160,000 aged Texans presently have prepaid health insurance. We feel that both nonprofit and commercial underwriters should continue to be encouraged, and not stymied by the establishment of a Federal program which would replace voluntary prepayment plans for many aged persons who can afford to pay for their own care.

Medical care for the aged who cannot afford voluntary health insurance and who need help in financing their medical needs will be facilitated by the implementation of the Kerr-Mills bill. Two months ago, the 57th Texas Legislature passed enabling legislation for the establishment of the vendor's medical care program. The Texas Medical Association actively supported this legislation which provides for medical and hospital services, and payments for nursing

home care.

The bill permits the program to be administered by the State Department of Public Welfare, by direct payments to vendors of medical services, or through a plan of voluntary prepayment health insurance. As evidence of our confidence in the American traditions of free enterprise, we feel that this program can best be administered by utilizing the mechanism of voluntary health insurance. Available funds can be used to purchase health insurance coverage for public assistance recipients, either through Blue Cross-Blue Shield of Texas, or from commercial carriers. This will insure the patient of free choice of physician and hospital; it represents minimal governmental control; and it will facilitate effective administration of the program. By utilizing voluntary health insurance, we believe that the State can best insure a program of high quality medical care for the aged who need help.

This new program will be placed into operation on January 1, 1962, and it will provide benefits to 221,000 Texans who are receiving oldage assistance. Thus, 30 percent of the State's entire aged population will be eligible for medical assistance.

In further support of the fact that there is no need for a Federal program of medical care for the aged, may I cite the study of the Texas Research League. The league is a privately supported, nonprofit, nonpolitical educational corporation which is devoted to research in the field of Texas government. It recently undertook a complete analysis of the medical needs of public assistance recipients in Texas. The 18-month study embraced cases in every county in our State, and it represented the most extensive analysis of its type ever taken. While the study confined itself to an analysis of the medical needs of public assistance recipients only, the ramifications are much greater. As defined by law and policy, public assistance recipients have the most meager economic resources of any group. If they have unmet medical needs of consequence, it would follow that other groups with greater resources should be studied to see if they also have unmet medical needs. Conversely, if no or only limited medical needs were found among these persons, it would indicate that no new governmentally sponsored medical programs would be needed for these other groups.

In its study, the Texas Research League reported that the Texas public assistance recipients represent 255,000 cases. Of these cases, 117,300, or 46 percent, were found to have a medical need. However, only 21,400, or 812 percent, had a medical need that was not being met. And of that number only 8,718, or 312 percent, had a medical

need not being met that could be satisfied by the introduction of any new program.

The league also reported one item of particular interest concerning the 21,400 cases with unmet medical needs. Free medical care was available to 9,600 of those cases, but the recipients refused to accept such care.

These figures of actual unmet needs may seem low compared to public statements which have been made about widespread medical needs, especially among the aged. Yet the facts clearly show that most of the medical needs of Texas public assistance recipients already are being satisfied under existing programs. In fact, according to the Texas Research League, public assistance recipients received $42.3 million in free medical care în 1960.

The league has concluded that medical needs that could respond to any type of new governmental program are much less than anticipated. This study clearly refutes some public statements which have been exaggerated by emotion and political opportunism. The league points out that no reason can be found for the Federal Government entering this field. It further emphasizes that respondable medical needs can be met adequately and more effectively by a State-local governmental approach which does not attempt to duplicate or replace existing public or private welfare programs, or services provided by relatives of the recipient.

In summary, on the basis of our experience and many studies in Texas, we vigorously support local and State responsibility. We oppose H.R. 4222 because we believe that a federally controlled program financed through social security would result in poorer-not bettermedical care. It would provide health benefits for millions who are not needy and who can afford to pay for their own. It would overcrowd our Texas hospitals and our nursing home facilities. It would stymie the growth of voluntary health insurance, which has filled a great need, and which has enjoyed a greater public acceptance than any other fiscal mechanism in the history of mankind. And, most significantly, this proposal for social security medicine is most expensive. It would increase social security taxes for both Texas employees and employers, and would further reduce the take-home pay of those who work.

As we view it, H.R. 4222 should be recognized for what it actually is a proposal for a compulsory program of socialized medicine for the aged. By common definition, socialized medicine is a system of health care which is administered, financed, and controlled by the Federal Government for that segment of the population it serves. Texas physicians want no part of socialized medicine, and we respectfully call your attention to the compelling findings of recent history. In those countries where socialized medicine has been adopted and free enterprise displaced, the quality of medical care has deteriorated, effective recruitment of qualified medical students has become impossible, and costs have increased immeasurably beyond all estimates. Our great Nation was built upon the philosophy of individual responsibility and initiative and the American traditions of free enterprise. I sincerely hope that you and the Congress of the United States will help keep it that way. Only through personal initiative and private enterprise can we maintain the great Nation of which we all are so proud.

Thank you very much.

The CHAIRMAN. Thank you, Dr. Renger. We also appreciate Dr. Davis being with you. We certainly appreciate, too, Mr. Thompson presenting you to the committee. Are there any questions?

Mr. ALGER. I am not going to question, but I did want to observe, since the time is so late, on page 7 you boil down to the fact that there are 32 percent of the people in Texas who have a medical need that might be covered by a new program. That is not to say that the 312 percent cannot be covered under existing programs, is it?

Dr. RENGER. No.

Mr. IKARD. You mentioned the Texas Research League's survey. I have heard of that, and I have been unable to get a copy of it. Do you by any chance have one?

Dr. RENGER. Yes, sir.

Dr. DAVIS. We would be glad for you to have it and we will supply other copies to the committee.

The CHAIRMAN. Will you please see that each member of the committee gets a copy.

Mr. ALGER. Will that be for the record, too?

Dr. DAVIS. Mr. Chairman, if I might suggest, we would be happy to submit this as factual information for the record. I would like to suggest that the chairman and other members of the committee look it over, and you all decide because it has a lot of meat in it.

Mr. IKARD. I would suggest you just furnish members of the committee with that.

Mr. CURTIS. You say this number of 812 percent had a medical need that was not being met and there was another group which could be satisfied with the introduction of a new program. Am I led to believe that this 812 percent might have their medical need met if their situation was called to the attention of the authorities or the proper people, or what does that mean?

Dr. RENGER. This survey was polled before the implementation of the Kerr-Mills bill.

Mr. CURTIS. There has been a statement made, and I know there is a specific case in Texas which was investigated, and I saw the Congressional Record on it, that there is no one in our society who is not getting adequate medical care, or could not get it if the situation were called to the attention of the proper people. I was trying to reconcile that with these statistics, because if there were a medical need not now being met-I do not care how small the group is even though it is only this 812 percent-I am concerned, in fact so concerned that I would inquire as to what was the situation. Was that because some of them, as you already pointed out, say that the recipients refuse to accept the care? Would the balance then be those who for some administrative reasons the people did not know their situation, or what was that?

Dr. RENGER. There were various factors. Religion would be one factor which would enter the picture. Another factor would be the geographical location. They might be way out on a ranch and not available to them. You know Texas is quite broad in areas there and sparsely settled. The different points of that nature would hinder them getting the assistance. Then, some of them will definitely refuse, as the Texas Research League has brought out. Ninety-six cases were offered the service, but they absolutely refused of their own ac

cord. The case in question that you mentioned-the one which was placed in the Congressional Record-involved a woman who waited 9 days before she ever asked a doctor to see her. She got service within 30 minutes after she phoned.

Dr. DAVIS. One point that should be brought up here is the geography is very important here. Out of all of our counties, 31 counties do not provide any health care for indigent or needy people at county expense. These are largely rural counties and a rather large number of people who were included in this survey as having a so-called respondable need live in these counties. It is not that it is not available to them, it is just that it is not available to them locally where they live.

Mr. CURTIS. That would be true of anyone regardless of age group who lives in that particular area.

Dr. DAVIS. Yes, sir. That is the sharp distinction. It does not look quite so sharp.

Mr. CURTIS. I have heard it is not a problem of age groups.

The CHAIRMAN. Dr. Johnson, if you will identify yourself for the record by giving us your name, address, and capacity in which you appear, we would appreciate it.

STATEMENT OF EMMETT R. JOHNSON, D.D.S., PRESIDENT, TEXAS DENTAL ASSOCIATION

Dr. JOHNSON. I am Emmett R. Johnson. I reside in Dallas, Tex., and I am engaged in the private practice of general dentistry. I appear before you today as president of the Texas Dental Association. The Texas Dental Association has a membership of 2,959 doctors of dentistry and 707 students in the two dental schools of Texas. Our association is a professional and scientific organization with the main objective of providing the best of dental care to the people of Texas.

The Texas Dental Association vigorously opposes H.R. 4222. While the bill does not provide for dental fees or extended dental treatment at Government expense, the bill does provide for extended health services and adheres to the basic framework of both the Forand bill and a measure introduced by President Kennedy last year while he was a Senator.

The Texas Dental Association is opposed in principle to the provisions of health care benefits by the Federal Government to any segment of the general population without regard to need.

At the last annual session of the Texas Dental Association held in Houston, Tex., April 30, 1961, the following resolution was adopted without a dissenting vote:

Resolved, That the Texas Dental Association express deep concern over the socialistic trends toward legislation favoring steps in the direction of socialized health services; be it further

Resolved, That the Texas Dental Association opposes the financing of medical service to the aged through social security taxes or any other Federal taxation believing that the people of America will, in the future as they have in the past. care for the aged through local and State philanthropic or charitable organizations in those instances where the aged have not made preparation to care for themselves; and be it further

Resolved, That emphasis be placed on the principle that individuals be encouraged to provide for their own welfare rather than look to the Federal Government for solving their financial problems.

As a major branch of the health services, the Texas Dental Association is deeply concerned about the health and welfare of our aged citizens and it is our firm belief that the vast majority of this segment of the population is receiving adequate care through their own initiative.

We believe that every citizen should provide for his own future health needs through the means now available in private channels such as health insurance, personal savings, and so forth. When, through adversity, the individual cannot care for himself, the responsibility should be passed to his family, the community of which he is a part and only to the State when no other means exists for his care. Traditionally, the physician and the dentist have provide health services for our unfortunate citizens who, through no fault of their own, cannot purchase these services. It seems unlikely that the physician or dentist would call upon the Federal Government to take over a service that has been so fully given without legislation.

The members of the dental profesion have, with pride and satisfaction, made their services available to the aged, the indigent, the needy, and the unfortunate without regard to fee in those instances where real need exists. In the same manner, the citizens of practically every community in Texas have through their own philanthropy cared for the health needs of their needy citizens.

In summary, we vigorously oppose H.R. 4222. We believe that H.R. 4222 is in reality a program of socialized medicine for the aged and Texas dentistry opposes with all the vigor at its command any steps to socialize any part of the health professions. We believe in the American tradition of free enterprise and we support the philosophy that private philanthropy will in the future, as it has so fully done in the past, care for our own needy without Government intervention. It is my sincere wish that the Congress will not lead us toward socialization but continue to encourage the people to solve their own problems through individual effort. We trust that Congress will think of reducing the burden of taxation rather than a continual increase of this burden.

Thank you very much.

The CHAIRMAN. Thank you, Dr. Johnson, for bringing to the committee the views of the Texas Dental Association. Are there any questions of Dr. Johnson?

Mr. ALGER. Mr. Chairman, might I belatedly-I was shuffling papers when the doctor came to the stand. I am so pleased to have you here, Dr. Johnson, and I think I can safely say that the view you have expressed is not only the view of the dentists whom you represent, but I think it pretty well represents the viewpoint of the majority of people that you and I live among down in the county of Dallas. I can safely say a large majority believe that we should take care of ourselves without Uncle Sam's help in this field, and I want to commend you for a fine statement.

The CHAIRMAN. Thank you very much.

Doctor Rosenbaum and Doctor Parrott.

Mr. ULLMAN. I would like to introduce to the committee two outstanding gentlemen from the State of Oregon, Dr. Edward E. Rosenbaum, chairman of the State Medical Society's Committee on Aging,. a member of the Oregon Council on Aging. With him is Dr. Max H. Parrott who is the president of the Oregon State Medical Association..