a doctor can prescribe the treatment appropriate for his patient without having to consider whether or not his patient can pay for it.

What then does the American Medical Association object to and of what are they afraid? What is wrong about a medical system that is able to consider the medical needs of the country as a whole and to take steps to deal with shortages of facilities and personnel, either in total or as between areas? Do our doctors want to perpetuate the present shortage and maldistribution of both in this country? What is wrong with a system that, while aiming at high standards of care, nonetheless exerts some oversight in the interests of consumers to see that the costs of such care are not wastefully high or that drugs are not unnecessarily costly? Has our medical profession no concern that unnecessary costs be eliminated or that the most effective use be made of all available medical resources?

One can only assume that our medical men are too busy to read the many available studies of the operation of such a socialized medical program as the British. Otherwise, they would surely have been impressed and excited by the astounding progress that has been made in all medical services in Great Britain since that country adopted socialized medicine. One hesitates to adopt the alternative explanation of organized medicine's phobia about socialized medicine; namely, that the profession is interested solely in maximizing the incomes of its individual members, in opposing any interference with their customary ways of doing business (their word, not mine) and refuses to admit that there is a public interest in any service rendered by a profession. Yet in the last resort, the question of the extent and quality of medical care that should be available to the people and the reasonableness of its costs, is one for the people and not for the profession to decide.

I can perhaps sum up my testimony by stating, first, that the bill under discussion is not socialized medicine, and second, that this is perhaps its major weakness. Nothing short of socialized medicine will enable us to grapple effectively with the vast array of problems that beset our present arrangements for the provision, the organization, and the financing of medical care.

Yours faithfully,

EVELINE M. BURNS. Professor of Social Work.

STATEMENT BY ALVIN T. PRESTWOOD, COMMISSIONER, ALABAMA STATE DEPARTMENT OF PENSIONS AND SECURITY

I am Alvin T. Prestwood, commissioner, Alabama State Department of Pensions and Security. This agency administers the public assistance programs (except MAA) authorized by the Federal Social Security Act, as amended. I speak for the Governor, who is chairman of the State board, for some 1,000 employees of this agency, and in behalf of approximately 261,000 aged people in this State. many of whom would benefit from the enactment of the Health Insurance Benefits Act of 1961 (H.R. 4222).

This department long as subscribed to the basic principle that a contributory social insurance program is the best means of protecting individuals and their families against loss of income due to retirement, disability, unemployment and death of the family wage earner and against health costs. We have been pleased over the years that, under the leadership of your committee, the Congress has taken action to extend and improve the insurance phases of the Social Security Act. The raising of the minimum benefit, the changes in the requirements for benefits, and the liberalization of the retirement test already enacted this year (Public Law 87-64) are the most recent examples. We are particularly pleased that you are giving consideration to legislation designed to provide health insurance for the aged under the social security system.

The medical care needs of the increasing aged population have been so well documented so many times that I will not detail them. Suffice it to say that with more people living longer than ever before there is a higher incidence of chronic diseases and disability. This means that there is an obvious need for protection against the consistently increasing costs of catastrophic illness and prolonged hospitalization. We recognize that the problem is large and complex. Its solution will require, among other things, the full use of individual and family resources, voluntary health insurance, social security, and public assistance. The legislation which you are considering will add the contributory social security plan. This, together with vendor-payment, medical-care pro

grams for the low-income aged authorized by Public Law 86-778 enacted last year, would make for a better balanced program. That there is need for both types of programs is illustrated in the facts presented below.

This pending legislation would be of immediate benefit to many persons in Alabama 65 years of age or over now as well as to countless thousands of such individuals in the years to come. Of about 261,000 persons in Alabama 65 years of age and over approximately 133,300 receive OASDI benefits. Included in this number are about one-fourth of our nearly 100,000 old-age-assistance recipients. If the major medical care needs of these beneficiaries are met through social security taxes and payments, the vendor-payment, medical-care program for old-age-assistance recipients could be improved and made more adequate. It was not until the more favorable formulas for Federal participation in the cost of medical care for the aged were enacted last year that Alabama established any vendor-payment, medical-care program for old-age-assistance recipients. At present we provide only for nursing care in licensed nursing homes, begun in October 1960, and for hospitalization for acute illness or major injury, begun on April 1, 1961. Due to inadequate State funds, arbitrary limits have been placed on both programs. For example, the Department can pay no more than $125 a month for the nursing care item in a licensed skilled nursing home and no more than $110 in a licensed nursing home. Similarly, a limit of 10 days' hospitalization in any one fiscal year has been imposed in addition to the restriction to acute illness and major injury.

In June 1961, vendor payments were made totaling nearly $201,500 in behalf of 1,951 old-age recipients for nursing care and about $122,600 in behalf of 836 such recipients for hospital care. We hope to liberalize the hospitalization program. If the health care needs of one-fourth of the recipients were met through social security and if State funds requested are appropriated, we expect to be able to do so. Sufficient State funds, however, are not anticipated to make it possible to provide a comprehensive or adequate medical care program for oldage-assistance recipients or to obtain the maximum available Federal funds. The Department does not have legal authority to establish a program of medical assistance to the low-income aged not receiving old-age assistance. Bills are pending in the Alabama Legislature authorizing the Department of Pensions and Security to establish such a program and to appropriate State funds to enable the agency to initiate a quite limited program. The potential number of persons who might be eligible for such a program would be greatly reduced if H.R. 4222 were enacted by the Congress.

Various groups have gone on record in support of contributory social insurance as a desirable method to provide health care protection in retirement. Notably among them are the American Public Welfare Association and the 1961 White House Conference on Aging. The State and county departments of pensions and security are active members of the APWA and support wholeheartedly the following which is one of its 1961 Federal objectives:

"Health costs of old-age, survivors, and disability insurance beneficiaries should be financed through the OASDI program. The health costs of aged, surviving, and disabled individuals and their dependents who are not insured OASDI beneficiaries should be met through an effective governmental program. Arrangements for achieving this objective should take into account the priority needs of the groups to be served; availability of facilities, personnel, and services; and protection and encouragement of high quality of care, including the organization of health and related services to effect the most appropriate utilization of services and facilities."

The 1961 White House Conference on Aging devoted major attention to the need of adequate health services to be available to all aged persons irrespective of their ability to pay. The section-income maintenance-to which this matter was assigned concluded that "the problem of financing an adequate level of high quality care for the aged is so large and so complex that it will require for solution the utilization of voluntary health insurance, of individual and family effort and resources, and the resources and instrumentalities of the local, State and Federal Governments." The majority recommended that:

“* * * to assure adequate health care for the aged with certainty and dignity there should be established a basic program for financing health care for the aged within the framework of the old-age, survivors, and disability insurance system."

I join many other individuals and organizations throughout the country in urging that you give favorable consideration to the principles and plans for financing health care for the aged contained in H.R. 4222.

Representative WILBUR D. MILLS,

Committee on Ways and Means,

House of Representatives, Washington, D.C.:

BOSTON, MASS., August 17, 1961.

After careful consideration of the King-Anderson bill, I am glad to express my approval of it which, if the safeguards incorporated in it are adhered to, should be of great aid in the case of the health of our aged citizens.

Hon. WILBUR D. MILLS,
Chairman, Ways and Means Committee,
House of Representatives, Washington, D.C.

DEAR MR. CHAIRMAN: It is my understanding that your hearing records on the health-care-for-the-aging bills will be open until August 18. I would like, therefore, to submit this letter and an enclosure for your record. (Attached petitions have been placed in the files of the Committee on Ways and Means.) As you can see, the petition bears the names of 2,100 citizens of New Jersey who are emphatically for a plan that will extend the social security system to this new area of protection for our aged and aging citizens. The names have been submitted by Mrs. Lillian Allan, corresponding secretary of the Hudson County Branch of the National Federation for Social Security, which has already forwarded 6,000 other signatures on petitions to your committee.

Few issues have caused a more heartfelt reaction among citizens of the United States, including many citizens who would not immediately benefit from the proposed social security plan.

It is significant, I think, that your committee should receive petitions bearing the names of more than 8,000 persons who believe that the social security approach offers the Nation the most equitable and effective method of meeting a growing national need.

As one who has long supported the social security principle, I am heartened by this evidence of keen concern by citizens of my home State. With best regards.

Sincerely,

HARRISON A. WILLIAMS, Jr.

AMALGAMATED MEAT CUTTERS AND BUTCHER WORKMEN OF NORTH AMERICA, Chicago, Ill., August 17, 1961.

Hon. WILBUR MILLS,

Chairman, Committee on Ways and Means,
U.S. House of Representatives, Washington, D.C.

Dear Mr. MILLS: On behalf of the 375,000 members of the Amalgamated Meat Cutters and Butcher Workmen of North America (AFL-CIO), we would like to urge committee approval for H.R. 4222, the bill to provide medical aid for the aged under social security. Our union firmly believes that this bill is among the most important and most needed pieces of social legislation Congress has considered in recent years.

We are disturbed at the use of name calling and innuendos which the opponents of H.R. 4222, especially the American Medical Association, have undertaken. Our study of the bill indicates no way whatsoever in which the Federal Government could dictate or even influence either the choice of doctor or any of the medical practices. We find it difficult to understand how the American Medical Association could honestly object to a social insurance scheme which would allow doctors and medical institutions to provides services to more older citizens and would assure that these doctors and medical institutions would be paid for these services.

Clearly, the statistics presented to the committee during the hearings demonstrate the tremendous need for social insurance of this type. When three out of five senior citizens have an income of less than $1,000 a year, it is simply ridiculous to argue that they can afford medical services without social insurance.

Further, it is outlandish to suggest, as the American Medical Association and its allies have, that providing for one's medical needs in old age through insurance which is to be paid while one is working is socialistic or somehow un-American. We are quite aware of the fact that AMA does not feel this way when it attempts to gain congressional support for H.R. 10, which it claims would allow doctors and other self-employed persons to prepare for their retirement.

Year after year, workers retire from long and productive employment with only a modicum of protection against medical bills. A serious illness of their own or their wives eats into the pension and savings to such a degree that they are left poverty-stricken. Is this what the AMA wants?

Enactment of legislation such as H.R. 4222 is long overdue. We hope that the committee will quickly approve it.

Very truly yours,

DEAR MR. CHAIRMAN: The American Federation of State, County, and Municipal Employees, which represents 220,000 State and local government employees in the United States, in the Commonwealth of Puerto Rico and a number of employees of the Canal Zone government, is gratified that your committee is holding hearings on H.R. 4222, the President's health insurance proposal, beginning July 24, 1961.

Because of the very limited time available for the hearings. Mr. Nelson Cruikshank, Director of the Department of Social Security of the AFL-CIO, who is testifying in support of H.R. 4222 will also speak of our international union and other affiliated unions of the AFL-CIO in support of this bill. Therefore, in lieu of giving additional testimony in a personal appearance, I would ask that you make this letter a part of the record of the hearings on H.R. 4222. Since the early 1940's, the American Federation of State, County, and Municipal Employees has worked steadily to obtain coverage under the OASDI system for members of existing retirement systems in State and local government services. The 1950 amendments to the Social Security Act made possible, for the first time, OASDI coverage for State and local government employees who were not covered by State or local retirement systems. Finally, in 1954, coverage was made available to members of State and local retirement systems who voted by referendum to accept such coverage. Today, of the 6.1 million State and local government employees, 3.9 million have OASDI coverage.

There are thousands of retired State and local government employees who are receiving pitifully inadequate retirement benefits, either from State or local retirement systems, from the Federal OASDI system, or from a combination of such plans. These persons may not receive medical benefits unless they are so poor that they can pass rigorous means tests and unless they live in a State which is not financially impoverished and has taken action to provide additional funds to match Federal grants under the Kerr-Mills bill. Rising medical costs are a growing threat to these aged retired, most of whom cannot afford the high cost of commercial insurance protection or the increasing rates under Blue Cross-Blue Shield plans. Public welfare programs are overtaxed by growing loads. Medical allowances are pathetically small.

The President's proposal would permit most working people to contribute during their years of employment for protection when they become age 65. It would assure payments for medical care and as a result safeguard the peace of mind and dignity of the aged. Only by the use of the OASDI insurance system will working people be enabled to contribute during their working life toward their health expenses after retirement. The President's proposal to provide health benefits for the aged through social security would assist private welfare agencies, hospitals, and nursing homes to do a better job; it would take a great burden from State public assistance agencies, thus permitting them to do a more adequate job for those who need public assistance and cannot qualify under social security.

Our International Union was represented at the White House Conference on the Aging, held in Washington, D.C.. on January 9-12, 1961, with more than 2,500 delegates in attendance. These delegates represented 53 States and territories and more than 300 national voluntary organizations interested or active in the field of aging. Of the many issues studied, the most controversial was the financing of medical care for the aged. The Conference made a policy declaration that the "Social security mechanism should be the basic means of financing health care for the aged." The recommendation became official conference policy. This delaration of support for the President's plan is most significant.

While asking your favorable consideration of H.R. 4222, we would point out that there are thousands of retired State and local government employees who retired prior to the date when social security was made available in their State or local employments and who, therefore, will not be eligible under the bill proposed for medical care through the social security system. Many of these retired persons are trying to subsist on retirement benefits of less than $50 per month and have no means of purchasing insurance protection against health hazards nor can they meet their medical care costs out of their incomes.

We urge the Commitee on Ways and Means to report out H.R. 4222 favorably because, if enacted, it will allow the American worker to retire with security and self-respect, knowing that this health costs are prepaid and without the humiliation of a means test. The program proposed will permit every person to choose his own doctor and his own hospital, and will help our aged, whose need for medical care and hospital care is two to three times that of younger people, to meet their medical bills which have risen 14 percent since 1947, and their hospital bills which have risen 20 percent during that time. This is a matter of national concern and we ask your support. Very truly yours,

ARNOLD S. ZANDER, International President.

STATEMENT ON BEHALF OF THE INTERNATIONAL LADIES' GARMENT WORKERS' UNION BY DAVID DUBINSKY, PRESIDENT, INTERNATIONAL LADIES' GARMENT WORKERS' UNION

The International Ladies' Garment Workers' Union and its members throughout the country have long been conscious of the importance of good health. At the beginning of this century the clothing trades were universally condemned by public spirited citizens for their scandalous labor standards and for their overcrowded, unsanitary, and disease-ridden shops. Aside from poor health caused by overcrowding, ignorance, and poverty, the sweatshop bred its own occupational diseases. The working life of the garment workers was the shortest of any industrial group. The infirmities of men in their thirties or forties were described by doctors as being due to galloping "old age."

Since the beginning of unionism in this industry, workers have searched for solutions to the problems of preventing disability, improving sanitary conditions in the shops, and caring for their sick and disabled fellow workers. When the first important collective agreement was achieved by our union in the New York ladies' coat and suit industry in 1910, a committee consisting of union, employer, and public representatives was created to police the sanitary conditions in the factories. In 1913, our first Union Health Center was opened in New York City. New York City is the major market in the garment industry and our Union Health Center there is our largest. In other cities throughout the country we have diagnostic clinics-in Allentown, Pa.; Boston: Chicago: Cleveland; Fall River, Mass.; Kansas City; Los Angeles; Newark, N.J.; Philadelphia; St. Louis; and Wilkes-Barre, Pa. (We also have one in Montreal. Canada.) In areas outside large cities we are now operating mobile health centers which go directly to the shops to provide their services to our members. In some cases arrangements have been made with local medical practitioners to serve our members. Thus, in one way or another, we manage to serve over 90 percent of our 447,000 members, at an annual cost of $6,800,000.

These medical facilities operated by our union, which for the most part provide services at no cost to our members, are financed by our health and welfare funds. These are maintained by employer contributions, based on a percentage of payrolls, under the terms of our agreements with them. Our health and wel fare funds also finance disability benefits, hospitalization, and surgical benefits,