APPENDAGE No. 5. SOCIETY RESOLUTION

Resolutions passed by the Pulaski County Medical Society during 1960 and Copies were sent to congressional delegation.

1961.

March 15, 1960

The Pulaski County Medical Society is in opposition to the passage of the Forand bill (H.R. 4700) and all similar legislation which provides for social security expansion for compulsory health insurance. Opposition is voiced because legislation of this type would remove the flexibility of medical approach and technique which is necessary for the best possible health care for every American. Also it is a political approach to a health problem developed by and would be administered by nonmedical people and it would distinctly weaken the patient-physician relationship.

Preferences expressed for legislation to provide for better control of inflation and voluntary insurance as being preferable.

For these reasons it is the opinion of this society that this measure and similar legislation should be defeated.

March 15, 1960

The Pulaski County Medical Society in opposition to the compulsory inclusion of physicians under social security urges the defeat of H.R. 9925 (Machrowicz) and all other similar legislation.

March 22, 1961

Be it resolved That the Executive Committee of the Pulaski County Medical Society in official session March 22, 1961, go on record as opposing H.R. 4222, title Health Benefit Act, 1961; that our representatives in Washington, D.C., be so informed of this action and to use their influence in opposition to the bill.

APPENDAGE No. 6. LETTERS TO CONGRESSIONAL DELEGATION

The following letter was sent to Congressman Mills.

Congressman WILBUR MILLS,

House Office Building, Washington, D.C.

LITTLE ROCK, ARK., March 16, 1961.

DEAR CONGRESSMAN MILLS: Once again, apparently, the Congress will be asked to consider a compulsory national health insurance law for the aged, to replace the Kerr-Mills law passed by the 86th Congress.

May I state my opposition to such efforts in the field of health through expansion of social security. I can find nothing there which is attractive, necessary, efficient, or economical. I much prefer to give the Kerr-Mills law a thorough trial I believe that it will answer the needs of our aged citizens.

You have been so valiant and perservering in your fight against these efforts to expand the social security system in the field of health. Please know that your efforts are appreciated by myself and by thousands of others, both in and out of the practice of medicine. I hope that you will not become weary in your efforts. If there is anything that we can further do to help, please let us know.

Thank you so much for giving me this portion of your time.
Sincerely,

JOSEPH A. NORTON, M.D.

The following letter was sent to Congressman Alford and Senators Fulbright and McClellan :

LITTLE ROCK, ARK., March 16, 1961. DEAR SIR: It appears that the 87th Congress will be asked to consider a compulsory national health insurance law for the aged, to replace the KerrMills law passed by the 86th Congress.

Once again, may I state my personal opposition to the social security approach to health care. I can find nothing in that approach that it seems necessary, efficient, or economical. I must prefer to allow a trial of the Kerr-Mills law.

Thank you so much for your aid in opposing social security expansion in this field in the past. I hope you can continue to give opposition to those efforts. Best regards to you. Thanks so much for giving me this time. Sincerely,

JOSEPH A. NORTON, M.D.

APPENDAGE No. 7. RESOLUTIONS OF LOCAL CHAMBERS OF COMMERCE

RESOLUTION OF LITTLE ROCK JUNIOR CHAMBER OF COMMERCE, APRIL 6, 1961 Whereas H.R. 4222, a bill for health care of the aged was introduced in the House and Senate on February 13, 1961, by Congressman King of California and Senator Anderson of New Mexico; and

Whereas the junior chamber of commerce is dedicated to the principles of free enterprise; and

Whereas H.R. 4222 is socialistic in nature and constitutes a disintegrating erosion of the free enterprise system upon which this Republic was founded; and

Whereas the Arkansas Legislature has implemented the Kerr-Mills program to become effective July 1, 1961, which will provide for all the aged who are needy: Now, therefore, be it

Resolved, That the members of the Little Rock Junior Chamber of Commerce assembled in meeting this 6th day of April 1961 urge all Arkansas Representatives in both Houses of Congress, to defeat the passage of H.R. 4222, and all legislation having a similar purpose: And, be it further

Resolved, That copies of this resolution be forwarded to all of the U.S. Senators and Representatives from the State of Arkansas.

RESOLUTION OF THE LITTLE ROCK CHAMBER OF COMMERCE

Whereas the Kerr-Mills bill adopted by the 86th Congress of the United States provides satisfactory medical care for the needy aged; and,

Whereas the Arkansas Legislature has implemented the Kerr-Mills bill in our State; and,

Whereas a system of compulsory medical care for the aged would cause health costs to be financed through higher social security taxes, and,

Whereas, it is the belief, of the Board of Directors of the Little Rock Chamber of Commerce that any compulsory health care program would constitute socialized medicine controlled by a bureau of the Federal Government, paid for by increased social security taxes, burdening both present and future generations, and leading to a decline, if not the end, of voluntary health insurance programs: Now, therefore, be it

Resolved, That the Board of Directors of the Little Rock Chamber of Commerce hereby opposes the passage of any new legislation which would weaken or kill the Kerr-Mills law.

Adopted this 12th day of May 1961.

BOARD OF DIRECTORS, Little Rock Chamber of Commerce.

The CHAIRMAN. Are there any questions of Dr. Norton?

Dr. Norton, I want to congratulate you on this very fine presentation of your views and those of the other very fine doctors in Pulaski County. You have made an outstandingly good witness. Thank you very much for coming before the committee.

Mr. Lander, will you identify yourself for the record, please?

STATEMENT OF DR. BERNARD LANDER, FOR SYNAGOGUE COUNCIL OF AMERICA

Dr. LANDER. Mr. Chairman and members of the committee, my name is Dr. Bernard Lander. I am chairman of the Commission on Family and Social Welfare of the Synagogue Council of America.

I am appearing on behalf of the Synagogue Council of America which represents the religious Jewish community of America, comprising the Central Conference of American Rabbis, Rabbinical Assembly of America, Rabbinical Council of America, Únion of American Hebrew Congregations, Union of Orthodox Jewish Congregations of America, and United Synagogue of America.

We endorse the President's health insurance proposal because we believe that there is an imperative and very large unmet need of the aged for hospital and nursing-home care. We also support this proposal for moral and religious considerations because we are convinced that the President's proposal provides procedures and a methodology for meeting these needs that are consistent with and in the spirit of our Judaeo-Christian heritage.

The superb report on basic facts on the health and economic status of older Americans, prepared by the staff of the Special Committee on Aging of the U.S. Senate, demonstrates and specifies the unmet needs of our older population for adequate hospital and nursinghome care.

While the aged constitute about 9 percent of the total population, they make up more than 55 percent of all persons with limitations due to chronic illness. The lower income aged in particular, have a high proportion of limitation of activity due to chronic illness: 82 percent of the over-65 population with family incomes under $2,000, have such limitations in activity, as against 75 percent of the aged with family incomes of $4,000 or more.

Nine out of ten persons who live to be 65 go to the hospital at least once between age 65 and death. About one of every five American aged is either confined to the house or has trouble getting around. In addition, approximately 5 percent of our aged spend the balance of their lives in institutions because of illness. A 1957 study of social security beneficiaries indicated that at least 20 percent of the beneficiaries were hospitalized during the year.

Fewer than one-half of the aged have any insurance to cover hospitalization. Furthermore, even when insurance policies are available they generally offer only limited benefits under limited considerations. For example, the Senate staff report finds that the Blue CrossBlue Shield plan in Oakland, Calif., offered 21 days in ward accommodations. In Arizona, they offer 21 days in semiprivate accommodations. Even then the aged are covered by some form of hospital insurance, this coverage is generally of a very limited

nature.

Coupled with the more extensive need of the aged for hospital care is also their severe limitations of ability to finance this care. The Bureau of Census data suggests that 55 percent of our aged populations have annual incomes of less than $1,000 and 23 percent have incomes of $1,000 to $2,000. Only 33 percent of the entire aged population have liquid asset holdings of $2,000 or more. At the same time, the medical bills for half of the families reporting hospitalized illness amounted to over $700.

It is thus abundantly clear that by and large one-half of our older population have neither the income nor the liquid assets to finance the long-term hospital care which is so essential in the illnesses that beset them.

We support the President's proposal because we believe that the inclusion of hospitalization services is a logical extension of the social security program to insure the American population against need in their declining years. Medical need is as real and essential as the need for food and shelter. The same concern that prompted our Government to promulgate and to broaden the Social Security Act should also inspire us to include hospital and nursing-home care. Moreover, we are concerned with the dignity of the individual. A means test is ultimately a pauper's vow. Our older people do not want charity. They are entitled to the preservation of their selfrespect. We have always supported the social security program primarily because of our moral and religious concerns with the preservation of the dignity of the person.

A means test robs a man of this sacred possession. We thus view our public assistance categories as a residual program to take care of the needs of those who are not covered by an insurance program. As our social security program is broadened, the outlay from the national budget for public assistance and old-age assistance programs will be to that extent reduced.

It may be of interest to note that in 1950, 22 percent and more of our aged were receiving public assistance help in the form of old-age assistance. This past year this proportion of our aged receiving such help has been reduced to under 14 percent.

In conclusion, our old people frequently cry out with the psalmist "Do not cast me off in old age, when my strength faileth forsake me not."-Psalms 71:9. I hope that we will heed this poignant cry of our aged and will not forsake them, in their declining years, when they suffer from the infirmities of old age for which they certainly bear no fault.

The CHAIRMAN. Are there any questions of Professor Lander?

If not, Professor, we thank you, sir, for bringing to the committee the views of the Synagogue Council of America.

Mr. Besdine.

STATEMENT OF DR. MATTHEW BESDINE, BROOKLYN, N.Y., ON BEHALF OF THE AMERICAN DENTAL ASSOCIATION

Dr. BESDINE. I am Dr. Matthew Besdine, of Brooklyn, N.Y., chairman of the American Dental Association's Council on Legislation. I am also president of the Dental Society of the State of New York. I am accompanied by Mr. Hal M. Christensen, the association's Washington counsel.

In accordance with the instructions contained in the press release issued by the chairman of this committee, dated July 11, 1961, we have attempted to keep this statement brief and free of repetition.

The members of the American Dental Association have an intense interest in H.R. 4222 and similar measures which would embark the Federal Government upon a massive health care program for a large segment of the American population. Many of this association's State and local constituent and component dental societies would have welcomed the opportunity to appear before this committee to present personally their views on this important legislation.

However, in keeping with the chairman's request, in the interest of conserving the valuable time of the members of this committee, the

following comments and recommendations will constitute the formal presentation representing the position of organized dentistry in the United States.

The American Dental Association has a membership of 95,000, and of this number, about 85,000 are engaged in the private practice of dentistry in large and small communities throughout the country.

The members of the dental profession are gravely concerned about the problem of extending the availability of dental health care to all segments of the population. This is reflected in official policy which establishes as one of the major missions of the American Dental Association the duty to assure to the greatest extent possible that dental care is available to all people of this Nation regardless of income, geographic location, or any other factor.

Thus, at the outset, in the interest of objectivity, it might be conceded that the American Dental Association and the sponsors of H.R. 422 have a common objective in that both are motivated by a desire to bring adequate health care to a segment of the population which includes some persons who may not be able to afford such care. The only point of difference that arises is how best this common objective can be accomplished. The American Dental Association does not believe that the means provided in H.R. 4222 and similar legislation constitutes a desirable or adequate approach.

H.R. 4222 adheres to the basic framework of legislation introduced in recent sessions of Congress by former Representative Forand of Rhode Island and would finance nursing home and other health-care benefits for persons meeting OASDI eligibility requirements. Such benefits would be provided without taking into consideration the economic needs of eligible recipients and no consideration would be given under the program to aged persons unable to qualify under OASDI rules.

While increasing numbers of dentists participate in hospital practice, it is recognized that dental care would be involved only to an incidental degree in the benefits proposed in H.R. 4222. At the same time, it is recognized that H.R. 4222 has far-reaching implications for members of all health professions as well as for others interested in the Nation's health. It would be naive, we believe, to ignore the real probability that once this type of program is initiated, it will be extended progressively to include comprehensive health care for the entire population. It is this potentiality within H.R. 4222 that gives pause and concern to health practitioners everywhere and is the reason for my appearance before this committee today.

This association does not believe there is a conscious desire on the part of the proponents of H.R. 4222 to introduce a system that may lead to a degeneration in the present high quality of the health services to which our people have become accustomed. Nor do we believe that the health practitioners of the country consciously would perform lower quality services because the Government, rather than private individuals or agencies, pays the bill.

It is believed, however, that the inescapable tendency would be for practitioners to perform their services in accordance with the rules, regulations, and directives promulgated by the Federal agency having sole control over their ability to provide a livelihood for themselves and their families.