselves.

California medicine has led the way for the rest of American medicine in seeking some way of joining the medical cost revolution without losing all of the power which doctors have traditionally exercised in both the scientific and economic aspects of medical practice. The doctors have come-reluctantly in many cases to accept the principle of voluntary prepaid health insurance, while fighting hard against any compulsory health insurance plan, whether Nationwide or State-wide.

Ten years ago the California Medical Association advanced $37,000 from its treasury to the California Physicians Service, newly organized under the leadership of Dr. Ray Lyman Wilbur, which proposed to provide medical and hospital care for groups of workers and their dependents on a prepaid, nonprofit basis. The step was taken only after prolonged debate in the CMA and in face of frank suspicion by the American Medical Association that the plan was a preliminary step toward "socialized medicine." It seems probable that only the prestige of Dr. Wilbur, then president of Stanford University, gave CPS its chance. Today CPS has 600,000 members and does an annual gross business of $15,000,000. In the same decade the Blue Cross plan for prepaid hospital care, started in the East, has grown in California to include 1,100,000 persons. Blue Cross paid out $9,207,012 last year in hospitalization benefits.

Group practice plans-such as the Permanent Health plan of Oakland and the Ross-Loos group in Los Angeles have also grown in size and scope since 1939. In addition, there are 144 private insurance companies writing health and accident policies in California. It is difficult to find out how many persons are covered by medical and hospital-care policies by these companies. In 1948 they paid out $1,278,139 in benefits on such policies, according to the State insurance commissioner's annual report.

The growth of these plans reflects the seriousness with which Mr. D's friends and neighbors regard the problem of modern medical care, and many, along with healthy (and lucky) persons like Mr. O., are buying some form of protection against the financial risks of illness, each thinking to himself: "Next year may be my turn."

Those who have not taken some such precaution are regarded as incurable optimists; or prefer to "take a chance." Many, of course, are ineligible.

Along with the issue of how medical care is to be paid for by families of low and moderate income, there is another controversy:

Is the amount of medical care available to the people enough to meet all their needs? Are there enough doctors, nurses, technicians, health officers and other personnel? Are there enough hospitals?

The News will examine the facts which lie behind these public questions, in a series of articles of which this is the first.

(Subsequently Senator Murray submitted the following personal statement and accompanying letter for inclusion in the record:)

Senator MURRAY. In practically all of the American Medical Associations' literature, it is alleged that Lenin said, "Socialized medicine is the keystone to the arch of the socialist state." Although no American places much credence in the statements of Lenin, I think it is of interest to know that the AMA apparently invented this quotation. Many scholars throughout the country have been unable to find it. As an example, here is a letter that I received from the Library of Congress, the greatest research organization in the world:

Hon. JAMES E. MURRAY,

THE LIBRARY OF CONGRESS,
LEGISLATIVE REFERENCE SERVICE,
Washington, D. C., May 2, 1949.

United States Senate, Washington, D. C.

DEAR SENATOR: The purported quotation from Lenin to the effect that "Socialized medicine is the keystone to the arch of the socialist state" has been the subject of considerable search from time to time. However, all of our efforts to trace this or similar statements by Lenin have been to no avail.

Our Russian specialist, Dr. Yakobson, states that in the premises the Senator's doubt as to the authenticity of this quotation is justified.

Very truly yours,

W. C. GILBERT,

Assistant Director, Legislative Reference Service.

NATIONAL HEALTH PROGRAM OF 1949

TUESDAY, MAY 31, 1949

UNITED STATES SENATE,

SUBCOMMITTEE ON HEALTH OF THE

COMMITTEE ON LABOR AND PUBLIC WELFARE,

Washington, D. C.

The subcommittee met, pursuant to adjournment, at 10:45 a. m., in the committee hearing room, Senator James E. Murray (chairman) presiding.

Present: Senators Murray, Pepper, Neely, Taft, and Donnell. Senator MURRAY. Gentlemen, the hearing will come to order. The first witness this morning will be Mr. Nelson H. Cruikshank, director of social insurance activities, American Federation of Labor. Mr. Cruikshank, will you take the stand, please. You may proceed. STATEMENT OF NELSON H. CRUIKSHANK, DIRECTOR OF SOCIAL INSURANCE ACTIVITIES, AMERICAN FEDERATION OF LABOR

Mr. CRUIKSHANK. Mr. Chairman, I have a prepared statement here which I believe was furnished your committee. With your permission I will read it and if there are questions, then I will be glad to answer them.

Senator MURRAY. You may proceed.

Mr. CRUIKSHANK. My name is Nelson H. Cruikshank, and I am director of social insurance activities for the American Federation of Labor. My office is in the American Federation of Labor Building, 901 Massachusetts Avenue NW., Washington, D. C.

I wish to express to this committee my appreciation for the opportunity to appear as a representative of the American Federation of Labor. My purpose in appearing here this morning is to present on behalf of the nearly 8,000,000 members of the unions affiliated with the American Federation of Labor our support for Senate bill 1679 and our opposition to Senate bills 1456 and 1581, together with some of the supporting reasons for this position.

The views that I present are not just my own. They represent the views of the American Federation of Labor as they have developed in conventions of our organization and by the social security committee in the discharge of obligations placed upon it by convention action. It was more than 10 years ago that the American Federation of Labor first adopted a resolution supporting national compulsory health insurance. This was in 1938. Similar actions were taken by the conventions of 1939, 1941, 1942, 1944, 1946, and 1947.

The executive council of the American Federation of Labor, meeting in August 1948, reported to our sixty-seventh convention in part as follows:

One of the major gaps remaining in our social-insurance program is its failure to provide for the costs of medical care. We know that about a third of the cases of public dependency arise through instances where through no fault of their own, workers have had to meet serious medical costs for themselves or members of their families that they were unable to pay. We have no desire to "socialize" the practice of medicine, but we agree that it is entirely feasible to spread the risk of the cost of illness by application of the compulsory insurance principle so that no worker need to labor under the constant fear of disastrously high doctors' and hospital bills.

Meantime the interest and demands of our membership and of people generally for providing for the costs of medical care through insurance continue to grow. The failure of Congress to act has not prevented many of our unions from providing some protection through collective bargaining. While this method is the best available at this time, we recognize that it is not as sound nor as practical as the comprehensive program envisaged in the Wagner-Murray-Dingell bill (S. 1606).

Of course, you recall this was a report made last August.

The sixty-seventh convention met in Cincinnati in November and in addition to adopting this report of the executive council unanimously adopted the following declaration on health insurance:

A comprehensive program to provide and meet the costs of medical care and service by the extension of social insurance should be established. Such program must preserve the individual rights of both patients and physicians. The program should include provision for an extensive program for the construction of hospitals and health centers, the training of medical personnel, and development of research.

This declaration has a somewhat different emphasis than earlier convention actions. It does not represent a retreat from earlier stands on the subject of health insurance but a step forward. The new emphasis is on recognition of the necessity for a comprehensive program which includes the training of medical personnel and development of research and in which health insurance is the keystone of the arch.

The Cincinnati convention also directed the social security committee to work out in more detail the standards applicable to such a comprehensive health program. This was done in January of this year. The committee reported the detailed specifications of this program to the executive council which met in February. The executive council adopted this program in full.

Just this month the executive council which has the authority of the convention between convention sessions held its second quarterly meeting of this year in Cleveland, Ohio, and it voiced its specific approval of Senate bill 1679 and opposition to Senate bills 1456 and 1581.

We note that there no longer seems to be a question as to the need for a different method available to the great mass of our population for meeting the costs of medical care and services. Ten years ago when our organization first espoused the cause of compulsory health insurance the opposition forces claimed that there was no need for any change in the method of payment. They have since shifted ground. The high and unpredictable cost of medical care is recognized. Even the most outspoken opponents of national health insurance now admit that there is a need for a new method for meeting the costs of medical care and we find them warmly espousing the programs which only a few years ago they labeled as "socialism and communism-inciting to revolution."

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