During the past fifty years, great progress has been made in the science of medicine and public health. We know vastly more today than ever before about the prevention and cure of disease. The rise of civilization on this continent and the growth of our wealth have made possible the establishment of many medical schools and institutions of medical research equipped with costly scientific instruments and laboratories. These institutions have attracted to them the best American talent as well as outstanding medical men from all over the world.
Where did all this wealth, which was the basis of the remarkable growth of medical science in America, come from? It came from the American people. Out of the immense fortunes accumulated by our captains of industry, endowments mounting into the hundreds of millions of dollars have been made to medical education and scientific research. Our local state and federal governments have also made liberal contributions to encourage research and improve public health.
It is therefore clear that the American medical science is not the creation of any single group: it is the outgrowth of a rich, young country. The American people—all the people—are therefore entitled to enjoy the benefits, and can ill afford to see this science made the basis of a cartel operated for the benefit of any special group.
The problem before the American people is: How well is American medical science distributed? What can be done to bring modern medical care within the reach of everyone? Hearings before congressional committees during past years have demonstrated the fact that the lower income groups in our population have much more sickness than the well-to-do and receive much less service.
Modern medicine has become so complicated a matter that the profession has been divided into a series of special branches, often making it necessary for several physicians and specialists to share in the treatment of an individual patient. Today, the doctor must have laboratories and hospitals and skilled, technicians at his ready service if his work is to be complete and successful. Many patients do not need the services of the specialist or the laboratory; but neither the patient nor the doctor can know until the diagnosis has been made. Thus, the continuance of the individual doctor who works apart from the organized facilities of the hospital or the group clinic has been possible only because these organized facilities are at his disposal when he needs them. In other words, competent individual practice of modern medicine has been possible only because there is also organized group practice. Many leaders of medicine seriously question whether a doctor can practice modern medicine at its best unless he is a member of an organized group of practitioners who pool their knowledge, skill, experience and equipment so as to give every service the patient needs.
While we have been making tremendous advances in medical science and in the development of educational institutions and facilities for medical service, a barrier has grown up in this country between the average American citizen and modern medical care. It is well recognized that the average American finds great difficulty in meeting the costs of adequate modern diagnosis and treatment when illness comes unexpectedly is very severe or involves complex services. Costs of hospital care have also—and necessarily—grown apace. A large part of our population, fearful of high medical costs, is deterred from consulting doctor when in real need of advice and care. Preventive medicine is greatly neglected, and diseases which are easily preventable play havoc with millions of our people.
This situation was recently dramatized by the records on rejection of draftees examined by the Selective Service Administration. More than one-half of the first 3,000,000 registrants examined were rejected for general military service. Out of every hundred men rejected, i6 were barred because of dental defects and 12 because of eye defects. Defects of the heart and blood vessels were the principal reason for disqualifying another 10. An additional six had venereal disease. Hernias caused the rejection of six more. Three out of every hundred were rejected chiefly because they were underweight, and tuberculosis and other lung diseases accounted for three more.
These boys and men, it should be remembered, were in the ages when health and Vigor should have been at their best. But even among the 22-year-olds, only three out of five could meet the standards; among those who had reached the age of 36, only one in five was accepted.
We have it on high medical authority that many of the causes for which individuals were rejected could have been alleviated or remedied by early treatment.
It is impossible to estimate accurately the losses which the United States is sustaining each year because of this unhappy state of affairs. The nation spends about $4 billion a year for health services and medical care. On an average day about a million workers—two percent of our entire working force—are unable to be at their jobs because of disability resulting from illness or injury. These absences mean an annual loss of more than a billion dollars in wages. In addition, it is estimated authoritatively that the withdrawal of wage earners from the labor market because of permanent disability or premature death costs the nation well over $5 billion a year in human capital. Altogether, sickness and disability levy upon the national economy a toil of something like $10 billion a year.
Unnecessary sickness and disablement and neglect of medical needs, result in an enormous burden upon public and private agencies and institutions—and taxpayers—-to care for dependents, widows and orphans, the aged and the crippled. The federal government and all states carry large financial burdens for the home relief of families and children made dependent by the illness or the premature death of the breadwinner. Much of this is preventable. It is socially criminal to overlook these facts and not to take the necessary steps against their continuance.
The Wagner-Murray-Dingell bill (S. 1161 and H. R. 2861) proposes that the federal government shall do its share for the security and protection of our population.
At this date, it is not necessary to discuss the merits of the bill’s provisions for social-insurance cash benefits. We have had a limited social-security system in operation, since 1935. It has more than fully demonstrated its imperativeness. Not even the bitterest political enemies of the present administration would want the measure repealed.
Our new bill is nothing more than an extension of the existing social-security system. It first undertakes to fill gaps in coverage left open by the limited and experimental system inaugurated in 1935; the benefits of the system would be extended to about fifteen million persons now excluded—chief among them farm and domestic workers, farmers, small business men and professional workers in non-profit institutions. Experience has demonstrated that this extension is both necessary and feasible. The time to inaugurate it is now, while an unprecedented number of men and women are in jobs; and when the initial insurance premiums would not constitute a hardship to anyone. Second, our bill undertakes to fill the gaps in the scope of the original system by providing insurance protection against important additional risks which threaten the security of working people and their families—the risk of income losses due to temporary sickness or permanent disability and the risk of not being able to afford, or get, needed medical and hospital care.
Inclusion of medical and hospital benefits in the social-insurance proposals has brought a vitriolic campaign of opposition from certain medical groups. In this connection it is worth recalling that more than ten years ago, the American Medical Association endorsed a minority report, objecting to voluntary insurance, which was prepared by some members of the Committee on the Costs of Medical Care. That report pointed out that if insurance is used to help people pay for their medical care, it had better be compulsory social insurance. New when compulsory insurance is proposed organized medicine calls for only voluntary measures.
Doctors who look upon their calling as a profession and not a trade and are truly conscientious in their relation to society, have told me in confidence that they are heart and soul for some drastic action to bring about better distribution of medical care and medical costs. Thoughtful men who come in daily contact with the sick and the ailing know that a very large proportion of our population does not receive adequate medical care, and that something must be done about it. They know, furthermore, that the government is the only agency which can do it effectively.
What does our bill (S. 1161) propose to do about medical costs? Briefly:
1. It would ensure the widest possible spreading of risks and of costs. Workers would find it possible to pay their way in small regular amounts when they are well and earning. 2. It would give people, no matter how small their incomes, unrestricted access to the most modern medical and hospital care.
3. It would preserve the personal relationship between physicians and patients.
4. It would raise the standards of medical care.
5. It would preserve inviolate the professional independence of the doctors.
6. For the majority of physicians, it would mean greater income as well as more secure income than they have ever had.
7. For millions o£ patients, it would mean not only proper medical care, but also the full dignity of American citizenship, free from the stigma of having to rely on public or private charity.
For employed persons, the funds for all the social-insurance benefits would be derived from a single contribution, thus simplifying the employer’s work in making reports and payments and effecting considerable saving in the costs of administration. As under the present old-age and survivors’ insurance system, no portion of wages, salaries or incomes in excess of $3,000 per year would be subject to levies for contributions to the fund.
The patient’s freedom to choose and change his doctor is guaranteed, as is the doctor’s, freedom to accept or reject patients. Access to specialists and appropriate payment for such specialist, service, are also assured. Laboratory services and costly appliances ordered by the doctor would be provided.
The bill does not change the customary free choice of hospitals. Fair payment to the hospitals is guaranteed and the highest practical standards of care are assured. Provision is made to foster scientific research.
I am dwelling at some length on the medical phase of the bill because it is the most misrepresented. An amply financed group which calls itself the National Physicians’ Committee for the Extension of Medical Service is carrying on a nationwide attack upon this proposed legislation. It is difficult for any citizen interested in the well-being of his fellow men to comprehend the reasons for this action. This group of physicians is employing methods and tactics which are utterly unfair.
Neither Senator Wagner nor I has ever claimed that our bill is a perfect instrument. It does offer a basis for honest and sincere discussion. With good will on all sides, a cooperative effort should be made to evolve something of great value in furthering the opportunities of the medical profession in their service to society and something that will answer the needs of our people. Instead of showing good will and cooperative spirit, the National Physicians’ Committee is squandering huge funds and vast energy to thwart this effort to bring more and better medical care and hospitalization to our people. If the same talents and the same funds were applied to constructive effort, the goal long awaited would soon be within our reach.
Despite widespread ballyhoo to the contrary, physicians are by no means of one mind with the self-style National Physicians’ Committee. For example, the Committee of Physicians for the Improvement of Medical Care—which includes many leaders in medical practice and in the medical schools—congratulated us upon the bill shortly after it was introduced. More recently, they published a report which offered suggestions for improving it. These were constructive criticism which showed painstaking study. Similarly, the Physicians’ Forum of New York has issued a penetrating analysis of the medical-care proposals. The Forum, while declaring that a “number of changes in the bill are necessary to assure that the medical benefits will provide the best quality of medical services,” approved the general features of the medical section of the Wagner-Murray-Dingell bill. Many other physicians have indicated their approval of the legislation in principle and are preparing suggestions for its improvement. These evidences of widespread interest and study among medical men are encouraging.
In my opinion, it is the duty of every liberal citizen, and more especially of every liberal physician, to make up his mind that since the problem of better and more widespread medical care must be solved, there should be no shirking of responsibility by any segment of our profession. All of us should, I believe, contribute generously and sincerely to solving the problem of our national health needs.
In his recent message to the Congress on the State of the Union, President Roosevelt included “the right to adequate medical care and the opportunity to achieve and enjoy good health” as an essential for an Economic Bill of Rights for the American people. IT is now up to the Congress to translate into reality this wish and need of the vast majority of the American people.