in your State might not be aggravated in ours; but it does give those communities an opportunity for medical service, and an opportunity to the young men who are interested in the medical profession. I wondered if you followed some reports in Kansas on that?

Dr. MONFORT. I have personal experience in one relation to that plan. My home was originally in northwestern Oklahoma, about 16 miles from the Kansas line. Right across the State line is a little town of Hardtner, which has a hospital which was endowed by a very wealthy and eccentric farmer. He started out, with one doctor in this hospital; and, according to this plan in Kansas, they have had four there, but none of them has stayed for more than a year. He has three doctors now, two of them are in this plan that you speak of, because it serves rather a wide community. The other doctor has been there for a number of years, a very fine surgeon. I have known him for a long time.

Senator SCHOEPPEL. The big problem is to make facilities available in the rural areas wherein it will attract young men of the medical profession to go into the communities and remain there.

Dr. MONFORT. Yes, sir. Senator, here is the thing. Is law your profession, Senator?

Senator SCHOEPPEL. Yes, sir.

Dr. MONFORT. If you, in your career as a student in law, married either as a student or in the first year or two that you were practicing, probably with someone else, in a large town, which happens to a doctor who has internship in a large hospital, and your wife was accustomed to living in a large town, do you think that your wife would want you to go to a small town and raise your family, where they did not even have sewage?

Senator SCHOEPPEL. Well, we did that, and we would be happy to go back to it.

Dr. MONFORT. I do not think a lot of them will, and the proof is that they have not. It is a hard problem. Usually the doctors who locate in a small town are the boys I mentioned in this plan a while ago, that I thought was right, with reference to the small colleges; that is, he came from a small town.

Senator SCHOEPPEL. But the main proposition that should be worked out effectively, preferably on a State level, should be to encourage greater hospitalization facilities in the rural areas, and then greater opportunities for trained medical men who may have some inducement to go out in those areas and be of service. Is that not the main problem?

Dr. MONFORT. Yes, sir. Senator, there is just this about it. With better roads, those people will have better medical care available. You cannot have a doctor in each "section" to take care of the people who live in a section of a square mile. There has to be a concentration some place, and the quicker you can get them there, the easier it is for them to get there, and the better medical care they are gong to have.

Senator SCHOEPPEL. To carry this a little further, I might say that the medical group in my own State, that is, the hospital association groups, divided our State into a number of districts; that is, they grouped one or two counties into a district, and then they tried to work out some progressive relationship for the establishment of hospitals on a community stimulated basis in each of those districts. Then the

medical school cooperated to the extent of sending interns out into each of those areas for a certain designated period of time. It has worked very satisfactorily, I might say.

Dr. MONFORT. I believe it would.

Senator SCHOEPPEL. That has, I think, in our State, which may be different, of course, in other States, stimulated a desire for those young men going into the rural areas to remain there. They have done quite well on the financial side, and rendered a great service.

Dr. MONFORT. Senator, there comes a matter in our State that has not been brought out, and that is the fact that in this tremendous area in which there is a small medical center, we have 8,000 people and 3 hospitals, and 10 doctors because we serve over 100,000 people. Those people are not people who use the doctor very often. They are rather hardy hill folk, and they are honest, and so on and so forth, and hard working. Of course, we have the "WPA type," as everybody has, but these hospitals are privately owned. The people of the community have not yet come to an educational point where they could any more than think that a community hospital is a good thing, yes, but that is as far as they go. The people have been taught for 60 or 100 years that when they need medical care seriously, they get it just like they get a pair of pants when their pants wear out, and they pay for it. They may have to wait for a while to pay for it, perhaps, depending on the cotton crop, and so forth and so on.

But, I might say, the hospital problem is not a problem as far as getting patients into the hospital is concerned. We have the beds, and they are full.

Senator SCHOEPPEL. Do you find your medical profession generally, in your section of the State, cooperating to the extent of trying to get a greater dissemination of medical care out into all of the areas, and do you think that they by themselves can do the job?

Dr. MONFORT. We can do it as far as humanly possible, and I might say that we work on an average of 14 to 16 hours a day. You cannot work much longer than that and retain your health.

Senator, I would like to throw in this suggestion, which has worked out pretty well in our community. As I say, this is a local thing, and some of you gentlemen may not be interested in it, but in that part of the country there are burial associations by the dozen. Every community has them. A bunch of these funeral directors decided they would implement the income of their salesmen by letting them sell commercial accident and health insurance, hospital insurance if you want to call it that, because primarily that is what it is, and they have done a marvelous job of covering those people up there; but they also sell them an ambulance clause with it, and that has been the greatest boon to us. I have one patient 68 miles away that comes to see me every 3 or 4 weeks in an ambulance. She could not come in a bus, but she has ambulance insurance, and she uses it. It has been a boon, as I say. I do not know that that would work anywhere else, but in our community it has helped.

Senator SCHOEPPEL. Doctor, do you not think that there is some program that has to be worked out there in greater assistance, or in a greater degree of assistance which can be given to those who are making the medical profession their chosen profession, in order to get more doctors to supply the demand?

Dr. MONFORT. Senator, you are right, except that at this time we are limited in facilities. For example, in Arkansas, there were 90 students accepted for the freshman class. Last year the State legislature decided instead of selecting them strictly on a basis of academic qualifications and recommendations, that they would take so many from each district. There has been quite a howl about that, strange as it may seem. They thought the idea was to spread the distribution of medical students in the smaller areas a little better, but it also lowered the qualifications of the next year's entrance class.

The CHAIRMAN. I might say that an editorial on that has appeared in one of the leading Arkansas newspapers. I did not read it, I just saw it this morning as I came in, but I believe that editorial is in criticism of that plan.

Dr. MONFORT. Yes, sir. This is kind of far-fetched to say, but you can say, "Why allow more students to get in, if they are not going to be as good doctors as you can get?" It will not help the situation very much.

Senator SCHOEPPEL. Doctor, I agree with you that the men who are chosen for entrance into those medical schools should be of the highest possible type, both in understanding and ability, and when we throw down the bars and machine them through, the general public is going to suffer.

I am very much interested in your testimony, doctor, because you come from a local cross section of probably the rural areas of America, and I just personally happen to be from a small town. My home town in Kansas was a town of 1,600 people, and I can well envision and understand some of the very problems you have mentioned here. But something has to be worked out, whether it is on a local State level with certain assistance from the Federal Government, or otherwise, that will enable greater facilities in the medical schools to turn out better and greater numbers of these people and get them out in the rural areas if we are going to sell this demand for public health. Dr. MONFORT. Yes, sir; you are right, Senator.

I would like to make somewhat a boasting statement, but I do not really mean it that way, about the character and quality of service that we try to give. Because we went in as a group to start with, and our group is just typical of the other groups, it is a boasting statement, but I am trying to get away from that idea. There are two of us in our group who do surgery, one female surgery, and the other general surgery. The other member is a member of the International College of Surgeons and I am a member of the American College of Surgeons. That would not have been possible had we not grouped together to give us time to specialize, or semispecialize which, incidentally, of course, is giving through increased knowledge better care to our patients.

Senator SCHOEPPEL. Thank you, doctor. That is all, Mr. Chairman. The CHAIRMAN. Senator Long?

Senator LONG. Doctor, in my State we have almost half the hospital days spent in State-owned hospitals at the State's expense, and we do find that although you say you do not want to have welfare workers connected with this problem, in order to separate those people who are eligible for free hospital care by reason of their poverty from those who can well afford to pay, we have to have somebody to go out

there and investigate them. A man does not need to be a doctor to investigate to see whether a man is rich or poor, does he?

Dr. MONFORT. No, sir; that, of course, is like anything else. There are good politicians and there are bad politicians; there are good welfare workers and there are bad welfare workers.

For example, one of the hospitals in town turned down a welfare. patient because she happened to be a doctor's sister. I say, the patient happened to be a doctor's sister, and had no more business being a welfare patient than the man in the moon. As I say, the hospital turned down the patient.

Senator LONG. You see, Doctor, you have two problems with regard to better medical care. One is the matter of administering. Certainly, nobody but a doctor or nurse or intern is competent to administer the care. You have another problem, which is that of paying for it. That is not a problem for those who are well to do and who have money of their own. They can afford to pay, and we expect them to. But with regard to those who cannot afford to pay, there is the problem of how we can help them out. I do not believe that the doctor is the only one who has an idea as to who can or cannot afford to pay for medical care. I believe anybody familiar with the problem knows about that.

Dr. MONFORT. Senator, we are going into socialized medicine again, but Blue Cross and Blue Shield can protect a family for the price of a pack of cigarettes a week; and a little more than that for most of the commercial plans, which take care of the emergencies.

Senator LONG. Yes, and a very good plan.

Dr. MONFORT. Senator, if a man cannot afford that, how in the world can he afford the tax plan? He cannot do it.

The CHAIRMAN. Senator Taylor, do you have a question? Senator TAYLOR. Doctor, your testimony boils down to this. In your estimation, the question of better medical care depends on many factors better roads, better sewage facilities in small communities, or maybe if you cannot get the better sewage facilities, it is a matter of educating the brides of young doctors to be more self-sacrificing? Dr. MONFORT. That is a good way to put it; yes, sir.

The CHAIRMAN. Thank you very much, Doctor. I wish you would extend my greetings to my constituents in your community when you get home, please, sir.

Dr. MONFORT. I will, Mr. Chairman. Thank you.

The CHAIRMAN. Dr. Young, will you come around, please?

STATEMENT OF DR. ROBERT YOUNG,1 PRESIDENT, AMERICAN ASSOCIATION OF PHYSICIANS AND SURGEONS, CHICAGO, ILL.

Dr. YOUNG. Gentlemen, I would like to read a prepared statement, with your permission, and after reading this, if you care to, I would be glad to answer any questions that I am capable of.

The CHAIRMAN. How long will it take you to read this statement, Doctor?

Dr. YOUNG. Not very long, Mr. Chairman.

The CHAIRMAN. All right, proceed. We will expedite it as much

1 See letter and supplemental statement filed by Dr. Young, p. 97.

Dr. YOUNG. The Association of American Physicians and Surgeons, which I represent as president, appreciate this opportunity of presenting its views on Reorganization Plan No. 1.

For the record, I should like to state that I was born at Columbus, Ohio. I received my college training at the Ohio State University and was graduated in medicine from Harvard Medical School in 1934. Since 1938, I have been engaged in the private practice of surgery in Columbus, Ohio; and also I carry on, in an administrative capacity, a practice of industrial medicine. I am an assistant professor in surgery and an assistant professor in preventive medicine at Ohio State University.

The Association of American Physicians and Surgeons is national in scope and has members in every State and in the Territories. The purposes of the association are to represent physicians in the fields of medical economics, public relations, and legislation. The ultimate test of all of its actions is the public interest. It is supported by the direct memberships of individual physicians.

On March 27, 1947, the association presented testimony before the Senate Committee on Expenditures in the Executive Departments on Senate bills S. 140 and S. 712.

These measures proposed to accomplish virtually the same objectives which are proposed in Reorganization Plan No. 1-Department of Welfare. At the time of presenting testimony on S. 140 and S. 712 in 1947, the association's opposition to these two measures was supported unanimously by telegrams from the association's State delegates. Also, the American Medical Association, which has a membership of more than 85 percent of the approximately 189,000 physiians in active practice in this country, presented testimony at that time which concurred with our association's testimony of opposition to S. 140 and S. 712.

Again on February 15, 1949, at the request of the association, I appeared before the House Committee on Expenditures in the Executive Departments to oppose the enactment of H. R. 782-a bill very similar to S. 712 and S. 140 and one that would accomplish almost the same objectives as those proposed in Reorganization Plan No. 1.

During the past 2 years at two different meetings, the delegates of the Association of American Physicians and Surgeons voted unanimously to adopt resolutions disapproving S. 140, S. 712, and H. R. 782. Since the members of each State elect their own delegates to represent them, it is my belief that these resolutions of opposition to measures like the President's proposal, honestly reflect the views of disapproval of the vast majority of the association's members to this measure.

Therefore, I believe it is reasonable to assume that the association's stand on Reorganization Plan No. 1 represents the convictions of a great majority of American physicians, and also, a considerable fraction of the thinking citizenry.

Reorganization Plan No. 1 proposes to constitute the Federal Security Agency a Department of Welfare, which would include the administration of the Nation's health, education, and social security activities. We are opposed to it for the following reasons:

(1) We believe such a department would not be in the public interest.