Hon. WILBUR MILLS, CONGRESS OF THE UNITED STATES, Chairman, House Ways and Means Committee, HOUSE OF REPRESENTATIVES, Washington, D.C., August 1, 1961. DEAR CHAIRMAN MILLS: Enclosed is a statement of the South Dakota State Medical Association on H.R. 4222. I would very much appreciate having this statement included as a part of the printed record of the hearings on this measure. Thanking you, I am, Sincerely yours, E. Y. BERRY. STATEMENT OF THE SOUTH DAKOTA STATE MEDICAL ASSOCIATION ON H.R. 4222 For the purpose of identifying the organization making this statement we would like to point out that the South Dakota State Medical Association was organized in 1882, nearly 80 years ago. It has been an effective organization since that time. Membership is voluntary and virtually all doctors belong. We have 485 licensed physicians in the State and 477 are members. We are organized into an association to assure continuing improvement in the medical care received by our people. Our services to the public and to our members encompass all fields that affect the health of the people. We actively support programs designated to decrease infant mortality, to prevent or treat congenital effects, to alleviate the affects of acquired defects. Rehabilitation programs, mental health programs, immunization for all and a host of other related programs are given continuing interest. We actively support medical education and nursing education both in advisory capacities and by lending financial support. Available to our members are efficiency rating programs designed to increase individual physician diagnostic ability. We enter into legislative activity only when proposed legislation might influence directly the health care of our patients or when a program is proposed, which program would alter or change the basic concepts of the practice of medicine as we know them. Our association has long been concerned with the quality and quantity of medical care available to the indigent and to the near needy. This is best demonstrated by our succesful efforts introducing and supporting legislation for adequate and high quality care for those on old-age assistance in 1957 and 1961. It is further demonstrated by our active support for the Kerr-Mills legislation both on a national and State level. We believe the Kerr-Mills law, properly implemented, will provide an equitable and honorable means for providing medical aid to the aged at the time such need develops. We believe people of all ages are deserving of the same opportunity. We do not believe that individuals of any age should receive community, State, or Federal aid for their medical care in the absence of demonstrated need. In South Dakota there are 8,700 people over 65 on old-age assistance. In 1940 there were approximately 15,000. A small number presently on old-age assistance also receive minimal social security benefits. The number is variously stated to be between 60 and 100. Our medical program for the so-called indigent aged includes physician and hospital coverage both in and out of the hospital or nursing home; the counties provide the financial aid for drugs and related items. The program also provides some dental care. As previously stated our association introduced and supported enabling legislation for a statewide indigent medical care program in 1957. This was done recognizing the need for adequate quality and quantity care within our borders. The State legislature this year appropriated funds to match available Federal funds such that the program advised in 1957 is now being started as of August 1, 1961. We of the association believe this was accomplished through our efforts demonstrating the presence of a problem and its equitable solution. Our State has a population of approximately 680,000. Census figures show that those over age 65 account for less than 11 percent, or 71,500 people. The number of aged not on OAA is 62,800. Of this number we believe about 5,000 fall into the category of those who might need financial aid in the presence of an illness-some with a minor illness, others with a catastrophic illness only. The figure of 5,000 is obtained in the following manner. Of the approximately 70,000 over 65 and not on OAA, some twenty-five to thirty thousand are already in a position to receive subsidized care either through Federal programs such as the Veterans' Administration programs, or State programs, such as the State mental hospitals, State soldiers home, and others. The remaining forty to fortyfive thousand aged are covered in well over 50 percent of the cases by some form of voluntary insurance which usually pays the majority of their hospital and physician bills, particularly since it is the policy of our medical association members to charge substantially reduced fees to the aged when there is any question of insolvency. These fees vary between 50 and 75 percent of normal fees and are designed only to offset the physicians' expense. Utilizing these figures we estimate approximately 5,000 individuals over 65 remain over the original seventy-five to eighty thousand over 65, who conceivably might need financial aid in any one year. It is for these we have urged the Kerr-Mills legislation. Our actions, our attitudes, our waiting rooms testify to our concern for proper care of all age groups, not just the aged. My presentation demonstrates our acknowledgement of the existence of a problem; but more important specifically demonstrates our belief the problem is not overwhelming and demonstrates that we thoroughly believe existing Federal legislation will make possible and probable solution of the problems of the care of the needy aged within the foreseeable future. We have studied the provisions of H.R. 4222 and oppose it. Our objections are basically four though each objection has ramifications covered adequatel by other opposition witnesses. First, we believe the actual financial need of the majority of the aged during times of illness has not been demonstrated. The picture past and present actions in South Dakota as they relate to medical care of the aged supports our position. Second, we object to the proposed change in the entire philosophy of social security from a program of payment of money to one of provision of services. The inherent danger of the change is that it puts the Government into the field of paying for services where it must, by the nature of Government itself, control those services. Third, we believe the placing of Government in control of services will result, over a period of time, in deterioration of the quality of care offered. This conclusion is nearly always expressed when men of high professional stature meet to discuss means to solve the known problem of providing care to all. Involved here are problems which would be created by overutilization of services, by increased difficulties of recruiting properly motivated people to be physicians or trained paramedical personnel. Specific discussion of these points will receive coverage, we believe, by other opposition witnesses. Fourth, we believe the cost of such a program as proposed by H.R. 4222 is almost impossible of prediction. That the cost would exceed predictions is almost certain. The economic forces set loose by high-level benefits and the necessary taxes are frightening. Again, our thoughts concerning costs and taxes are conclusions generally held by physicians and actual tabulated expectations fall more into areas covered by other opposition witnesses. We in South Dakota believe the problem of medical care for the needy and near needy aged can be and is being solved gradually under existing legislation, through cooperation of the governmental agencies involved and those who now actually provide the services. STATEMENT OF JOHN W. HASH, M.D., PRESIDENT, WEST VIRGINIA STATE MEDICAL ASSOCIATION As president of the West Virginia State Medical Association, I offer this statement of opposition to H.R. 4222, the King-Anderson bill. I request that this statement be included in the official printed record of the hearings conducted by the Committee on Ways and Means. The Legislature of West Virginia, at a special session called by former Gov. Cecil H. Underwood, implemented the Kerr-Mills law on October 5, 1960. Through cooperative effort, the department of welfare, the West Virginia State Medical Association, and the hospital, pharmaceutical, and nursing home associations have provided our over-65 eligible citizens of West Virginia adequate medical and hospital care. Our medical assistance for the aged program covers acute illnesses, exacerbations of chronic diseases, and medications for a certain group of chronic condi tions including diabetes, arthritis, cardiovascular diseases, Parkinson's disease, and others. This type of care, based on need, is the best way to care for our older citizens. The AMA program does not impose itself upon those citizens who neither want, nor need it. Statistics based upon a survey of hospital administrators during a 3-year period prior to 1960 (which enjoyed a 97-percent return on questionnaires sent during West Virginia's preparation for the White House Conference) revealed that only 33 percent of West Virginia's over-65 citizens paid their own way. These statistics showed the financial sources of coverage of over-65 citizens are Another interesting statistic in this survey, which included actual experience of hospitals over a 3-year period, revealed that the average length of stay of over-65-year-old patients was 7.3 days. The average length of stay of all patients was 7.1 days. This figure is far removed from those statistics given by advocates of the social security approach. Our over-65 citizens are using the MAA program to an equitable extent, and abuse has been minimal. Our program has been successful because of the means test which has not embarrassed anybody. Life, itself, is a means test. One cannot buy a car, build a house, enter college, without undergoing a means test and this is good. This is American. Our Federal Government has used this test in many of its programs-the FHA for example. If it is good in the FHA, veterans, and other programs, it is good for citizens over 65. Under MAA, the Federal, State, and local teamwork reduces excessive controls by any one group, promotes State and local responsibility, and minimizes dependency on the Federal Government. We believe that the best approach is cautious as regards spending, conservative as regards imposing taxes, and efficient in its administration. The care of the aged is the responsibility of our total society. Under the MAA program, payments are made for hospital care, nursing home care, drugs, appliances, certain transportation, and for professional services. Under the provisions of H.R. 4222 no provision is made for payment for professional services. The professionals should not be subjected to underwriting any social services program to an extent greater than their just share of taxation. Our society frowns upon discrimination. Incentive and ambition will be destroyed if our tax burden continues to rise. Family responsibility and the responsibility of the individual to prepare for his retirement would be diminished under the social security approach. As a practicing physician, I am aware of the many who would abuse a program that social security would pay for. Recently a case was brought to my attention in which vigorous effort was made by a couple who wanted to put papa in a nursing home while they went on vacation. Isn't it reasonable to ascertain the need for the Government to pay for such care? It is my sincere belief that the Kerr-Mills law should be given adequate opportunity to prove its worth without political interference. If the Congress of the United States felt in 1960 that this was a good solution to the problem why should not the Congress of 1961 be willing to give the program a chance? Is this problem a political, or a humanitarian one? JEFFERSON COUNTY MEDICAL SOCIETY, Mr. WILBUR MILLS, Chairman, House Ways and Means Committee, DEAR SIR: Jefferson County, Ala., Medical Society, comprised of 661 physicians, wishes to place with the House Ways and Means Committee, this statement in opposition to H:R. 4222, otherwise known as the King bill, and is identical to S. 909, introduced by Senator Anderson. Our reasons for this opposition are many but briefly stated are these: (1) H.R. 4222 is not related to the need of persons over age 65 but would provide only for those covered by the social security program and without re gard to need. This would be further usurpation of family and individual responsibilities by government with attendant erosion of the moral fiber of our people. (2) The Kerr-Mills legislation providing for Federal-State matching funds for programs of health care to the needy patient over age 65 is adequate to meet the need. It allows health services for those over 65 who develop a need although not under social security, or even State or local welfare programs. (3) H.R. 4222 would necessitate additional increases in the social security tax rate already scheduled to reach 91⁄2 percent on the employer and employee by 1969, and undoubtedly would cause a raise in the taxable wage base. (4) The cost under H.R. 4222 would be enormous. As one example, the Health Insurance Association of America estimates that the nursing home program alone would cost $513.9 million a year to start and would triple within 10 years. It can be anticipated that H.R. 4222 would encourage many thousands of persons not actually in need of health services to insist on it as their right, as has been the result in England. This obviously would delay health services for those actually in need. (5) Voluntary insurance programs have made great progress in extending coverage to all Americans who need it and particularly progress has been made in programs for the over 65 citizen. It is our opinion and one we believe is shared by insurance experts, that the King-Anderson proposal would adversely affect the insurance industry which, after all, provides tax income which helps operate the Government. (6) We hold that care of the elderly is primarily a family concern and to remove this responsibility is to weaken the family structure of our society. When families are no longer able to aid its members, the problem then is one of community concern, then of State and lastly of Federal concern. (7) We contend that health care needs of the elderly are being met largely on a local basis in Alabama with some State-Federal assistance. This, we feel, is the proper relationship for the welfare of the public and our democratic system of government. Local physicians give about $3,300 worth of charity service each annually in their offices and in the public clinics. They make no charge for this charity service. Local government in Jefferson County now is providing around $3 million a year for health services to the sick-poor. Alabama already has in operation a medical care program for the elderly under the Kerr-Mills Act. Some 728 received hospital and nursing home care amounting to $112,502 in May 1961. The current session of the State legislature is expected to provide additional funds to expand this program. Also, it should be noted that State welfare payments have been raised from $38 a month to $60 and are expected to reach $75 shortly. (8) We take specific exception to the provision in the King bill which states that nothing in this title shall be construed to authorize any Federal officer or employee to exercise any supervision or control over the practice of medicine or the manner in which medical services are provided, "Except as otherwise specifically provided." (9) We believe that to inject Government even further into health care via the King bill than it is already, would jeopardize the close physician-patient relationship which has been an important basis for the high quality of medical care this Nation enjoys. For these reasons, therefore, we strongly urge that the House Ways and Means Committee oppose H.R. 4222 which action we believe sincerely would be in the best interest of the public, members of the modern health team and of our democratic system of government. Yours sincerely, S. BURFORD WORD, M.D., President. STATEMENT ON MEDICAL CARE OF THE AGED BY THE NAUGATUCK VALLEY MEDICAL SOCIETY OF CONNECTICUT In an atmosphere of freedom and private initiative, the doctors of America are providing our senior citizens with the best medical care available anywhere in the world. When treatment in a modern community hospital is required, the cost of this hospitalization is often high and some of our senior citizens de finitely need financial help in meeting these hospital costs. To help those who need financial aid, the Naugatuck Valley Medical Society endorses the use of the Kerr-Mills legislation, Public Law 86-778. This law provides Federal grants out of geenral tax funds to each of the States to finance the hospitalization and medical care of those elderly citizens who need help. This legislation is determined locally, administered locally, and is responsive to the special needs of local citizens. A social security method has been proposed, the King-Anderson bill, H.R. 4222. From 1957 to 1959 the social security fund had a net operating loss of over $20 billion ($2,378 million). The social security tax on the first $4,800 of income is scheduled to increase to 9 percent by 1969. However, it has already been necessary this year to consider revising the tax rate with an immediate increase in both the percentage and the amount. Present commitments alone could eventually require a 15 percent taxation on the first $10,000 of income under the social security tax program. A wide-sweeping medical care program to include all the elderly citizens regardless of need would immediately require still another addition to the tax and this would be increased each year. A worker of 21, therefore, would pay these increasing taxes for hospital care for all the aged regardless of their need for at least 41 more years before he himself retires. The NVMS opposes the social security method. The society opposes it because of the unrealistic financial burdens it would place on the taxpayer, and because it feels that medical care and all other needs of our citizens should be provided only for those who need financial help. The most critical issue, however, is whether or not the patient, doctor, and hospital will be socialized. Today, the Government has a firm hand in much of that which our citizens do. The Socialist Party of America supports the proposed social security legislation. This is the beginning of the socialized medicine for which they have been working. If passed, the Federal Government will begin to enter the doctor-patient relationship and influence the kind of care patients will receive according to bureaucratic rather than medical standards. Free choice of physician and hospital with its personal, private, and confidential benefits will eventually be lost. In effect, the choice is between voluntary enterprise and Government planning. The voluntary method has been most successful. To entertain Government planning would be unwise. Because of its lower cost, local administration, and its provision of help to only those but definitely all of those who need help, the Kerr-Mills legislation, Public Law 86-778 for medical care of the aged is supported by the medical society. The King social security bill is opposed because it represents a higher and unneeded cost and because it is the initial step in the socialization of health care, which the Naugatuck Valley Medical Society believes would lead to poorer medical care at greater expense to the taxpayer. COWETA COUNTY MEDICAL SOCIETY, Hon. WILBUR MILLS, M.C., Chairman, Committee on Ways and Means, 1102 House Office Building, Washington, D.C. DEAR MR. CHAIRMAN: This testimony is presented in behalf of the Coweta County Medical Society, Newnan, Ga. The Coweta County Medical Society is composed of 17 physicians engaged actively in the practice of medicine in Coweta County. This county is a partially industrialized, primarily rural political division in northwest Georgia. Its population is approximately 32,000. All physicians practicing in this county are active members of the county medical society. The membership includes eight general practitioners, two otorhinolaryngologists, one general surgeon, two obstetrician-gynecologists, two internists, and two pediatricians. Eight of these physicians are enaged in group practice. The Coweta County Medical Society was founded in 1882. Accomplishments in behalf of community well-being by the medical society as a group have centered largely about (1) hospital construction and operation, (2) public health programs, and (3) maintenance of a high order of professional and ethical competence among its members. Since the early part of this century, the Coweta County Medical Society has been active, often as the vis a tergo, in movements for new hospital construction. The most recent example of this is the society's active and vocal influence on local civic forces which resulted in the construction of the Coweta General Hospital to be opened in March of 1962. In the second regard, the society has never failed to answer the requests of the local |