11. Alternative suggestions are herewith made which would result in improvement of the health of the aged (1) The condition of one's health is, in a large part, a manifestation of one's emotional reaction to his environment. Healthy and wholesome environmental reactions are manifested by people of integrity, of independence, of freedom of action, of self-reliance, of self-discipline, of thrift, of humanity and of morality. It would seem to be that if we are genuinely interested in the problem of human health then we are genuinely interested in developing these characteristics to their utmost in the individual with whom we are concerned. Certainly, the progressive centralization of our Government and its attendant arbitrary decisions, compulsion, and assumption of responsibility for adequate provisions for the individual tend to undermine these very characteristics which are the cornerstone of mental and physical health. (2) Our Government should keep faith with its citizens. When, out of a sense of patriotism, a citizen loans his savings to his Government by purchasing a governmental bond, it would seem incumbent upon the Government to see that the amount of money invested would at least retain its purchasing power over the period of the obligation. As is well known to this committee, this situation has not existed in the recent past. On the other hand, our Government has not kept faith with its senior citizens, since the purchasing power of their life savings has been constantly and progressively eroded by the inflationary policies of our Government. If we are genuinely interested in doing something for the aged, we do not need to give them more money, we simply need to allow the money which they now have to obtain such stability as would be required to permit them to purchase the items aspired to at the time the money was put aside. (3) If our Government is to function "by the people and for the people" then we must, by some means or other, prevent the administrative employees of our Government from assuming the position of establishing the policies of our Government. They must occupy themselves more with enforcing the laws of our land, and less with shaping the laws to suit their own personal philosophical and ambitious concepts. At the present time the social security apparatus, including Mr. Wilbur J. Cohen, is simply a group of specialists interested in a particular development who are being allowed to use public funds for the purpose of manipulating public opinion in favor of their interests. As Hayek states, "the result is that both voters and legislators receive their information almost exclusively from those whose activities they ought to direct. It is difficult to overestimate the extent to which this factor has helped to accelerate development far beyond what the public would otherwise have allowed. Such subsidized propaganda, which is conducted by a single, tax-maintained organization, can in no way be compared with competitive advertising. It confers on the organization a power over minds that is in the same class with the powers of a totalitarian state which has the monopoly of the means of supplying information." The appointment of strongly biased individuals to high administrative posts in Government and toleration of their daily persecution of a large and responsible sector of our public, should not, and cannot be long condoned if our type of government is to survive. (4) Since the basic entity in health care is a patient and a physician, the chief way that we can raise the level of medical care in the United States would be by increasing the amount of time which the doctor could spend with his patient. The necessity of visiting the many patients unnecessarily hospitalized, and the preparation of the numerous forms whose completion is an integral and inseparable portion of governmental activity would, of necessity, materially diminish the time available for the physician to spend with his patient, and could only result in a lowering rather than a raising of the level of medical care in the United States. (5) We must have more and better doctors. Largely as a result of recent policies which tend to discriminate in favor of education in the material sciences as opposed to the healing sciences, a shortage of first-class applicants for medical education is developing. The conversion of the physician into a second-class civil servant and "form-completer" can only further tend to discourage the intelligent, the imaginative, and the humanitarian from entering this most important field. The CHAIRMAN. Dr. Philip R. Lee. Dr. Lee, if you will identify yourself for the record by giving us your name, address, and capac ity in which you appear, you will be recognized. STATEMENT OF PHILIP R. LEE, M.D., ON BEHALF OF THE PHYSICIANS OF THE BAY AREA OF CALIFORNIA FAVORING THE KING BILL AND THE BAY AREA COMMITTEE FOR MEDICAL AID TO THE AGED THROUGH SOCIAL SECURITY Dr. LEE. Mr. Chairman, I am Philip Randolph Lee, member of the Medical Association, California Medical Association and the Santa Clara Medical Association. I am a member of the Department of Internal Medicine, Palo Alto Medical Clinic, Palo Alto, Calif.; assistant clinical professor of medicine, Stanford University School of Medicine, Stanford, Calif.; special consultant, restorative services and medical rehabilitation, U.S. Public Health Service, Washington, D.C.; Advisory Committee on Aged and Handicapped Services, Santa Clara County Department of Welfare, San Jose, Calif.; chairman, Senior Citizens Division, Community Council of Northern Santa Clara County, Palo Alto, Calif.; board of trustees, Channing House, Palo Alto, Calif. I am very grateful for the opportunity to appear before you representing the Bay Area Committee for Medical Aid to the Aged through Social Security, and the more than 70 physicians in the Palo Alto area and other physicians in the bay area who publicly support the King bill. I have a list of those physicians, if I might submit that with my testimony. The CHAIRMAN. We are glad to have it and it will be included in the record. (The document referred to follows:) PALO ALTO-STANFORD AREA PHYSICIANS SUPPORTING KING BILL (H.R. 4222) 1. Russel V. Lee, M.D., executive consultant, Palo Alto Medical Clinic, Palo Alto, Calif., clinical professor of medicine (emeritus), Stanford University School of Medicine. 2. Arthur Kornberg, M.D., professor and executive head, Department of Biochemistry, Stanford University School of Medicine, Palo Alto, Calif., Nobel laureate in medicine. 3. Don J. Jackson, M.D., executive head, Department of Psychiatry, Palo Alto Medical Clinic, director, Mental Health Research Institute, Palo Alto, Calif. 4. Halsted R. Holman, M.D., professor and executive head, Department of Medicine, Stanford University School of Medicine, Palo Alto, Calif. 5. Norman Kretchmer, M.D., professor and executive head, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, Calif. 6. Andrew Hunt, M.D., associate professor of pediatrics, director of ambulant patient services, Stanford University School of Medicine and Stanford Medical Center, Palo Alto, Calif. 7. Maurice Osborne, M.D., Department of Pediatrics, Palo Alto Medical Clinic; assistant clinical director, student health services, Stanfard University, Palo Alto, Calif. 8. Daniel Feldman, M.D., associate professor of medicine, director, rehabilitation services, Stanford University School of Medicine and Palo Alto Stanford Hospital Center, Palo Alto, Calif. 9. James Paulsen, M.D., Department of Psychiatry, Palo Alto Medical Clinic: director, psychiatric services, student health service, Stanford University, Palo Alto, Calif. 10. Anthony Felsovanyi, M.D., assistant clinical professor of medicine, Stanford University School of Medicine, private practice, Palo Alto, Calif. 11. August Meier, M.D., head, Department of Orthopedic Surgery, Palo Alto Medical Clinic, Palo Alto, Calif. 12. George A. Wood, M.D., Department of Industrial Medicine and Surgery, Palo Alto Medical Clinic, Palo Alto, Calif. 13. Esther Clark, M.D., chief of pediatrics and head of professional personnel. Palo Alto Medical Clinic; professor of pediatrics, Stanford University Medical School. 14. Richard Cutter, M.D. 15. M. Harry Jennison, M.D. 16. Julian Pichel, M.D. 17. Robert Shelby, M.D. 18. Thomas Ball, M.D. 26. Dean Storey, M.D. (retired). 29. Lois Todd, M.D. (retired). 30. Richard S. Lee, M.D. 31. James W. Newell, M.D. 32. Samuel Roland, M.D. 33. Rudolph Bock, M.D. 34. Arthur Spar, M.D. 35. Louis Zamvil, M.D. 36. Margo Paulsen, M.D. (inactive). 37. Margaret Yates, M.D. (inactive). 38. Irwin C. Kasle, M.D. 39. Francis Motzenbecker, M.D. 40. Philip Heersema, M.D. 41. Robert Spitzer, M.D. 42. Frank Cassidy, M.D. (retired). 43. Amy Stannard, M.D. (retired). 44. Richard Worthington, M.D. 45. Alan Kringel, M.D. 46. Jon Kosek, M.D. 47. W. W. Hoffman, M.D. 48. Fred Eldridge, M.D. 49. Herbert Hultgen, M.D. 58. Francis Eugene Yates, M.D. 59. Joseph DiCaprio, M.D. 60. Sumner Yaffe, M.D. 61. Norman Sissman, M.D. 62. Leslie Zatz, M.D. 63. Alan Brown, M.D. 64. Avram Goldstein, M.D. 65. John Josse, M.D. 66. Robert Greenberg, M.D. 67. Robert Cody, M.D. BAY AREA PHYSICIANS SUPPORTING THE KING BILL (H.R. 4222) Redwood City: Henry Mayer, M.D. Edward Sweeny, M.D. Mountain View: Arthur Ortenburger, M.D. Los Gatos: Harold Kazmann, M.D. (retired). San Jose: Victor Corsiglia, Jr., M.D. Sandor Burstein, M.D. Asher T. Gordon, M.D. Kalmen A. Klinghoffer, M.D. Berkeley: Joel Fort, M.D. Sheldon Margen, M.D. Leon Lewis, M.D. Mary A. Sarvis, M.D. Edward Rogers, M.D. Oakland: Frank Anker, M.D. Benjamin Lieberman, M.D. El Cerrito : Sedgwick Mead, M.D. E. Richmond Weinerman, M.D. The CHAIRMAN. You are recognized. Dr. LEE. The Palo Alto and Stanford area draws patients from a wide area so we have more physicians than one might expect from our population. The number of physicians practicing in the area is about 250. Thus, more than 25 percent of the physicians in my hometown support the King bill, publicly. Is it any wonder, then, that I should believe that the leaders of the American Medical Association have misinterpreted the feelings of physicians on this issue? I do not believe that Palo Alto, which is a Republican community, politically, is unique in the views about this matter held by the physicians, many of whom are, like myself, members of the Republican Party. This is, as we see it, not a matter of partisan politics, but of social consciousness and desire to make accessible the benefits of modern medical care to the aged. In my testimony I wish to direct my remarks particularly to the question, Do we provide the aged of this country with access to the highest quality medical care of which we, as a country, are capable, both professionally and financially? Will the King bill, H.R. 4222, if passed into law, improve that quality of care to which the aged have access and will it increase the aged's access to these services? It is in this area that I will testify primarily. I hope to follow the outlines suggested in the committee's press release of July 11, 1961: extent of need for legislation on this subject. In this section I will discuss the four points raised by the committee regarding the need for this legislation with emphasis on the follow ing: The continuity and coordination of the aged patient's medical care as his unique need; the manner in which the King bill will serve as a necessary complement to existing government and private programs in financing the medical care services needed by the aged; the improved quality of medical care for the aged which I believe will result from the passage of the King bill. THE EXTENT OF NEED FOR LEGISLATION ON THIS SUBJECT (a) The character and nature of the basic medical care requirements of persons aged 65 and over are similar to those of the population as a whole, but are greater in extent and degree. From my experience as a practicing physician, I am convinced that the aged individuals' "unique need" is continuity and coordination of care. By this I mean care under the direction of a single personal physician who either renders the care himself or is intimately aware of what services are being provided and who is providing them, whether these are rendered at home, in the office, in the hospital, in a nursing home, or elsewhere. Continuity and coordination of care is particularly important for the aged because over 70 percent of them suffer from one or more chronic conditions, the management of which requires the utilization of multiple medical care services. The utilization of these services is often difficult for an aged patient because it is difficult for him to adjust to change. When hospitalization or institutional care is required, this adjustment can be particularly difficult. Under these circumstances, continuity and coordination of the aged patient's care by a single personal physician is often the key factor in effective utilization of the multiple medical care services needed by the patient for his recovery and rehabilitation. The California Health Survey of 1954-55 illustrates the extent of the medical care requirements of the aged. In this survey it was found that persons 65 years and over received, on the average, 2 days of hospital care annually per person, as compared with about 1 day for persons 45 to 64 and considerably less than 1 day for persons under 45. The average length of stay for hospital admissions was 17 days for persons over 65 and 11.2 days for those under 65. Exclusive of individuals in acute general hospitals, it has been estimated by the California State Department of Health that approximately 5 percent of California's population 65 or over are in institutions. Of these 60,000 people there are 24,000 in nursing homes or chronic hospital facilities, 22,000 in boarding homes or private institutions for the aged, 10,000 in mental institutions and about 4,000 in other Federal or State institutions. In the mental hospitals of California the aged comprise almost 29 percent of the population while this group constitutes less than 9 percent of the total population. Based on my own personal experience. I would estimate that over 90 percent of the residents of California's nursing homes are 65 or older. The need for rehabilitation services for the aged is great, because they suffer from such disabling conditions as mental illness, strokes. arthritis, Parkinsonism, and fractured hips. Most of these conditions can be improved by treatment and the disability which the patient suffers can often be markedly reduced by appropriate rehabilitation services. These services for the aged must often be provided for a |