The association has consistently and vigorously maintained the position that the aged and the indigent should receive the same quality of drugs and medications and the same high level of pharmaceutical service as other citizens. At the same time, it has joined with the other health professions in defending the principle of free choice of health services. It is only realistic to acknowledge that in many localities throughout the United States, aging and medically indigent patients are not receiving adequate and timely medical care.. The health professions and our State and Federal Governments are rightfully concerned with the needs of these citizens. However, the attitude of the Minnesota State Pharmaceutical Association to ward the King-Anderson bill, H.R. 4222, must properly be based upon conditions in Minnesota, rather than elsewhere. In studying the situation in Minnesota, we have had the benefit of the statistics compiled by the Minnesota State Welfare Department concerning the medical-economic status of persons 65 years of age and over. This data, published under the title, "Minnesota's Aging Citizens, a County by County Statistical Report," indicates, among other things, that only 7 percent of all persons over 65 in this State are medically indigent. This figure represents only 0.7 percent of Minnesota's total population. The needs of these citizens are amply fulfilled by Minnesota's old-age assistance program which provides complete medical services, including drugs and medical supplies. This statistical report further indicates that 87 percent of the people interviewed had no unmet medical needs, and only 5 percent could not meet their medical needs because of inability to pay. However, further questioning re vealed that the persons included in this 5 percent were not aware of the health services available to them through the medical profession and the State welfare programs. After careful examination of this and other pertinent information, it seems apparent that Minnesota's aging and medically indigent are now receiving adequate health service or have adequate health service available to them. For this reason, the Minnesota State Pharmaceutical Association feels obliged to state its opposition to the King-Anderson bill (H.R. 4222). Minnesota's experience illustrates that the medical needs of the aging citizen can be adequately met by the individual States, with the Federal Government fulfilling its responsibility by furnishing funds which are administered by the States. Health, as has often been said before, is a uniquely personal matter. The needs of the individual patient can best be determined and fulfilled on the local level by physicians, pharmacists, dentists, and welfare officials who know his needs firsthand. It cannot be denied that the health needs of our aging citizens constitute a national problem, but it is questionable whether a nationalized, rather than a localized program, is the most desirable answer to this problem. Representative WILBUR MILLS, IOWA PHARMACEUTICAL ASSOCIATION, Chairman, House Ways and Means Committee, DEAR REPRESENTATIVE MILLS: The Iowa Pharmaceutical Association representing 1,557 registered pharmacists employed in 822 retail pharmacies, hospital pharmacies, educational institutions, service drug wholesalers and pharmaceu tical sales representatives in Iowa, wish to again reaffirm our opposition to medical health care under a social security program. As a representative for pharmacy, we are opposed to the King bill (H.R. 4222) now being heard before your committee. For all practical purposes, there is no basic difference between H.R. 4222 and the Forand bill H.R. 4700 introduced in the 86th Congress. I would therefore call your attention to the statement of the Iowa Pharmaceutical Association given by A. Phillip Coontz, president of the Iowa Pharmaceutical Association in 1959 before the House Ways and Means Committee in June of 1959. Mr. Coontz stated that pharmacy was not directly involved but indirectly through pharmaceutical service provided patients in hospitals but were cognizant that the program could be the initial step toward an eventual and inevitable socialization of our profession. Irregardless of the title, King bill or Forand bill, the mechanics of socialized medical health care are present, irrespective of the statements made that the medical health care program under social security, proposed by the present administration, is not socialized medicine. The Socialist Party of the United States, who should be considered an authority on the definition of socialism, has stated that the proposed legislation is socialized medicine. Mr. Coontz further explained that social security type medical health care legislation would lower the high standard of medical treatment, health education, and medical and pharmaceutical research. The results of individual and collective voluntary pursuits and initiative are much more productive than a compulsory, governmental demanding and control of an individual or collective endeavor. Under a governmental compulsory program, the loss of personal initiative and desire would without question, not provide medical care for the American people to the degree they have become accustomed or provide any more than a normal advancement in medical science and research. The statement of the Iowa Pharmaceutical Association also stated that an additional tax burden would be placed on the working people which is the only alternative when associated with social security. They would be forced not only to pay for their own medical care but for people of means well able to pay for current health care. The only sane procedure is the payment of health benefits through the many types and increasing availability of private insurance medical health programs. As private citizens, who through the free private enterprise system, have progressed socially and economically superior to any other form of economy, we are increasingly concerned at the trend of creeping federalization of our everyday activities. The King bill (H.R. 4222) is creeping Federal control over medical care which cannot provide the professional economical control and administration by the or through the mechanics of our free and private enterprise system at local, county, and State levels. The Iowa Pharmaceutical Association endorses and supports the American Medical Association and the Iowa State Medical Society Kerr-Mills law and worked diligently to secure passage in the Iowa General Assembly of its enabling legislation. It is our sincere belief that such legislation should be given adequate time and effort to provide medical care for the near needy before further consideration is given other forms of medical care legislation. Pharmacy has always and will continue to enjoy the opportunity to work with medicine to provide the best in pharmaceutical service for improved health services for the individual. As representative for the Iowa Pharmaceutical Association, I would ask and consider it a privilege to have this letter entered in the proceedings of the House Ways and Means Committee hearings on the King bill (H.R. 4222). DEAR MR. CHAIRMAN: This letter is submitted in behalf of the Pharmaceutical Manufacturers Association on H.R. 4222, a bill amending the Social Security Act to provide for the payment of certain institutional care and home health services to aged persons over 65 eligible for social security or railroad retirement benefits. Payment for the services of physicians is not included. This association is a nonprofit membership association, incorporated under the laws of Delaware, with its principal office in the city of Washington, D.C. At the present time, there are about 140 member companies which are engaged in the manufacture of prescription pharmaceutical products, and these companies produce in excess of 95 percent of the Nation's total production of such products. The Pharmaceutical Manufacturers Association is in favor of helping those who need help and therefore it supports the approach of the Kerr-Mills Act for the medical aid of the aged law in providing medical care to aged persons over that proposed in H.R. 4222. The Kerr-Mills Act enacted only last year by the Congress is a voluntary cooperative Federal-State financing program which provides medical care for every aged person over 65 in need. It supplements and does not supplant individual voluntary health insurance. It enables the States to set up the programs they believe are most suited to the needs of their own citizens. Additionally, the benefits of the Kerr-Mills Act are not limited as to type or extent of care but are based on need and local determination. Under it, payment is limited to the care of people unable to pay their own bills. This association would therefore urge that the Kerr-Mills Act be given the opportunity to demonstrate what it can do once it is in full operating effect in all the States. One year's time is hardly believed to be sufficient to make such a showing, especially when this is coupled with the phenomenal growth of the voluntary health insurance plans which are being extended to embrace those in the older age groups. In the relatively short period of time in which the Kerr-Mills Act has been in effect, the acceptance by the States of its principles has truly been outstanding. A very substantial number of these, and two U.S. possessions, have enacted Kerr-Mills programs and more State legislatures still have pending before them proposals implementing this program. For the foregoing reasons, the Pharmaceutical Manufacturers Association is opposed to the enactment of H.R. 4222. It would be deeply appreciated if you would make this letter a part of the record of the hearings on H.R. 4222. Sincerely yours, Hon. WILBUR MILLS, AUSTIN SMITH, M.D. GEORGIA PHARMACEUTICAL ASSOCIATION, INC., Chairman, House Ways and Means Committee, DEAR SIR: We wish to request an opportunity to submit testimony for the record on H.R. 4222 on behalf of the Georgia Pharmaceutical Association, which organization represents the 2,5000 pharmacists practicing in the State of Georgia. The Georgia Pharmaceutical Association is opposed to any Federal legislation to provide aged persons with health care other than such which may be established by absolute need since we feel such legislation will constitute a burdensome and unnecessary increase in taxation and lead to complete socialized medicine. We also feel that such legislation is inherently detrimental to the principle and philosophy of free enterprise and the dignity of citizens of a free nation. Very truly yours, LEON BROWN, President. Hon. WILBUR D. MILLS, Chairman, House Ways and Means Committee, U.S. House of Representatires, Washington, D.C. DEAR REPRESENTATIVE MILLS: This is in reference to the King bill, H.R. 4222. I am 100 percent opposed to this bill. Previous legislation should be given a fair trial and should be kept on a voluntary basis rather than a flat blanket coverage. Free enterprise cannot continue to exist unless individuals and local government are allowed to function. Efficiency is increased through the grassroots rather than through Uncle Sam thousands of miles from the problem. Rather, our local government and people should stand on their own feet. I want opportunity not necessarily all security. Mr. Khrushchev will be glad to give us security with a ball and chain. Let's not keep repeating mistakes from past history. Governments have tried this before and have failed. Your kind consideration in considering opposition to the King bill will be most appreciated. Please insert this letter into the committee's hearings. Thank you very much. Kindest regards. JOHN VERBY. COOK COMMUNITY CLINIC, Cook, Minn., June 27, 1961. Re H.R. 4222. Representative WILBUR D. MILLS, Chairman, House Ways and Means Committee, DEAR SIR: I am most definitely opposed to the King bill. and antagonistic toward the practice of good medicine. inserted in the committee's hearings. Sincerely, Representative WILBUR D. MILLS, I feel it is impractical I wish this letter to be WM. C. HEIAM, M.D. CUT BANK, MONT., June 29, 1691. Chairman, House Ways and Means Committee, U.S. House of Representatives, Washington, D.C. DEAR REPRESENTATIVE MILLS: The following resolution has recently been passed by the local medical staff. The medical staff of Glacier Memorial Hospital endorses wholeheartedly federally passed legislation in 1960 for the medical care of the aged. This legislation is the Kerr-Mills bill which entitles State supervision of Federal and State funds for medical and surgical care for needy older people. This medical staff is opposed to the administration's current proposal, the King bill, H.R. 4222, which is a compulsory Federal aid supervised medical care program for older people who are entitled to the social security benefits. Our medical staff wished you to be aware of this resolution and also would appreciate it if you would make it a part of the permanent records of the hearings which are to be held, we understand, in the near future. Most sincerely yours, ROBERT K. WEST, M.D., Chief of Medical Staff, Glacier Memorial Hospital. TO THE STATEMENT OF THE TEXAS HOSPITAL ASSOCIATION IN OPPOSITION PASSAGE OF H.R. 4222 BY F. R. HIGGINBOTHAM, PRESIDING OFFICER, HOUSE OF DELEGATES, TEXAS HOSPITAL ASSOCIATION, SAN ANTONIO, TEX. Mr. Chairman and committee members: This statement is presented in my capacity as presiding officer, House of Delegates of the Texas Hospital Association, a voluntary nonprofit association representing 698 members of which 492 are institutional members, accounting for 55,191 hospital beds in the State of Texas. The prime objective of our association is that we are dedicated to improving the health care of all Texans. I submit this statement in behalf of that objective. The Texas Hospital Association has vigorously opposed any legislation or action that in our view will damage the outstanding health care provided our people. The most recent affirmation of the action of our membership occurred May 17, 1961 when a resolution was unanimously adopted by our house of delegates (the official policymaking body of the association) opposing further encroachment by the Federal Government in providing for health care of the aged through the social security mechanism. LACK OF NEED FOR THIS LEGISLATION We are convinced that this legislation is not required. Studies in Texas by various organizations and individuals indicate that Texas residents 65 years of age and older are not the poor, sick people described by those people advocating H.R. 4222 and similar legislation. For example, the average length of stay in short-term, general hospitals for all types of cases, nationally, is 7.6 days. The average length of stay for all patients in Texas in short term, general hospitals during 1960 was 6.1 days. The experienece of one large voluntary prepayment organization covering 78,000 persons aged 65 and over in Texas indicates a median length of stay of only 7.66 days-only 1.56 days in excess of all Texas patients and .06 of 1 day in excess of the national average for all patients. The aged population in Texas (approximately 745,000) represents approximately 8 percent of the total population. Numerous studies conducted by our member hospitals indicate from 8 to 12 percent of admissions to short term, general hospitals are aged persons-in other words, the medical needs of the Texas aged are not greatly in excess of the general population. EFFECT OF H.R. 4222, IF PASSED The effect of unnecessary legislation is difficult to measure; however, an apparent side effect is the provision of free care for those eligible for social security regardless of need. I shall not dwell at length on the philosophy of the social security program, but it has been proven that it is not an insurance program or annuity paid for in advance by an individual, thus making anyone who is eligible for social security automatically eligible for benefits, regardless of need. In other words, we object to providing free care to all over age 65 persons regardless of need. We likewise object to being forced to submit to regulation and supervision by an agency of the Federal Government. This is provided through the centralization of power of inspection, regulation, and approval by the Secretary. The broad latitude afforded the Secretary in prescribing that a hospital must “meet such other conditions of participation as the Secretary may find necessary" is unwise, unwarranted and places too much power in the hands of one individual or of the Federal Government. Much has been said against the means test by proponents of H.R. 4222. May I point out that H.R. 4222 contains a means test by providing a deductible feature on hospital and outpatient benefits. This feature works to the advantage of the wealthy aged and to the disadvantage of the indigent aged. COSTS OF H.R. 4222 Based on facts available, the costs of H.R. 4222 in Texas would vary considerably the mean cost in the Tarrant County, Tex., survey indicates $384.51 per hospital stay. The Blue Cross-Blue Shield of Texas statistics reveal average cost per case of $176.70. Travis County, Tex., reports an average cost per case of $289.03. Based on an average length of stay of 7.66 days at $30 per day cost in the short term, general hospital, we project an average cost per stay of about $229.80 in the short term, general hospital. May I point out, however, that the above costs are presently being borne voluntarily by our people, our hospitals, and our physicians without compulsion through social security or similar taxing devices. Many of our aged have provided for prepayment health care coverage (approximately 25 percent). Many of our hospitals have reported that hospital bills for the aged are not major problems. For example, one small hospital that annually provides in excess of $50,000 charity care each year reported that only 3.9 percent of the discharged charity patients were 65 years of age or older. SUMMARY We view H.R. 4222 as a proposal for providing socialized medicine for one segment of our population-the so-called aged. We are presently and can continue to care for our own, and firmly believe that this unwarranted centralization of regulation and control in an agency of the Federal Government will lead not only to a deterioration of the excellent care now being provided, but will tend to spread to other segments of the population. We believe that with continued cooperation between hospitals, physicians, nursing homes and the local citizenry, we can continue to provide quality health care without Federal interference through the social security program. We fear that the Federal Government as a purchaser could exercise the power of the purse in many ways that will tend to ultimately destroy our voluntary, free enterprise hospital system and seriously restrict the continued growth and service of our voluntary prepayment insurance plans. We are of the opinion that overutilization, misuse and abuse of our hospital and health facilities and personnel will occur should this free care program as |