segment of the practice of private diagnostic specialists. It would prevent free choice of physicians in that patients eligible for the benefits would be compelled to go to hospital clinics for diagnostic services rather than to private offices. If provisions for such diagnostic services is considered desirable, it is suggested that it would be more equitable and convenient to provide such services at either hospital outpatient clinics or in the offices of qualified diagnostic specialists. It would have further merit in preventing expensive duplication of equipment and office space and disrupting the practice of these diagnostic specialists by forcing patients into hospital outpatient departments and away from private offices. Many Blue Shield and combined Blue Shield-Blue Cross plans have been providing medical diagnostic benefits either in hospital outpatient clinics or in the offices of qualified diagnostic specialists for years. A substantial body of actuarial experience has been gained in the administration of these programs and their practicality has been demonstrated repeatedly throughout the country. In medical practice in America under the free enterprise system, patient flow has gone to those who offer the better medical service. H.R. 4222 would alter this fundamental concept by dictating that patient flow for diagnostic medical services go specifically to hospitals as such rather than to the physicians practicing these medical specialties under their own name. This statement does not concern itself with the broad principles and implications of this pending legislation but does ask that the obvious inequity of attempting to eliminate private medical diagnostic specialists be removed from its provisions. Very respectfully, LEONARD S. ELLENBOGEN, M.D. PAYSON, ARIZ., July 31, 1961. Mr. LEO H. IRWIN, Chief Counsel, House Ways and Means Committee, DEAR SIR: I take this opportunity to urge you wholeheartedly to oppose and defeat the King-Anderson bill, H.R. 4222. Here in the middle of the mountain country of the State of Arizona, our county is probably one of the least populated in the United States, yet not one of the indigent inhabitants goes without medical care. An abundance of funds are available from private organizations and the general county welfare fund to provide any and all of those aged indigents medical care. Therefore I wish to add my testimony to those previously recorded in your records to the extent that absolutely no Federal aid to the aged can by any stretch of the imagination be said to be needed. In order to preserve free enterprise, which is the lifeblood of America, I urge you to defeat such socializing tendencies that may crop up from time to time in Congress, whether in medicine, education, or whatever. Sincerely yours, DAVID B. GILBERT, M.D. ZUMBROTA, MINN., June 28, 1961. Representative WILBUR D. MILLS, Chairman, House Ways and Means Committee, DEAR SIR: I would like to express my firm opposition to the King bill. Please insert my letter in the hearings of your committee. I am not against Government aid for people who really need it, but I do oppose a general giveaway program for everyone regardless of their need. Sincerely, JAMES W. HALVORSON, M.D. (The following letter was forwarded by Congressmen Blatnik and Quie of Minnesota :) MINNEAPOLIS, MINN., July 5, 1961. DEAR CONGRESSMAN BLATNIK: Would you please insert this letter into the committee hearings on the King bill (H.R. 4222) and note that I am opposed to any health benefits for senior citizens under the Social Security Act. Sincerely, E. B. JEROME, M.D. MESABA CLINIC, Hon. WILBUR D. MILLS, Chairman, Ways and Means Committee, House of Representatives, Washington, D.C. Hibbing, Minn., June 28, 1961. DEAR REPRESENTATIVE MILLS: I am writing regarding the proposed King bill (H.R. 4222), which I understand soon will be discussed at a public hearing. While on the surface this legislation seems admirable, it is not difficult to envision its long-term ramification. Its proponents have clearly stated it is a foot in the door which will allow more restrictive and encompassing measures to follow. While the bill contains a supposed safeguard against interference by Federal officials with medicine or its allied services "except as specifically provided" in the bill, really no protection is afforded at all. Since the organizations covered by the proposed bill must meet conditions and participation as directed by the Secretary. Certainly this affords a certain degree of control by the Federal Government over medical services. We have the best standard of medicine in the world, and have recently been given adequate legislation to protect those needy individuals who want help. Let's not force all of us to pay more money to give blanket help to everyone whether needing it or not. I would appreciate it if you would insert this letter in the committee's hearings. I realize it is but a straw in the wind, but it reflects the opinion of a considerable number of lay and medical people in this area, and we hope may in some small way help prevent something we feel is harmful and potentially seriously dangerous. Sincerely, RICHARD R. MOYER, M.D. Congress of THE UNITED STATES, HOUSE OF REPRESENTATIVES, Hon. WILBUR D. MILLS, Chairman, Committee on Ways and Means, DEAR MR. CHAIRMAN: Enclosed is a copy of a letter regarding medical care for retired persons, sent to me by Dr. Karen Olness and 31 other medical students. Because of their direct connection with this problem and their desire to work out the best possible program, I am requesting that it be made a part of the hearing record when your committee takes up this subject. With kindest regards. Sincerely yours, WALTER H. JUDD. The Honorable WALTER H. JUDD, House of Representatives, Washington, D.C. MINNEAPOLIS, MINN., June 9, 1961. DEAR REPRESENTATIVE JUDD: We are junior and senior medical students who wish to express our opinions regarding present day care for senior citizens in the United States. We feel qualified to do this because we have made a special effort to determine needs of America's senior citizens, because we have spent considerable time working with patients in Government institutions, and because we are exceedingly interested in this problem. We believe that: (1) Needs of senior citizens for food, shelter, clothing, and medical care are not clearly defined on a nationwide or on a statewide basis. Surveys have been too smal Ito be significant and have indicated conflicting results. Legislation for assistance with no firm basis of fact is likely to be unsatisfactory. We suggest, therefore, that more efforts be made to determine these needs. (2) It may be difficult or impossible to determine such needs on a nationwide basis, because there is likely to be tremendous variation from State to State. We believe that needs must be determined on a statewide basis and that legislation for aid should be planned and controlled by State governments. We heartily endorse the recommendation of the White House Conference on Aging that local communities should immediately create committees on aging in order to make this problem meaningful to everyone. (3) Federal aid to States and local communities may be necessary; but it should not be legislated on such an arbitrary vehicle as social security. Such aid must be flexible in accordance with variant needs from State to State and, most important, from person to person. We believe that medical aid to persons who cannot pay for it must not have such severe restrictions on extent of service (i.e., days of hospitalization and nursing home care) or demand as high initial payments by patients as is planned by the King-Anderson bill. These limits are unrealistic. (4) Physical health of senior citizens is determined to a great extent by their emotional health. Financial assistance alone is not a panacea for all the problems and needs of our senior citizens. We believe that more efforts must be made to keep senior citizens busy with useful activity. We believe that retirement should not be compulsory and abrupt. We feel that more senior citizens' clubs should be organized. The effect of such clubs on and health of senior citizens in Minnesota is proof of their efficacy. We wholeheartedly endorse the conclusions of the White House Conference on Aging which stated that rights to health and necessities of life entail obligations as well. Sincerely yours, Re bill, H.R. 4222. The CHIEF CLERK, KAREN OLNESS, M.D. HOUSE OF REPRESENTATIVES, Washington, D.C., August 15, 1961. Ways and Means Committee, House of Representatives, New House Office Building, Washington, D.C. MY DEAR SIR: I have been requested by Dr. Herbert M. Olnick, 724 Hemlock Street, Macon, Ga., to respectfully request that his views, as set forth in the within enclosure, be filed as a part of the record in connection with your hear ings on the bill, H.R. 4222. If your hearings have been concluded at this time, then I would appreciate it very much if you would incorporate this statement in the record on this bill. Thanking you, and with best wishes and kind regards, Sincerely yours, CARL VINSON, Member of Congress. MACON, GA., August 7, 1961. COMMITTEE ON WAYS AND MEANS, Washington, D.C. MR. CHAIRMAN AND MEMBERS OF THE COMMITTEE: I am Dr. Herbert M. Olnick of Macon, Ga. I am a practicing radiologist and currently president of the Georgia Society of Radiologists. I wish to confine my remarks to the radiologic aspects of H.R. 4222. H.R. 4222 proposes to cover outpatient diagnostic tests on a deductible basis when performed in the hospital. Hospital departments are already overcrowded due to the provisions of commercial health insurance policies which require that the patient examined be hospitalized. The radiologists practicing in 1,500 private offices represent a bed of available talent for examining the clients of the proposed social security program. They have the time to do this work be cause these offices have been shunned by most commercial health insurance provisions. These offices represent an investment of over $100 million. If H.R. 4222 restricts the service to hospital departments, these private offices will eventually disappear. The public will have to expand hospital departments to the tune of $100 million as a replacement. The absence of a ceiling on the amount of diagnostic test benefits available after the deductible is paid will cause staggering expense. From my own experience, I would venture to state that the average patient would run a bill of over a hundred dollars in just X-rays alone. We practicing radiologists oppose the King bill because it is unfair to private office radiologists; because it will promote abuse and waste of medical talent; and because it will result in poor medical care for the people who are really sick. Overtaxing radiologic personnel causes the sick patient to be lost amid the vast influx of mildly infirm patients. The sick patient get slighted and the diagnosis is more apt to be missed because a proper amount of time cannot be given to the one who needs it. I recommend that this committee consider the weakness of this bill to which I can personally testify. While the administration claims that doctors' services are not covered under this bill, it is immediately evident that hospital doctors are covered in four specialties whereas their colleagues who attempt to serve the public from private offices are being forced into a corner by the provisions of H.R. 4222. The sponsors of this legislation look forward to the day when all doctors will work for hospitals. I urge that the committee consider subsidizing an insurance program that would incorporate the above features without concentrating total discretionary power in the Secretary of Health, Education, and Welfare. Respectfully submitted. Hon. WILBUR D. MILLS, Chairman, House Ways and Means Committee, House of Representatives, Washington, D.C. HERBERT M. OLNICK, M.D. OLMSTED MEDICAL GROUP, DEAR REPRESENTATIVE MILLS: I would like to take this opportunity to express my extreme dissatisfaction with the King bill, H.R. 4222. I am surprised and disappointed that anyone who loves freedom would propose such a bill that could endanger our high standards of medical care and democratic way of life. Let me urge you to do everything possible to defeat this bill. If it is possible, would you insert this letter in the committee hearings minutes? Sincerely, STATEMENT OF R. B. ROBINS, M.D DUANE L. ORN, M.D. Mr. Chairman and members of the committee, I am Dr. R. B. Robins, a family physician from Camden, Ark. My good personal friend, Chairman Wilbur Mills, knows that I have a great interest in the question of medical care under Federal sponsorship and control. As a physician and as a citizen who has been active in governmental and political affairs (I served from 1944 to 1952 as the national Democratic committeeman from the State of Arkansas), I feel justified in appearing here today to present my views with respect to H.R. 4222. I have opposed in the past the Truman health program and the Forand legislation. Now you are considering the King-Anderson bill. They are all part and parcel of the same thing-programs providing for or leading to a system of government dominated medical practice. You may recall that I testified before this committee 2 years ago, against the Forand bill. I had then just returned from England where I had the opportunity of studying, first hand, the British National Health Service. I stated then the faults and dangers which are inherent in a national health system, and I say to you now that my many contacts with friends in England confirm my conclusions that the British system becomes more and more distasteful to the people--the patients and the physicians. The British National Health Service, now 13 years old, is still being plagued with rising costs, greater inconveniences, increasing governmental redtape, and a diminishing quality of medical care. It is no wonder, then, that more and more doctors from England seek to establish themselves in the United States. It is no wonder, then, that more and more physicians in England are sending their sons to study medicine in this country. It is no wonder, then, that more and more British people are seeking private care at their own expense in lieu of the public care to which they contribute through taxpayments. The experience of Great Britain in attempting to estimate the cost of the national health service at its inception and our experience in estimating costs of our social security programs indicate to me that it is extremely likely that the real cost of the program proposed by H.R. 4222 will greatly exceed initial estimates. In a concise examination of the British National Health Service, Prof. John Jewkes, who occupies the chair of economic organization in the University of Oxford, writes in his recently published work "The Genesis of the British National Health Service": "It is equally clear that the Government was taken by surprise at the high level of demand under the new conditions. No estimate made before 1948 had set the annual cost to the exchequer of the national health service above 170 million pounds. The cost at an annual rate came out at 377 million pounds for 1948-49 and 433 million pounds for 1949-50." Dr. Jewkes relates the difficulties encountered by the Government in its attempt to hold the cost line and of these attempts says: "The steady and continuous struggle on the part of British governments to restrain the demands for medical service has led those who had assumed that the principle of 'the best possible medical service free for all' meant literally what it said and did not mean 'the distribution roughly according to the principle of first come first served of the supply of free medical services which the Government thought adequate'-to complain of the 'tyranny of the exchequer.' Certainly the efforts on the part of successive governments to keep expenditures within what were deemed to be proper bounds, and at the same time avoid political unpopularity, have had some unfortunate long-period consequences." Our Nation's medical societies oppose H.R. 4222. They represent the overwhelming majority of practicing physicians in the United States. While the task force report made made to President Kennedy on health and social security for the American people urged Federal action to increase the supply of medical and other health personnel, even consideration of bills such as you have before you, in my opinion, is today influencing young men against entering the private practice of medicine. We doctors have strongly supported Kerr-Mills legislation. I know that by now you have heard repeated testimony on this subject. The proponents of H.R. 4222 have labeled this legislation (Kerr-Mills) inadequate or degrading. But "catch terms" do not establish the value of any law. Kerr-Mills fills the gap between those who can well afford to pay for their health care, as they pay for everything else, and those who are unable to pay for such care and of necessity must seek public aid. May I ask this committee to deliberate with caution. Favorable action of H.R. 4222 will be irrevocable. The growth of private insurance, the value of Kerr-Mills, the unknown costs, the dangers of federally regulated medicine, must be carefully considered. This is not a political question. Certain groups, while condemning medical societies for their interest and their activity in educating their members and presenting their views to the public, have themselves been using medical care for the aged as the instrument for organizing our elder citizens into a political block. These organizations are far more interested in using these groups in political campaigns than they are in the welfare of the aged or of the rest of us. May I say also that some appointed officers of our Government seem to be forgetting their responsibilities to all the people and have joined in the organizing and lobbying activities of these special interest groups. Mr. Chairman and gentlemen of the committee, I want to thank you for allowing me to again express my sentiments. May I also request that my oral and written statements given 2 years ago to your committee be reinserted in the record. I believe them to be pertinent to your consideration of H.R. 4222. Representative WILBUR D. MILLS, Chairman, House Ways and Means Committee, ROCHESTER, MINN., July 4, 1961. DEAR MR. MILLS: I am writing at this time to add one more voice in opposition to the King bill (H.R. 4222) which I believe is soon to come up for specific action. I am convinced that the Kerr-Mills bill is the best instrument currently available to help those senior citizens who need help in paying for their medical expenses. I hope you will be able to insert this letter in your committee hearings and that this undesirable King bill will be convincingly defeated. Yours sincerely, E. D. ROOKE, M.D. |