They are distinguished physicians from my home State. The CHAIRMAN. Thank you for the very fine introduction of these witnesses. We are pleased to have you with us today. STATEMENT OF DR. EDWARD E. ROSENBAUM, CHAIRMAN, COMMITTEE ON AGING, OREGON STATE MEDICAL SOCIETY; ACCOMPANIED BY DR. MAX H. PARROTT, PRESIDENT, OREGON STATE MEDICAL SOCIETY Dr. ROSENBAUM. Thank you, Mr. Chairman. I am Dr. Edward E. Rosenbaum, representing the Oregon State Medical Society. I am a physician in private practice in Portland, Oreg., and am chairman of the State medical society's committee on aging. In the State of Oregon we have a council on aging appointed by the Governor and I have been a member of that council and on its executive committee. from its inception. With me is Dr. Max H. Parrott. Dr. Parrott is in private practice as an obstetrician-gynecologist in Portland, Oreg., and is President of the Oregon State Medical Society. We appear here in opposition to H.R. 4222. The Oregon State Medical Society was founded in 1874. From its very inception the society was founded on the principle that the welfare of the patient is paramount and is above all other considerations. In its very beginning the society fought for a strong department of health in the State of Oregon. The society consistently supported such bills before the Oregon State Legislature and finally succeeded in 1903. Since that time members of the State medical society have served on the State board of health without pay. To assure quality of medical care, the society has supported strong medical practice acts and to assure quantity, the society operates a physicians' placement service. The State medical society played an active part in the founding of the University of Oregon Medical School located in Portland. Its original professors and leaders were all members of the State medical society and at the present time 500 members of the society serve the University of Oregon Medical School teaching and taking care of indigent patients. These members receive no monetary compensation. In recent years the society, with the American Medical Association, has supported Federal legislation which resulted in the passage of the Kerr-Mills bill and successfully worked with the State legislature so that the Kerr-Mills bill was implemented in the State of Oregon and becomes effective November 1, 1961. I bring these facts up simply to point out that the ethics of the American physician has always been that the welfare of the patient and his country is above all other considerations. We appear here today in opposition to this bill because we sincerely believe that the passage of it would be detrimental to our patients and ultimately to our country. At the present time there are approximately 185,000 persons in the State of Oregon over 65 years of age. It is our opinion that the medical needs of these people can be met through currently existing mechanisms or by extension of these facilities. Eighteen thousand of these people are receiving old-age assistance medical care. This is the most needy group. Their medical care is being handled by the State public welfare commission. These people are not on social security and in no way would be helped by the passage of H.R. 4222. The group just above this in the economic scale of so-called medically indigent can be helped and taken care of by the Kerr-Mills bill as it has been passed in our State. In our State those with an income of less than $1,500 a year, single, or $2,000 per year if married, will be eligible for medical assistance under the Kerr-Mills bill. Through the instigation of the Oregon State Medical Society, the Oregon Physicians' Service has just made available to our senior population a senior citizens' surgical-hospital plan. This is a lowcost plan, premiums on which amount to approximately $9 per month for a married couple. It will provide hospital and surgical benefits for our senior citizens and unlike most health insurance plans for the aged this plan is offered on a continuous open enrollment basis. At the present time no reliable statistics exist as to the number of persons actually in need of economic medical assistance. As a matter of fact to the best of our knowledge, there is no case in Oregon where an individual has been denied medical service because of inability to pay. At the moment it is brought to our attention that such cases exist within the State, the Oregon State Medical Society is equipped and ready to provide such individuals with immediate medical care of the highest quality. The State council on aging, whose members represent a cross section of thinking in our State, after reviewing many of the only available statistics, has recently concluded that these statistics usually represent the bias or subconscious emotional thinking of the gathering agency. This inconclusiveness suggests that extensive impartial surveys must be done lest we act unwisely in emotional haste. The Multnomah County Medical Society, the county where Portland is located and where we have the greatest concentration of population, is sponsoring a continuing survey to determine how many people over 65 in the county are actually in need of economic assistance for their health care. This survey has been publicized through television, radio, and the newspapers. It is being conducted by city and county public health nurses who have been asked to report the complete circumstances of any case where any person says he cannot get health care, for any reason whatsoever. Of 1,986 home visits made initially by these nurses and cataloged to date, only 11 persons (including 3 over 65 years of age) said they were "unable" to get health care. In no case, however, was the fault an economic one that could not be corrected locally; and in no case would H.R. 4222 have been the answer to the problem. For the information of this committee, a statistical report of the results of the initial study period is attached to this statement. We believe the State of Oregon during the past year has developed a mechanism for providing medical care for our senior citizens. This can be done through the traditional method of physicians donating time, through the welfare commission, through the Kerr-Mills bill, and through private insurance plans. These plans are flexible and can be expanded if the need is greater than it appears to be at the present time. We believe that it would be unwise to pass new Federal legislation until our present methods have been given a fair and thorough chance to prove what can be or need be done. We oppose H.R. 4222 because we feel there is no need for it at the present time in the State of Oregon. We believe that it is a plan which will lead ultimately to Federal control of medicine. This com mittee is well acquainted with the fact that social security cash benefits are constantly being enlarged and expanded. The committee is also well aware that the previous bills of this nature introduced in Congress and discarded by this committee-have all included physician care and physician control in greater or lesser degree. The sponsors of H.R. 4222 imply that physicians' services are not now included, although in contraindication the bill itself does specifically state that four of the medical specialties are included. We who have followed this type of legislation in the past know that ultimately all physicians would be included, since it would be imprudent and impossible for the Government to pay for medical care without developing controls on hospitals, nursing homes, and ultimately the practice of medicine. We know historically that socialized medicine in Great Britain was started in a very similar way. Our opposition to H.R. 4222 is based on the maxim that Oregon is better able to provide proper health care to all its citizens through exisitng voluntary health insurance plans, statewide Kerr-Mills implementation, and continuing community efforts. We believe that these programs for meeting the health care costs of our aged citizens should be allowed to develop to their fullest capacity. We are convinced that it would be unwise, premature, and unreasonably expensive to duplicate or replace our present plans and programs by the enactment of H.R. 4222. Thank you. Mr. ALGER. Mr. Chairman, may I ask unanimous consent to have inserted in the record at this point a statement entitled "Indigent Medical Care Needs of Texas Public Assistance Recipients," which is data resulting from an 18-month intensive analysis of medical needs of 319,000 Texas public assistance recipients. The CHAIRMAN. Without objection, the statement will be inserted in the record at this point. (The statement referred to is on p. 855.) 76123 0-61-pt. 3-18 The CHAIRMAN. Thank you, Dr. Rosenbaum, for bringing to us the views of the Oregon State Medical Society. We appreciate your bringing along the president of the society. Mr. Curtis. Mr. CURTIS. I cannot fail to express my deep appreciation to you and the people in Oregon and the committee engaging you for having conducted this kind of survey. I just wish that you people had done this before in other areas. It still needs to be done in other areas just to be sure of this. In a minor way I have tried to do the same thing as an individual Congressman. When people were claiming there were a lot of people in my area who were unable to get medical aid, I, as best I could, publicized it and said "Write to me on a confidential basis, I will follow through on any case," because I wanted to find out what was going wrong, or was there a gap here, Doctor, I have gotten only one reply out of some 400 people who originally wrote to me, including my labor leaders in the city saying they knew of someone. Only one person took the trouble to reply to give me a case I could go to work on. I have gone to work on a number of cases and each time I have found out that there were district facilities, there were misunderstandings sometimes, there were a couple of instances where there were administrative errors, but in all instances it was something that our present setup could take care of and I want to add one other thing. This isn't to say, and I am sure your testimony isn't saying it, that we haven't got a lot to do to continue to improve our health care and our quality and so forth, and we want to get on with that too. Dr. ROSENBAUM. Thank you. Mr. CURTIS. Thank you very much. Mr. KING (presiding). Mr. Ullman. Mr. ULLMAN. I again want to express my appreciation to my physician friend from Portland and would appreciate it if you would send a copy of your new insurance policy, the OPS. Would you make that available to the committee just for the files so we could have it here in case we want to refer to it? Dr. ROSENBAUM. We would be delighted to make a policy available to the committee and the reports of our continuing study. Mr. KING. That would be helpful. Mr. ULLMAN. That would would be helpful to the committee; yes. Thank you. Mr. KING. We appreciate your offer to do that. We appreciate your testimony. Mr. CURTIS. May I ask one other question? Did the Department of Health, Education, and Welfare express any interest in what you are doing? Do they know about it or have they shown any concern? Dr. ROSENBAUM. Well, I don't know if they have expressed any interest. I really can't say if they know about it or not, but I think you have a good point and we will so inform them. Mr. CURTIS. Yes; I wish you would. This is for the record, too, and they will read the record. I have just wondered why there hasn't been more concern in the Department of Health, Education, and Welfare as to what is being done in local communities and local States. When the Connecticut plan just recently went in for health insurance for the aged I did contact the Department and asked if they were going to make any comments or whether they had been following it, and it was a negative there, too. I hope you will send it to them, and I hope they develop the kind of procedures in the Department so they collect this data from all over the country and in that way become a clearinghouse so that you could get the benefit of other studies. We had a very interesting study prepared in the State of Delaware along these lines with some extremely interesting results. Mr. KING. Are there any further questions? If not, Dr. Rosenbaum, I just have one. The committee is pleased with your statement that every effort is being made in Oregon to avoid the possibility of any one going without medical care, but in the event you find persons who, for whatever reason, have not had medical care, do not such persons, no matter who reports them or where they are reported to, finally end up on the public assistance medical program? Dr. ROSENBAUM. Congressman, as I understand your question it is, Does every person who does not receive medical care end up in the public assistance program? Mr. KING. Yes. Dr. ROSENBAUM. Not necessarily. Some of them might. Some people do not receive medical care simply because they are afraid of going to the doctor. Some people do not because they do not have transportation. Two of the cases we uncovered did not want medical care because of their religious beliefs. Two youngsters, and this was the saddest thing and shows this couldn't be handled by the King bill, who were not being taken care of weren't being taken care of because their father refused to leave work during the day and drive. them to the doctor and the mother did not want to spend the money for the taxi. This of course could not be directed by any legislation. This is a social problem. Mr. KING. But generally those unable to pay who have become chronically ill, when they are reported are cared for, of course; but in most cases that type would end up on the public assistance rolls? Dr. ROSENBAUM. I think some of these people would end up on the public assistance rolls. I think in the future some of them will end up under the Kerr-Mills bill. Those that I encounter personally in my practice I seldom put on public assistance. I donate my own services and the hospital that I am affiliated with happens to have a private resource fund, an endowment. I frequently use that. The other hospital I am affiliated with has a teaching bed. I frequently call up an intern and say "We have a good case." We cannot handle them all and some of them end up on public assistance of course. Mr. KING. The only reason I ask the question is that I understood that quite well, Doctor, but I feel that repeatedly through our testi |