or State health departments in communicable disease control and often has sponsored of its own volition such projects as polio vaccination clinics. In regard to the currently widespread discussions on the medical needs of the elderly, the Coweta County Medical Society feels that its membership is the most qualified (indeed, the only qualified) group to know the medical needs of the aged ill of Coweta County, Ga., and that we are the only group capable of understanding the infinitely complex problems involved in satisfying these needs. We, therefore, feel justified in presenting the following testimony. We can offer no valid set of statistics as to the per capita income of Coweta County citizens over the age of 65. In this county such figures have very little pertinence to the amount or quality of medical care these aged-ill persons receive. In this part of the benighted South the family unit is still largely intact. Our people still hold to the curious 19th century notion that children have the primary responsibility for indigent and/or ailing parents. It is a rarity to encounter an aged indigent for whom there is no child to assume responsibility for medical costs. There are, of course, exceptions. We feel that medical care for these exceptions is adequately handled at the present time by county (Coweta County hospital authority) subsidy of the Newnan Hospital or by budget adjustments of the Newnan Hospital, an essentially eleemosynary institution. In 1960 over $200.000 was spent by these two agencies for hospital care of the indigent. Approximately 50 percent of these funds were spent in the care of indigent persons over the age of 55. Free medical care afforded by physicians (as a purely individual service) cannot be assessed because no effort on our part has ever been made to advertise these facts. When budget appropriations are made by the State of Georgia to secure funds under the Kerr-Mills Act, the problem of availability of medical care to Coweta County's indigent-ill oldsters will be virtually nonexistent. The membership of the Coweta County Medical Society realizes the Hebraic injunction to children regarding honor due parents is less heeded in the more enlightened parts of the United States where a more progressive society is in step with history and demands social reforms. We further realize that special local problems such changes in traditional attiudes and family organization have produced required special (local, we would hope) solutions. Inasmuch as our Victorian situation in this regard provides our oldsters not only with medical attention but also values they need a great deal more, respect, affection, a place, we prefer that New York City, Detroit, Los Angeles, and so forth, solve their aged-ill problems in their way and that we be allowed to solve ours in our way. The membership of the Coweta County Medical Society has read in toto S. 909, 87th Congress, equivalent of H.R. 4222. We find that the text of this legislative proposal contains numerous contradictions to its vital opening thesis: "*** 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 or over the selection, tenure, compensation, or any officer or employer of any hospital, skilled nursing facilities, or home-help agency, or, except as otherwise specifically provided to exercise any supervision or control over the administration or operation of any such hospital facility or agency." We call special attention to section 1603, paragraph A. subparagraph 4: to section 1606, paragraph A. subparagraphs 5 and 7; section 1606, paragraph B, subparagraph 2, 6, and 8: section 1606, paragraphs E and F; section 1609, paragraph A, subparagraph 1, and same section. paragraph B. Anyone who has ever had any but the most casual experience with the operation of institutions for the care of the ill immediately recognizes that the provisions cited above effectively insure thoroughgoing Federal control of any cooperating institutions. It is not difficult to control the practice of medicine: Any hospital tissue committee or records committee know this. Under the cited provisions of this proposed legislation, it is preposterous to state that the bill does not authorize any Federal control over the practice of medicine or the manner in which medical services are provided. It is even more preposterous to state (as has been done repeatedly by proponents of this and similar legislation) that this bill will not involve physicians themselves. In summary, the Coweta County Medical Society submits the following items of testimony: (1) There is no significant lack of medical care for the older citizens of Coweta County, Ga. (2) For at least three decades, the medical profession, the local city, and county governments, and society at large have provided adequately for the indigent aged ill. (3) Any default in provision of adequate medical care for our aged ill that has escaped the attention of the agencies cited above or that will arise in the future can be more than adequately dealt with under the provisions of the KerrMills Act. (4) The membership of our society has read and studied the provisions of the so-called Anderson-King bill, and we find its provisions in direct contradiction to its own section 1601. Further we are especially alarmed by the closing section of the companion title IV, section 402, as promise of further Federal encroachment upon a domain which we know from years of personal experience represents one of the most private and intimate relationships between individuals. Respectfully submitted. ERNEST E. PROCTOR, Secretary, Coweta County Medical Society. FLOYD COUNTY MEDICAL SOCIETY, Rome, Ga. The undersigned identifies himself as a practicing physician in the specialty field of obstetrics and gynecology certified by the American Board of Obstetrics and Gynecology and holding membership in the Floyd County Medical Society, Georgia Medical Association, American Medical Association, Georgia State OB-GYN Society, Southeastern OB-GYN Society and American College of Obstetricians and Gynecologists. I am currently serving as president of the Floyd County Medical Society, an organization of some 57 physicians who practice in Rome and Floyd County and whose purpose is the assurance to the lay public of ethical medical protection through the stimulation of high standards of quality in the medicine practiced in this community. The relationship between the lay public and medical profession in this community and trade area of approximately 85,000 people has been excellent and each group has shown great respect for the other. The society has as one of its aims the assurance of the people of this area having readily available medical care regardless of background. It has the responsibility of staffing the emergency call rotation at the hospitals and indigent clinics for the county in which all needy patients, regardless of age, are seen and cared for without limit and without restriction. The Floyd County Medical Society would like to voice unanimous and serious objection to the legislation now before your committee, H.R. 4222 (King bill). Our obpections are based on what we feel to be logical fact and are enumerated for your consideration: (1) The bill would remove the voluntary aspect of health insurance and thus prevent freedom of choice and free enterprise from this area. (2) The bill would be available to only those aged persons who are eligible for social security and leave unprotected those who are not. (3) The King bill would definitely lower the caliber of medicine practiced because it would be under the jurisdiction of Federal control, a control which would dictate the procedures and treatments to be carried out and the institutions in which they could be carried out. (4) The King bill would be extremely costly in that social security taxesalready scheduled to become 9 percent of payroll in the years ahead-would have to be further increased, and it would necessitate the creation of a vast new bureacratic task force to supervise this workings from Washington, D.C. (5) The King bill indicates to us a mere beginning toward completely socialization of medicine because we feel that when this compulsory insurance for the aged is implemented it will be gradually expanded to include all age groups. (6) The legislation before the committee is not necessary because the KerrMills bill enacted last year and already being implemented in 46 States is sounder and more desirable than the present bill being considered. The medical profession favors the Kerr-Mills bill because: (a) It would preserve the quality of medicine by maintaining the present freedom of patients to choose their physician, and freedom of doctors to treat his patient as he sees fit. (b) The medical benefits afforded by the bill would be unlimited and be applicable to all persons in the age group, not just those eligible for social security. (c) It affords the individual the opportunity to continue in a voluntary health insurance program. (d) It avoids the waste of tax dollars. (e) It is administered from a State or local level rather than from the Federal or national level. 76123-61-pt. 4——27 We, of the Floyd County Medical Society, are heartily in favor of the people of our area and those of the State and the Nation continuing to get the medical care which they need and want. We feel that those who can pay for this care should do so, and those who cannot should be able to get it through assistance. We favor the assistance being given not as proposed by the King bill, but through the Kerr-Mills bill which is already enacted and maintains the important features and rights as enumerated above. Thank you for your kind consideration of this statement of our testimony. August 1, 1961. JOY CHAMBERS, Notary Public, Floyd County, Go. STATEMENT BY J. G. MCDANIEL, M.D., PRESIDENT, FULTON COUNTY MEDICAL SOCIETY, FULTON COUNTY, Ga. Mr. Chairman, I am Dr. J. G. McDaniel, a practicing physician in Atlanta, Ga. I am past chairman of the council of the Medical Association of Georgia and currently it is my honor to serve as president of the Fulton County (Atlanta) Medical Society. The Fulton County Medical Society, representing over 900 doctors of medicine. is vigorously opposed to the enactment of H.R. 4222. It is equally opposed to the philosophic concept on which the bill is based. The doctors in the Atlanta area, and I feel certain that this would be the case over the entire State, regard any bill which attempts to legislate preferred status to a single segment of the population is pernicious and destructive on its face. This bill would restrict the benefits it proposes to administer to those persons covered by title II of the Social Security Act and to those covered by the Railroad Retirement Act. In so doing this, it seems to make an arbitrary assumption that these are the people who need help in meeting the costs of certain specified but limited health needs. Such an assumption has no basis in fact. The very people which this bill proposes to subsidize are the ones least in need of help. In Georgia, we have approximately 290,000 persons over age 65 and, of this number, approximately one-third are classified as financially indigent, that is. they are presently on the relief rolls of the welfare agencies. These people are not covered by social security and it should seem obvious to anyone seeking the truth in this matter that these are the people who actually need help. We feel that across-the-board medical assistance to all recipients of benefits under the Social Security Act and the Railroad Retirement Act, regardless of need, constitutes a dangerous precedent and could threaten the total collapse of continued high-quality medical and hospital care in this country. We believe that a locally administered health care program, such as would be possible under the Kerr-Mills law, provides the best solution to the problem. It will provide complete medical care on the basis of need as opposed to providing less medical care on an indiscriminate across-the-board basis, without regard to the ability or willingness of the great majority of our people to provide for themselves such medical care as they may require. It is our belief that the Federal Government should be restricted to those things which the States and the people cannot do for themselves and the proponents of H.R. 4222 have failed to demonstrate that the States and the people are unwilling or incapable of handling their own health needs. In addition to this, it is our firmly held conviction that such legislation as H.R. 4222 represents a real and present threat to the quality of medical care in this country. We are further of the opinion that the enactment of this bill would merely be the beginning of a program the very nature of which must be expanded from time to time. For if age alone, rather than need, is to be the criteria by which an individual becomes eligible for benefits, then we submit that there can be no logical argument made against the extension of this program to include groups other than the over-age-65 group. This bill, in the opinion of the physicians I have the privilege to represent, is an unwarranted intrusion into a sphere of human problems that can more expeditiously and less costly be handled on the State and local level. The practice of medicine is and should be an intimate and personal thing. It does not lend it. self to inflexible control. Each case must be treated separately and the physician must be free to vary appropriate treatments to fit the requirements of the individual case. In the opinion of the Fulton County Medical Society, the enactment of this bill would be the forerunner of legislation so entangled in bureaucratic regulations and controls as to make it exceedingly difficult for a doctor to have the freedom which he must have if the quality of medicine is to remain at its present high level. It matters not that this bill piously 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 service is provided. What is important is the fact that it is not possible to guarantee in this bill or any other bill that such supervision and control by Federal officers and employees may not be written into the program at a later date. Indeed, if we are to judge the future by the past, then such regulations will inevitably become a part of any program to render medical assistance under social security. The doctors in Fulton County and indeed the people also have long been active in seeking the best possible medical and hospital care for those people who cannot afford the cost of these services. As an index of the extent to which medical assistance to the indigent of all ages is being given in Fulton (Georgia) County, let me call to the attention of the committee these statistics furnished by the assistant hospital administrator for the Grady Memorial Hospital in Atlanta. In 1960, this tax-supported hospital carried 27,215 admissions for inpatient care. At its clinic there were 470,143 visits by persons seeking treatment on an outpatient basis. Essentially, Grady Memorial Hospital is operated for the care of indigent persons over age 65 as well as under age 65. The above figures include a small percentage of emergency cases which are not indigent; however, by and large, this hospital in Atlanta is operated for the care and treatment of those persons who cannot afford to pay for their own medical and hospital care. The Fulton County Medical Society sincerely and thoughtfully believes that this bill is not in the best interests of the very people it proposes to help. We cannot reconcile what is apparently two opposing aspects of this legislation. These are (1) the cost of hospital and nursing care is such as to impose an everpresent threat to the financial security of people in low- and moderate-income brackets, and (2) the bill would subject 100 percent of the income of those persons making $5,000 and less per year to increased social security and selfemployed taxation. It would appear then that the major burden of supporting this program would fall on the shoulders of those people whose income might logically be the reason for this program in the first place. In conclusion let me reiterate the unyielding opposition of the Fulton County Medical Society to the enactment of this bill. Compulsory health insurance is an alien concept and we urge total rejection of H.R. 4222 by the members of this committee. DALTON, GA., July 31, 1961. LEO H. IRWIN, Chief Counsel, Committee on Ways and Means, DEAR SIR: Please include this statement in the written testimony in opposition to H.R. 4222 (King bill). I am Paul L. Bradley, president, Whitfield County Medical Society and have been asked to speak for the 30 members that I represent. This society is more than 40 years old and the main purpose is to maintain a high standard of medical practice in this community. To this end we have participated in local health activities, such as conducting mass polio immunization program with volunteer physicians serving in this capacity. We have staffed and maintained active for many years the Judd Memorial Cancer Clinic for indigent patients. In this service patients with neoplastic disease who are indigent receive the best possible care without charge, including hospitalization, surgery, and X-ray therapy. For the past 6 years we have staffed and maintained a cardiac clinic for care of indigent patients in this category. The hospital receives funds from the city and county that defrays cost of hospitalization of patients not covered under the above two services. Members of the Whitfield County Medical Society have actively supported the Kerr-Mills bill, which is now in the process of being activated by the State of Georgia. We are anxiously awaiting the activation of this law as we feel that this will certainly be entirely adequate to take care of all our needs of indigent medical care of the aged. We now have two fine nursing homes available in Whitfield County that are doing a splendid job of skilled nursing-home care. The one great defect in the King bill (H.R. 4222), is forcing prepaid medical care (to a somewhat limited degree) on people receiving social security bene fits that are in no way needy. It would appear that forcing charity on those who have no need of it is more degrading than requiring a "pauper's oath" of truly indigent patients. After all, the VA has required a "pauper's oath" to be signed for years and I have never heard a complaint against this procedure being required by the VA. In conclusion I would like to very strongly recommend that the Kerr-Mills legislation be given a chance to do the job. I feel confident that once this is allowed, such broad coverage legislation as H.R. 4222 (King bill) will be obviously unnecessary. Sincerely, PAUL L. BRADLEY, M.D., President, Whitfield County Medical Society. CONGRESS OF THE UNITED STATES, HOUSE OF REPRESENTATIVES, Washington, D.C., August 4, 1961. In re hearing on H.R. 4222. Chairman, Committee on Ways and Means, DEAR MR. CHAIRMAN: On behalf of the Illinois State Medical Society, I am submitting herewith for inclusion in the record of the hearing on the bill H.R. 4222 copy of the statement of Du Page County Medical Society in opposition thereto. I shall sincerely appreciate it if you will have the enclosed statement included in the printed hearing on this legislation. Thanking you for your many courtesies and with best personal wishes, I am, Sincerely yours, ELMER J. HOFFMAN, STATEMENT OF THE DU PAGE COUNTY MEDICAL SOCIETY IN OPPOSITION TO H.R. 4222 Du Page County is a suburban and rural area with a population in excess of 320,000 and the membership in our medical society numbers 203 practicing physicians. Our society has made a study of the medical care for the aged and finds that there is no need in our area for any additional Federal aid. We emphasize that private and local agencies now are adequately meeting the medical requirements of needy citizens of all ages. I. THE EXTENT OF NEED FOR LEGISLATION ON THIS SUBJECT A. The character and nature of the basic medical-care requirements for persons aged 65 and over and whether or not these are in any respect unique It is felt that the nature of the illnesses of older people will come largely under the following six categories: 1. Cardiovascular.-Illnesses in person over age 65 with respect to the cardiovascular systems will mainly involve heart disease which needs as treatment mostly restriction of salt and activity, plus a few simple drugs such as digitalis and diuretics. These are mostly inexpensive, and the vast majority of this treatment can be done on an outpatient basis. Secondly, heart attacks which may require hospitalization or nursing home care, followed by effective outpatient care, possibly including anticoagulant treatment. Thirdly, cerebrovascular acidents or strokes are very common ailments, some of which are |