medicine elements of compulsion, regulation, and control; and the result would be severe damage to the entire mechanism. But let us pretend this wouldn't be so. Let us pretend that some of this measure's proponents are correct when they state that it would affect the aged, and the aged only; that no further expansion is either necessary or contemplated; that we are only talking about a handful of doctors, not all doctors, and only about providing a medical program for the aged, not the entire population.

Is it possible for a system of medical care to exist for long with part of it government-controlled and the balance free? I submit that it is not, Mr. Chairman.

Those who maintain that there will be no expansion of H.R. 4222 are blind to the lessons of history and deaf to the voices of the bill's most ardent supporters. For those supporters are ardent only because they know the measure is certain to expand.

Why, otherwise, would avowed proponents of national compulsory health insurance support H.R. 4222? It would be naive, Mr. Chairman, if we attributed this new position to a change of heart. I believe they consider the benefits of the bill too limited, and its coverage too restricted. On the other hand, they believe that a tax increase can be sold on the "nickel-a-day" basis and that the inclusion of deductibles provides an aura of fiscal respectability. They further believe that if the measure is passed now it can be changed later, for the precedent will have been solidly established.

I suggest that this is their reasoning, Mr. Chairman. This is why they have set aside, for the time being, the radical surgery they once openly proposed on the free practice of medicine.

But if the American people agree to try the alternative treatment recommended by H.R. 4222, they will quickly learn that they have merely been offered a strong and concentrated dose of socialized medicine.

If there is any doubt as to the ultimate aims of the proponents of this legislation it might be wise to consider their specific comments.

Nelson Cruikshank, head of the AFL-CIO's Social Security Department, informed this Committee in 1959 that his organization still endorses compulsory health insurance for all. Mr. Cruikshank supports H.R. 4222.

Walter Reuther, president of the United Automobile Workers has said--and I quote: "It is no secret that the UAW is officially on record as backing a program of national health insurance." Mr. Reuther supports H.R. 4222.

"

Former Representative Aime Forand (D-R.I.) has stated: "If we can only break through and get our foot inside the door, then we can expand the program after that. Congressman Forand was referring, of course, to his own measure, H.R. 4700, 86th Congress. However, he also supports H.R. 4222.

I submit, Mr. Chairman, that considerations of the Congress regarding this proposal cannot be limited to the merits or demerits of H.R. 4222 in its present form; they must include the question of what H.R. 4222 would become. President Kennedy himself has characterized this measure as "just a beginning." Many others have been equally candid.

The question that must be answered overrides the matter of whether use of the Social Security mechanism is a good or a bad way to go about helping the aged in the financing of their health care. The multi-billion dollar question is this:

Do the people of the United States want to purchase, through an increased compulsory payroll tax, socialized medicine for the elderly, and ultimately for every man, woman and child in the country?

The medical profession is convinced the people do not. Socialized medicine, when presented to the Congress without subterfuge, in the WagnerMurray-Dingell proposal, was overwhelmingly defeated. Similarly, any forthright proposal to socialize medicine for Americans would, we believe, encounter the same fate.

Because we believe this to be true, and because our faith in the people of this nation has never weakened, the medical profession has bent its every effort to strip the disguise from measures like H.R. 4222 and reveal them for what they are: plans to socialize medicine for one segment of our population.

We will continue to speak bluntly when we must. And we will do so in good conscience because the health care of 180,000,000 of our patients is at stake. We want the opportunity of continuing to provide the highest quality of medical care within our capacity. Having come this far--to the point where we provide the world's best medical care--we wish to go even farther, and improve our system, our skills, our talents, our techniques, our facilities, and thus the health of our patients to the ultimate potential.

We cannot achieve the magnificent goals that modern science has made attainable if we must function under the control of the Federal Government.

Many of my colleagues have studied the British system at first hand. All have said the same thing about their experience: socialized medicine is not for the United States because it would decrease the quality of our medical care.

They have told me of limitations imposed upon physicians in prescribing the best drugs for a patient; of desperate searches for a hospital bed in which to place a critically ill patient; of overutilized services; of staggering patient loads; of forms to be filled and certificates to be made out and endless correspondence with the government. They have told

me of waiting lists for admission to hospitals so long that routine elective surgery sometimes required delays of a year or more.

Mr. Chairman, four staff members of the magazine "Medic a l Economics" visited six representative English cities in an effort to get an idea of what medical life is like in Britain these days. Their findings appeared in the July 17th issue and are presented to the reader as a composite interview distilled from doctor's comments.

This composite British doctor sees about 30 patients a day in his office and makes about 20 house calls as well. As a general practitioner, he has no connection with his local hospital although he is allowed to visit a patient who is hospitalized. He hasn't touched a scalpel in years and seldom will handle so much as a laceration himself, preferring to take his patient to the hospital and a specialist.

He is likely to feel that he has been converted into a first-aid station, comparable with casualty clearing stations on a battlefield, for all specialist services are based in the hospitals. As our composite family doctor put it, "A lot of us used to complain bitterly about being mere signposts to the hospital. But we don't any more. It dawned upon us that we get no bonus for doing specialist work. The family doctor's pay is the same whether he's brilliant or dull, energetic or lazy."

Medical reading has declined. Let me quote again: "Family doctors don't read much professional stuff any more. Why should they, when all the interesting cases are in the hospital as in- or out-patients?"

The article closes with this exchange between reporter and physician: "Do you feel your professional skill has fallen off?"

I'm a man

"No, it's my rapport with patients that's suffered. with a job now, not a man with a calling. The job's safe, and it's pensionable. My professional judgment is as good as the next man's. But the National Health Service has knocked the mainspring out of my life, and I'm never going to get it back.

"And what," asked the reporter, "is that mainspring, Doctor?"

"

"Ambition, my dear sir, the doctor replied. "That's what I've

got none of any more. Plain, old-fashioned ambition.

A constant complaint, Mr. Chairman, is the number of patients which flood doctors' offices seeking treatment for trifling or imaginary ills.

The lack of new hospitals has created a bottleneck to placement

of young doctors with specialized training.

And John McMichael, professor of medicine at London University,

just recently accused the government of retarding medical research because new discoveries might cause a jump in health service costs.

These and similar complaints are the by-product of any medical system in which finance is considered more important than quality. And as I have discussed at greater length elsewhere, this inevitably happens when government enters the health care field. The conflict between government's effort to hold costs down and the effort of the health professions to supply quality care is always resolved in government's favor.

Needless to say, the patient is the ultimate sufferer.

To sum up, Mr. Chairman, H.R. 4222, would provide socialized medicine for the aged. It would become socialized medicine, in time, for everyone.

SECTION VI

COST ESTIMATES FOR H. R. 4222

Gentlemen, I am a doctor, not a statistician or an actuary-a fact which causes me some concern in attempting to comment on the estimated cost of the King bill. And in all candor, I must say that the Department of Health, Education and Welfare has not made the task easier. I understand, however, that we have not been mistreated in this since none of the individuals or agencies interested in H. R. 4222, including this Committee, was supplied with any breakdown of the estimate until these hearings began last week.

When H. R. 4222 was first introduced, HEW announced little more than its lump sum cost and the fact that it would be a program financed by raising the Social Security tax.

The bill, of course, spelled out the financing method to be used. It called for a tax increase in 1963 of one-fourth of one per cent for employers and employees alike; and three-eights of one per cent for the self-employed. However, the tax base upon which this increase was to be levied was to be moved up from $4,800 to $5,000 per year, beginning next year.

ascertain.

On what basis HEW had worked out this formula, we could not

Meanwhile, the proponents of H. R. 4222 were describing its cost in somewhat off-hand fashion, as only a nickel a day for the average American. In a society all too familiar with installment buying, this popularizing statement undoubtedly laid many fears to rest.

Now, it appears that a nickel a day won't quite do it. The Secretary of HEW has informed us that although the percentage of tax increase is the same as originally proposed, it has been necessary to raise the wage base from $5,000 to $5,200.

server.

Again, this seems like a minor revision to the casual ob

It is far from it. We are talking about a tax increase of major proportions.

To the man who earns as much or more than the newly suggested base figure, this represents an increase in his Social Security tax of more than 17%. Translated into his take-home pay, it represents the difference between $144.00 currently and $169.00 if the bill is passed.

But, there is more here than meets the eye. In addition to