no help to the aged in helping cushion the costs of illness. Yet those who favor a compulsory national health plan continue their charges that the voluntary health insurance system is ineffective. For example, the Committee may have heard it stated that our voluntary health system offers no protection to 28 per cent of the civilian population, or, 49 million persons. The reason why this is true, it is said, is because the 49 million people involved simply cannot meet the premium rates. And why not? Because these unprotected members of the population are the aged, the disabled, the low-income workers, and the unemployed. Is it true--as is sometimes alleged--that 49 million people do not have voluntary health insurance because the cost of the premium is beyond their means? The Health Information Foundation has examined data on those of the aged with, and those without, voluntary health insurance. Of all the aged surveyed, less than three per cent had tried to obtain health insurance and been turned down. Of those uninsured at the time of the survey, about one-half said they could not afford or could not get health coverage; one-fourth said they had never thought about health coverage; and most of the remaining fourth said they did not want coverage. Frankly, Mr. Chairman, there has been a concerted and deliberate effort to discredit voluntary health insurance. To state that voluntary health insurance is beyond the ability to pay of 49 million people is either evidence of bias or an inability to draw logical conclusions from plain facts. It may be true that 49 million do not have voluntary health insurance. It is not true that all of them are unable to afford the premiums --as the survey of the Health Information Foundation shows. Another criticism in the campaign to discredit voluntary health insurance is that relatively few of the aged obtain benefits through it. This is usually presented as an indictment; however, it may be interpreted more appropriately as evidence that the aged are in good health--and particularly the insured aged. The fact that one is lucky enough--or better, healthy enough-to escape the need for using health insurance certainly does not mean he has been inadequately covered. He bought, paid for, and received protection of a certain type for a certain period of time. That in itself is value received. Just the same, let us look briefly at another example of how statistics on health insurance are misinterpreted. The Social Security Administration's Bureau of Old Age, Survivors and Disability Insurance reached the following conclusion after conducting a survey of insurance beneficiaries in 1957: "Relatively few--14 per cent of the couples and nine per cent of the non-married beneficiaries--had any of their (total medical care) expenses covered by insurance." Now, it is a feature of all health insurance that one must use medical care in order to receive a benefit. But apparently this axiom has eluded some of the experts. It should further be pointed out that hospital insurance is far and away the most common type among insured persons. Therefore, in a survey such as the above, many persons failing to be hospitalized during their illness would be counted among those who received no benefits from their policies. Analysis of the data yielded by the survey reveals that 79 per cent of all OASDI beneficiary couples and 84 per cent of all OASDI nonmarried beneficiaries surveyed did not enter a hospital during the survey period. The data are not arranged to indicate whether those who were hospitalized had health insurance and received hospitalization insurance benefits. Nor is it clear whether the 14 per cent of the couples who had some of their medical care expenses covered by insurance received hospitalization benefits only, or received hospitalization plus other benefits. Nonetheless, the data suggest that a possible 65 to 70 per cent of the beneficiary couples who did use the hospital could have obtained aid in paying the cost. This performance of voluntary health insurance is extremely good. The multiplicity of plans, coverages and rates is sometimes referred to as a weakness by critics of voluntary health insurance. I feel, however, that this is one of the greatest strengths of the voluntary mechanism. It is a strength for the simple reason that it permits the individual a wide variety of choices in the selection of a health care plan. He can select the plan that is uniquely best for him, the plan tailored to his need. Even assuming that most people prefer a particular kind of plan-whether it be employee benefits, with or without Blue Cross or Blue Shield or some other device--there is still available to them a wide variety of health insurance programs. Let me sum up this discussion by pointing out that the performance of voluntary health insurance is one of the great arguments against a national compulsory "health" scheme for any segment of the population. Voluntary health insurance has done a remarkable job in its brief history. It is capable of doing an even more remarkable job in the years ahead, not only in terms of the steadily increasing percentage of our population that will be covered, but in the quality of the coverage that it will provide. In addition, use of voluntary health insurance assures free choice by the individual buyer of the coverage best suited to his particular requirements. Under H.R. 4222, choice of coverage would be eliminated. In its place would be substituted a rigid, inadequate pattern of benefits imposed on the aged by the government, regardless of individual needs or wishes in the matter. SECTION XII KERR-MILLS IMPLEMENTATION AND REASONS WHY WE PREFER THIS APPROACH Before taking up the discussion of the Kerr-Mills Act, it is perhaps appropriate to point out the medical profession's qualifications in connection with the provision of health care for the indigent. Without fear of contradiction, we believe we can state that we were the first to assist in the provision of medical care for those who could not afford to pay, and thus have right to comment on the subject. Through the ages, since medicine began, the vast majority of doctors have given of themselves and their skill to the needy without recompense. They still do. As stated earlier, the value of the medical care donated by private practitioners in the United States now totals $658 million a year. With the total cost of the Kerr-Mills Law figured at $263 million for the first year, and $520 million for each year thereafter, it is clear that the donation of professional services by physicians constitutes a substantial financial contribution to the nation's health. A recent survey disclosed that more than 98 per cent of all physicians give free medical care; and that 60 per cent of all doctors devote 10 per cent or more of their working hours to such work. Although the survey cannot be 100 per cent accurate because of the difficulties encountered in estimating the value of services freely given by physicians, we believe it is not far off the mark. Care to the needy in terms of time spent and fees reduced or foregone; home and office care provided by physicians without charge, or at a fraction of their usual fees; unpaid work for ward cases in hospitals; service in clinics; contributions to public health programs; service to schools; these and other donations mount up. The American Medical Association's Committee on Indigent Care has, since 1948, studied state and local programs for the needy; analyzed Federal Public Assistance legislation and published reports to the AMA membership; and made recommendations to the Association's House of Delegates as to ways in which state medical associations may improve local programs for the needy. own way. The primary purpose of these studies and recommendations has been the improvement of the care provided to those unable to pay their In 1956, the AMA House of Delegates approved and adopted the "Guides for Medical Societies in Developing a Plan for Tax-Supported Personal Health Services for the Needy", prepared by the Committee on Indigent Care. We would like to quote, at this time, two of the policy statements from those Guides: 76123 0-61-pt. 39 "Patient care provided in tax-supported personal health "The responsible administrative agency and the individuals The American Medical Association has continued to work towards this goal of "adequate, high quality care for the needy," and has continually reaffirmed the need for medical leadership in these programs. It has recommended that state medical associations become fully acquainted with both the validity and the application of eligibility standards; it has recommended formal liaison with local governmental agencies involved in financing care for the needy; it has recommended medical initiative in explaining to the public the need for funds essential to adequate medical care programs. In April, 1960, as part of a joint mailing with the American Hospital Association to all state medical and hospital associations, the American Medical Association prepared a checklist, "Adequate, High Quality Care for the Needy--An Action Program for the Medical Profession", giving detailed suggestions as to ways in which professional health organizations might assure the most effective use of available health resources to meet their community's responsibilities for the needy. In June, 1960, the AMA House of Delegates adopted a policy statement on the responsibility for personal health services, stating that this "is primarily the responsibility of the individual. When he is unable to provide this care for himself, the responsibility should properly pass to his family, the community, the county, the state, and only when all these fail, to the Federal government, and then only in conjunction with the other levels of government, in the above order." As a natural implementation of this policy statement, the American Medical Association supported the passage of Public Law 86-778 at the national level, and the passage of state legislation to put it into operation locally. The Committee on Indigent Care met with officials of the Bureau of Public Assistance in Washington last October to discuss this bill and, at the November 1960 meeting of the AMA House of Delegates, the Association's Council on Medical Service presented a detailed report on the Act and recommendations for its implementation. These recommendations were adopted by the House and became the official policy of the AMA concerning implementation of this bill. We believe that, if these recommendations are put into effect in State |