AUGUST 8, 1961. OTTO K. ENGELKE, M.D., President-elect, Michigan State Medical Society, Washtenaw County Health Department, Ann Arbor, Mich. DEAR DOCTOR ENGELKE: In accordance with our phone conversation this morning I am, as you requested, putting in writing my questions on the statement of the Michigan State Medical Society before the Ways and Means Committee last week. As I indicated to you this morning, we have been asked to evaluate the statement of the Michigan State Medical Society and would like to identify the sources of several statements in your presentation. In your statement you indicated: "Initial experience has demonstrated that nine-tenths of our over-65 citizens either do not require medical service or they are in a substantial financial position and can meet medical service costs through a private contract, or through the legal obligation of some other government agency." Since we have seem no statistical evaluations which would justify such a conclusion, could you please identify the source for this statement. If there is no published course, or, if this is an estimate, could you please indicate who made the estimate and the basis for the estimate. Similarly, your statement said: "For example, over 50 percent of the families over age 65 have some form of health insurance, and this percentage is increasing rapidly." Again we would like to have identified the source of this estimate since it ap pears to be at substantial variance with published data as is available on the extent of insurance among Michigan's over-65 population. We would very much appreciate your providing us the documentation for these assertions before the House Ways and Means Committee. Sincerely yours, MARTIN A. COHEN, Program Consultant, Social Security Department, UAW. Mr. DAN KUSHNER, AUGUST 9, 1961. Executive Editor, New Medical Materia, New York, N.Y. DEAR MR. KUSHNER: As you will recall from our recent telephone conversation, I am interested in learning more about the survey showing that U.S. physicians provided in excess of $650 million of free services in 1960, as reported in the May 1961 issue of New Medical Materia. The amount of free care furnished by physicians has a rather direct impact on the question of medical care for the aged now under study by the House Ways and Means Committee. Since opponents of the Anderson-King bill have advanced the figure of $657 million of free care to minimize the need for the bill, it is a matter of some importance to be able to evaluate your survey from a technical and methodological standpoint. Because the text of the May article states only that the findings are based on a large nationwide sample, it would be most helpful if you could furnish us with the following additional information with respect to the survey: (1) Please explain how the survey was conducted, whether by personal interviews, by mail, or otherwise. (2) For each State, how many physicians were included in the sample? What percentage of the total number of practicing physicians does this represent? (3) Please explain the method by which the sample was selected. (4) Of these physicians in the sample from whom information was requested how many replied? (5) What was the largest number of interviews or replies received from physicians in any of the State samples? What was the smallest number? What percentage of the respective State's practicing physicians do these figures represent? (6) Please explain the method used to derive a dollar value for the free services provided by the individual physicians included in the survey. (7) What were the questions the respondents were asked to answer? (8) For each of the States and the District of Columbia and for the accumulative totals, please furnish the frequency distributions of the dollars of free medical care provided plotted against the number of doctors providing the care. I hope you will be able to provide us with this information at an early date. Very truly yours, JACOB HURWITZ, Consultant, Social Security Department. Mr. KING. The committee will recess for approximately 10 minutes. Mr. ALGER. Mr. Reuther, I disagree with so much that you say yet I am going to try to be temperate, and I want you to help me. Mr. REUTHER. I will be glad to cooperate. Mr. ALGER. Inasmuch as we met before on this forum, and I think both of us are going to be around for a while yet, I want to learn to understand your thinking better. I would like to start out, rather than taking the time which I cannot begin to take to ask all of the questions I had in mind, to say that I have read at least twice all of your statements and I have listened as attentively as possible to your oral testimony. I have a page on everything I want to ask you about, but rather than doing that by questions at this time, I want to start out by reading a dozen or so allusions that you made to the American Medical Association. While I have no brief for them or for any man, as a member of this committee, I think you were unfair, and let me tell you why I think so. These are the phrases you used, and I will give you the exact quotes. First, you said, "The doctors and insurance companies should stop ganging up on America's aged people." Second, "Thwart the clearly expressed will of the people"; "deliberate distortion"; "AMA puts pressure on"; "AMA support of the Kerr-Mills bill because it won't work"; "complete cynicism"; "outright dishonesty"; "deliberate mislabeling"; "distortions of the fact"; "dishonesty"; "fraudulent"; "slippery statistics and fear of social security"; "irrational." Those are some of the things you said about them; and, so far as their testimony goes, I have been rather impressed by the fairness of their remarks, and I have a feeling that what you said about propaganda campaigns and the attacks made on you and Mr. Meany actually could be a smokescreen to cover up the fact that you are pretty well giving it to these fellows. Do you care to comment any further? Do you not think you have been a little unfair in your zeal to present your side? Mr. REUTHER. The sharpest criticism I made in my testimony with respect to the American Medical Association was essentially to quote what Dr. Fishbein Mr. ALGER. Who is Dr. Fishbein? Mr. REUTHER. He now publishes a periodical called Medical World News. I do not know what his official position was, but he was one of the top persons in the American Medical Association. I think he was the editor of their Journal. He was certainly their recognized spokesman and, therefore, I say here that I merely quote what he says. Mr. ALGER. When did you take his quotations? Mr. REUTHER. April 14, 1961-very recently. Mr. ALGER. Do you realize that you are rather vulnerable when you say you do not know what his role is. Let me tell you, and I am a recent student of this. He has not been with the AMA since 1948. The statements you make are quoting a man 15 years after he was removed from his so-called position as spokesman, and I understand that the views that he expressed back then, while he had the right to, did not reflect the American Medical Association and, as a result, that was the reason for his being divorced from that association. Mr. REUTHER. I think you are misinformed. He has a very close, sympathetic, working relationship with the American Medical Association. The editorial policy of Medical World News reflects their point of view. Mr. ALGER. I must categorically say that is not my understanding If I am wrong and, as you say, misinformed, the record will stand as you and I said it, and we can thrash it out another time, but Dr. Fishbein is not an authority on the AMA. I am contesting your using him as a spokesman of their position or stating that he is sympathetic. I want to categorically say that I do not think this is true, and I will stand corrected if I am wrong. Mr. REUTHER. I am quoting him not as their spokesman but as a person who has contact with people in the American Medical Association and who is a reliable reporter. He reported on what they did at this conference. He says it was a secret strategy conference in Chicago; that they had policemen there these are his words "to see that no one got in, and at that strategy conference we decided not to attack the President because he was too popular but to attack labor; not to discuss the merits by sloganizing the thing but by using the socialized medicine threats." This is what he reports. What happened after that meeting Mr. ALGER. But it Mr. REUTHER. Let me complete my statement, please. They followed through and did precisely what Dr. Fishbein said they would do. They raised the socialized medicine scare in publications, and they began to attack the labor movement and tried to make us the culprits. This is precisely what you have done. Mr. ALGER. You are repeating what you have already said. I know what you have said and I have been here listening to it. You are making another mistake by changing the subject. I quoted to you Walter Reuther's language, not Dr. Fishbein's langauge. You say the toughest criticism comes from him. I have quoted Mr. Reuther's language about the American Medical Association, and I simply said to you, sir, and I could be wrong, and I said you are unfair and you switch it over to Dr. Fishbein. Mr. REUTHER. Do you think I am unfair as an American when I see the publications of the American Medical Association in which my name and Mr. Meany's name is mentioned time after time after time after time-when we are made the culprits. In trying to get medical care financing for the aged through social security we are considered "welfare staters driving for socialism." It is really a question of standards, of what is proper and improper. We are victimized. Mr. ALGER. You are entitled to your opinion-you and Mr. Meany who are the acknowledged spokesmen for almost all of the people whom you represent and you have been the only two here to testify this way yet as labor leaders. Yet, we have had a great parade of different doctors, sometimes the same doctors appearing but generally a great wealth of different doctors, but they have all been espousing the same view. I do not share Mr. Curtis' view, which I think was a temperate one that you undoubtedly represent all of the views. I do not recall the exact wording. Mr. CURTIS. I said the overwhelming majority of the membership of the UAW. Mr. ALGER. That may be true, but I do not think because you represent an overwhelming majority that you represent all of them even as we have doctors who disagree with the American Medical Association. Mr. REUTHER. I do not represent every single wage earner for whom I bargain on this isue. I do think I speak for 99 percent of them. Mr. ALGER. That is the point. You are their spokesman. There is nobody in this country who takes a priority over you and Mr. Meany and Mr. Hoffa as spokesman, so why do you seem surprised that somebody wants to criticize you by name. They are not going to criticize somebody else in the labor movement, a shop foreman or somebody else, so why do you consider it unfair to take it out on you? To me, it is rather logical. Mr. REUTHER. Then you agree with their strategy. Mr. ALGER. That may be a difference of opinion, After reading your statement, I tried to break it down into certain categories where I disagreed and where I could draw some information. Mr. Curtis, I think, has said things better than I can to get further information. I would do well to study your views because you do not answer my questions in your statement that I have, but if I may, rather than asking questions on this subject, I want the record to show-and I am going to give another list drawn from your printed statement-I have respect for your viewpoint although I disagree with it, and I hope you will agree even though I am zero on your AFL-CIO legislative yardstick, that at least I mean well. You may not agree but I, too, want to be humanitarian even if it is in a different way. If I may, Mr. Reuther, and I have no bitterness in saying this, these are some of the categorical things I disagree with. You say it is not socialized medicine; I say it is. You say the majority of the older people have no health insurance, that they have inadequate financing, and it stands in the way of their getting health care, and that millions of people lack medical care. I take issue with these things. You say the insurance policies have tricky loopholes and boobytraps. I think that may be true of some policies, but I think it is indicting an entire industry. In any event, I do not want the whole industry indicted because a few may be in the category which you mentioned. On page 7 you said the insurance industry is not interested in adequate programs but just a share of the market. I do not think that is fair, Mr. Reuther. I do not think you could look them in the eye next time you sit down at the table to work out a voluntary program in which you have a great hand and be too proud of that statement. I respect your view, but I do not think that is fair. Mr. REUTHER. On the insurance front we had great resistance until we told them they did not have the policies we needed. When we told them we might have to organize our own insurance company, the situation changed. Mr. ALGER. Anybody as able and as sharp as you are is going to get a lot of attention from us. Mr. REUTHER. Flattery will get you nowhere. Mr. ALGER. Nobody knows this better than I. I know what the labor leader's opinion is of me. Then you say most Americans support this bill. I categorically denounce that statement because in my district I am convinced a majority do not. You call it a cynical conspiracy of opposition. I do not think that is so. Opposition does not mean it is a cynical conspiracy. Then you say that nothing restricts the choice of physicians in this bill. I categorically say it does. You say that you do not want to impair the dignity of the medical profession. I say you have done more singlehandedly to do that than any witness thus far by the terms you have used. On page 5 of your statement you say that many thousands of doctors are for medical care under the social security system. I contest that figure but I cannot prove it at this moment. You are concerned for the aged as well as the younger people. Here I take issue with you. Here I think you are concerned only with the 14 million aged who will get something for nothing, not having paid in a penny on the program. Some of your other younger union people who do not have the good fortune of the aged will pay in as long as 45 years even as they have to support their own program if they do not get it through collective bargaining. I think we are giving a gratuity: to 14 million and, asking your own younger working people to pay for it doubly. You are supporting those who did not pay. I think that double load on those not aged is one that will wean away some of your own supporters. In any event, I take issue with you. I do not contest your concern for the aged in any regard. You say that the aged do not want charity. I think this is something I would like to argue with you about at a time which is more proper. I do not think a lot of people remember the true definition of charity. Your appraisal of the insurance field does not match the figures given us and you say medical care for the aged is a major domestic issue, and I claim it was not until you made it one. Now, would you like to bemuddle any or all of that? I have some more but I will attach an appendix to my statement. Mr. REUTHER. I do not want to try to take this list of yours and comment on it. I just want to say it is not correct to say that I personally have attempted to impugn the integrity or the humanitarianism or the good faith of doctors. That is not true. I said in my oral presentation that as a human being I am very grateful to them. It was the doctors who made me whole when I was fighting for my life. I think overwhelmingly the doctors of America are decent people who want to do what is right and want to practice good, high-quality medicine and minister to the needs of the people of this country. just happen to disagree with the official position of their organization. I I ask you to differentiate-I have lots of arguments but I never get bitter with an individual. I may disagree with the position of an organization. In this case, I am not condemning individual doctors; I am disagreeing sharply with the announced position of the American Medical Association. I think they are doing a great dis |