(18) The committee on aging made liaison with the local groups concerned with the problems of our senior citizens, and arranged talks, panels, etc., before the local senior citizens group and before local civic clubs, seeking to arouse concern and interest, and to offer information. The county society is also represented on the Pulaski County Health and Welfare Council, a function of our local United Fund, and is currently participating in a committee study of the costs of medical care in our community, with that organization.

(19) A representative from the Pulaski County Medical Society was on our State commission on the aged, and attended the White House Conference on Aging.

(20) Several of our society members serve on a local committee trying now to organize a home for the aged for a local church group.

(21) The county society has now before it for consideration a successful plan instituted last year by the St. Louis County Medical Society, Missouri, whereby a patient, regardless of age, who feels unable to meet the full cost of medical care, can apply, without charge, for a financial investigation which results in the issuance of a medical credit card, entitling the patient to a percentage reduction in fees from participating society members.

(22) The Pulaski County Medical Society has publicly stated (see attached copy of "Letters to the Editor," Arkansas Gazette, July 1961) that the society and its members guarantee medical care to all in our county, regardless of financial, race, or other status.

(23) The members of the Pulaski County Medical Society give many hours of free medical care in our county through such activities as tumor clinics, the Children's Hospital, health clinics, medical center clinics, the Rehabilitation Center for the Blind, the Florence Crittenton Homes, various pre-summer-camp physicals, etc. A recent survey showed that 146 private physicians in Pulaski County gave 1,780 free hours of medical care per week.

APPENDAGE No. 3. IDENTIFICATION OF WITNESS

Dr. Joseph A. Norton, representing Pulaski County Medical Society in Arkansas a partial listing of personal service to community, to church, and to profession, to indicate interest and concern and involvement in Pulaski County, Ark. : Community service

(1) Active member, Little Rock Chamber of Commerce (Cultural Affairs Committee, Education Committee, Public Health Committee, Governmental Affairs Committee).

(2) Board of Directors of Arts Council of Greater Little Rock.

(3) Board of Directors of Little Rock Philharmonic, Inc., and past president of Little Rock Philharmonic, Inc.

(4) Board of Directors of Arkansas Opera Company.

(5) Board of Directors of Arkansas Choral Society.

(6) Board of Directors of Greater Little Rock Chapter of the Society for the Preservation and Encouragement of Barbershop Quartette Singing in America, Inc., and charter member of the local chapter.

(7) President of Pulaski County Audubon Society.

(8) Board of Directors, Advisory, Urban League of Little Rock.

Church service

(1) Deacon and elder, Westover Hills Presbyterian Church, Little Rock.

(2) Past president, Men of Washburn Presbytery, Arkansas.

(3) Past moderator, Washburn Presbytery, Arkansas.

(4) Past president, Men of Synod, Presbyterian Church, U.S., Arkansas.

(5) Past chairman, Synod Council, Presbyterian Church, U.S., Arkansas.

(6) Member, Board of Christian Education, Presbyterian Church, U.S., As-sembly.

(7) Moderator, Synod of Arkansas, Presbyterian Church, U.S., Arkansas.

Professional

(1) Past president, Pulaski County Medical Society.

(2) Past vice president, Arkansas Medical Society.

(3) President, Arkansas Radiological Society.

(4) Various committee work, Arkansas Medical Society and Pulaski County Medical Society (American Medical Education Foundation Fund, civil defense, public relations, program, Senior Medical Day).

(5) Past president, and current acting president, Medical Alumni of University of Arkansas.

(6) Associate professor of radiology, University of Arkansas School of Medicine, located in Pulaski County.

APPENDAGE No. 4. LETTER TO ARKANSAS GAZETTE

To the EDITOR OF THE GAZETTE:

LITTLE ROCK, ARK., July 16, 1961.

A recent letter to the editor of the Arkansas Gazette concerning local medical care and costs in this area deserves comment.

Apparently the author of the letter has experienced personally, or in his close circle of family or friends, some unfortunate episodes of illness-with considerable physician, hospital, and drug expense. This is unfortunate, but most of us, sooner or later, fall victim to some illness or disability. We should take care in our good health to prepare ourselves mentally, physically, spiritually, and economically for such adversity.

The medical profession believes that the American way to meet such emergencies is primarily through private enterprise, such as private health and accident insurance, and through reduced or charity services of local hospitals, private physicians, and health agencies. Where these needs cannot be met locally, State and Federal facilities and programs may be needed.

We take issue with the statement in the letter that free medical care is not available in our area. A recent survey of the private practitioners of Pulaski County shows they gave 1,780 free hours of medical care per week through private offices, hospitals, and clinics. The Pulaski County Medical Society is ready at all times to arrange for medical care for anyone in need, regardless of ability to pay for such services. All who are unable to meet full medical costs will find available local physicians and hospitals for partial or full charity services.

The rising cost of medical care in our country has not kept equal pace with the increase of costs of goods and services. Inflation, unles controlled will increase the cost of food, clothing, shelter, cosmetics and all other elements of our standard of living. It has been repeatedly shown by Federal statistics that the increase in the cost of physician care is much less than the increase in cost of other common services and goods, even though the quality of medical care has consistently improved to the level that, generally, American medical care is now the envy and goal of all the world.

We appreciate this opportunity to comment on this recent letter to the editor. We want to help those in need of medical care, regardless of their social, economic, or racial status. We urge the use of private health and accident insurance. We urge each family to arrange immediately for a private family physician. We urge each individual to talk over medical costs and economic status at the first visit to his physician, that proper and suitable arrangements might be made and misunderstandings about finance not occur. The medical profession locally has always and will continue to cooperate with all agencies whether county, State, or Federal welfare to provide medical care for all age groups, regardless of ability to pay. Further, we welcome questions and constructive criticisms about the local medical care. Where we are found deficient, we would like an opportunity to make correction. Where we are found correct, we would like an opportunity for explanation. Where there is need, we would like an opportunity to help. The phone number of the Pulaski County Medical Society office is Franklin 5-6695.

Thanks so much for this opportunity of reply and explanation.

PULASKI COUNTY MEDICAL SOCIETY,
Dr. JOHN WILLIAM SMITH,

President.

Dr. JOSEPH A. NORTON,

Immediate Past President.

APPENDAGE NO. 5. SOCIETY RESOLUTION

Resolutions passed by the Pulaski County Medical Society during 1960 and 1961. Copies were sent to congressional delegation.

March 15, 1960

The Pulaski County Medical Society is in opposition to the passage of the Forand bill (H.R. 4700) and all similar legislation which provides for social security expansion for compulsory health insurance. Opposition is voiced because legislation of this type would remove the flexibility of medical approach and technique which is necessary for the best possible health care for every American. Also it is a political approach to a health problem developed by and would be administered by nonmedical people and it would distinctly weaken the patient-physician relationship.

Preferences expressed for legislation to provide for better control of inflation and voluntary insurance as being preferable.

For these reasons it is the opinion of this society that this measure and similar legislation should be defeated.

March 15, 1960

The Pulaski County Medical Society in opposition to the compulsory inclusion of physicians under social security urges the defeat of H.R. 9925 (Machrowicz) and all other similar legislation.

March 22, 1961

Be it resolved That the Executive Committee of the Pulaski County Medical Society in official session March 22, 1961, go on record as opposing H.R. 4222, title Health Benefit Act, 1961; that our representatives in Washington, D.C., be so informed of this action and to use their influence in opposition to the bill.

APPENDAGE No. 6.

LETTERS TO CONGRESSIONAL DELEGATION

The following letter was sent to Congressman Mills.

Congressman WILBUR MILLS,

House Office Building, Washington, D.C.

LITTLE ROCK, ARK., March 16, 1961.

DEAR CONGRESSMAN MILLS: Once again, apparently, the Congress will be asked to consider a compulsory national health insurance law for the aged, to replace the Kerr-Mills law passed by the 86th Congress.

May I state my opposition to such efforts in the field of health through expansion of social security. I can find nothing there which is attractive, necessary, efficient, or economical. I much prefer to give the Kerr-Mills law a thorough trial I believe that it will answer the needs of our aged citizens.

You have been so valiant and perservering in your fight against these efforts to expand the social security system in the field of health. Please know that your efforts are appreciated by myself and by thousands of others, both in and out of the practice of medicine. I hope that you will not become weary in your efforts. If there is anything that we can further do to help, please let us

know.

Thank you so much for giving me this portion of your time.
Sincerely,

JOSEPH A. NORTON, M.D.

The following letter was sent to Congressman Alford and Senators Fulbright and McClellan :

LITTLE ROCK, ARK., March 16, 1961.

DEAR SIR: It appears that the 87th Congress will be asked to consider a compulsory national health insurance law for the aged, to replace the KerrMills law passed by the 86th Congress.

Once again, may I state my personal opposition to the social security approach to health care. I can find nothing in that approach that it seems necessary, efficient, or economical. I must prefer to allow a trial of the Kerr-Mills law.

Thank you so much for your aid in opposing social security expansion in this field in the past. I hope you can continue to give opposition to those efforts. Best regards to you. Thanks so much for giving me this time.

Sincerely,

JOSEPH A. NORTON, M.D.

APPENDAGE No. 7. RESOLUTIONS OF LOCAL CHAMBERS OF COMMERCE

RESOLUTION OF LITTLE ROCK JUNIOR CHAMBER OF COMMERCE, APRIL 6, 1961 Whereas H.R. 4222, a bill for health care of the aged was introduced in the House and Senate on February 13, 1961, by Congressman King of California and Senator Anderson of New Mexico; and

Whereas the junior chamber of commerce is dedicated to the principles of free enterprise; and

Whereas H.R. 4222 is socialistic in nature and constitutes a disintegrating erosion of the free enterprise system upon which this Republic was founded; and

Whereas the Arkansas Legislature has implemented the Kerr-Mills program to become effective July 1, 1961, which will provide for all the aged who are needy: Now, therefore, be it

Resolved, That the members of the Little Rock Junior Chamber of Commerce assembled in meeting this 6th day of April 1961 urge all Arkansas Representatives in both Houses of Congress, to defeat the passage of H.R. 4222, and all legislation having a similar purpose: And, be it further

Resolved, That copies of this resolution be forwarded to all of the U.S. Senators and Representatives from the State of Arkansas.

RESOLUTION OF THE LITTLE ROCK CHAMBER OF COMMERCE

Whereas the Kerr-Mills bill adopted by the 86th Congress of the United States provides satisfactory medical care for the needy aged; and,

Whereas the Arkansas Legislature has implemented the Kerr-Mills bill in our State; and,

Whereas a system of compulsory medical care for the aged would cause health costs to be financed through higher social security taxes, and,

Whereas, it is the belief, of the Board of Directors of the Little Rock Chamber of Commerce that any compulsory health care program would constitute socialized medicine controlled by a bureau of the Federal Government, paid for by increased social security taxes, burdening both present and future generations, and leading to a decline, if not the end, of voluntary health insurance programs: Now, therefore, be it

Resolved, That the Board of Directors of the Little Rock Chamber of Commerce hereby opposes the passage of any new legislation which would weaken or kill the Kerr-Mills law.

Adopted this 12th day of May 1961.

BOARD OF DIRECTORS, Little Rock Chamber of Commerce.

The CHAIRMAN. Are there any questions of Dr. Norton?

Dr. Norton, I want to congratulate you on this very fine presentation of your views and those of the other very fine doctors in Pulaski County. You have made an outstandingly good witness. Thank you very much for coming before the committee.

Mr. Lander, will you identify yourself for the record, please?

STATEMENT OF DR. BERNARD LANDER, FOR SYNAGOGUE COUNCIL OF AMERICA

Dr. LANDER. Mr. Chairman and members of the committee, my name is Dr. Bernard Lander. I am chairman of the Commission on Family and Social Welfare of the Synagogue Council of America.

I am appearing on behalf of the Synagogue Council of America which represents the religious Jewish community of America, comprising the Central Conference of American Rabbis, Rabbinical Assembly of America, Rabbinical Council of America, Union of American Hebrew Congregations, Union of Orthodox Jewish Congregations of America, and United Synagogue of America.

We endorse the President's health insurance proposal because we believe that there is an imperative and very large unmet need of the aged for hospital and nursing-home care. We also support this proposal for moral and religious considerations because we are convinced that the President's proposal provides procedures and a methodology for meeting these needs that are consistent with and in the spirit of our Judaeo-Christian heritage.

The superb report on basic facts on the health and economic status of older Americans, prepared by the staff of the Special Committee on Aging of the U.S. Senate, demonstrates and specifies the unmet needs of our older population for adequate hospital and nursinghome care.

While the aged constitute about 9 percent of the total population, they make up more than 55 percent of all persons with limitations due to chronic illness. The lower income aged in particular, have a high proportion of limitation of activity due to chronic illness: 82 percent of the over-65 population with family incomes under $2,000, have such limitations in activity, as against 75 percent of the aged with family incomes of $4,000 or more.

Nine out of ten persons who live to be 65 go to the hospital at least once between age 65 and death. About one of every five American aged is either confined to the house or has trouble getting around. In addition, approximately 5 percent of our aged spend the balance of their lives in institutions because of illness. A 1957 study of social security beneficiaries indicated that at least 20 percent of the beneficiaries were hospitalized during the year.

Fewer than one-half of the aged have any insurance to cover hospitalization. Furthermore, even when insurance policies are available they generally offer only limited benefits under limited considerations. For example, the Senate staff report finds that the Blue CrossBlue Shield plan in Oakland, Calif., offered 21 days in ward accommodations. In Arizona, they offer 21 days in semiprivate accommodations. Even then the aged are covered by some form of hospital insurance, this coverage is generally of a very limited

nature.

Coupled with the more extensive need of the aged for hospital care is also their severe limitations of ability to finance this care. The Bureau of Census data suggests that 55 percent of our aged populations have annual incomes of less than $1,000 and 23 percent have incomes of $1,000 to $2,000. Only 33 percent of the entire aged population have liquid asset holdings of $2,000 or more. At the same time, the medical bills for half of the families reporting hospitalized illness amounted to over $700.

It is thus abundantly clear that by and large one-half of our older population have neither the income nor the liquid assets to finance the long-term hospital care which is so essential in the illnesses that

beset them.