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PICKAWAY COUNTY MEDICAL SOCIETY,
Circleville, Ohio.

DEAR MR. MILLS: The Pickaway County Medical Society may be small in numbers, however, in our love for our country, its freedoms and our profession we bow to no one.

The Governor of our State has tried to tell us we should use prescription blanks furnished by the State of Ohio in writing prescriptions for old-aged persioners. There is not a physician in Pickaway County that uses his approved prescription form with five copies. Also, the Governor has given us an approval list of drugs to use on these same patients. I hope you will bring this to the attention of your committee. Justice Robert H. Jackson's ruling on ÂÂÂ §preme Court case 1942, stated, "It is hardly lack of due process for the Government to regulate that which it subsidizes."

We further desire you and your committee to understand that we will never implement a Socialist-Communist system of nationalized medicine as long as we are free men, Mr. Cohen and Mr. Ribicoff notwithstanding.

We urge you and your committee to withhold approval of the King-Anderson bill.

Yours truly,

E. L. MONTGOMERY, M.D.,
Secretary-Treasurer.

STATEMENT OF WILLIAM A. BARRETT, M.D., PRESIDENT, ALLEGHANY COUNTY (PA.) MEDICAL SOCIETY

I am William A. Barrett, M.D., president of the Alleghany County Medical Society in Pennsylvania. The following thoughts are respectfully offered to the Committee on Ways and Means of the 87th Congress in opposition to H.R. 4222 known as the King-Anderson bill.

In Alleghany County and western Pennsylvania no need for this legisla tion exists. There are 156,344 people over age 65, of whom 76,461 are enrolled in Blue Cross and approximately 75 percent of these are enrolled in Blue Shield. increasing numbers in commercial insurance programs and pension arrange ments, and 7,200 per month are receiving help from the Pennsylvania Department of Public Assistance 39 percent of OAA are State funds and 61 percent are Federal funds. An additional 3,500 might be estimated as medically indigent. These, with Public Law 86-778 (Kerr-Mills) implemented in Pennsylvania by Governor Lawrence's signature on H. 1595 last week, will be adequately provided for.

Many older citizens are financially able to provide for their own care through voluntary prepayment commercial insurance plans, retirement programs, or through the help of relations. Rapid increases in the above figures, excepting those on public assistance, are gradually lessening the number of those needing outside help. Implementation of the Kerr-Mills provisions will properly care for the needy and medically indigent.

Since the present social security tax admittedly pays for current benefits to beneficiaries, we believe it is unfair to further tax the present labor force to provide through Federal Government medical, hospital, and nursing-home care for millions of citizens who already receive these through private sources and re

resources.

Increasing numbers of the industries are including hospital and medical care provisions with their retirement programs; some with individual conversion privileges and increasing numbers without changes in premium rates. In this manner workers actually provide for their own care during working years. The expansion of these programs will gradually but inevitably provide actuarily sound protection for the vast majority of our citizens in their retirement. Most importantly, it would (a) allow complete freedom of choice, and (b) inflict no additional tax burden or resultant inflationary spiral upon our people. Although older citizens do require more medical attention and longer hospitalizations than younger age brackets, yet their problems are not unique. They are afflicted with the same basic conditions that are seen in other groups. As groups, infants, small children, pregnant women, workers in high-accident-risk factory jobs, munition or radioactive metal workers, et cetera, all require some special care or attention, yet the problems in each group are basic to all. The absolute fact that good medical care must be individualized, as it is tailored for the above groups, eliminates those over 65 years from more than average atattention.

Present requirements in this area are now being met with the following: hospitals in Alleghany County:

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Of the 29 nonprofit hospitals in Alleghany County with a bed capacity of 8,009, there was an average census of 6,405. Since beds for emergencies, obstetrical cases, needed repairs, cleaning and other household requirements preclude a 100-percent occupancy, the actual usage of these facilities is quite high. The medical care program is being met by the traditional American system of free enterprise. Voluntarily, and in the finest tradition of the medical profession, every patient needing medical care reecived the best available, regardless of his ability to pay either the physician or the hospital. Fluctuations in employment and changing percentages of the different age groups are not factors, nor do they influence the fundamental principle that everyone does and will receive good medical care.

COSTS

The senior citizen Blue Shield program in Pennsylvania costs $1.83 per month for one person and $3.66 per month for those with one or more dependents and pays the participating physician 75 percent of the plan A (lower rate) fee schedule. The Blue Cross program costs $6 per month, and a special campaign was put on to try to reach all over 65 who had not been previously covered.

Public assistance funds have been inadequate for the ordinary living of those requiring help (3). In 1959, Pennsylvania paid $94.40 per aged male per month ($1,144.80 per year) and $140.65 per aged couple per month ($1,687.80 per year). The Social Security Administration (Bureau of Labor Statistics consumer expenditure data, August 1959) allows $183 per aged couple per month ($2,196 per year). The extent to which the studied aged were living with relatives, or other arrangements that make apparently low incomes adequate, were not determined.

Pennsylvania provisions for paying for medical care to those on public assistance includes $1.50 per office call or for treatment at a hospital clinic (paid to the clinic) and $2.50 for a house call by a private physician. An estimated 14 percent of OAA recipients used this service in a 6-month period of 1958. About 89 percent of the total were estimated to have had health problems during that period. These figures suggest that 75 percent of these older citizens on the State rolls are receiving their care (1) without charge by physicians and (2) through the payment for services by relatives.

None of the studies indicate a lack of physician or hospital care, nor the inability of patients to receive such services. The basic problem, as is so often true with many of us, is an insufficiency of dollars. With an adequate financial income, the patient can select his own care and pay for it. Therefore, a greater cash indemnity, not the purchase of services, such as the King-Anderson bill would do, would be best for the over age 65.

Our physicians are actively working at all hospitals in this area to insure good medical care to our people through (1) hospital accreditation requirements, (2) utilization committees, and (3) teaching programs.

Hospital accreditation requirements through the joint committee of the American Medical Association, the American College of Surgeons, and the American Hospital Association are zealously and strictly adhered to so as to provide our people with safe and efficient institutions in which to have their illnesses treated and at the lowest possible cost.

Staff physicians of these hospitals make up their own critical committees to safeguard patients and try to keep down the costs to patients and prepayment groups. These committees are:

(1) The tissue committee which passes upon each piece of human tissue removed at operation to assure our patients that correct diagnoses are being made in the vast majority of instances and that unnecessary surgery is not being done.

(2) The utilization (admission) committee determines the need for hospitalization, tends to prevent the overuse of hospital facilities, laboratory tests, et cetera. Their efforts are directed toward the proper utilization of all facilities for which patients and prepayment plans are paying with the view toward minimizing the cost and providing good care to more patients. (An explanatory "Guide" is enclosed.)

(3) The censors committee of four counties in western Pennsylvania-Alle gheny, Beaver, Lawrence, and Westmoreland-reviews the activities of the utilization committees in each of the 34 hospitals in this area. Their efforts are to insure proper functioning of the committees and correlation with hospital administrations.

The Allegheny County Medical Society Foundation has been chartered to administer funds in cooperation with the Hospital Council of Western Pennsyl vania so that adequate personnel, mechanical equipment, and cooperation can be developed to promote the proper and active functioning of utilization committees in this area. This project has been approved by the hospital council and the Hospital Planning Association of Allegheny County.

(4) The credential committee of the 10th councilor district of the Pennsyl vania Medical Society has a file on most of the physicians in the area which lists their training, specialty qualifications, hospital and teaching affiliations, and other pertinent information.

(5) The Blue Cross review committee, with a rotating membership from almost every hospital, reviews all hospital charts which have been questioned regarding proper utilization by patient, physician, Blue Cross, or hospital utilization committee. In the past 2 years, 6,150 charts have been reviewed by this committee; 1,652 were "A" cases of which Blue Cross accepted liability on 243, based upon this committee's judgment. Of the 4,498 "B" cases of questioned overstay which have been evaluated, 3,593 appeared to reflect proper use of facilities. In the cases in question, 905 letters of admonition have been written to physicians in charge.

(6) The health insurance review committee has, for the most part, considered cases presented by commercial insurance carriers when the question of overutilization, improper treatment, or excessive fees were presented. In 2 years, 131 cases were considered. Of these, 85 involved questionable fees. In those instances where a satisfactory solution of the problem was not arrived at following this committee's recommendation, the case was referred to the censors committee or the grievance committee.

The Insurance Council has been able to draw a circle around this area because of the lowered incidence of problems.

(7) The grievance committee is active in each component county society and handles local problems referred to it from the above committees, the board of directors of their society or the public.

All physicians are concerned about their patients' medical care and the seeondary factors which influence their recovery. Medicine and surgery are of prime consideration but stress factors exerted by family and financial problems greatly influence, favorably or unfavorably, the rate and completeness of that recovery. These factors necessarily must be evaluated by the doctor and he must honestly advise what he believes to be the course best suited and in the best interest of his patient.

Many proponents of the King-Anderson bill, and similar legislation, charge that physicians object because of personal reasons. This is not so. In the treatment of patients, the immediate need must receive primary consideration, but the ultimate goal and the long-range result must be paramount. The same consideration of medical care as regards quality and the ultimate effect upon the public health and the best interest of our country are the primary concern of our profession.

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In fighting for the freedom of medical practice, freedom of choice and free enterprise, physicians actually are trying to preserve the basic heritage of our people. Restrictions, limitations, and controls on medical practice would effectively control the patients-all of our citizens.

Therefore, as president of the Allegheny County Medical Society of approximately 2,000 physicians, I present this evidence and testimony in their behalf. The vast majority of our members are positively and unalterably opposed to a compulsory taxation of all workers, under the social security law, to provide Government controlled medical and hospital services to millions of people who are financially able to pay for their own care, either from cash resources or through some of the prepayment plans.

Our objection is not to the aged, since most of us care for many of them, but we do refute the need for this type of legislation and the methods it proposes to care for them. For centuries physicians have recognized and responded to the need. We are gravely concerned (1) about the compulsory methods by which proponents of the King-Anderson bill would attempt to meet such a need; (2) about the long-range deterioration of medical care which would inevitably result; (3) about the lack of challenge or personal satisfaction from a creditable job well done that such legislation would produce; (4) about the continued decline in the total number of physicians that the decreased incentive and increased controls would inevitably produce; (5) about the naivety of those who believe a fourth of 1 percent tax on a $5,000 income would pay for such a program; (6) about the inevitable control of hospitals and hospital care, facilities and medicines, hospital costs and construction, hospital accommodations, supplies and equipment, medical care and patients. We strongly object to a law that places control of medical, hospital, and nursing home care in the hands and at the whim of one individual-a nonmedical person. There is no word in H.R. 4222 that would prevent these things.

We highly commend the Congress for its wisdom in having passed the Public Law 86-778 and earnestly request that time be given to evaluatee its efficacy before plunging our economy and the future health of our peeople into a vast abyssmal unknown from which there could be no return.

In the name of our 2,000 members, of the Allegheny County Medical Society, I thank you for the privilege of submitting some of our views on H.R. 4222 for the Congressional Record.

WILLIAM A. BARRETT.

STATEMENT BY PASCAL F. LUCCHESI, M.D., PRESIDENT OF THE PHILADELPHIA COUNTY MEDICAL SOCIETY

I am Dr. Pascal F. Lucchesi, president of the Philadelphia County Medical Society. I am executive vice president and medical director of the Albert Einstein Medical Center in Philadelphia, and serve in an advisory capacity with several health and welfare agencies in the city of Philadelphia and the Commonwealth of Pennsylvania.

I would like first to say a few words about our society. The Philadelphia County Medical Society is made up of approximately 3,600 practicing physicians in the greater Philadelphia area. It was founded in 1849 to advance medical knowledge, to maintain high ethical standards among physicians, to protect the interests of its members, and to seek ways of making the profession more useful to the public.

Today, 112 years later, it still seeks the same objectives.

The Philadelphia County Medical Society maintains several vital services for the benefit of the Philadelphia community.

It provides an emergency medical service for persons who are unable to reach their own physicians in an emergency.

It maintains a professional relations and grievance committee to which patients or physicians may refer complaints or grievances with respect to alleged unethical or unprofessional conduct or disputes over professional fees.

It maintains a speakers bureau, which makes available to local service and community organizations, qualified lecturers on various health and medical topics.

It has developed and continues to maintain a close working relationship with civic and community agencies, particularly in the areas of civilian defense and disaster medicine.

It studies proposed medical legislation at all levels and makes recommendations in order to safeguard health and welfare standards and the private practice of medicine.

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It prepares a column of authoritative medical information for a daily newspaper and sponsors or participates in radio and television health information programs.

These activities represent a cooperative effort by Philadelphia physicians to improve the health and welfare of everyone in the community. But the objectives of the society require that the organization serve the medical profession as well, by advancing research, by maintaining ethical standards, and by protecting the interests of members.

To carry out these responsibilities, the society conducts medical studies and investigations, and presents scientific programs of an informational nature at regular intervals throughout the year.

It sponsors an annual postgraduate institute for member physicians, consisting of a week of scientific lectures designed to keep members abreast of the latest developments in medical research.

It publishes a weekly journal of medical news and information of special interest to Philadelphia doctors.

It maintains a medical library and reading room.

To protect the interests of its members, the society makes available several group health and accident insurance plans, and assists in providing legal serv ices in problems of professional liability.

Before I present the society's views on proposed legislation that would affect the medical care of the aged, I would like to review briefly the previous activity of the society in this regard.

In our own State of Pennsylvania, more than $23 million are spent annually by State agencies for the care of the needy and aged sick in the form of publie assistance medical payments, State aid to hospitals, payments by the school medical assistance program, and in the operation of the State-owned general hospitals.

During the last session of our general assembly, legislation was enacted providing for the care of aged, indigent persons in foster homes at State expense. In 1958, the State department of welfare also began to pay for the care of the medically indigent in nursing homes in cases where such care was indicated.

These approaches to the problem were made possible by joint cooperation between the State and Federal Governments, working through the public welfare department of the State government. They received strong backing from the Philadelphia County Medical Society, which believes that they offer a logical approach to the medical care of these people.

In Pennsylvania, there are seven distinct types of institutional care for the aged and needy which deserve special attention. They are:

(1) The 10 medical and surgical hospitals operated by the Commonwealth of Pennsylvania;

(2) The Philadelphia General Hospital operated by the city of Philadelphia;

(3) The 182 voluntary, nonsectarian general and special hospitals which in each biennium apply for and receive tax funds to help defray the cost of caring for the needy and aged sick;

(4) The 74 voluntary sectarian hospitals which do not receive State aid; (5) The 58 institutional district homes or hospitals which care for persons "requiring public care because of physical or mental infirmities": (6) The 57 voluntary homes and agencies which will receive State aid; and

(7) The nearly 800 voluntary and proprietary nursing homes which, although they do not receive State aid directly, are reimbursed for care of State patients under the public assistance program.

In July of this year, legislation to implement the Federal Kerr-Mills law was passed by the Pennsylvania State Legislature. Benefits provided by this law will include inpatient hospital care, outpatient posthospital care and visiting nurse services in the home. Thus, the major part of medical expenses incurred by the medically indigent aged should be covered. It is estimated that some 62.000 persons in Pennsylvania will benefit by this legislation.

Passage and utilization of Kerr-Mills legislation, however, is only one of several measures recommended by the Philadelphia County Medical Society in order to provide adequate medical care for our older citizens. In February of this year, the society adopted a 12-point program calling for action in various areas to cope with this problem.

Among these recommendations were:

(1) The reduction of physicians' fees for medical care furnished persons 65 years of age and older where economic circumstances dictate;

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