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Surely you understand that these diagnostic services encompass a very large part of the everyday practice of medicine. These X-ray examinations and other diagnostic examinations are performed by doctors of medicine, and fees must be paid to these doctors of medicine. When these services are performed in the private offices of doctors of medicine, as most of them are, a fee is paid to the doctor. When performed in hospitals, the doctors' fees are often disguised as hospital charges. Still, there is a payment to the doctor for his services under

the auspices of the hospital.

Is the administration hiding behind the subterfuge that it will not be paying doctors' fees by establishing the hospital as a necessary intermediary between the patient and the diagnosing doctor of medicine?

Is it not completely obvious that the administration bill does indeed cover the fees of doctors who do these diagnostic examinations, however the fee may be disguised?

I will not dwell on these inconsistencies any further. The crux of this matter is that the bill so transparently and completely does deprive the patient of the privilege of going to the doctor of his choice for the performance of a diagnostic service. Yes, sir; it compels the patient to utilize the professional services of the doctor who has elected to practice as the tool of a lay hospital administration, a doctor who has given up his birthright to a direct personal relationship with his patient.

The patient will no longer be free to obtain such services from the doctor of medicine who has built up his own practice under our blessed system of free private enterprise.

Your bill is discriminatory, sir. It discriminates against me and it discrimiinates against my patient. Your bill would arbitrarily alter the methods of practicing medicine.

I submit, sir, that the continued statements of administration spokesmen to the effect that this bill neither covers doctors' fees nor compromises the free choice of a doctor cannot represent anything but ignorance or deliberate misrepresentation.

I am not going to enter into the whole argument against compulsory health insurance. You are not going to be swayed from your position on this and I respect your right to your opinions. But, if the Government is going to pay for doctors' services, let us say so openly. And let us not say that the doctor's service is only worth paying for when done in the confines of some overcrowded. impersonal, lay-dominated institution called a hospital.

I most sincerely request some enlightenment with regard to the administration's position on the question I have raised.

Please do not tell me that these outpatient diagnostic services are not the services of doctors of medicine. Sir, I have been performing these services on outpatients in my office for a good many years, and if these are not doctors' services, then I must have wasted a good many other years in training to perform them.

Over 100 Florida radiologists and many of my fellow physicians here in Duval County will be most interested in a clarification of your position, which I earnestly hope will be forthcoming.

Yours sincerely,

IVAN ISAACS, M.D.,
Vice President, Florida Radiological Society.

DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE,
Washington, May 31, 1961.

IVAN ISAACS, M.D.,

Vice President,

Florida Radiological Society,

Jacksonville, Fla.

DEAR DR. ISAACS: The press of many legislative duties has prevented me from replying sooner to your letter of February 16 addressed to Secretary Ribicoff. I trust you will forgive the delay.

Your letter of February 16 raises a question that has been recognized by those who have been involved in framing the administration's health insurance recommendation. The decision to include hospital services but not physicians' services outside the hospital has necessitated the drawing of a line between the two, and there seems to be no way to draw the line that will be satisfactory

in all respects to all those concerned. This difficulty is not unique to a Government-financed system; in one form or another it has been encountered in many private prepayment plans.

To provide payment for hospital care, yet exclude altogether payment for the ancillary services which hospitals do and must make available would deprive the benefits of a substantial part of their value. Although we recognize that there is a medical component in these services and that they are similar or identical to services which are rendered by or under the supervision of physicians in private offices, we believe that they are nevertheless an essential part of an inpatient hospital benefit if it is to be meaningful to the beneficiaries. Accordingly, we concluded that coverage of the typical hospital ancillary services should be included in the administration's recommendation.

The coverage of these services when rendered to hospital outpatients reflects primarily the desire to avoid or minimize the use of hospital beds for diagnostic work that can properly be performed on an ambulatory basis. You are, of course, familiar with the belief of some authorities that unnecessary use of beds often results from payment for these services when rendered to inpatients only. We have thought that the $20 deductible would mitigate, although admittedly it would not obviate altogether, the impact on nonhospital radiologists. Some physicians undoubtedly will take into consideration the fact that radiological services provided in hospital outpatient departments to aged beneficiaries would be paid for, to the extent that the cost exceeds the deductible, by the social security system.

We are still considering these matters in connection with pending legislation. I appreciate your having written us.

Sincerely yours,

WILBUR J. COHEN, Assistant Secretary.

STATEMENT OF NELL F. STEPHENS, LICENSED PRACTITIONER

Mrs. STEPHENS. Mr. Chairman, I am Mrs. C. A. L. Stephens, licensed practitioner.

I am sorry my name does not appear on your list. I usually do mine in writing and hand it in. The committee knows the work I have done for the past 11 years in trying to bring out just what this hearing has done.

I wish to thank each and every member for all knowledge that you have gained on this subject and I hope that it will be most helpful. I am in opposition to this bill. Let me recall to you a fire we had in Washington at the Mount Vernon Nursing Home, the conditions of which I reported personally in 1954 and 1955 which were not gone into thoroughly. Had they been done so, those seven lives would have been saved.

There are many unfit nursing homes in the District of Columbia. In behalf of all the people of the United States and the District of Columbia, let me beg of you do not place the care of the aged and aging under the social security system. We do not need socialized medicine and we nurses, along with doctors, will fight socialized medicine along with any form of socialism in the United States of America. May I present this statement for the committee to read? Mr. KING. Yes, you may.

(The statement of Mrs. Stephens follows:)

Congressman MILLS,

WASHINGTON, D.C., August 4, 1961.

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

MR. CHAIRMAN AND ALL MEMBERS OF THIS COMMITTEE AND THE U.S. CONGRESS: In opposition to H.R. 4222, I wish to state again and again all in America do not need "socialized medicine" or socialism in any form. We do need to

break up "the racket" where crime is continuously committed and it is done on the sick, afflicted, and helpless. Therefore, I repeat again and again, close up nursing homes, placing patients in proper hospitals where they are cared for by licensed doctors and nurses. States rights enters into this subject. Let each and every State care for its own, and family, township, or community, including all agencies that assist the poor and needy, not forgetting the number of people assisted by our American churches, who are always helping the sick, afflicted, and helpless. The above, who need assistance, should be given assistance through welfare State welfare or county or township welfare departments.

State hospitals must be improved and enlarged where needed. A State nursing home, in connection with, but separate from State hospitals, is the solution toward breaking up the racket.

In behalf of all people of the District of Columbia, all nursing homes seem to be unfit and should be closed. Patients should be placed in the District of Columbia General Hospital. District of Columbia General Hospital should be taken away from the Health Department and controlled by a board of directorsas a State hospital-employing the proper trained and licensed doctors and nurses, and other personnel, which would give employment to many more needed professional trained personnel.

The care of the aging and aged should not come under control or through social security program-definitely not.

Thanks to all of you who will recall my work of days and years gone by in trying to get the present conditions known and corrected, and breaking up the terrible crimes known to be committed on the aging and aged, sick, afflicted, and helpless people of the District of Columbia and the United States of America. The Lord's will be done. Amen.

Sincerely,

NELL F. STEPHENS

Mrs. C. A. L. Stephens, Georgia L. P. Nurse, No. 2766.

Mr. KING. The committee wishes to thank you for your unscheduled contribution.

Mrs. STEPHENS. Thank you so very much, for allowing me this time.

I am doing night duty on a little case over in Alexandria, Va. I didn't want to delay too much, so at the last moment I wrote this statement just about 15 minutes ago.

Mr. KING. Thank you very much.

This concludes the public hearing on the President's health insurance proposal.

The record of the hearing will remain open until the close of business Friday, August 18, 1961, for the submission of additional data. statistics, and other material, which has been requested of the various witnesses during the hearing, and for the submission of additional material by members of the committee.

Also, at this time I request unanimous consent to include in the record a list of publications of the various committees of the Congress during the past several years relating to health, medical care, medical facilities, and rehabilitation which was prepared in response_to_a request by the staff for the information of the members and the general public.

(The material referred to follows:)

SELECTED LIST OF PUBLICATIONS

OF THE

COMMITTEES OF THE CONGRESS

RELATING TO

HEALTH, MEDICAL CARE, MEDICAL FACILITIES,

AND REHABILITATION

73084

Printed for the use of the Committee on Ways and Means

U.S. GOVERNMENT PRINTING OFFICE

WASHINGTON: 1961

COMMITTEE ON WAYS AND MEANS

WILBUR D. MILLS, Arkansas, Chairman

CECIL R. KING, California
THOMAS J. O'BRIEN, Illinois
HALE BOGGS, Louisiana
EUGENE J. KEOGH, New York
BURR P. HARRISON, Virginia

FRANK M. KARSTEN, Missouri

A. 8. HERLONG, JR., Florida

FRANK IKARD, Texas

THADDEUS M. MACHROWICZ, Michigan

JAMES B. FRAZIER, JR., Tennessee

WILLIAM J. GREEN, JR., Pennsylvania
JOHN C. WATTS, Kentucky

AL ULLMAN, Oregon

JAMES A. BURKE, Massachusetts

NOAH M. MASON, Illinois
JOHN W. BYRNES, Wisconsin
HOWARD H. BAKER, Tennessee

THOMAS B. CURTIS, Missouri

VICTOR A. KNOX, Michigan

JAMES B. UTT, California

JACKSON E. BETTS, Ohio

BRUCE ALGER, Texas

STEVEN B. DEROUNIAN, New York

HERMAN T. SCHNEEBELI, Pennsylvania

LEO H. IRWIN, Chief Counsel

JOHN M. MARTIN, Jr., Assistant Chief Counsel
THOMAS A. MARTIN, Minority Counsel
GERARD M. BRANNON, Professional Staff
RAYMOND F. CONKLING, Professional Staff
ALFRED R. MCCAULEY, Professional Staff

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