As the members of this Committee are well aware, the controversy over national compulsory health plans has gone on for many years in this country. It has waxed and waned, but never entirely abated. Those who would like to see a socialized system of medicine set up for the United States are grimly determined, tireless, and disciplined.

Undiscouraged by repeated defeats, they return to the attack.

Invariably, they fix upon the Social Security Act as the vehicle

best suited to their purpose.

During the formative years of the Act, considerable support developed within the Roosevelt Administration for the adoption of a national compulsory insurance program under Title II.

Needless to say, the American Medical Association would have resisted that proposal, had it been necessary. It was not necessary because the idea was dropped. Thus the AMA did not--regardless of charges to the contrary--oppose any phase of the original Social Security Act.

As Franklin Delano Roosevelt commented the "Act contains four provisions dealing with health that are very often forgotten, especially in the heat of a political campaign. Those provisions received the support of outstanding doctors during the hearings before the Congress. The American Medical Association, the Public Health Association, and the State and Territorial Health Officers' Conference, and I think the Nurses' Associations as well, came out in full support of the public health provisions.

I quote our late president because I wish it to be absolutely clear that the medical profession has not and does not oppose the principle of Social Security.

In subsequent years several proposals were made to enact a limited version of a national compulsory health plan. These measures sought to extend hospitalization benefits to persons covered by OASDI. They were introduced in 1942 by Representative Elliott (D-Ala.) and in 1943 and 1945 by Senator Green, (D-R. I.). These bills were rejected.

Then in 1948 the Wagner-Murray-Dingell Bill was introduced, advocating--among other things--a Federal program to provide comprehensive hospital and medical services for the entire population. The AMA accurately described this plan as "socialized medicine" and fought it with every resource it could muster. So did a majority of the American people. And the measure was decisively rejected.

In recent years more limited versions of the master plan--all based upon use of Title II of the Social Security mechanism--have been introduced by the score. The most recent and prominent was, of course, the Forand Bill (H. R. 4700) of the 86th Congress.

Representative King's proposal--like its predecessors--is also based on a gross payroll tax collected and administered through the Social Security Act.

Why have all these measures chosen Title II of the Social Security Act as the vehicle through which our present system of medical care can be taken over by the Federal Government? I think there are several reasons.

First, the sponsors of such legislation hope to gain public approval of their proposals through the use of a system generally accepted by the American people.

Second, there is the lesson they have learned from abroad--that social insurance plans are evolutionary, not revolutionary, in character. The move gradually from lump sum benefits to retirement payments, to survivorship payments, to cash disability benefits, to temporary cash sick benefits, to national compulsory health schemes.

Third, those who like the idea of placing our system of freely practiced medicine under the thumb of the Federal Government know that decent, humane people try to help their neighbors. Thus they have sought to create a broad-gauged problem--the inability of the aged to finance health care costs--where no problem, or a small problem, exists. After dramatizing the alleged "need" of an entire group, after picturing sixteen and a half million people as poverty stricken and debilitated, the proponents of socialized medicine then say: "This isn't socialized medicine. We're only talking about the aged. We're not covering physicians. We're simply asking that our retired people be protected as a matter of right, through the Social Security system.

The argument, on its face, sounds harmless enough. But it is riddled, through and through, with illogic, lack of candor, and disregard for the facts.

Now the entire push to make our present system of medical care a federally controlled and operated activity is simply a single battle in a continuing war. Our nation is divided into two camps. At issue is the vital question of the proper role the Federal Government should play in our society.

On one side are those who demand--vigorously and through every means of persuasion--an ever-enlarging role for the Federal Government. On the other side are those, like ourselves, who oppose the efforts now being made to increase the government's direction and control over our way of life.

That the Federal Government functions in areas which do not concern it is an unarguable statement. Members of the Committee have read, I feel sure, the Hoover Commission reports and the reports of the Commission on Intergovernmental Relations. Even the most casual study of

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these documents discloses example after example of Federal trespass into areas formerly reserved to private effort, or into areas more properly the purview of state and local governments.

This, then, is one of the major problems of our time. The nation's physicians are among those who believe that increasing Federal direction, regulation, and control threaten the existence of individual freedom. To be candid, Mr. Chairman, we feel that the Federal Government is once more seeking to broaden the scope of its encroachment.

The steady drift of the Federal Government into areas of activity in which it does not belong has been accelerated by political expediency, in many cases. We are now confronted with such a case:

H.R. 4222--the campaign issue, the platform pledge, the politi

cal promise.

Mr. Chairman, we are convinced that campaign issues, pledges and promises are not the basis on which to deal with health care. As doctors, we are concerned with the prolonging of lives, the control of disease, the provision of health care.

We have done our job. If we had not, the life expectancy of the average American would not have increased as it has. We have succeeded, not failed, in prolonging life for millions of people under a system of freely practiced medicine. Are we to be penalized for our success because of campaign issues, platform pledges, and political promises? Are we to remain passive and silent while others seek to destroy the world's finest system of medical care in the name of political expediency?

We proudly acknowledge, Mr. Chairman, that the health professions have, in prolonging life, helped create a vast sociological problem. And we submit that only a free medical profession can cope with that portion of the total problem involving the health care of the elderly.

The Federal Government is not being asked to move into a vacuum of unmet need. It is being asked, under H. R. 4222, to pre-empt an area of successful accomplishment in the name of political expediency.

From the beginning of the Social Security system, the Congress has adhered to certain basic principles in drafting legislation affecting the system. Among these principles have been those providing that benefits should bear some relation to the individual's earnings, and that benefits should be paid in cash, not in services.

It has once more been proposed that we abandon these principles. Instead of allowing the beneficiary to use cash benefits in any way he pleases, it is now suggested that he be required to accept health services for himself regardless of whether he likes the idea or not, or whether he needs these services or not.

This is a hazardous deviation from the original purpose of the Social Security Act. And it demonstrates a dangerous brand of thinking, not new to the world, but comparatively new to the United States.

It is the thinking of "Government knows best."

This legislation proposes that we distrust the brains and capacities of today's Americans. It suggests that the aged--as an entire group--are not capable of looking after their own affairs and providing for their own needs.

In my opinion, this is patronizing and paternalistic.

I do not believe that people who have raised families, held jobs, fought wars, weathered depressions, paid their bills, and voted for the candidates of their choice throughout busy, productive lifetimes become suddenly, at 65, incapable of deciding how to spend their money. And I fail to see how the Federal Government, whose course these same people helped to chart, can logically explain why it is so much more intelligent than those who created it.

Let me quote the words of a great labor leader on this subject:

"Compulsory social insurance is in its essence undemocratic and it cannot remove or prevent poverty. The workers of America adhere to voluntary institutions in preference to compulsory systems, which are held to be not only impracticable but a menace to their rights, welfare and their liberty. Compulsory sickness insurance for workers is based upon the theory that they are unable to look after their own interests and the state must interpose its authority and wisdom and assume the relation of parent and guardian."

Those are the words of Samuel Gompers, Mr. Chairman. He wrote them in 1917, but they constitute a wise and timely warning nearly half a century later.

H. R. 4222 sees the Federal Government as "parent and guardian" for the health care of sixteen and a half million older people, presumably because the aged are "unable to look after their own interests."

Subscribe to this premise, and government--authoritarian and vise--could brush aside any or all of our individual freedoms. Under the slogan "it's all for your own good," the Federal Government could regiment doctors, nurses, patients, hospitals, nursing homes and any other element of our health care system that stood in its way.

All of H.R. 4222's disclaimers of control of the practice of medicine and of the administration of medical facilities and programs do not alter the fact that what the Government subsidizes, it also controls.

SECTION V

EFFECT OF THE BILL IMMEDIATELY AND POTENTIALLY ON

THE QUALITY OF MEDICAL CARE

Mr. Chairman, early in this testimony I stated the paramount reason why the medical profession opposes H.R. 4222. Let me stress it once more. We believe this bill would lower the quality of medical care available to the older people of the United States.

In discussing our reasons for this conviction, we should like

to consider the measure from two standpoints:

First, from the standpoint of H. R. 4222 as it now stands.

Second, from the standpoint of H. R. 4222 as it would expand.

Let us begin by pointing out that this country's system of medical care is unlike that of any other. It is unique, in that it operates freely. Although government performs a number of essential functions within this system at the local, state and Federal levels, it thus far has sought to supplement, not supplant, the efforts of the health professions. In the United States, the health professions have therefore been free to pursue their constant search for better methods of treatment, more effective drugs, more efficient techniques.

By way of contrast, other countries have developed systems under which government exercises, to a greater or lesser degree, controls on the provision and financing of health care. Further, these controls are not confined to programs of indigent care but cover the entire population regardless of need.

Which approach is the more effective? And which is better for the United States?

In seeking to answer these questions, it is relevant to point out that America has become, in recent years, the medical Mecca of the world. When I began medical practice, students who could afford it flocked to the medical centers of Europe for their basic and post-graduate education. Today, medical students from all over the world come to the United States.

The quality of medical education in American schools is unsurpassed anywhere. The qualifications of the American physician are unmatched anywhere. We research, we experiment, we improvise and we treat freely because we are free to do so; and the results speak for themselves.

The

Ours is a dynamic system of health care -- and it works. very fact that we now have sixteen and one-half million Americans 65 years of age or older proves that it works.