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TRENDS
By JOHN P. HUBBARD, M.D.,
Contributing Editor
This and subsequent descriptions of events and trends are intended to be unbiased and factual, pre-senting both sides of controversial matters so that conclusions may be formed from critical appraisal
of things as they are. These statements do not necessarily reflect the opinion of the u’riter nor are they to be interpreted as official opinion of the Academy.
T THE present writing, the 81st Congress has reconvened but it is doubtful whether
much, if any, attention will be given to the many health bills which have been dis-cussed at such length in Committee and on the Floor. By the time this review and preview is published, the 81st Congress will have finally adjourned and all unfinished business in
the nature of bills which have not been enacted into law will be washed off the slate. But
this does not mean that the unresolved issues will necessarily be dead ; they may be intro-duced in the 82nd Congress and appear in similar, if not identical, form. It is timely,
there-fore, to consider the status of certain of the health bills as a guide to the situation that we
may expect to see unfold in the newly elected Congress.
COMPULSORY HEALTH INSURANCE
Despite the all-out campaign waged by the AMA and many other powerful organizations,
compulsory health insurance will undoubtedly continue to be a storm center. A bill for compulsory health insurance has been introduced, in one form or another, into every
Congress since the first Wagner-Murray-Dingle Bill was introduced in 1943. It is not likely
that the 82nd Congress will break this chain. Mr. Oscar Ewing has not stepped out of his position as Head of the Federal Security Agency, although the AMA has demanded his resignation in quite unmistakable terms ; nor has he abandoned his vigorous support of a
system of universal health insurance. In an address on November 19, he said “we must find means to bring the best health services within the financial reach of every man, woman
and child ;and in my mind, that can best be accomplished through national health insurance as advocated by President Truman.’ ‘ On November 26, in an address before the Harlem
Interracial Platform, he ripped into the AMA with the following words: “Are we to haul
down our flags and permit the AMA and other reactionary organizations of this country to continue to utilize the present international crisis as a smoke screen for their selfish
policy of scarcity in medical personnel ?‘‘ In this address, he referred to the need for basic
health services in local communities ; to the ‘
‘crying
need for more hospitals and healthcenters-particularly in our small towns and rural areas’ ‘; to the need for an increase in
the supply of doctors, nurses, dentists, and other medical personnel. In reference to the
,‘fundamental question of health insurance’ ‘ he stated that ‘‘a solution to this problem of
health and medical care must continue to have an A-I priority on the nation’s order of
current business.”
The ranks of those members of Congress who have stood for compulsory health
Representative Biemiller, who has been an outstanding opponent of the AMA and pro-ponent for government health insurance, and Senator Claude Pepper who was defeated
last summer in a Florida primary. It should also be noted that Senator Donnell, the Senate’s most persistent foe of compulsory health insurance, was defeated. Senator Murray, whose name has repeatedly appeared in the Murray-Wagner-Dingle Bills, is a likely candidate
for Chairmanship of the Labor and Public Welfare Committee to which health legislation
is referred in the Senate.
LOCAL HEALTH UNITS
A bill for local health units has been one of the most noncontroversial bills, and has had
favorable, although not final, action in both the 80th and 81st Congress. In the Senate, S. 522 was passed without a dissenting vote in the first session of the 81st Congress. A companion bill, H.R. 5865, was favorably reported by the House Interstate and Foreign
Commerce
Committee
and has been before the Rules Committee since June 1950. A concerted effort is now being made to secure passage of this bill even before the 81stCongress adjourns.
The position of the AMA in regard to the Local Health Units Bill has been somewhat
difficult to follow. This legislation has been supported in the House of Delegates by resolu-tions over the past several years ; it has had favorable editorial comment in the Journal of
the American Medical Association; and local public health service is included in the I2
l)oint program of the AMA. As late as June 20, 1950, the Washington office of the AMA stated in regard to HR. 5865 “The American Medical Association has approved this bill.”
In view of its strong power in the past, it is hard to understand the action taken by the
House of Delegates in San Francisco in opposing this legislation.
FEDERAL Am TO MEDICAL EDUCATION
S. 1453 and H.R. 5940, companion bills, which would provide for federal aid to
medi-cal education have been actively considered in both Houses. S. 1453 was passed by the
Senate in September 1949. It has received active support from the deans of medical col-leges, but at the same time has also been the cause of considerable controversy aroused
by the AMA. In December 1949, the Council on Medical Education and Hospitals and
the Board of Trustees issued a joint statement on these bills. The matter is set forth in the
report
of the Council as follows : “This statement listed several criticisms of the bills and concluded that the bills were not satisfactory since they were potentially dangerous to thecontinued academic freedom of the medical schools. Subsequently, the Council collaborated
with the Committee on Legislation in preparing a statement which was issued on January I 5, .1950 and which set forth specific recommendations for changes in the proposed legis-lation that would safeguard academic freedom and make the bills acceptable in the opinion
of the Committee on Legislation and the Council.
“The proposals for federal aid to medical education put forth up to the time this report
was written have been presented as solutions for a peacetime problem. Discussion and
TRENDS 135
A new factor has been introduced into the question of federal support of medical and
dental schools. As reported by Gerald Gross in the November 27, 1950 Washington Re-port on Medical Sciences, the American Legion has just launched a survey to ascertain
,‘facts and figures on veterans hospitals, need for additional hospital beds, medical
man-power shortage, and medical teaching institutions throughout the country . . .as promptly as
possible.” This particular study therefore concerns itself not only with medical and hospital care, but also with professional manpower. With the full weight of the powerful American Legion behind it, this action may have considerable bearing on Congress’s decision on
federal aid to medical education.
SCHOOL HEALTH SERVICES
The companion bills S. 1411 and H.R. 3942 provided for federal grants to aid the
states in developing health services for children of elementary and secondary school age. This bill passed the Senate without a dissenting vote and in the House was reported
favorably by the Health Sub-Committee of the House Interstate Commerce Committee but the full Committee took no action on the bill. The bill calls not only for periodic medical
and dental examinations for all children, but also for treatment of the defects revealed by
these examinations. It would be left up to the individual states to determine whether or not this treatment might be given irrespective of the economic status of the parents. This
treat-ment clause permitting curative service to be given without a means test has been the cause of
opposition on the
part
of the medical profession. Nevertheless, this bill which has receivedconsiderable Congressional attention in recent years, will undoubtedly appear again with
