geons General of the Army, Navy, Air Force, and Public Health Service, and the Chief Medical Officer of the Veterans' Administration. As president of the association and as its official representative, I therefore speak on this issue for the overwhelming majority of physicians within this country.

With this introduction, let me state that the Nation's doctors vigorously oppose H.R. 4222, 87th Congress, and any other legislation which seeks to invoke the use of title II of the Social Security Act as a method of financing a Federal program of health care for the aged. As physicians, we have many reasons for this position, ranging from the philosophical to the practical, from the general to the specific. Our major concern, however, is that the passage of H.R. 4222 or similar legislation would retard rather than promote the science and art of medicine and the betterment of public health.

For this reason alone we urge that this measure be rejected; but there are many other reasons germane to this hearing that we should like to discuss.

We have done so thoroughly in a document I should like to file with the committee. With your permission, Mr. Chairman, I ask that our entire statement be accepted for the record.

The CHAIRMAN. Without objection, it will be at the conclusion of your remarks and Dr. Annis' remarks.

Dr. LARSON. Thank you, Mr. Chairman.

This document is lengthy, but I feel sure the committee is aware that the problems of the aging are extremely complex. It is not possible, therefore, to discuss the specifics of H.R. 4222 without considering them in relation to patterns of life within the United States; the Sociological nature of the problem; the opposing philosophies involved; and the nature of the people this measure proposes to benefit. Taken out of this context, Mr. Chairman, it is impossible to view H.R. 4222 in its true perspective, or to understand the far-reaching consequences that would attend its passage. I hope, therefore, that members of the committee will try to find the time to read the document we have filed. We shall only be able to touch upon some of its main points, Mr. Chairman, in deference to the busy schedule of the committee.

I will touch upon only one aspect of the positive story—the success to date of the Kerr-Mills medical aid for the aged law (P.L. 86-778). I call this a positive portion of our testimony because much of it, necessarily, involves our reasons for opposing H.R. 4222; and it is the obligation of responsible men to support, as well as oppose; to produce workable alternatives to dangerous or unworkable ones; and to offer solutions of a positive nature while rejecting those that are unwise. The position of the AMA can be summed up in the 10 words, Mr. Chairman.

We favor helping those of the aged who need help. We believe that the Kerr-Mills law provides a workable method whereby medical benefits can be made available to those of the aged who need them.

The AMA supported this legislation from the beginning and it supports it today. Our physician members have done everything within their power to get the law functioning effectively within the individual States, and it would be false modesty if we did not claim some share of the credit for the law's rapid implementation.

Yet we have never believed the Kerr-Mills law could do the job alone. No legislation could accomplish that complex task-a fact which I am sure was clear to those who drafted the law and supported it in Congress.

But if Kerr-Mills cannot do the job alone, it can play a vitally important role in solving the problem of helping the needy aged finance the cost of their health care.

We have stated repeatedly, and do so again, our belief in the efficacy and value of Blue Cross-Blue Shield plans and privately purchased health insurance, which have grown at a phenomenal rate in recent years.

Further, we believe in the great contribution made through the voluntary efforts of American citizens, working together within their own communities, to solve community problems.

These, then, are the devices in which we place our confidence.

Implementation of the Kerr-Mills law has proceeded with unusual speed, despite a number of handicaps which tended to slow down the process. I shall refer to these handicaps later. It is appropriate first, however, to show the record as of mid-July.

The program was in operation, as of then, in 12 States. Legisla tion had been enacted in 15 more, and bills were under consideration by the legislatures of 6 other States.

Old-age assistance had been expanded in the States of Indiana, Mississippi, North Carolina, and Texas; and such a program was still under consideration in the State of Delaware.

No legislation had been enacted by 12 other States, whose legisla tures adjourned. This is by mid-July.

The record is surprisingly good, Mr. Chairman, when we consider the handicaps to enactment which Kerr-Mills implementation bills faced throughout the country. Some of the States passed only limited programs, setting these limits out of laudable fiscal caution. Statistical estimates concerning the number of aged who need help. the type of help they need and its cost, have varied so widely that State legislatures, especially those with little experience with formal statewide vendor payment medical care programs, are sensibly attempting to gain valid experience with the program before expanding. There has also been a campaign of active disparagement to hamper implementation. The very people who support H.R. 4222 have been its active leaders, categorizing the MAA portion of the law as an administrative monstrosity, a "pork barrel," a program to pauperize the aged, and so on.

This campaign has been in operation ever since Congress passed the law and it is significant that efforts to disparage Kerr-Mills were made long before most States had determined who would be eligible and how the program would be administered.

It is not hard to see why these tactics have been used, Mr. Chairman. Obviously, it was because a full, effectively operating KerrMills law would, in itself, constitute a powerful argument against the compulsory social security financing method advocated by H.R. 4222. There is the final circumstance that claims have been made over and over again that MAA would be outmoded by an OASDI-oriented program such as the King-Anderson bill. Some State legislatures were, therefore, reluctant to devote State funds to MAA on the grounds that it might quickly be superseded.

We submit, Mr. Chairman, that the record of implementation is exceptional under these conditions.

I should like to make one final point:

Potentially, depending upon how it is implemented by the States, the Kerr-Mills law is capable of financing whatever health services are needed for any individual over the age of 65 who cannot pay for these needed services himself.

The medical profession believes that this potential should be realized to the fullest possible extent, and has worked and will continue to work to achieve this goal.

Thus, we feel it would be foolish and wasteful, a usurpation of State and local authority, and a destruction of individual responsibility to destroy this program by enacting H.R. 4222.

We believe the Kerr-Mills law deserves a chance to prove itself. We are confident that it will do so, if given that chance.

Now, Mr. Chairman, I should like to turn the presentation of AMA testimony over to Dr. Annis. He will discuss our objections to H.R. 4222 and elaborate on several of the points I have made thus far. The CHAIRMAN. Dr. Annis, you are recognized.

Dr. LARSON. Thank you, Mr. Chairman.

Dr. ANNIS. Mr. Chairman and members of the committee, I am a practicing surgeon from Miami, Fla., with what I believe is a typical practice. My patients are young, middle aged and old. I treat bluecollar workers and white-collar workers, professional men and small businessmen, executives and indigents; and, of course, their families. I filed my official statement. Testimony given before this committee during the past week has contained so many distortions, halftruths, fabrications, misstatements, which taken together constitute a ruthless and brutal attempt to discredit the doctors of this Nation, and their American Medical Association; therefore it is a pleasure for me to appear before the committee in the interest of truth, in the interest of getting the record straight.

The American Medical Association has been accused of not being representative of the doctors of this country. Dr. Larson in his testimony outlined briefly the democratic setup of the American Medical Association. We in Florida send one delegate for every 25 members of the county society to our State house of delegates. These are voted on from year to year and serve from 1 to 3 years of their terms. Our officers are changed every year in posts in which they serve without pay, for the advancement of the art and science of medicine and contributing to the public health. This is a democratic organization changing its officers with regularity-men who serve without pay. Secondly, we have been accused of being against social security. Only this morning on the television program known as "Today," the Secretary of Health, Education, and Welfare, speaking, I am sure, from misinformation, repeated, Mr. Chairman and gentlemen, an oftrepeated lie, namely, to the effect that the American Medical Association opposes social security, that we oppose Blue Cross. This is not true, but it has been repeated so often, it has been reprinted so often, been retold so often, that even doctors in this country think it is

true.

However, the record, Mr. Chairman, and I would like to establish it on the record of this committee in the interest of truth, will show that the American Medical Association since 1934 has a consistent

record on the part of its house of delegates and its board of trustees as favoring prepayment and voluntary health insurance and encouraging plans of all types carrying out the purposes of insurance. At no time have they testified against the principles of the Social Security Act itself.

We have also been accused of applying sanctions against those doctors who dared disagree with the elected representatives of the medical association.

Yesterday Dr. Bert Howard, who is sitting on my right, the assistant executive vice president of the American Medical Association. was accused by name of trying to influence a doctor who was trying to transfer his membership and medical society from the city of Boston to my home city in Wayne County, in Detroit, Mich. This was untrue. This was a downright untrue statement. And these things should not go into the record unchallenged.

We have been accused of being opposed to things. Time and again newspaper people, friends of ours, civic leaders, and Members of the Congress, who are busy with so many things they cannot possibly know the background of the activity of any association in its detail, have accused us of being opposed to everything.

Mr. Chairman and gentlemen, we are opposed to many things. We are opposed to disease, to pain, to misery; we are opposed to cancer and to polio; we are opposed to an unavoidable death; we are opposed to obesity because of the diseases which it produces. We are opposed to all of these things, but in being opposed to these things, we are opposed also to anything that is going to lead to poor health; we are opposed to anything which will lead to a shorter life or bad medicine. We are opposed to quackery of all kinds, whether it be mechanical, nutritional, or whether it be political quackery, but in the long run in being opposed to things we are for things.

We are for study. We are for research. We are for experimentation with new ideas, new techniques, new drugs. We are for vaccinations, for innoculations, against diseases. We are for Salk vaccine: we are for the Sabin vaccine. This, too, was a misunderstanding on the part of many people in America.

My home city of Miami in the county of Dade is a good example of the combination and the utilization of advanced research in this particular field. We used to have polio as a common problem at home. When Salk vaccine came out, because of the leadership of American Medical Association, it was encouraged and utilized by people around the Nation, including my home area of Dade County in Florida. When the Sabin vaccine came out, we were fortunate. We were one of those areas that was given this vaccine as a mass trial, trying to blanket the whole area, and, Mr. Chairman, less than 6 weeks ago, our newspapers reported that for the first time in many, many years, we went 365 days without one case of polio in all of Dade County. This, we think, was a real record.

We continue to encourage Salk. We continue to encourage Sabin. We continue to encourage anyone whose research is going to add to the immeasurable prolongation of life in this country. These are the things that we are for.

We are for longer, healthier, enjoyable lives. We are proud of our part in prolonging the life of Americans. We know that in 1900 there were only 3 million people in this country who lived to be 65,

and this year we are now approaching 17 million. We are proud of the part that American medicine has played, but in prolonging life, we want people to enjoy life. We are against those discriminatory practices in hiring the elderly whereby you look at a man's age rather than his ability before he is hired. We are against compulsory retirement at 65.

Many of my patients at 65 are younger in their heart, younger in their ability to do things, than many who are in their forties or fifties. The elderly must be useful. We say that our Nation is facing a perilous time. Whenever do we need more to have the background and the knowledge and, most important, Mr. Chairman, the wisdom, which comes from the utilization of knowledge over the years, of our elderly citizens? If there was a time that we needed them, and needed to keep them healthy to enjoy and play their part, it is today; and in so doing, we are adding to their livability. What good does it do to give a man more years it he does not enjoy life to the fullest? These are the things we feel. We do not think a person should be made obsolescent because he is 65 years of age. We do not think these people should be categorized as people who can no longer take care of themselves and that these are people who, because they have reached the numerical 65th birth date, must be cared for by the Federal Government at the expense of the working people.

Doctors, hospitals, nurses, drugs, cannot supply the warmth, the need for affection, the appreciation, the friendliness, the respect that makes life worthwhile. The need for the example of our older people in the raising of our children is most important to the future of this Nation because upon our children lies the Nation's future. Only to the extent that we continue to recognize and, by example, practice the fourth commandment, honoring our fathers and mothers and honoring our grandparents and the other older people, will we help in the formation of character of our young people as they come along. By precept and example we can take advantage of the knowledge and experience and the know-how of these elderly people who have so much to contribute to the future of America.

They tell us that medical care is costly. No one knows it better than the doctors. I have practiced medicine in the State of Florida for 23 years. I went into the practice of medicine before the days of sulfanilamides and the antibiotics. I practiced medicine almost in the days not too far removed from the little black bag and the horse and buggy, although they were still using the Fords which were produced in my home city of Detroit.

But, just as automobiles and transportation has improved fantastically, we have moved from the horse and buggy medicine into jet-age medicine, and the jet that takes me from Miami to Washington costs $4 or $6 million to build, but it can transport more people in a day back and forth between Miami and Washington than a hundred horse and buggies could do in a couple of months. So it is in medicine. We have heard a lot about the advances in other fields of science, in electronics. We were thrilled with the astronaut and the development of what can be done. We know down there in Florida at Cape Caniveral they have missiles that they can fire 4,000 miles to the South Atlantic and hit targets 9 times out of 10. We say this is marvelous, and it is.