The cost of these existing programs is small compared to the estimated cost of proposed Government health plans. (10) We favor in addition to continued implementation of the Kerr-Mills law by the States new legislation providing additional tax incentives for people to purchase health insurance and medical services. This would cost the Government far less than the proposed medical plan and in addition stimulate individual initiative, and private enterprise rather than stifle it. (11) Compulsory taxes to pay for unneeded assistance for medical care costs is socialized medicine for that segment of the population covered and is admittedly a "foot in the door" approach to increased and eventually universal coverage. (12) Continued increase in social security taxes on the present and future workers to cover unearned benefits added to those already retired is inequitable and must threaten the stability of the entire social security system. The cost of the unearned benefits given to those already retired can never be wiped out without increasing the tax to a considerable degree or to dip into the general revenues. (13) The King-Anderson proposal would encourage those seeking medical services to request hospitalization to avail themselves of free laboratory and X-ray services and as a necessary step in entering a nursing home or getting home care services under the proposed program. The only logical resolution of this expensive dilemma would be to include the outpatient services under the program. When people learn that they must pay the first $10 of costs each day for the first 9 days of hospitalization and the fees of their surgeon, physician, and private duty nurse as proposed they will demand fuller coverage. (14) The study made in the Danville area indicates that the senior citizens ability to purchase medical services is as good if not better than other age groups. Therefore, free medical care would make an inequity in favor of this group. Since other age groups also have great problems there would soon be a clamor to remove this inequity which favors the well off retired and cover everyone regardless of age. (15) Although the King-Anderson proposal has been called an experiment in medical care plans what Congressman would dare to vote for the repeal of such a program once started? It could only be expanded indefinitely and the payrolls of future workers mortgaged to pay for the unearned benefits without their consent. (16) The Federal Government or any government must control what it finances in order to protect the taxpayers dollar. Certain controls are written into the proposal and more would inevitably be added with the program in operation and as the coverage was expanded. (17) The proposed legislation has been called a prepaid health insurance plan. The fact that social security is not insurance should be obvious to anyone who understands the true mechanism of financing the system, which has been and always will be a "collect the taxes when needed to pay benefits" plan. The Social Security Administration itself has declared that its funds are not collected and disbursed on the insurance principle but on the welfare principle. (18) Judging from public meetings and local and regional newspaper editorials, there is a great and growing awareness and concern regarding the implications of our increasingly federally controlled economy. In conclusion on the basis of our experience and our situation in Vermilion County, on data available or published, and studies made by our society members, we strongly urge that the House Committee on Ways and Means disapprove H.R. 4222. STATEMENT OF THE JEFFERSON COUNTY MEDICAL SOCIETY, LOUISVILLE, KY., IN OPPOSITION TO H.R. 4222 Mr. Chairman and gentleman of the House Ways and Means Committee, I am Dr. Homer B. Martin of Louisville, Ky., a physician in general practice, and am representing the views of the Jefferson County Medical Society, of which I am first vice president. We are grateful to be permitted to express our sentiments here since we are a group, comprising one-third of Kentucky's practicing physicians, whose position in this vital matter compels us to speak. We feel qualified to express these "grassroots opinions" as we are daily caring for these aged individuals and their problems. In my own practice, one out of six persons treated is past the age of 60. Kentucky, long a keystone of American medicine, as recently as 1910 graduated one-third of all the doctors in the entire United States. We are representative economically as well since our State's citizens range from those who are the most prosperous to those who have the least of life's offerings. SURVEYS ON MEDICAL CARE Like many who are interested in this topic, we find ourselves confused at times by the sheer weight of the many dependable surveys that we must pause to avoid faulty conclusions based on mere numbers. As important and necessary as these studies are, we must keep in mind that we are dealing with human beings and not cold statistics. We must not be overwhelmed by figures since, in no instance. does a mathematical equation invariably solve a human problem. These many surveys have measured the needs of the married and unmarried, the aged and the young, the employed and the unemployed, the rich and the poor, the rural and the urban, those living with families and alone, and so on ad infinitum. However, the problem is simply one of whether there is a need, the extent of the need, and a solution, if it does not already have a solution. There is common agreement, among all knowing people, that the elderly con stitute the fastest growing segment of our population. Further, a careful medical examination would show some physical defects in all these oldsters since, in the inevitable march of time in aging, the natural faculties fade and defects become apparent in the heart or blood vessels, in the eyes or ears or elsewhere. Increased health needs may come at a time in life when the individual is usually less able to be employed and therefore has a decline in income and the burden seems to increase due to these factors: the very sick are frequently the poorest and therefore the least likely to have made provisions for illness during their more productive years. Experience indicates that a small percentage of families require the lion's share of welfare programs. Similarly, a small percentage of individuals in poor health consume a major portion of the medical care in all age categories among the elderly. PRESENT PROGRAMS IN KENTUCKY All programs in Kentucky, prior to 1960, were on a local level with no appropriations on a statewide basis for medical purposes. However, other programs were in force to assist those in need. The needy children and adults in our county who become sick are served by a pediatric and general hospital having a bed space of approximately 600 beds. Over 500 persons are treated there as outpatients daily. The best possible quality of medical care is rendered to these patients by the physician teachers of our medical school and physicians of our community who contribute their services. The budget of these institutions, along with varied social and medical services, is supported by taxation and charitable gifts. Furthermore, in our county of one-half million individuals, there are 10 private hospitals, all of which serve charity patients. I will not enumerate the varied services available to those in need in this report but only indicate the scope of these activities which are promoted through the voluntary efforts of the entire community. Nearly $ million is contributed each year in our county to sustain the operation of our medical programs. The Kerr-Mills law, recently enacted, now provides our near-needy aged the same benefits of other private patients. Many of our career social workers, along with others who are essential to the program, have expressed their confidence in the potentials of this program. The growth in understanding, patient utilization, and service benefits under the Kerr-Mills law in the short time it has been in effect demonstrates the practical applications of this law. Along with other States we are, at present, endeavoring to improve the administrative element of this program. Although Kentucky does not rank as one of the wealthiest of States, we have assumed our responsibilities by providing the highest quality of medical care for all persons in need, keeping uppermost the dignity of the individual recipient. A great addition to our State's program this year has been the creation of the new University of Kentucky Medical Center. OUR POSITION ON H.R. 4222 Unless an affirmative answer can be unequivocally made to each of the following questions, then the Congress should not adopt a social security linked medical program. Current surveys provide the basis for our answers. Question 1: Are there enough needy aged to justify this broad program? Answer: We believe that the medically indigent may be found in one-tenth of our county's population. The working population should not have to bear tremendous expense necessary to provide the remaining nine-tenths with unnecessary and uncalled-for facilities. Question 2: Do the elderly feel present care inadequate? Answer: The overwhelming majority of the elderly have repeatedly expressed satisfaction that their own needs are being met (Youmans, Shanas et al). Question 3: With present programs in operation for the needy, will creating a new medical program be economically and logically justified? Answer: The social security system administers cash benefits. To create a new medical administration within social security would be an unnecessary duplication of this service provided by the Kerr-Mills apparatus. Question 4: On the basis of future needs, is there adequate justification for radical innovations? Answer: Future generations of older citizens will reflect educational advances as well as financial planning for old age sufficient to reduce substantially the percentage of needy and near-needy. Question 5: Is it correct or fair to refer to the provisions of H.R. 4222 as being like Blue Cross insurance? Answer: It is incorrect to speak of a payroll tax increase as insurance of any type. Question 6. Does governmental medicine increase the number of doctors? Answer. The United States, with 1 doctor for 750 people, is the only country improving the doctor-to-population ratio. Incentive and freedom from control can maintain this improvement. In England, the 1 doctor to 877 persons declined to 1 per 1,149 between the years of 1947 and 1957 (the decade of national health service). Question 7. Will this medical program improve or even maintain present quality of medical care? Answer. Experience shows paid-for medical care encourages overutilization. Since general physicians will inherit this increased workload, along with the necessary recordkeeping over and above his present hours, medical care will necessarily deteriorate. Time required to stay abreast of modern medicine will beencroached upon, and progress will falter so far as the individual patient is concerned. Question 8. Has Kerr-Mills been adequately tried? Answer. All involved legislation requires changes which come with experience. The Social Security Act was passed with the full understanding that it would require improvement with practice. The Kerr-Mills law was conceived by this committee, based on sound principle, to meet actual need and deserves a fair trial. Question 9. Will H.R. 4222 permit the growth of private insurance and incentive for individual protection? Answer. Discovery of the true health picture of the elderly population has effected many new concepts in medical insurance. The removal of personal responsibility in the late years would promote an air of apathy toward insurance in the healthy, lower risk years. Question 10. Is it logical to assume the present limits of H.R. 4222 designate its ultimate extent? Answer. The inevitable progression of any broad-scale social program toward expansion. We are certain the most sincere advocates of those proposals would admit its ultimate extent cannot be determined at this time. Without the assurance of reasonable limitations, can we subscribe to a foreign concept of medical care? SUMMING UP I would like to iterate that the overwhelming majority of older people, in all dependable surveys, can well afford adequate care and are satisfied with the present system of care. The have felt no need to change from the system which has worked well since our democracy arose as a new form of government. As a physician in general practice who spends his time with patients in their homes, in my office, and in hospitals and nursing homes, and who must spend the evenings in study to keep abreast of the rapid progress in medicine, I must admit that I am doing every bit of work which I can accept in all good conscience. This proposed legislation will impose an increased patient load with the necessary paperwork to such a degree that it will be a physical impossibility to render first-class service to all of my patients. I look to you, as members of a committee which traditionally handles the most complex problems of the 76123-61-pt. 4-28 American people, to see that the highest quality care remains a standard in the United States. (The following statement was filed with the committee by Hon. Eugene J. McCarthy, a Senator, and Hon. John A. Blatnik, and Hon. Walter H. Judd, Hon. Odin Langen, and Hon. Ancher Nelsen, Representatives, in the Congress from the State of Minnesota :) To Whom It May Concern: HENNEPIN COUNTY MEDICAL SOCIETY, The officers and members of the Hennepin County Medical Society-some 1,200 in number-wish to express their individual and collective condemnation of the proposals contained in H.R. 4222 and any and all amendments thereto. Our objections to this proposed legislation are founded on the belief that those individuals financially able to provide for the cost of health care, without undue hardship upon themselves or their dependents, should be required to do so. It is not the responsibility of a benevolent Government, at any level, to provide for its citizens those necessities of life which they are well able to acquire for themselves. Upon the shoulders of those engaged in the practice of medicine rests the continuing responsibility of rendering needed health services, at fair and reasonable fees, within the ability of the patients to pay without undue hardship: to stimulate Blue Cross, Blue Shield, and the insurance industry to offer broad programs of hospital and medical coverage, at attractive premiums and without regard to limitations as to the ages of the applicants. A commitment from the members of the medical profession expressing a willingness to accept drastically reduced fees, in caring for the aged insured under such plans, would enable the insurance industry to offer broad coverage and low premiums. The health services now available to beneficiaries, under the five categories of eligibility administered through the Minnesota Division of Social Welfare and the respective county welfare boards, sets a pattern of health care for the needy which might well be followed by other States throughout our Nation. Old-age assistance, aid to dependent children, aid to the blind, aid to the disabled, and child welfare services are the five classifications referred to. This is a program generous in its coverage and completely adequate to the need, providing hospital, nursing home, and/or boarding home care, without limitation. so long as the need for same has been medically established by the physician of their choice. The provisions of the Kerr-Mills legislation-which this society supported— broadens the base of the old-age assistance and other programs; it embraces more people and places the responsibility of financing and administering such legislation where it belongs. H.R. 4222 acts on the false assumption that a certain class of citizens (those eligible for social security benefits) because of age are financially unable to provide themselves with necessary health services, at their own expense; that this, therefore, should become the responsibility of the Federal Government. The astronomical costs of such wasteful and unqualified expenditures would be an additional burden upon the taxpayer. H.R. 4222 proposes to provide certain items of "skilled nursing home services," "home health services," "outpatient hospital diagnostic services," and other units of ancillary care without application of a “means test” and without knowledge that the health resources of each community are adequate to fulfill these promises and provide the services, in whole or in part, which a benevolent Government offers in H.R. 4222. H.R. 4222 deprives the American citizen of his right and privileges as a freeman-to be self-sustaining, self-reliant, and independent. By virtue of his age, and his contributions to social security, he becomes a ward of the Federal Government, without resources, and unable to pay for necessary health care. BOARD OF DIRECTORS AND MEMBERSHIP AT LARGE. STATEMENT OF CHARLES MILLER, M.D., SECRETARY, ST. LOUIS COUNTY MEDICAL SOCIETY, KIRKWOOD, MO. Mr. Chairman and gentlemen, I thank you for the opportunity to appear here today to discuss H.R. 4222. I am Dr. Charles Miller, Jr., of Kirkwood in St. Louis County, Mo. I am in the private practice of medicine in Kirkwood, Mo. I am secretary of the St. Louis County Medical Society and chairman of the past-65 committee of that organization. I have taken time from my practice in the hope that the information which I have accumulated in my work with the aged will be of value in assuring my own aging patients and those of future generations the best possible medical care. It is the broad purpose of the Missouri State Medical Association to promote good health care for all persons in the State of Missouri, both young and old. Specifically, the past-65 committee of the St. Louis County Medical Society of which I am chairman was organized as an experiment in providing care in the office of private physicians for elderly persons of limited income. The program works something like this: Any patient past 65 years of age in our community may consult his physician concerning the cost of his medical care. Through this conversation the physician may be able to determine the percentage of the usual medical fee which an elderly patient should be able to afford to pay by consulting cost charts which are supplied by our committee. If a physician cannot readily determine the need of an elderly person or if there is reason to believe that the answers which he has obtained are not correct, he may refer this person to a specially trained interviewer who will give a more extensive interview and determine the need of the individual for reduced fees. In either case, once our committee has determined the need of the individual, a card is issued to the person which entitles him to a percentage reduction from the usual fee in the office of any participating physician. At this time we have approximately 400 physicians in St. Louis County, Mo., participating in this program and through a single screening operation a patient may receive all manner of specialized types of medical care at fees tailored to meet his own needs. Interviewing a patient to fit the fee to his income is neither unique nor need it be embarassing. Among the many ministers whom I have taken care of in years gone by, I have never had an objection to the charity which has been proferred. Throughout our land millions of persons pass similar screening tests in order to qualify for full coverage under Blue Shield programs which provide full service benefits for families with limited incomes. People who are closely associated with these programs tell me that there is no problem in obtaining the necessary information to see that persons qualify. In this case we have found in our past 65 program no evidences of embarassment or reluctance to apply. We have obtained a certain amount of unique experience in the handling of the problems of the aged and in learning about their true financial situation through our program. Incidentally, the program has been given wide publicity in our area including news releases, editorials, television interviews, and radio commentaries. Announcements have been made through Golden Age Clubs in our area concerning the program. Recently the Sunday picture supplement of our largest St. Louis newspaper described our plan. There has been widespread enthusiasm among both senior citizens and others in our community and yet, curiously enough, the actual use of the plan has been small. In my own practice I would conservatively estimate that I serve some 400 persons or more in this age group. I have discussed the problem of meeting medical bills with patient after patient in the past-65 age group and almost universally the answer has been, "Your program is a wonderful thing. I have always wondered what I would do if I had a really large medical bill. Since I haven't had one, I really have no need of help." To date, in my practice, 12 patients have applied for reduced fees. Ten patients have been accepted and given reduced fees and 2 have been rejected. In the overall committee experience, we have found that 60 percent of those persons who have applied for reduced fees are covered by hospitalization insurance. I am sure that the percentage in the general population past 65 in our community is much higher. I am sure you will be interested in knowing that our own com |