Our initial survey was made on patients, aged 65 or over, dismissed from All Saints Hospital. Although we realized that this probably would load the survey in favor of Senator Anderson, we took 100 cases alphabetically from the current file of those who left the hospital without paying their bills in full. Three of these cases bear 1959 dates; all others occurred in 1960.

These are the results of that survey:

1. Age: Mode, 65; median, 72; mean, 72.9.

2. Patients who carried insurance, 80.

3. Recap by service: Medical, 61; surgical, 22; orthopedic, 11; urology, 5; gynecology, 1; total, 100.

4. Hospital bill: Mode, $100 to $250; median, $250 to $300; mean, $384.51. Then we checked with the physicians involved in each of these 100 cases as to the total charges for that illness. In each case we contacted every physician who was involved in the case and requested the total charges for that illness prior to hospitalization, during the hospitalization period, and during the posthospitalization period.

These are the findings regarding physicians' charges for illness: Mode, 0 to $49; median, $50 to $99; mean, $114.62. Compare:

We will be happy to submit our work sheets to the inspection of any doubting Thomas.

The committee wishes to thank Mr. Fred W. Kelly, business manager of All Saints Hospital, and Dr. Mal Rumph, chairman of the Tarrant delegation to the House of Delegates of the Texas Medical Association, for their able assistance in this survey.

This committee plans additional surveys, but makes this survey public at this time for the information of both the profession and the public. We trust that other physicians in other areas in this and other States will survey their local situation, feeling that they, too, will find that Senator Anderson's figures are fantastic.

Respectfully submitted.

JAMES W. BROOKS, M.D.,

Chairman, Medical Jurisprudence Committee of Tarrant County
Medical Society.

APPENDIX NO. 1

A COMMUNITY SURVEY OF HOSPITAL AND PHYSICIAN COSTS FOR MEDICAL Care TO PATIENTS OVER 65 YEARS OF AGE

With the cooperation of members of the medical staff and the administrator of Renville County Hospital, Olivia, Minn., a study was made of the costs of medical care to those patients over the age of 65 years who were hospitalized in this typical community hospital during the year 1960. Ours is a general hospital of 41 beds and 10 bassinets, located in an agricultural community of west-central Minnesota. The majority of patients treated here are residents of Renville County.

This information is provided for consideration in the current discussions concerning financing the costs of medical care for the aged. We believe that our own data furnish sound basis for the conclusion that this particular problem is being well met under existing circumstances. Members of our medical staff know of no individual in this area who is not receiving proper medical care because of financial inability to pay for such care.

The data now presented summarize the findings of our study of those patients receiving care in the Renville County Hospital.

1. Patients over age 65 admitted to hospital during 1960: 256.

2. Total 1960 hospital admissions for patients over 65: 350 (21.5 percent of the total (1,630) admissions).

3. Patients having multiple 1960 hospital admissions: 63 (24.6 percent of the patients)-1 patient had 8 admissions, 2 patients had 5 admissions each, 5 76123-61-pt. 4——31

patients had 4 admissions each, 9 patients had 3 admissions each, and 46 patients had 2 admissions each.

4. Admission service division: 52, or 14.8 percent, were surgical admissions; 298, or 85.8 percent, were medical admissions; and 47 patients had at least one surgical admission.

5. Patient's age: Mode, 65 years; median, 74 years; and mean, 75 years. 6. Patient's total 1960 hospital bill: Mode, $36; median, $226; and mean, $350.54. Figures used here were the total hospital bills rendered a given patient in 1960, regardless of his number of hospital admissions.

The attached tabulation sheet shows that 75 percent of the patients used private resources to pay their bills, 25 percent being paid by Government agency; 84 patients, or 33 percent of the group, had some insurance coverage to aid payment.

Only 21.4 percent, or 55 of the patients, had hospital bills larger than $500, 7.4 percent (19 patients) being over $1,000.

As of February 1, 1961, just 23, or 8.9 percent of the patients had not paid their hospital bills in full. Yet only seven of these (2.7 percent of the whole) had made no payment on account, the rest having made some payment.

7. Physicians' bills: Mode, $30; median, $56; and mean, $105.69. Here we contacted each patient's physician (seven physicians) and requested the total charges for illnesses treated in the hospital during 1960.

Only 1.6 percent, or 4 patients, had physicians' bills over $500; 9.1 percent or 22 patients, had physicians' bills over $300.

As of February 1, 1961, 15.7 percent, or 38 patients, were known to have some of the physician's bill unpaid.

It was found that just 9.6 percent of the total hospital-physician bills rendered these patients for care during 1960 in these illnesses remained unpaid as of February 1, 1961.

8. A comparison can be drawn between our data and that previously published by the Tarrant County Medical Society of Texas, as contrasted with undocumented figures circulated by Senator Clinton Anderson and others. The latter have stated that the average cost per illness to the elderly is $1,000— $450 hospital bill and $550 doctor bill.

The data assembled in this survey warrant our agreeing with the members of the Tarrant County Medical Society that "Senator Anderson's figures are fantastic." It is demonstrable that hospital costs far exceed physician costs. But more important, these data provide evidence that 75 percent of those patients over age 65 in our community are able to pay for their medical costs from private resources, and all the others are already adequately assisted by welfare agencies. There is no unmet need which requires the passage of new Federal legislation to pay for health care in our community. There is no warrant here to pass legislation which would compel the workers of America, through increased social security taxes, to pay the medical costs for the 75 percent of those over 65 who are already able to pay their own costs adequately. J. A. COSGRIFF, M.D.,

For the Medical Staff, Renville County Hospital.

Tabulation of the payers of hospital costs for the 256 patients over 65 years of age admitted to the Renville County Hospital, Olivia, Minn., from Jan, 1, 1960, through Dec. 31, 1960

These 256 patients over age 65 accounted for a total of 350 separate hospital admissions during the year, and thus comprised 21.5 percent of the total (1,630) hospital admissions during 1960: 75 percent of these patients paid their bills through private resources, 42 percent paying their entire bill themselves, and another 33 percent having partial or full assistance from their private insurance in paying costs. The remainder, 25 percent, had their hospital bills paid by

A study of patients age 65 and over admitted to St. Mary's Hospital, Roswell,
N. Mex., is herein reported for comparison with similar data previously pub-
lished by other sources: Tarrant County Medical Society of Texas; Renville
County Hospital of Minnesota; Presbyterian Hospital, Albuquerque, N. Mex.,
and figures recently circulated by Senator Clinton Anderson.

This pilot study is of 100 consecutive admissions of patients over age 65 in
the latter part of 1960. There were a total of 421 admissions of patients 65
and over in the year 1960, and an additional study is underway to include the
remaining 321. It is felt immediate reporting of this data is important and
pertinent in view of pending legislation. Particularly is this so in that one of
the initial sponsors of the King-Kennedy bill, Senator Anderson, is from this
State. We are sure he would desire actual figures from his own constituents
for consideration.

We feel voluntary insurance has been and will continue to do the job of
financing medical care. We concur with others in not regarding OASI as
insurance. We feel the word "social" as in social security is in reality a true
derivative of socialism.

76123-61-pt. 4-32

The passage of this type of legislation discourages thrift, initiative, and selfreliance. It encourages the Nation further into welfare statism.

1. Number of over-age-65 admissions during period Sept. 25, 1960, through Dec. 31, 1960--

2. Number of patients over age 65 admitted (2 multiple admissions). 3. Surgical admissions__.

Medical admissions___.

4. Patients' age: Median, age 74; range, 65–96.

5. Total hospital bill (average per illness). Hospital bills larger than $500---

Hospital bills paid by private sources_.

Physician bill over $500–

Physician bill over $300___.

Hospital bills paid by insurance or government sources_

6. Total physician bill (average per illness).

Physician bill paid by private sources_.

Physician bill paid by voluntary insurance sources.

Physician bill paid by government sources..

7. Comparison with other data:

100

40

$214.02

90

$91. 65

Senator Anderson's figures are overestimated for one hospital in his State by more than 300 percent on the basis of this study.

A. S. BLAUW, M.D.,
Secretary-Treasurer,

Chaves County Medical Society.

Southwest Presbyterian Hospital, Albuquerque, N. Mex., survey of 100 consecutive discharges from general hospital, selected solely on basis of age over 65

(Appendix No. 2 is identical with article on p. 535.)

Hon. WILBUR D. MILLS,

CONGRESS OF THE UNITED STATES,

Chairman, House Ways and Means Committee, 1134 House Office Building, Washington, D.C.

HOUSE OF REPRESENTATIVES,
Washington, D.C., July 31, 1961.

DEAR COLLEAGUE: Mr. Al Doerr, secretary of the North Dakota Pharmaceutical Association, has forwarded a resolution adopted by this group expressing strong opposition to passage of the King bill, H.R. 4222.

You will observe in the resolution that the oppositions to enactment of this proposed measure are clearly and succintly stated. I would like to request that this resolution, adopted at the 76th Annual Convention of the North Dakota

Pharmaceutical Association, held in the city of Williston on June 6, be brought to the attention of the members of your committee during the consideration of this bill, and incorporated as a part of the committee hearings.

With kind regards, I am,

Very sincerely,

DON L. SHORT, Member of Congress.

RESOLUTION

Whereas the Congress of the United States has for several sessions considered various bills relative to providing and subsidizing the sickness costs of the aging and is currently considering the King bill (H.R. 4222); and

Whereas the members of the North Dakota Pharmaceutical Association consider the King bill to be socialized medicine for a large but special group of our population; and

Whereas the estimated cost for any of these plans is astronomical and unpredictable; and

Whereas the vast majority of individuals over the age 65 do not require Federal assistance; and

Whereas in North Dakota physicians have always contributed their services to the care of the indigent and semi-indigent of all ages; and

Whereas studies have failed to demonstrate any degree of unmet needs which would warrant Federal participation in providing care for all persons over 65 years of age; and

Whereas it is the sincere belief of the members of the North Dakota Pharmaceutical Association that the physicians of North Dakota have always desired to improve the medical care for all persons; and

Whereas the members of the North Dakota Pharmaceutical Association feel that political medical practice would hinder and not improve this medical care: Now, therefore, be it

Resolved, That the members of the North Dakota Pharmaceutical Association meeting in annual session in the city of Williston, N.D., this 6th day of June 1961, commend those Members of the Congress and all others who have maintained a steadfast opposition to furthering the cause of socialism; and be it further

Resolved, That the North Dakota congressional delegation be urged to oppose the passage of the King bill; and be it further

Resolved, That a copy of this resolution be sent to the President of the United States, the Vice President of the United States, the Speaker of the House of Representatives, the members of the House Ways and Means Committee, the Secretary of Health, Education, and Welfare, the Governor of the State of North Dakota, the honorable Members of the North Dakota congressional delegation, the president of the American Pharmaceutical Association, and to the president of the North Dakota State Medical Association.

STATEMENT SUBMITTED BY ORACE HANSON, PRESIDENT, MINNESOTA STATE
PHARMACEUTICAL ASSOCIATION, ST. PAUL, MINN.

The Minnesota State Pharmaceutical Association was founded in 1884 and has a current membership of more than 2,000 registered pharmacists. It is one of the oldest and largest societies of its kind in the Nation.

Broadly stated, its objectives are to encourage the maintenance of high ethical and educational standards in the field of pharmacy, and to support practices and legislation which promote the safe and efficacious distribution of drugs and medicines, thereby promoting public health and welfare for the benefit of all citizens of the State.

Recognizing that pharmacy is integrally related to the overall health services of the community, the association has for many years worked closely with State and community health professions in seeking to determine and fulfill the needs of our medically indigent and aging citizens.

Representatives of the association have served on various bodies concerned with this problem, including interprofessional committees, and committees appointed by the State board of health, the State welfare department, and the Governor's conference on aging.