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Mr. KING. Very good. Any further questions?

Mr. DEROUNIAN. I have a question.

Dr. Emerson, it is apparent that you have read the bill. I think some of the criticism we may have to some of the witnesses, both proponents and opponents, is that they don't discuss the bill, but you have discussed the bill and we are indebted to you for your approach to it.

Now I will just ask you this question: On page 5 you referred to the myriad of reports that would result from this bill if it became law. Have you had any personal experience in your own practice regarding filling out records in present Federal programs?

Dr. EMERSON. Yes, sir. This is what prompted me to put this one item in the report. I have two instances, particularly, to mention, both of which come under the Federal Workmen's Compensation Act, in one of which I was called and asked if I would personally take care of this patient by one of the Government agencies.

Having submitted reports over a period of 3 months, having submitted 1 form which was not in triplicate, but 12 copies, then at the end of about the fourth month I received a letter saying that they had no record of this particular case.

After tracing it down, the record was found in another office down the hall.

Another instance came up where a person developed a hernia working for the postal department. The man had rather extensive allergies. He wanted to go to his family doctor who had sent him to me. He wanted to go to a hospital of his choice. He was told it was necessary for him to go to the Marine Hospital on Staten Island. Voluminous correspondence went back and forth between the patient and his place of employment of which the sum and substance was that if he went to the Marine Hospital he would be covered. Otherwise, he would have to assume the cost on his own. I am mentioning this not from the standpoint of the records, but I think of the effect that it has on the patient. It is one of frustration and it is not what we call prompt service. The records on these two cases would be equivalent many times of the record that you would noramlly consume with a hernia. If you can compound this many times even though this may occure only infrequently, which I doubt, you would find the amount of records, the delay, the confusion, the redtape that goes on to process a nationwide program of this type. I do not believe the patient is going to like it from what I have heard from the ones, particularly friends of these two people. I would hate to mention before this distinguished committee the remarks that have been made.

I think this is merely one illustration. I think none of us like to make out forms, but we make out forms for the New York State program where they have Blue Cross and Blue Shield and Major Medical. We are very happy to do it. We are interested in our patients' care and we want them to get the best care possible. We want them to utilize all their insurance programs, and I firmly believe that this can be done. The closer you keep it to the local level, the more effective, the more advantageous it will be to the patient and, after all, he is the only one that really counts.

The CHAIRMAN. Any questions?

Doctor, we thank you, sir, for coming to the committee and bringing us your views.

Dr. EMERSON. Gentlemen, it has been a pleasure.

The CHAIRMAN. Dr. Mann.

Dr. Mann, I see that you are accompanied by our colleague, Mr. Stafford. Would you like to present Dr. Mann?

STATEMENT OF HON. ROBERT T. STAFFORD, A REPRESENTATIVE
IN CONGRESS FROM THE STATE OF VERMONT

Mr. STAFFORD. I would appreciate it, Mr. Chairman.
The CHAIRMAN. You are recognized, sir.

Mr. STAFFORD. It gives me a great deal of pleasure, speaking you might say for the entire Vermont delegation to the House, to present to this committee the president-elect of the Vermont Medical Association, Dr. Roger Mann, who wishes to make a statement as a witness before you. He is accompanied by the executive secretary of our State medical society, Mr. C. Getty Page, who is a fellow townsman of mine from Rutland, Vt. I appreciate this opportunity, Mr. Chairman, to make this introduction to you and the members of the committee. I apologize if I may for leaving personally because I have another appointment that started 5 minutes ago, if I might be excused.

The CHAIRMAN. We appreciate your coming to the committee to present Dr. Mann and the secretary of the Vermont Medical Society. Thank you very much.

Mr. STAFFORD. Thank you.

The CHAIRMAN. Dr. Mann, we have allotted you 5 minutes.

In order to get within that time if you need to omit some parts of your statement do so with the understanding that the entire statement will appear in the record.

STATEMENT OF DR. ROGER W. MANN, PRESIDENT-ELECT, VERMONT STATE MEDICAL SOCIETY; ACCOMPANIED BY C. GETTY PAGE, EXECUTIVE SECRETARY

Thank you very much, Mr. Chairman, and members of the committee. My name is Roger W. Mann. I am a physician-a general practitioner and have been in practice for 20 years in northern Vermont. I live in the town of Waterville which has a total population of 322, and my office is in the village of Jeffersonville which has a population of 346. My practice includes 9 small towns and parts of several other towns where the population ranges from 155 to 1,295an area covering approximately 337 square miles. This is a "backwoods" practice in a low-income area, 20 miles from a hospital, and in 1960 41.6 percent of my patients were 65 years of age or older. I am chairman of the Indigent Care Committee of the Vermont State Medical Society, medical examiner for Vermont State District No. 6 which includes 11 towns, a director of New Hampshire-Vermont Blue Shield Service, and have been chairman of the local school board for the past 16 years.

I am making the following statement on behalf of the Vermont State Medical Society of which I am the president-elect. Vermont's position is unique as far as the aged population is concerned since

11.2 percent is over 65 years of age. This is the fourth highest in the 50 States. We recently conducted a survey of how the aged population in our State pays its medical bills. We found that our older citizens are well able to meet their obligations with Blue Shield, private insurance, and from savings or current income. I shall go into the details of the survey later in this testimony.

The Vermont State Medical Society has 460 members. This is 95 percent of the total physicians in the State. The purpose of the Vermont State Medical Society is to promote the public health; to encourage and aid the progress and development of the sciences of medicine and surgery; to advance the general, moral, social and intellectual welfare of its membership; and to facilitate communication and encourage cooperation among physicians and surgeons to the end that the standard of professional skill, care, and judgment may be elevated generally.

The Vermont State Medical Society has been active in the following

areas:

1. In the fight against poliomyelitis. In 1894 it cooperated with the State board of health in the investigation and reporting of the epidemic outbreak which occurred in the summer of that year. Dr. C. S. Caverly then published a report which stood out as the best contribution on the disease up to that time, and instigated research of this "new" nervous system disease. Since the availability of Salk vaccine the State medical society has cooperated in establishing free clinics which have brought a high rate of inoculations statewide, and has resulted so far this year in a complete freedom from new cases in Vermont. As a final onslaught on polio the society is aiding the Vermont Health Department in sending mobile units to cover even the smallest towns in isolated areas in an attempt to complete a total innoculation for prevention of the disease.

2. In organization of the New Hampshire-Vermont Physician Blue Shield Service in 1942.

3. The society acts as a Vermont physicians placement service— helping localities within the State to find physicians.

4. It makes available a mediation board whose purpose is to prevent and resolve misunderstandings-to clarify and adjust differences between physicians and patients as well as physicians and physicians, and to assist in maintaining the high levels of professional deportment already established by the principles of medical ethics.

5. It has sponsored the Vermont Joint Council To Improve the Health Care of the Aged, which council consists of representatives from the State medical society, State nursing association, State dental association, and the Vermont Hospital Association.

6. It has a very active committee on nursing education in Vermont which led to the establishment of a 2-year nursing education course (associate-in-arts degree).

7. In 1960 the society's committee on aging completed a survey of the way the older people pay their medical bills in Vermont.

Aside from these services to the general public, the society at least twice yearly assists in the conduction of meetings for the professional education of its members; it publishes a monthly newsletter to inform the individual physicians as to the medical news in the State, with a calendar of the meetings and current medical events; and it keeps

the members alerted to impending State legislation as well as congressional activities.

The Vermont State Medical Society has been active through its committees in assisting the State welfare department in the implementation of old-age assistance laws. The society expressed approval of implementing the Kerr-Mills law in the State of Vermont in a formal resolution passed in 1960 by the house of delegates, at which time it set up an indigent care committee. On July 11, 1961, Governor Keyser signed the Hoff bill, which implements the Kerr-Mills law in the State of Vermont, and makes available for the near-needy over 65, $570,000. The Vermont State Medical Society has actively supported this bill and is now working with the State welfare department in organizing the administration of the law.

At the local level in Vermont each town or city has an overseer of the poor, and the care of the indigent-aged or otherwise-is handled on this basis by the town wherein the person resides; however, the State also has a transient law so that any indigent person, or medically indigent person, needing medical care (regardless of his residence) may receive it. The State welfare department handles the old-age assistance program which provides free nursing home care to any of the old-age recipients in nursing homes that are State inspected for quality of care as well as safety from fire and other hazards. There is also available to old-age assistance recipients up to a month's free hospitalization. In the month of June 1960 old age assistance was granted in Vermont to 5,593 persons.

Our society committee on the aged has been very active in dealing with problems of the aged. Its chairman, Dr. Clifford Harwood, attended the White House Conference on Aging, and more recently (June 15-16) the followup of the White House Conference on Aging, Because the State of Vermont has one of the highest percentages of older people of any State in the Union-11.2 percent of our population is over 65 years of age-it was felt by the committee that a survey of the manner in which the older people pay their medical bills, as well as other statistics, might be in order. This survey was conducted during the month of January 1960. Each doctor in the State was given a set of forms on which each 65 years person and of age older whom he saw during the month of January 1960 was to be tabulated, and several questions answered about each patient. Fiftysix percent of the physicians in the State cooperated in conducting this survey in which a total of 5,172 patients were reported-these patients were of the ages 65 to 106. Pertinent facts which were brought out by this survey were these:

1. Two women to every man seek the doctor in this age group. 2. Only 13 percent of the aging seeking medical care this month were bed-bound or chair-bound.

3. It was gratifying to note that 66 percent lived with spouse or relatives as a part of their family group.

4. Fifty percent of these patients were on social security-this is somewhat lower than the national average which gives evidence that there are a great many in Vermont who do not come under the social security program and would therefore not receive benefit from a medical care program tied in with social security.

5. Sixteen percent were on old-age assistance and 13 percent on other retirement plans.

I

6. Forty percent of those surveyed were on Blue Shield insurance, and 12 percent were cared for by other private health insurance.

7.

Five percent of the group will have their bills taken care of by the town or State.

8. Twelve percent the family will pay for.

9. Two point three percent had no charge made by the doctoreven though this survey did not attempt to include the free clinics in the larger hospitals around the State.

10. Twenty-nine percent of the group paid from their savings or

income.

11. Twelve percent had reduced charges from the doctors.

Summing up these percentages (see attached chart) shows that 80.7 percent of the group surveyed plan to meet their obligations with Blue Shield, private insurance, and from savings or current income. The patient's families will assume the responsibility in 12 percent of the cases, and the responsibility fell to the city or town in 5 percent. The physician subsidized in full 2.3 percent of the patient care load, and in part 12 percent. Incidentally, 32 percent of the patients were seen in their homes, which shows that the physicians still make a considerable number of house calls in Vermont, even during the month of January.

It is rather outstanding to note that the New Hampshire-Vermont Blue Cross-Blue Shield plan has accepted the aged (from 65 on up) since its beginning in 1942 at no increase in permium or reduction in benefits.

The 1960 Bureau of Census shows the population of the 65-year and older group to be 43,741 in Vermont. By using the percentages which were found in the society's survey of the aged it would therefore appear that:

Eighty point seven percent (or 35,298) would meet their obligations with Blue Shield, private insurance, or from savings or current income;

Twelve

percent (or 5,249) would be taken care of by their families; Five percent (or 2,187) would be taken care of by their city or town; and

Two point three percent (or 1,006) would be subsidized in full by their physicians.

When further aid is given to the aged by the addition of funds available under the implementation of the Kerr-Mills law it should certainly be obvious that no additional medical care programs are needed in Vermont.

I wish to go on record as being opposed to H.R. 4222 for the basic reason that it is unnecessary in Vermont. To be more specific, I feel that through the old-age assistance program and the transient law, along with Blue Cross-Blue Shield and other private insurance companies plus the additional funds now available through the Kerr-Mills law-the people of Vermont, who have among them one of the highest percentages of the 65 and over group of any State in the Union, now have adequate medical care.

We, the physicians in Vermont, are privileged to be a part of the team which gives to Vermont and to America the best medical care found anywhere in the world today.

Thank you very much, gentlemen, for your kindness in listening to me at such a late hour.

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