ultimate objectives, the hospital has the right to, distinctly reserved to it in the bill, require that the patient shall pay for the additional facilities over and above what the bill guarantees.

Senator MURRAY. May I interpose a question right there? Under existing conditions, many people in this country find it impossible even to get into a hospital where they could use those multiple-bed accommodations. In fact, they do not get in at all, and this bill certainly will make it possible for the people of the country to get hos-1 pitalization even though they occupy the less expensive bed.

Senator DONNELL. May I ask the Senator, Does this bill, S. 1320, provide for the construction of hospitals? We have the Ball-Burton bill for that purpose, and this bill, S. 1320, has nothing to do with the construction of hospitals?

Senator MURRAY. No; but it has to do with the support of the hospitals after they are constructed.

Senator DONNELL. But it contains the provisions I have read, does it not, Senator, with respect to the hospital facilities that are guaranteed in the bill?

Senator MURRAY. Oh, yes.

Senator DONNELL. Now, I would like to call attention further-I do not think this is ultratechnical-you have come here to give us your opinions about this bill and you have studied the bill, have you not? Have you read the bill from cover to cover?

Mr. CAREY. Yes, sir.

Senator DONNELL. If you do not mind turning to page 8, line 20 says this:

If the Board after consultation with the Advisory Council finds that the personnel or facilities or funds that are or can be made available are inadequate to insure the provision of all services included as dental, home-nursing, or auxiliary services under section 201 of this title, it may by regulation limit for a specified period the services which may be provided as limited or modify the extent to which, or the circumstances under which, they will be provided to eligible individuals. Any such restriction or limitation shall be reduced or withdrawn as rapidly as may be practicable and, in the case of dental services, priority in the reduction of withdrawal of any such restriction or limitation shall be given to children.

So we find, do we not, Mr. Carey, that you are not going to get just 100 percent under this bill, all kinds of medical services, hospital, home-nursing, auxiliary, and dental services, but the Board, if it finds there is not enough money in the sack, has the right to restrict and by regulation limit for a specified period-and I am quoting"the services which may be provided as benefits" to be eligible. That is provided in the bill, is it not?

Mr. CAREY. I think that is a very fair statement. It does not hold forth any promises that cannot be accomplished. It tells the people just exactly what they can expect. It does not promise perfection or Utopia. It tells them that there might be shortcomings. It tells them that in the event shortcomings exist, fair steps will be taken in order to establish some system of priority that will give greater consideration to children. I think it is a splendid provision. I am pleased that those who prepared the legislation incorporated that in the bill. It is the kind of provision that all people can readily understand.

Senator DONNELL. It is not overtechnical, is it?

Mr. CAREY. No; it is a very fine statement.

Senator DONNELL. It is clear as to what it means, is it not?

Mr. CAREY. Certainly.

Senator DONNELL. And it does not guarantee?

Mr. CAREY. It is so clear, Senator, that I wonder why questions re raised on that paragraph.

Senator DONNELL. I tried to make that clear. Don't you undertand that?

Mr. CAREY. I think it is clear to you, Senator.

o me.

I stated it was clear.

Senator DONNELL. I think it is perfectly clear.

Certainly it is clear

Mr. CAREY. Can we proceed now to some other portion of the bill? Senator DONNELL. Now, we will proceed in a few minutes, Mr. arey-don't get in too much of a hurry here.

Mr. CAREY. May I tell you why? I do have to take a 1:40 plane nd unfortunately, it will be necessary that I take it or make other rragements.

Senator DONNELL. Well, we will endeavor to speed up as much as e can, Mr. Carey; however, you have come here to testify, and we hought you could stay until we got through with the testimony. We ill proceed as rapidly as we can.

You referred here to the medical profession, and I want to ask you hether or not you have yourself studied the question as to how the lan of compulsion insurance from pay-roll taxes and the provision of octors through the means similar to this bill over in England, how that as affected the quality of medical services over there? Have you tudied that question?

Mr. CAREY. I have had conversations with the leaders of their govrnment on this question in England just a matter of a few weeks ago. Senator DONNELL. Do you mind telling us what particular leaders Fou discussed that with?

Mr. CAREY. I would mind.

Senator DONNELL. You would prefer not to tell us?

Mr. CAREY. I would prefer not to.

Senator DONNELL. Have you examined any of the officials?

Mr. CAREY. I was going to say, as well as in other countries within— well, as recently as 30 days, in Czechoslovakia.

Senator DONNELL. Do you mind giving us the names of those leadrs whom you talked to?

Mr. CAREY. NO; I could tell you their position.

Senator DONNELL. Would you mind doing that?

Mr. CAREY. I have no objection to doing that.

Senator DONNELL. That is as to Czechoslovakia? You prefer not to s to England?

Mr. CAREY. I just could not at the time give you-I just do not recall ll of them and I would not be certain of the correct pronunciation of ome of their names, but I could get the information for you, Senator. Senator DONNELL. Very well.

Mr. CAREY. In Czechoslovakia it was people in charge of the program, such as the minister in charge of labor and social activities; members of the staff. I do not have readily available their names in letail.

And I have also talked with other people in the same capacity it other countries including the Soviet Union.

Senator DONNELL. How about New Zealand? Did you talk to any. one in that country?

Mr. CAREY. I have some of them, but not as much as I have in some of these European countries, and not nearly as recently. (Subsequently Mr. Carey addressed the clerk of the committee follows:)

CONGRESS OF INDUSTRIAL ORGANIZATIONS,

Washington 6, D. C., September 3, 1947.

Mr. PHILIP R. RODGERS,

Committee Clerk, Labor and Public Welfare Committee,

United States Senate, Washington, D. C.

DEAR MR. RODGERS: I wish to acknowledge receipt of your recent letter re questing the names of the foreign officials with whom I discussed the effects of compulsory insurance upon the standards of medical care.

I am attaching a list of names so that you may include it in the official pub lication of the hearings. Most of these people participated in the several dis cussions in varying degrees.

Sincerely yours,

JAMES B. CAREY, Secretary-Treasurer.

Union of Soviet Socialist Republics.-M. P. Tarasov, Mme. N. V. Popova.
Great Britain.-V. Tewson, A. Deakin.

France.-B. Frachon, L. Jouhaux, G. Monmousseau.

Mexico.-V. Lombardo Toledano.

China.-H. F. Chu.

Australia.-E. Monk, E. Thornton.

India and Ceylon.-S. A. Dange, V. B. Karnik.

Belgium.-E. Kupers.

Italy.-G. DiVittorio.

Czechoslovakia.-A. Zapotocky.

Africa.-B. Goodwin.

Senator DONNELL. Do you like the Soviet plan, concerning which you have had discussion with people from Russia?

Mr. CAREY. I would not use that model. I prefer to keep on S. 1320, if I may.

Senator DONNELL. Have you read any official reports or articles, by commentators, of any nature in regard to the success or failure, or intermediate ground between success and failure, of Great Britain's experience, particularly as it reflects itself in the quality of medical service that has occurred?

Have you read any such reports or comments?

Mr. CAREY. Yes; I have. And I might say at this moment that I am here to testify on behalf of a great number of other people. I cannot detail the kind of reading they have engaged in in this field, but they express pretty firm opinions with regard to many of these questions, and when Senator Murray and I raised the question about the kind of opposition that the principles contained in S. 1320 received, I did admit that a lot of argument was developed on the basis that in this country we have superior medical services rendered the people, and that I readily grant, but as to saying that we cannot improve our medical services, I would say there is a great deal of room for improvement, based on my personal experience, what I have read and what others have had in terms of experience, and in terms of the needs of the people I represent.

Senator DONNELL. I am wondering, Mr. Carey, if you can tell us of any specific article, booklet, pamphlet, document, that you have

read in regard to the effect of Great Britain's system on the quality of medical service in that country?

Mr. CAREY. No, sir-that is, as to making a comparison.

Senator DONNELL. Maybe I did not make that clear. What I mean is, have you read anything at all, any report, whether official or unofficial, book, document, pamphlet, newspaper article-anything that you have read in regard to the effect on the quality of the service of a medical nature in Great Britain which has resulted from the existing Compulsory health-insurance plan in England?

Mr. CAREY. I have read a great deal, but I could not state names of pamphlets, or booklets, or authors.

Senator DONNELL. Can you give us the name of any one of them? Mr. CAREY. No, sir.

Senator DONNELL. Now, you speak here of the fact, as you say, that there is no compulsion, and you make quite a point of that, I think. You say one of the outstanding attributes of S. 1320 is that it would impose no compulsion on anybody. I will ask you to state if one of the outstanding attributes of S. 1320 is that it contemplates the collection of a tax from the people who are subject to that tax under the terms of S. 1320?

Mr. CAREY. I made reference here to the fact that no one is required under this law to accept treatment or to become part of this program in terms of rendering service.

Senator DONNELL. Of course, there is nothing that requires a person, after paying his taxes, to avail himself of the benefits. He can waive those, of course, if he wants to.

Mr. CAREY. That is what I make reference to here.

Senator DONNELL. In other words, you mean then, I take it, with respect to compulsion, that after you and all the others who are subject to this tax-and all of us because a large amount or some part of the expense is going to be derived from general revenues-I take t you agree to that?

Mr. CAREY. Yes, sir.

Senator DONNELL. I say now that after we have all paid in our taxes, in one form or another, to set this scheme up under S. 1320 you mean by saying there is no compulsion, as I understand it, that there is no obligation on the part of any one of us to avail ourselves of the benefits of it?

Mr. CAREY. There is an obligation, very definitely.

Senator DONNELL. There is?

Mr. CAREY. There is an obligation on the part of every citizen of this country to avail himself of the opportunity of being healthy. You cannot walk around the streets of our community here diseased. There is an obligation on the part of all the citizens to conform to the needs of society, as I mentioned later in the course of my testimony. There is certainly an obligation on the part of the American Congress to give consideration to the needs of the people. There is an obligation to do that on this subcommittee. There is an obligation on people to work and avail themselves of the opportunity of employment, but that does not necessarily mean that they are compelled to do it. They may not avail themselves of the opportunity.

I do not care to get into a discussion of the meaning of the word "compulsion," but, if you will point out where S. 1320 does exercise

64431-48-pt. 3-17

compulsion on anyone, I am sure we could save a considerable amount of time.

Senator DONNELL. I have always understood that the assessment of taxes involves an element of compulsion and I still think so, notwithstanding your argument that this bill is free from compulsion

Mr. CAREY. By "compulsion," I mean no compulsion other than that which a citizen is obliged to do, to maintain citizenship and good standing in a community. There are certain things that a citizen is required to do, it is true, and I say there is nothing in this bill where the people are compelled to do things against their will, for their benefit.

Senator DONNELL. Even after we have paid the taxes, then, this bill does not compel us to accept any benefits under it? That is what you mean?

Mr. CAREY. That is correct. And there is compulsion in this sense that a person, even though he has no children, is compelled to pay taxes to support these schools. I think they get benefit from that, There have been people, citizens, that pay their taxes and send their children to private schools. They are compelled to support the instrumentalities of society for the education of the children generally. So, in that sense it might be considered that there is compulsion. Certainly there is.

Senator DONNELL. You referred earlier, Mr. Carey, this morning to the fact that you and the A. F. of L. representatives, and possibly you mentioned someone else, would all agree, generally speaking, and you referred a while ago that there had been no collaboration in the preparation of the material that has been presented here to the committee; that you could all agree on the principles that you have presented here?

Mr. CAREY. Yes, sir; I stated that after listening to the representative of the American Federation of Labor, Mr. Cruikshank, and I am quite certain if you put, not the words, or the thought contained in it, but the principles in the testimony he presented and the testimony that I, as a representative of the CIO present here, you will find they are very consistent; or if you take the statement that was presented for the record by Mr. Potofsky, you will find that they are consistent with these.

Senator DONNELL. In fact there is a very striking similarily, is there not, Mr. Carey, in a great many of the statements that have been presented to this committee? They take up, for instance, the American Medical Association's finding and with respect to medical indigents: they refer to the "charity" nature of the Taft bill; they go into the numerous questions in which there is a very striking similarity in the statement, is there not? There is no question about that?

Mr. CAREY. There is no question but that there is a striking similarity in the positions they take; yes, sir. I might say, Senator, that that is not surprising because this is a matter that has been thoroughly discussed. I do not think there was any collaboration between the members of the Resolutions Committee of the A. F. of L. in their meetings or the meetings of the CIO Resolutions Committee in their meetings, and yet their resolution adopted on the subject contains the same general ideas, and especially on this question with regard to whether we should take the principles contained in S. 545 or the approach contained in S. 1320, and I think that in each instance,

and