human problem. We think this is putting pragmatic idealism to a practical test.

Mr. Chairman, I believe that this new proposal is sound, sensible, and workable. I believe that when it is on the statute books and when we get 10 years of experience with it, the doctors, who were against social security in the early days-the people who said social security was the first step toward socialism, will be convinced again. by history and time. Again it will prove that the unique genius of America, lies in the community doing what cannot done by the individual, and the individual in association with other people in voluntary groups supplementing the governmental program. This is what the King bill approach makes possible.

Mr. Chairman, I urge your committee to give this proposal speedy and favorable action so that America can not only meet the great challenge in the world, but so that we can demonstrate that, within the framework of our free society, we can find answers to pressing human problems without sacrificing our political or spiritual freedom. Thank you.

(Mr. Reuther's prepared statement follows.)

STATEMENT OF WALTER P. REUTHER, PRESIDENT, UNITED AUTOMOBILE, AIRCRAFT, AND AGRICULTURAL IMPLEMENT WORKERS OF AMERICA (UAW), AND OF THE INDUSTRIAL UNION DEPARTMENT, AMERICAN FEDERATION OF LABOR AND CONGRESS OF INDUSTRIAL ORGANIZATIONS (AFL-CIO), IN SUPPORT OF H.R. 4222

The moral health of every civilization can be read in what it does for those who have contributed to society throughout their lives and now must depend on that society for sustenance and health in their remaining years. This is a vital test for our civilization. It is a test that America would normally pass with flying colors. We have the humanity. We have the resources. We have the will. And, having enacted a basic contributory social insurance system which is approaching universal coverage, we have the machinery to serve the health as well as the economic needs of those who have played their part in this country's development.

America's older people need a reliable and effective instrument for financing health care. This ranks foremost among their unmet needs. I believe that most Americans today are aware that something must be done. President Kennedy, in his message to Congress on health and hospital care, proposed a program of prepayment of health costs for aged beneficiaries of the social security system which would enhance the ability to pay for and obtain essential health services, which would guarantee absolutely freedom of choice of hospital and physician under a sound program "entirely in accordance with the traditional American system of placing responsibility on the employee and employer rather than on the general taxpayers, to help finance retirement and health costs." Prominent congressional leaders have advanced legislation to provide for better financing of health care for the aged along these lines. The Governors of most States have endorsed such legislation. It has been supported by such respected journals as the New York Times, Business Week, the Washington Post, and others.

Editorial support

On May 10 of last year the New York Times, after considering alternative proposals, said: "We believe that the arguments for using social security are overwhelming." Again this year, the New York Times remarked editorially:

* the President has wisely proposed a health insurance program administered by the social security system and financed by an increase of one-quarter of 1 percent each in the contributions of employers and employees * * "Such a program could be put into effect nationally at one and the same time and by an organization already trained and fitted for the task. It would put all States and beneficiaries on an equal basis. It would avoid any further use of the hated 'means test.' And none of it would be financed from general tax Much of its cost would, in fact, be covered by those who would stand to benefit directly from it.

revenue.

"Another great advantage of this setup would be its avoidance of anything that could honestly be called 'socialized medicine.' Every beneficiary would be free to choose his own doctor and hospital. And there would be no Government supervision or control of the practice of medicine or of the services of any hospital."

Business Week, in an editorial dated February 18, said:

"The essential question, therefore, is whether the social security system is the best way of meeting costs that cannot be avoided, in any case. We see no better alternative to social security for doing the essential job: spreading the burdens of old age over the years when people are younger, are working, and have more adequate incomes."

The White House Conference on Aging, in January, said "that the social security mechanism should be the basic means of financing health care for the aged."

Most Americans support this bill

The majority of the American people favor such legislation. The Gallup poll, in a recent roundup of public opinion, inquired: "Would you favor or oppose having the social security tax increased in order to pay for old age medical insurance?" This poses the issue in its most forbidding form, stressing the tax burden rather than the benefit advantage of such a program. Nevertheless, 67 percent said they would favor such a tax increase, 26 percent said they would not, and 7 percent were undecided. While 69 percent of those 50 years and over favor such legislation, even at ages 21 to 29 as many as 63 percent favor it. Not only are aging people themselves anxious to see something done, but younger adults expressed themselves in favor of such legislation.

Powerful forces, however, are at work to thwart the clearly expressed will of the people. The American Medical Association, the insurance industry, and some organizations of business and industry, such as the chamber of commerce, have joined in a coldly calculated, well-heeled drive to dissuade Congress from meeting this most pressing need.

A cynical conspiracy of opposition

For complete cynicism and outright dishonesty, it would be hard to match the AMA's current public relations campaign against the President's proposals for health insurance for the aged under social security. Medical World News, a magazine edited by Dr. Morris Fishbein, in its April 14, 1961, issue, has revealed some of the details of:

"*** a secret strategy conference in Chicago, where AMA officials and State society leaders from across the country met to plan their campaign against the Kennedy aged health program."

"Strictest security precautions," the report goes on to say, "were taken to exclude outsiders. Special police guarded all the entrances to the meeting, admitting only delegates with special identity cards."

At this 2-day secret conclave it was agreed to continue the deliberate mislabelling of the President's plan as "socialized medicine."

Medical World News says:

"In discussing the campaign theme, there was general agreement on the usefulness of the 'socialized medicine' slogan because widespread public opposition to this had been built up over the years. It was felt that the specific issues in the aged health care argument were more difficult to explain."

Not socialized medicine

Here is evidence of the AMA's deliberate distoration and dishonest sloganizing of a program they know is not "socialized medicine." I think that every Member of Congress should realize that the AMA knows full well that what President Kennedy has proposed is not "socialized medicine." I think that every aged person and every son and daughter worried about the cost of mother and dad's hospital bill knows this. I think that every American should know that in this campaign the medical profession is engaged in the worst kind of hucksterism in America today.

Attack on labor

The strategy adopted was to make labor the target of its campaign.
In the words of Medical World News:

"The plan also calls for avoiding direct attacks on President Kennedy, who is the chief proponent for the social security approach to Federal aid. The feeling is that he still is too popular, and that the principal opponent should continue to be organized labor."

Labor is not the only target of attack. The June 1961 issue of the American Journal of Nursing editorializes:

"We're not a little perturbed by a statement in one of the recent medical journals reporting on a special meeting of American Medical Association officials and State leaders: 'One decision was to work on the grassroots level to get local nursing groups to repudiate the American Nurses' Association endorsement of the social security approach to aged care coverage.' * * *.

"*** One has the uneasy feeling that doctors do not recognize that they themselves through planning tactics of this kind are actually mixing up politics and medicine in their very efforts to fend it off. For in a sense they are taking advantage of the professional working relationships between doctors and nurses-in which doctors certainly have a higher degree of authority on medical questions to try to sell a point of view on a political issue, not a medical one." According to the New York Times of July 29, the American Nurses' Association has since testified before the committee of the pressures placed on nurses to withdraw their support, although the association took its stand in 1958 and overwhelmingly confirmed it at its 1960 convention. The Times quotes the nurses' spokesman: "However, evidence to date indicates that nurses believe firmly in the position taken by their professional association."

This is the brand of politics engaged in by the organization that has so widely publicized Sir Luke Fildes' picture of the doctor attending a sick child with the admonition: "Keep Politics Out of This Picture."

Hyperthyroid public relations

In the words of an editorial in the San Francisco Chronicle, dated April 23: "The American Medical Association is in the recurrent throes of a typically hyperthyroid public relations campaign, and, on the basis of ample clinical experience, we would say that the prognosis is bad.

At the very outset of its current seizure, the AMA has aroused public suspicion of the good faith of the 180,000 phyisician-members it repersents and who pay for its inept and expensive essay in persuasion. This it has done by grossly misrepresenting the purpose and plain provisions of the health plan for the aged put forward by President Kennedy. Among notable distortions of the facts, we cite these breathless warnings from the AMA:

***When the Federal Government enters the privacy of the examination room-controlling both standards of practice and choice of practitioner—the cost includes loss of freedom: your doctor's freedom to treat you in an individual way; your freedom to choose your own doctor *** It would lower the quality of health care, with remote and impersonal bureaucratic control replacing the confidence and closeness of the doctor-patient relationship * * *."

"We have studied the plan and find nothing in it, explicity or implicitly, which puts Uncle Sam in the examination room or elsewhere in the field of diagnosis or treatment. We find nothing that restricts any patient's choice of physician or any physician's choice of treatment. The plan is not in the least concerned with doctor-patient relationship, except in the area of paying the bill. It provides the required funds as part of the social security system. Why the AMA regards payment from this source as abhorrent, we cannot discover.

"Again we suggest that the kind of extravagant campaigning now under way achieves little more than to impair the dignity and repute of a great and honored profession."

The least that we could expect from the medical profession, however much it may fear President Kennedy's proposal, is that it will conduct itself accurately and responsibly before the public. I am afraid that by departing from this minimum standard of conduct, the AMA will do serious damage to the profession it represents.

Dissenting doctors

It should be clear that, in spite of all of the pressure tactics of organized medicine, a good number of physicians do not go along. I have received numerous letters from doctors disassociating themselves from the American Medical Association line. Here is an excerpt from one of them:

"I am only one of many thousands of physicians who believe that medical care for our senior citizens should be through social security. In this way they will get needed medical care as a matter of right and with a sense of dignity. It is difficult for me to understand the opposition of the AMA."

Pressure on doctors

Many doctors feel under great pressure to conform to the AMA line. As one physician wrote me after a recent television debate on health care for the aged: "It is no exaggeration *** to state that we would virtually lose our referral practices if we publicly took a stand such as this. However, if a showdown ever comes, the AMA would not have a unanimous support."

Another wrote:

"I am aware of the consequences to me and my family should these sentiments be public, but I had to write to salve a guilty conscience brought on by planning to pay my dues that I might continue to practice."

As my testimony proceeds I will examine the issues that are being raised in opposition to the President's proposal. I intend to show that just as the term "socialized medicine" is dishonest and fraudulent, so too are the allegations that such legislation would impair the freedom of the American people, would restrict the practice of medicine, or would constitute a step toward socialism. These scare words and slogans serve mainly to obscure the problems we must solve. Need will not disappear

We Americans are increasingly concerned with the financing of health care for the aged because it is a real issue and no amount of public relations effort will make it disappear. We as a people have to square our accounts with the aged and with those younger people who are concerned about what will happen to their parents now. Most of all it is an issue which we must examine in the light of our national conscience, our faith in the rectitude and the responsibility of our laws and our social institutions.

What is really at issue is the simple and inescapable fact that older people have augmented health care needs, and no amount of public relations will talk this out of existence. The aged have twice as many chronic conditions, spend almost 21⁄2 times as many days restricted to their beds, are limited in their activities by chronic conditions six times as often, visit physicians appreciably more, and spend two to three times as many days in the hospital as people of the younger ages. They have to pay for greater quantities of health care when such services are rapidly increasing in cost.

Less able to pay

The undeniable fact is that older people are less able to pay for the additional health care that they need and no slick public relations campaign will change this. As the Department of Health, Education, and Welfare has shown, acknowledging the difficulties in pinpointing the exact income of the aged:

"***No matter what study is cited or how it treats income, it is likely to show that at least one-half of all persons 65 and over have less than $1,000 income for a year."

While some have claimed that personal income is not a valid measure, the fact is that in no income group in adult life is the average per capita income as little as among people 65 and over.

Majority uninsured

The fact is that the majority of older people do not have any health insurance whatsoever, and no public relations campaign will give the older people the health insurance they need. We have seen a lot of slippery statistics attempting to inflate the availability of health insurance among the aged, but the only an thoritative studies show that somewhat less than one-half are insured. The fact is that much of the health insurance that older people do have is grossly inadequate typically providing far less protection than the insurance available to the unretired.

Aged don't want charity

The fact is that inadequate financing is standing in the way of health care for older people. The resources of the patient often must be taken into consideration when the doctor decides what the treatment for an illness shall be. The probability is that a great many millions of older people do not get medical care because they do not have the money to pay for it and they don't want to ask for charity, from doctors or from public or private welfare agencies.

These problems will be with us until we solve them. I submit that the prudent and humane course is for Congress to act now.

Chronic opposition

Such action has been opposed by some of the organizations who have testified here. When have they ever favored improvement in social security? Congress has not followed their advice in a whole series of enactments by which the basic system has been improved in response to the need to meet their pressing human problems. It is a sad but certain fact that positive proposals almost never come from those who are now opposing the President's plan. Among the chronic opponents of social security improvement is the chamber of commerce and some other employer groups who resist expenditures for the general welfare, no matter for what purpose and no matter how great the need. Then we have the insurance industry which is interested not so much in the development of adequate programs as in preserving what it believes would be its share of the market. Finally, the AMA and other medical organizations who are so consumed by fear of the social security system that their discussions in relation to it are irrational.

Do nothing

For a long period of years, the only answer that these opponents offered to a pressing social problem has been to do nothing. For a long time they denied the existence of a problem.

Inadequate alterations

The next step in the succession of opposition was to assert that voluntary plans could do the whole job. Again the hard fact is that until such legislation as the Forand bill began to be seriously advanced, the voluntary plans did not even try to cover the aged and they cannot by themselves solve this problem even now. The sale of special policies hurriedly devised in the last few years has been nearly futile. In the absence of reliable statistics on their performance, the insurance industry has advanced, and the medical profession parroted, unwarranted optimistic projections of how well the aged would be covered. With great fanfare, many insurers have been announcing open enrollment for 65-plus subscribers. While some of these policies have eliminated the more notorious evils of past insurance practice, they still have a very modest range of benefits. They still have tricky loopholes which disqualify for preexisting conditions and most individual health insurance for the aged still has such boobytraps as cancellation and nonrenewable clauses.

No minimum standards

There are no minimum standards for health insurance. Many of the policies being offered aged people are especially ill suited to meet the needs of their subscribers. The fatal weakness of these attempts to squeeze blood from a turnip is that they still place the entire burden of an extra heavy health risk on the aged themselves, who have the least ability to pay for it. The unassailable fact is that health insurance for older people is very expensive and they do not have the money to pay for it. This cost must be spread over the whole population.

A MAJOR DOMESTIC ISSUE

The failure of private agencies to deal seriously with the health needs of the aged has resulted in a series of constructive legislative proposals. From an obscure issue, health care for the aged has become a matter of central concern on the domestic scene. By the 1960 elections, it had become a subject on which no candidate could remain silent. Then Senator Kennedy made it a major issue in his campaign. Vice President Nixon acknowledged the need for further legislation to provide some form of health insurance by associating himself with the plan introduced by Senator Javits and some of his Republican colleagues. Thus far, legislative activity has gone no further than to extend public assistance benefits to certain of the medically indigent. This does not replace the need for the basic social insurance approach to financing.

What it can and cannot do

THE KERR-MILLS LAW

We have to consider the Kerr-Mills law in terms of what it itself can ac complish, the problems it can meet, and its limitation. We must also evaluate the contention of some that the Kerr-Mills bill is the answer to the basic