This becomes even more ridiculous when the second line "10 percenters," the Negro population that constitutes 10 percent of the population in America and reasonably represent 10 percent of the existing aged group 65 years of age or approximately 7,000 aged Negroes are considered. This group, because of discriminatory practices in the three E's, economics, education, and environment, finds itself in its golden years with virtually no eggs laid by the golden goose. The eggs that are fertilized with squalor, prejudices, and inadequacies, can hatch out only human misery, poverty, diseases, and words of charity. However, they represent the children of a sick society that made them this way. It therefore, becomes the duty of that same society to care for the children it has produced, fully cognizant of the fact that if they are undesirable, they are still the product of a warped society possessed of dim visibility into the heart of social consciousness.

However you look at it, the distribution of health facilities and the availability of good health is a question of money. It is ironic that we lead the world in the eradication of epidermological diseases; in the techniques of modern medicine; in program of research; in surgical skills; in the vast production of patent drugs such as the antibiotics, the hypertensive agents, hormones, antidiabetic, and antiarthritic drugs, and yet have not conceived of a way to make these health services available to all people in America in all segments of life. It is inconceivable that America recommends this health package to free emerging nations as a way of life with such glaring shortcomings in the distribution and availability of health services to her own people at home. It is time to equate good medical care with human need and not dollars and cents. Medicine is a profession, the only business it has, is to get busy and practice the art of good medicine for the good of humanity.

I heartily endorse a program of health and medical care for the aged through a contributory plan administered under social security.

H. L. Beales, in his book, "The Making of Social Policy," states that: “Basically what we confront is a problem in the control of the social environment. Such control is exercised through the implementation of social policy, which may be defined as those public provisions through which we attack insecurity, and endeavor to prevent or repair social losses produced by a competitive market and industrial economy."

As President Kennedy recently stated in his health message to the Congress, "the health insurance for the aged program will meet the needs of the millions of the aged who do not want charity, but where entire financial base for security and often that of their children may be shattered by an extended hospital stay." Social security offers a more economic manner of financing health care for the aged. Once this program comes into effect, medical insurance premiums would taper off, and the insured would receive wider benefits."

COMMERCIAL INSURANCE

Statistics reveal many times over that commercial insurances are incapable of providing an all-inclusive policy to adequately take care of the medical and health problems of the aged.

Only 2 out of 5 aged 65 years or older have any form of health insurance, and much of this is inadequate. Only 46 percent of the aged were covered by some form of hospital insurance as late as 1959, according to the U.S. National Health Survey. Commercial premiums are fixed regardless of income. Even though the incomes of the aged are less, their premiums are higher than the younger age group, because they require more medical care. The usual fee for the average premium is $7.50 a month, and this provides a $10 maximum allowance per hospital day which does not provide half the average hospital cost, which today is $25.

Actually, many commercial policies are really not as available as theoretically they profess. This is true, because such factors under requirements lead to complete exclusion of preexisting organic conditions. It is also factual that a great number of the insurances will not admit Negroes as a beneficiary, because they are regarded as poor health risks. Hence, the average aged Negro is loaded down with small industrial policies that pay from $5 to $10 weekly. For these he pays weekly premiums of 35 to 50 cents. Even if the Negro were an acceptable insurance risk, only a very small segment would be financially capable of purchasing such a policy. It is noteworthy that it was not until 1947 that even professional Negroes were insured by such big companies as Metropolitan and New York Life unless they had a "rider's" clause, refusing payments for a greater number of conditions than those for which they would benefit.

Under the present King-Anderson bills, the small increase in social insurance under the socal security system can be financed by a slight increase in social security taxes of $12.50 a year. This amount approximates the monthly premium for a commercial policy that does not even provide half the benefits as the more comprehensive social insurance policy.

The cry of socialization of the administration health bill is fallacious, for it is plainly stated that this legislation shall not permit the Federal Government to tamper with hospital administration or with the practice of medicine. It is important to quote from the bill the following:

"PROHIBITION AGAINST INTERFERENCE

"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, or compensation of any officer or employee of any hospital, skilled nursing facility, or home health agency; or, except as otherwise specifically provided, to exercise any supervision or control over the administration or operation of any hospital, facility, or agency. "FREE CHOICE BY PATIENT

"Any individual entitled to have payment made under this title for services furnished him may obtain inpatient hospital services, skilled nursing home services, home health services, or outpatient hospital diagnostic services from any provider of services with which an agreement is in effect under this title and which undertakes to provide him such services."

It is further pointed out that government programs for care of the aged should impose no governmental controls on the operation of hospitals. However, the American Hospital Association, in a statement approved in 1958, made the point that Government should see to it that these are reasonable criteria for determining the eligibility of hospitals to participate in such programs.

In its statement of August 20, 1958, the American Hospital Association disclosed: "Such a program (Government participation to meet the hospital needs of the retired aged) should provide reasonable criteria to determine the eligibility of hospitals to participate, but the Federal Government should be precluded from interfering in the administration and operation of hospitals providing the services."

Could it be that one of the principal objections to the social security program for the aged is that this would permit the Negro doctors to put their "foot in the door" of all hospitals that for so many years have excluded them from their staffs because of race? Such opposition to social progress distorts the inevitable climate of social changes that lags so far behind, it may already be too late.

Another scare word so frequently used by the opposition is the misuse and careless abuse of the term "freedom." One's freedom is on trial when he is hungry and is not free to eat because he has no food; or he is cold and has no clothing because he is not free to wear them; or because he has no freedom to quench his thirst because of lack of water. The freedom of securing good health for the aged is in danger only when there are stockpiles of drugs and unused storehouses of health services that are unavailable, when he is sick and not free enough to secure good medical care. Freedom must be planned, it must be worked for and fought for. Planned freedom means freedom from restrictions to a more orderly way of doing things within an accepted restricted planned economy.

Dr. Wilbur Cohen, Assistant Secretary of Health, Education, and Welfare, best summed this up in a recent statement to the Jacoki Medical Society in Washington, D.C.:

"It seems to me that a program which would lift unmanageable cost burdens from an aged patient needing hospital care would also be a relief to the physician, for he could hospitalize his patient when necessary without fear of the economic consequences to the patient. It would give added substance, it seems to me, to the freedom of doctor and patient together to choose the kind of care best suited to the patient's needs. This freedom of choice is inevitably compromised when an aged patient needs but cannot afford hospital care and is unwilling to plead pauperage to obtain it."

Our success in adequately providing good medical care for the aged in todays complex society requires much more deliberate patterning, which will be based on looking ahead to envisage possible consequences. Society sets limits to what can be done at any given time, unless these limits are transcended by evolution

or violent change. It is a travesty on human justice when social inefficiency which results when human resources are not adequately utilized are permitted to go in want when there is ample supply to meet the needs of all with proper distribution.

In medicine, as in agriculture, we already reached the point where our production exceeds our consumption.

The people of America have a professional and moral obligation to create a social and cultural environment in which human beings can live a full, healthy, and happy life.

Tribute must be paid to the dedicated men of science for their many advances that have lengthened the lives of our peoples. History will record how this new emerging human resource may best be utilized to strengthen the concepts and principles of adaptation in an ever-changing society.

RESOLUTION OF AMERICAN ASSOCIATION OF PUBLIC HEALTH PHYSICIANS OPPOSING H.R. 4222, THE HEALTH INSURANCE BENEFITS ACT OF 1961

Whereas the American Association of Public Health Physicians represents a large proportion of the health officers of the Nation, most of whom, because of the very nature of their work, have an intimate knowledge of the medical care requirements of the aged; and

Whereas great progress is being made by voluntary health insurance plans in extending coverage for those over 65 years of age; and

Whereas sufficient time has not elapsed for the various States to initiate and evaluate health programs based upon the Kerr-Mills law which was passed by Congress last year; and

Whereas H.R. 4222, the Health Insurance Benefits Act of 1961 which is now before the Congress of the United States would completely destroy all incentive for expanding voluntary insurance plans, would cover all beneficiaries whether or not they needed assistance, and would also be very costly: Now, therefore, be it

Resolved, That the American Association of Public Health Physicians express opposition to H.R. 4222, the Health Insurance Benefits Act of 1961 which proposes to place a Federal medical program for the elderly under the social security system; and be it further

Resolved, That voluntary health insurance be supported and urged to accelerate its progress in extending coverage to that group of people over 65 years of age; and be it further

Resolved, That the American Association of Public Health Physicians urge each State to initiate and expand as rapidly as possible health programs for the aged based upon the Kerr-Mills law.

Passed by the trustees of the American Association of Public Health Physicians assembled June 27, 1961, in New York City.

STATEMENT OF THE ASSOCIATION OF AMERICAN PHYSICIANS & SURGEONS, INC., BY DR. ROBERT J. MOORHEAD, PRESIDENT

We are pleased to have this opportunity of testifying against the Health Insurance Benefits Act of 1961 (King-Anderson bill, H.R. 4222).

The Association of American Physicians and Surgeons represents ethical physicians in medical economics, public relations, legislation, and freedom. Our objective of "freedom" can be defined by stating that we oppose the socialization of all segments of the economy just as vigorously as we oppose socialized medicine. Eligibility for membership in the American Medical Association is prerequisite for membership in AAPS.

We oppose H.R. 4222 because:

(1) There is no demonstrated need for such legislation. (See app. No. 1-our own reprints of surveys in Tarrant County, Tex.; Renville County, Minn.; two surveys in New Mexico to refute loose figures used by some propenents of the measure in their discussions of costs to the elderly.) For every survey figure that purports to show a need, there is another survey figure to show just as strongly that no need exists. For instance the study conducted by James W. Wiggins and Helmut Schoeck, both members of the sociology and anthropology department, Emory University, Atlanta, Ga., revealed that 92 percent of the aged

interviewed said that they had no unfilled medical needs and the remaining 8 percent listed lack of financial resources as one of the least important reasons for failure to relieve the need.

(2) It would lower the quality of health care. It is an historical fact in other countries that government controlled medical care (socialized medicine), like the King-Anderson proposal, has led to a deterioration of medical care. (See app. No. 2 "I Quit Socialized Medicine.")

(3) Enactment of the King-Anderson bill, would be a forerunner to the decline and eventual end of private health insurance, a system which has enabled a vast majority of Americans to voluntarily finance their health care needs-a system unsurpassed by any other nation.

(4) The King-Anderson program has been deceptively referred to as an insurance program financed through the social security system-and not as socialized medicine. Factually, the King-Anderson proposal would provide socialized medicine for the aged because any program which calls for a system of compulsory health care and which is financed, controlled, and regulated by the Federal Government, is socialized medicine for those whom it serves. (5) It would place Congress under continuous pressure for the provisions of the bill to be extended by the simple process of removing the age 65 limitation and thus lead to compulsory socialized medicine for the entire population. (6) Medical care for the aged-or any age group-is not the constitutional nor the moral responsibility of the Federal Government and its agencies. Care of the aged, and all age groups-medical or otherwise-is and should be the responsibility of families and local communities.

(7) The King-Anderson bill has been described by its proponents as a medical care "insurance" program which would be built on the structure of the social security "insurance" system. If the proposal were an "insurance" program, which it isn't, it is deception of the highest order to maintain that an "insurance" system can be built upon an "insurance" system that does not exist. Social security is not insurance as evidenced by the Supreme Court decision of May 24, 1937, when it upheld the Social Security Act to be constitutional with change in the terminology: “Annuities' became 'relief' payments for the general welfare and 'premiums' were designated as 'taxes'." It is a "relief" program pure and simple with individuals compulsorily taxed and the amount of “relief” payments and taxes determined by the pressures put on Congress, as witnessed the many increases in the amount of the relief payments and the tax rate since the program was started.

(8) More recently, the Supreme Court ruled that "social security is not insurance" in the case of Nestor v. Flemming on June 20, 1960. Then Secretary of HEW, Flemming, declared in his brief: "The old-age monthly benefits program which title II of the Social Security Act establishes is not a federally administered 'insurance' program. The contribution exacted under the social security plan is a true tax. It is not comparable to a premium promising payment of an annuity commencing at a designated age." Secretary Flemming's position was upheld by the Court.

We further find the proposed legislation to be undesirable because:

(1) It would upset the traditional physician-patient invaluable factor of free choice. Patients choice of hospitals under the bill is limited to hospitals electing to participate and permitted to do so. It follows that choice of physicians is limited to those physicians practicing in participating hospitals. Federal control of hospital usage and charges for hospital care are specifically provided and the bill further provides for hospitals to "meet such other conditions of participation" as the Secretary of the Department of Health, Education, and Welfare may find necessary-meaning virtually no limitation on the controls that could be set up,, including qualifications and activities of medical and nursing staffs.

(2) It would directly control services in the fields of radiology, pathology, anestesiology, and physiatry for both hospitalized patients and ambulatory patients seen at hospitals. This would constitute a radical step toward the eventual Federal control of the services of all physicians-a full program of socialized medical care with its deteriorating effects on the quality of medical services delivered.

(3) It would create a large new bureaucratic agency, supervising medical care by far-off Washington controls-removed from individual needs--and with the customary blundering ineptitudes of bureaucratic government.

We strongly support the views expressed in an editorial of the Cincinnati Enquirer on January 15, 1961, entitled "Health Care for the Aged" and offer

their objections as further reasons why the Association of American Physicians & Surgeons opposes H.R. 4222 :

"It would simply be the first step toward socialized medicine for all Americans. Our second objection is that what the Federal Government pays for it eventually controls. Wherever the Federal Government provides the fundsfor municipal airports, for housing and slum clearance, for education and research grants-it eventually attaches conditions and sets standards.

"Our third objection stems from financial precariousness of the social security system itself. In the first 25 years of its existence, social security took in some $70 billion through compulsory taxes on the earnings of American workers. During the same period, it paid out $50 billion in benefits. At the end of 25 years, it had $20 billion left in assets and at the present rate of benefits, $360 billion in obligation. For every dollar social security now has in the till, in other words, it must eventually pay out $18 in benefits. This means, among other things, that the Nation's younger workers, who generally need every penny to meet present obligations must be taxed for the rest of their working lives to pay for free medical care for aged and aging Americans, including millions able and willing to care for themselves.

"This leads to our fourth objection to the medical care plan: It is a compulsory program for which all Americans covered by social security must pay. regardless of whether they want or need the benefits provided. There has been such a powerful propaganda campaign in behalf of medical care for the aged within the last few years that opposing it is very much like opposing motherhood, patriotism, and virtue itself." The Cincinnati Enquirer says that the Nation, the States, and the communities of America must work to overcome the plight of aged Americans, just as they must work to overcome juvenile crime, ignorance, and poverty in all its other forms. Finally, "to maintain, however, that the only answer, or even the best answer, is to force all Americans into a compulsory system of Federal medical insurance is to advocate a system that would inevitably become a greater evil than the one it is designed to remedy." Members of the Association of American Physicians & Surgeons believe that the American people of all ages (not only the aged) should receive the highest quality of medical care it is possible to render, regardless of the ability of the patient to pay for such care. Under the U.S. system of private practice— with freedom of choice of physicians and patient kept inviolate the American people have been and are receiving the finest medical care in all the world. No other country has health records to match those of the United States. To our knowledge, no individual is being denied quality medical care because of inability to pay for it regardless of age. This is further indication that there is no demonstrated need for the ill-advised provisions of the King-Anderson legislation.

To destroy this system of medical care which has carried the American people to the pinnacle of receving the highest quality of medical care administered any where in the world by imposing a system of compulsory socialized medicine on first the aged, and then inevitably the entire population, would be a stark tragedy for the Nation.

For these reasons, and for many others presented to this committee, we urge committee members to stand unalterably opposed to the King-Anderson bill (H.R. 4222) and back their convictions with their votes.

APPENDIX NO. 1

""TAIN'T SO, SENATOR ANDERSON"

COSTS TO THE ELDERLY

For some time Senator Clinton Anderson has been sending what he terms documented letters to physicians in New Mexico. In them he has made the undocumented statement that the average cost per illness to the elderly is $1,000-$450 hospital bill and $550 doctor bill.

Like most other physicians, we of the Medical Jurisprudence Committee of the Tarrant County Medical Society have felt that Senator Anderson must have pulled these figures out of a hat. However, we knew of no available survey to refute these figures. Hence, we resolved to institute surveys in our own com munity to see just what the situation is here in Fort Worth.