VOLUNTARY HEALTH PROTECTION

One other kind of organization that is playing an increasingly important role in the financing of health care is the voluntary health protection plan-both Blue Cross and Blue Shield and the commercial insurance companies.

In Missouri, 1,417,000 people have hospitalization protection through the two Blue Cross plans in the State. Blue Shield protects 1,063,000 members for medical-surgical expense.

Blue Cross alone protects 30.9 percent of the State's entire population, while Blue Shield alone covers 22.4 percent.

It is important to note also that the number of those with private health protection continues to grow rapidly. St. Louis Blue Shield alone has increased its membership by more than 100,000 in the last 2 years.

For the State as a whole, Blue Cross membership increased by 17,300 people last year-Blue Shield membership rose by 49,700.

In Missouri, both Blue Cross and Blue Shield offer membership without regard to age, as do a number of the commercial insurance companies. A person can join at any age, and retain membership for life. We estimate that there are now about 95,500 members over age 65 in Blue Cross and Blue Shield alone in Missouri, or about 25 percent of the population over 65 not being taken care of under old age assistance.

Membership in the plans is, incidentally, offered both on a group basis and to those without group affiliation. Group membership is available to Farm Bureau groups as well as to industrial organizations, and we have some 47,000 farm people enrolled in Blue Cross through the Farm Bureau, and about 28,000 in Blue Shield. This is in addition, of course, to those farmers who have enrolled on an individual basis.

DETERIORATION OF QUALITY OF CARE

The Missouri State Medical Association opposes the King bill, and similar proposals for medical care programs under the social security system, finally, be cause we who are close to and vitally concerned with the problems of providing health care are convinced that such an approach can only lead to a lowering of the quality of care available.

A great deal has been said about socialized medicine in connection with this bill. Without overly belaboring the point, I would like to point out briefly why the physicians of Missouri believe this proposal would lead to a full-scale program of Government medicine in the United States and why socialized medicine would result in poorer medical care for our citizens.

The King proposal is, of course, a limited one. It is limited, among other things, to those over age 65 and to those eligible for social security payments. It is limited to certain health care services, and for limited periods of time. It provides that the patient pay a certain number of dollars out-of-pocket for certain of the services included.

The question is which one of these limits is to be removed first? The pressures will be tremendous, logical, and irresistible.

If this is a program for prepayment of the costs of 90 days of inpatient hospital care after age 65, why not 180 days, or 365 days? If those reaching 65 need this program, why not the other groups receiving social security payments-the disabled, dependent children, and so on? What of those who retire at the optional age of 62 recently authorized? If hospitalization is to be provided, should not the taxpayer be allowed to prepay the costs of physicians' care, drugs, and all other services?

Finally, if it is necessary or desirable for those who are eligible for social security payments to be covered by such a Federal Government program, is it not just as necessary and desirable for all citizens to be covered by the same program? While the need for pensions may be confined to those retired because of age or disability, the need for medical care is universal at all ages and conditions of occupation.

There would seem to be little question that this program, if enacted, would and must expand until it covered all health services and all citizens. And since it would be Government-provided medicine, it would be full-scale socialized medicine-and necessarily Government-controlled medicine.

Some have argued that this bill specifically provides that the provision of the health services covered would not be Government controlled. Such arguments do not stand up either from a reading of the bill itself, which specifically sets forth that those who provide the services must agree to abide by regulations

promulgated by the administering agency-or on the test of logic. That which the Government provides, it must control in the interest of the taxpayer. Congress and any administration would not and should not abdicate the responsibility to see that tax money is well and prudently spent.

That there will be Government interference and Government control is not simply theory. Experience with various present Government programs both here and abroad amply demonstrate that the relationships and attitudes between the patient and his physician and hospital are affected adversely when the Federal Government has an active role in the administration of these plans. When you have Government rules and regulations, there is interference with the way health services are provided.

Because the rules and regulations are mostly administrative-because they cannot take into account the best practice of medicine, if only because the procedures of the best medicine change rapidly-Government interference affects the provision of health services adversely. Government medicine is bound to result in poor quality medicine.

SUMMARY

In summary, the physicians of Missouri are convinced that the problems of financing health care for the aged have been greatly overstated. We are convinced that those who do need help have adequate assistance available to them through the services of individual physicians, hospitals, and private health and welfare organizations-in cooperation with local and State government resources aided by the vendor and Kerr-Mills programs. We are convinced that those who do not need direct financial assistance have ample opportunity to provide for themselves through the private, voluntary health protection organizations. Finally, we are convinced that the proposals embodied in the King bill are but the first step toward full-scale Government medicine for all citizens, and that this can lead only to poorer medical care for the people.

It would be most unfortunate if the medical care in this Nation, which has reached one of the highest standards in the world under our present free practice were relegated to second rate by act of Congress. The physicians of Missouri urge that the King bill not be passed.

STATEMENT PRESENTED IN BEHALF of the MEDICAL SOCIETY OF NEW JERSEY BY RALPH M. L. BUCHANAN, M.D., PRESIDENT, THE MEDICAL SOCIETY OF NEW JERSEY

As president of the Medical Society of New Jersey, I offer this statement of opposition to H.R. 4222 (King-Anderson), in the name of the 6,500 physicians who are its members and of the approximately 3,000 members of its woman's auxiliary.

H.R. 4222 would amend the social security law by adding a new title (XVI) under which inpatient hospital services, skilled nursing-home services, home health services, and outpatient hospital diagnostic services would be provided to any individual over age 65 who is entitled to social security benefits under title II of the social security law.

The Medical Society of New Jersey-in common not only with other members of the medical profession but with all who are dedicated to the preservation of a sound character in our people and in our Nation and to the maintenance of a sound and well-balanced national economy-is for

(1) The retention by the individual citizen-and of that citizen's familyof responsibility for selecting, arranging, and paying for his own necessary health care.

(2) The limitation of tax burdens upon the individual citizen and his family so as to leave to them the financial means of meeting this responsibility.

(3) The development and widespread utilization of adequate and economical private voluntary health insurance coverages as the best means of enabling such individual citizen and his family to meet this responsibility.

(4) The intervention of Government to assist only those citizens who need health care and are themselves demonstrably incapable of meeting the costs for it.

(5) The maintenance at a minimum of Federal governmental intervention and control. We hold that the assignment of responsibility for financing necessary health care should be in the following order: the individual citizen; the family; local voluntary agencies; local, county, State, and Federal Government-each to take over only when the prior agent of responsibility cannot meet the need. Because of this point of view we sup port the principle of the Kerr-Mills law as essentially preferable to the principle of H.R. 4222 and all like legislation.

In consequence of what it is for, the Medical Society of New Jersey is necessarily against

(1) Any policy or program that would relieve or wrest from the individual and the family the right and responsibility to be independent, selfsustaining, self-reliant, and free.

(2) Any policy or program that would so multiply burdensome taxes upon the individual citizen and his family as to deprive them of the financial means to retain and exercise those four fundamental rights and responsibilities.

(3) Any policy or program that would encourage government, at any level, to eliminate or supplant voluntary free enterprise systems of insurance coverage, or of any other fundamental business or service operation.

(4) Any policy or program that would enlarge for government at any level entrance into and influence over the lives, rights, and duties of individual citizens-in short, any policy or program that would give to government the control and direction of the lives of citizens instead of reserving to citizens the control and direction of their government.

In consequence of the foregoing, the Medical Society of New Jersey disapproves and opposes H.R. 4222 for the following reasons:

(1) H.R. 4222 would supply the health services embraced to all persons over 65 years of age, whether those persons are themselves financially able to provide and pay for such services or not.

This, we hold, is unjust and undesirable. It is our contention that individuals of any age who can provide for their own needs should be required and encouraged to do so, and should not be permitted to meet such needs at the expense of fellow citizens who, in many instances, are more financially straitened than those for whom the benefits are being supplied.

Any program which unjustly burdens one group of citizens with financial obligations in order to indulge undeservedly another more favored group of citizens is demoralizing to both groups of citizens and is hostile to the spirit and the economy of the Nation.

(2) H.R. 4222 would change the fundamental character of social security benefits by substituting services for the dollar benefits that have prevailed from the beginning of the social security program until now. If adopted, therefore. H.R. 4222 would establish a precedent that could lead to the discontinuance of all dollar benefits to social security recipients, and to the provision of food, shelter, fuel, clothing, and varied services instead. All this would involve a violation of the fundamental original agreement, in accordance with which the covered citizen, by paying into the program, could look forward to receiving dollar payments, after his retirement, to enable him to defray the expenses of his daily living.

Under this new concept, the social security beneficiary would be denied the freedom of selecting and paying for commodities and services of his own choosing and, like a witless incompetent, would be expected to take whatever it was decided he needed and should receive.

(3) H.R. 4222 is a discriminatory piece of legislation because

(a) It discriminates in favor of those citizens having social security entitlement-and, as we have shown, with unjust indifference as to their really needing help or not-and at the same time discriminates against those citizens whose lives were such as never to permit them to earn entitlement, but whose distress is such as to place them in dire need of help. (b) It discriminates against wage earning individuals-married and unmarried-who are called upon through increased social security taxes to supply each year, by their compulsory "contribution," the revenues necessary to meet the constantly increasing disbursements for benefits of all kinds. As such, H.R. 4222 is a soak-the-poor tax proposal, which—since no exemptions can be claimed, no matter how many dependents a man may have will levy on every working man or woman's earnings in order to raise the moneys necessary to meet annual expenditures. Viewed in this light,

the social security program will prove to be a tax monster, devouring and crushing the average wage earner as income tax never has or should. (4) H.R. 4222 is an inadequate and misleading measure because its benefits would still involve serious out-of-pocket expenditures for those recipients who really need to be helped. Under it, every hospitalized patient would be required to pay $10 a day toward hospital charges for the first 9 days. This poses for the recipient a total potential liability of $90-a formidable amount to the needy beneficiaries who deserve to be helped, but an amount of relative inconsequence to the well-to-do recipients who, in justice, should pay their own way.

It is the position of the members of the Medical Society of New Jersey-speaking as citizens who love their country and as physicians whose lives are dedicated to the welfare of their fellow citizens-that H.R. 4222 is unsound and unacceptable legislation because it ineffectually and inadequately prescribes for the condition it is seeking to ameliorate.

We believe that citizens of the United States should want, and should be encouraged, to develop their own strengths and to make their own security; and we believe that it is the duty of Government to maintain a social, political, and moral climate that will enable and induce them to do just that.

We believe that no one should be denied necessary medical services because of inability to pay.

We believe that it is properly the responsibility of society and Government to help those citizens who are in need to attain the necessities which they cannot themselves provide.

We believe that only those in need should be thus helped, and then only to the true measure of their need.

We believe that any policy or program which would encourage in citizens an attitude of dependence where independence should exist, and would impart to Government responsibilities and powers of determination and action which should be reserved to the citizens, is subversive of the character and true good of both our citizens and our country.

That is why we oppose H.R. 4222 and the principles for which it stands.

That is why we ask the members of this Committee on Ways and Means of the House of Representatives-and indeed, all the Members of Congress-to reject this measure and all other measures of its kind.

CONGRESS OF THE UNITED STATES,

Chairman WILBUR MILLS,

HOUSE OF REPRESENTATIVES, Washington, D.C., July 28, 1961.

Ways and Means Committee, House of Representatives,

Washington, D.C.

DEAR MR. CHAIRMAN: Enclosed are copies of statement presented by Dr. William E. Badger, president, New Mexico Medical Society.

I will appreciate you incorporating Dr. Badger's written testimony in your committee hearings on medical care for the aged.

Respectfully yours,

THOMAS G. MORRIS.

STATEMENT OF THE NEW MEXICO MEDICAL SOCIETY BY WILLIAM E. BADGER, M.D.

Mr. Chairman and members of the committee, I am william E. Badger, M.D. I practice surgery in Hobbs, N. Mex., and I am president of the New Mexico Society.

The New Mexico Medical Society was founded in 1886 to bring together all doctors of medicine in the territory to exchange medical knowledge and experiences. Membership in the society is voluntary to all physicians in the State who have a license to practice, physicians in Government service, and to those in training. Ninety-seven and six-tenths percent of the licensed physicians in the State are members of the New Mexico Medical Society. We have 619 members.

The society began publishing health materials to assist the citizens of the territory through local newspapers in 1891. In 1907 the society made the first move toward the establishment of a department of public health in the State to protect the people against various diseases and in 1924 the first resolution was passed by the delegates in annual session to cause a board to be established to

certify to the credentials of all physicians who moved to the State. The primary concern of the society was and is the citizens of the State of New Mexico.

The New Mexico Medical Society has long been interested in the various problems of the aged in New Mexico. Through the department of public welfare in New Mexico, the members of the society have rendered care to the medically indigent and old-aged-assistance programs for a great number of years. It is to be noted that our welfare program is perhaps the most comprehensive medical program of any State and has been for a number of years. It should further be pointed out that the physicians of the State render care to welfare clients at approximately one-fourth of their usual charges to those not on welfare, and in one period they provided free service in order to keep the program solvent. Our members are certain that they have had sufficient experience with State and Federal types of programs to speak authoritatively.

The Mexico Medical Society serves as the fiscal administrator of the Medicare program in New Mexico as a service to the Government and to the wives and children of military personnel.

The new board of the department of public welfare has asked the society to assist them in working out a plan for implementing the Kerr-Mills law in this State. Our committee is working with this board and we can assure you an amicable program will be worked out pending the board's ability to allocate funds for this program.

The New Mexico Medical Society sponsored two statewide conferences on the problems of the aged: one in November 1959, the other in January 1960. These conferences were well attended and a free exchange of ideas was experienced. It is believed that the consensus of the majority was that aid for the needy aged should first begin at home, then the community, next to the State and, as a very last resort, the Federal Government.

The New Mexico Medical Society was most active in the Governors' White House Conference on Problems of the Aged and indeed on each county level.

A service insurance contract for the low-income families has been sponsored by the society since 1946. Our society further reduced the fees of its members for contracts to be written for all over 65 years of age by both voluntary and commercial insurance companies.

The Blue Shield program of New Mexico has contracts with over 7,000 citizens of our State who are 65 years of age and older. These contracts are standard Blue Cross-Blue Shield contracts that can provide for up to 365 days hospital and medical care for each illness. The cost of this insurance coverage to the patient varies from $8 to $8.82 per month. These contracts may never be cancelled by the company for any cause other than failure to pay the premium.

The physicians of this State are sure that the needs of our older citizens have been grossly exaggerated. We are cognizant that there are some who need help: however, the Kerr-Mills law is specifically designed to care for these needs. Attached to this letter are two exhibits, marked "A" and "B," of two different independent surveys made in New Mexico to point out the average costs of both hospitals and physicians to these older citizens.

Our State society and many of our county medical societies have made it known through their offices and newspapers that no one need go without medical care because of inability to pay.

Our society has a firm conviction that if Congress is convinced that our older citizens can be cared for medically only by establishing a service feature to the social security program that this will be the longest step toward socialization, both of medical and industry, that has been taken by our Government to date. The need for a drastic approach such as this is definitely not indicated in reality. In New Mexico, the older citizens who need assistance are not covered by social security. These people would be covered by the Kerr-Mills law. It is of interest to note that the overwhelming majority are taken care of now through our comprehensive welfare medical care program mentioned in the fourth paragraph of this letter.

Our opposition in general rests on the premise that the Anderson-King bill is compulsory in nature covering all those covered by social security whether there is need or not and also neglecting some who have need. It seems obvious to us that such a program under social security is but an opening wedge with built-in pressures for expansion and eventually ending with the socialization of our profession, no matter how sincere the present backers of the social security approach are in disclaiming any intention of such a result.

In New Mexico we are at present attempting to find the means to implement the Kerr-Mills legislation this year and have reason to believe we will be suc cessful. We have, as a society, recently called on our Congressmen to give us all