The facts and figures we have presented provide ample evidence that Indiana can and will meet and solve its own problems-costly, paternalistic legislation from the Federal Government will not solve anything-it will only compound

Hospitals reporting admissions of people 65 years of age and over for a 30day period.---

Total admissions 65 and over for period: 54.26 percent paid by insurance_

34.91 percent paid by cash_

8.90 percent paid by welfare------1.93 percent unpaid---.

Total (100 percent)

Hospital beds in Indiana:

Total number hospital beds now available_-_

Number beds being added by remodeling now in process-

Number new beds being added by construction of 6 new hospitals_-_

Total beds available and in process

Nursing home beds in Indiana: Total nursing home beds‒‒‒‒‒

71

2, 364 1, 521 388

84

4,357

30, 004

1, 088 486

31, 578

NOTE. No figures available on additions by remodeling or new construction. STATEMENT OF THE IOWA MEDICAL SOCIETY IN OPPOSITION TO H.R. 4222, 87TH

CONGRESS

Mr. Chairman and members of the committee, I am Homer E. Wichern, a practicing surgeon; I reside at 300 Tonawanda Drive, Des Moines, Iowa. I am here in my official capacity as Chairman of the Legislative Committee of the Iowa Medical Society and as the official spokesman for the Board of Trustees of the Iowa Medical Society which has 2,424 members.

Throughout the century and more of Iowa's history, we doctors, together with the private, county, and State hospitals, have met the health needs of economically marginal elderly people, as well as the needs of everyone else who couldn't pay for his care. We have treated these people in their homes, in our offices or at local hospitals, either free of charge or at greatly reduced fees, and the local hospitals have provided them with beds and nursing care on a similar basis. It should be pointed out that in addition to this, the counties and the State of Iowa have long cooperated in providing ambulance service to and from Iowa City where hospitalization and specialist care at the university hospitals was available not only for welfare clients with problem illnesses but also for ordinarily solvent people whom protracted health difficulties might otherwise impoverish. The university hospitals is a centrally located health center which is publicly supported and each of the 99 counties have a liberal quota of available beds at this center.

As far as we know, no case has been called to our attention wherein these services were denied a resident of the State. Certainly this applies to the elderly group of individuals. It is our belief that the type of help which these people would find most acceptable would be a system under which they might budget, that is, prepay, their emergency health care costs. For more than 20 years the hospitals have had available Blue Cross plans and on April 12, 1945, we physicians started Blue Shield, which began writing contracts in September of 1945. These plans, together with those of several commercial insurance companies, furnish protection in somewhat varying degrees for threequarters or more of the population of the State. Two years ago last spring, again in cooperation with the hospitals, the physicians prompted Blue CrossBlue Shield to offer the senior 65 health insurance policy which carries a premium of $6.35 a month; $3.05 for Blue Cross and $3.30 for Blue Shield. Under this policy, physicians are entitled to no more than three-fifths of their customary charges and the hospitals provide a similar service at cost. A total of more than 12,000 policies of this type have been purchased to date, and though exact figures are not available, it seems certain that at least as many more have similar special policies from Mutual of Omaha, Continental Casualty and other commercial firms. The physician-sponsored Blue Shield plan has never,

in its history, canceled a policy because of age and today more than 6 Iowans over age 65, including some over the age of 90, carry Blue Cross and Blue Shield coverage, which percentage is higher than when all other ages an combined.

Recent surveys in Iowa have revealed no prevalent unmet health needs among the elderly people. The most recent of them, the 15-county survey, TE conducted last summer under the auspices of the Federal Department of Hea Education, and Welfare. During interviews with the sampling of noninstit tionalized elderly people in these 15 counties no more than 1 in 20 of the respondents said he or she needed medical care or dental treatment but could get it because of the cost. Iowa physicians, along with the other members of the American Medical Association, strongly supported passage of the KerrMills bill by the 87th Congress. Last fall, and at the urging of the Iowa Medical Society and a number of similar professional organizations, the 19 General Assembly of Iowa passed a highly satisfactory Kerr-Mills enabling ac (H.F. 470), designed to permit the establishment of whatever health-care plans may be found necessary for the near-needy aged in our State. This problem is still under study by the legislature and it appears in due season the appropriation will be made when budget requirements of other necessary items are filled

In Iowa, we are convinced, the Kerr-Mills Act has simply been delayed in tating effect and it is our opinion that the Kerr-Mills approach to providing health care for the aged will come about in due season.

In the meantime, Iowa doctors are convinced it would be a serious mistake for Congress to enact the King-Anderson proposal (H.R. 4222) or any other plan for providing health services to OASI-benefit recipients. The following are our reasons: First, and foremost, such a scheme would indicate that fr the first time, Congress would appropriate a service benefit in counter distine tion to the cash benefits already in effect, the cost of which cannot be predicted Secondly, such a scheme would do nothing for a considerable sector of the aged. which numbers approximately 100,000 people in Iowa. In this connection. I should like to quote from the report of the 15-county survey to which I made an earlier reference: "Among those past 75 (social security), coverage was considerably lower than in the younger groups (that is, 65-70 and 70-75), and was es pecially low among the oldest women. Apparently many of the people pas 75 had failed to qualify for social security coverage in time, and were left out of the program. We might note (and I am continuing to quote) that these people would not receive the benefits of the proposed program unless coverage is extended to those who have been left out."

For these reasons, the physicians of Iowa respectfully ask you to reject the King-Anderson bill (H.R. 4222, 87th Cong.) and all similar proposals for attaching health care for all needy aged to the social security system. We are sure that this committee, in its wisdom, is aware of the fact that not enough time has been given to the implementation of the Kerr-Mills legislation (H.F. 470) and that the benefits of this bill have not yet been brought to fruition. Instead, we ask that you allow sufficient time for the States to implement and test the ade quacy of the Kerr-Mills Act.

STATEMENT OF THE LOUISIANA STATE MEDICAL SOCIETY BY PHILIP H. JONES, M.D. IN OPPOSITION TO H.R. 4222, 87TH CONGRESS

Mr. Chairman and members of the committee. I am Dr. Philip H. Jones, of New Orleans; and I represent the Louisiana State Medical Society. I am a delegate from this society to the House of Delegates of the American Medical Association. I am emeritus professor of clinical medicine of Tulane University. I am editor of the Journal of the Louisiana State Medical Society. I practice internal medicine in New Orleans.

The Louisiana State Medical Society is composed of 2.600 physicians in 46 parish and district medical societies. There are approximately 3.100 livered physicians established and practicing in the State. This organization repre sents &4 percent of the doctors practicing in Louisiana. This society was organized in 1903, and the purposes then as now are:

** with a view to the extension of medical knowledge, to the advance ment of medical science; to the elevation of the standard of medical education. and to the enforcement of just medical laws; to the promotion of friendly intercourse among physicians, and to guarding and fostering their material interests and to the enlightenment and direction of public opinion in regard to the greatest problems of State medicine."

The Louisiana State Medical Society agrees with and supports the physicians of the American Medical Association in opposing the enactment of all legislation for the aged under the social security provision as contained in H.R. 4222. The reasons for this position pertain to general considerations, and also, to the condition of the aged as at present cared for in the State of Louisiana.

The general objections to the bill are, as follows:

It would lead to Government bureau control medicine by progressive accretions every 2 years. It will be expanded to cover the whole population, and simply as a matter of successive adjustments, socialized medicine will become established. The major advocates of the bill obvioulsy envisage this as their ultimate goal. This may seem remote but as the President has said, his bill is "just the beginning."

H.R. 4222 will not provide for one-fourth of the aged, which is approximately 4 million. Among those for whom it makes no provision are approximately 2 million receiving old-age assistance under Federal-State programs.

The social secrity approach to medical care for the aged is unfair in that it places a burden of the costs of the program only on the low-income workers with payment based on gross income. If medical care of the aged is to be regarded as a national problem, it should be financed from general revenues as provided in title VII of Public Law 86-778 (Kerr-Mills law).

The expense of operation of this proposed law will become more expensive as the number of aged increases, even though the proportion of the needy aged will be decreasing.

The social security approach is unnecessary. About 50 percent of those over 65 (approximately 8 million persons) have some form of health insurance. One and a half million of our aged are now receiving cash benefits from corporate pension plans.

One million persons over 65 receive veterans' pensons, as well as social security benefits.

Approximately 5 million of our aged are still employed, or are the wives of workers who are employed.

One million retired persons currently receive annuities, which were privately purchased.

The bill violates the principle of independent Americanism. Medical care is first the responsibility of the individual, then in succession, the family, the community, the State, and more remotely, the Nation. In the era in which most of the aged about whom we are concerned grew up, it was and still should be a tenet of good, provident citizenship for the individual to prepare for his old age.

In the initiation of previous State medical programs, the estimate of the burden of taxation has been too low. This has been true in whatever State of the community the attempt has been made. The eventual cost is two to three times the estimate. The $1 billion estimated for the cost of this proposed law would probably be only one-third of the total eventual annual expense.

The specific objections to this bill as applied to the State of Louisiana are, as follows:

The need for such legislation does not exist here. Louisiana has approximately 242,000 individuals over 65; 125,000 of these are on the public assistance rollsthe highest of any State. At present, their need for hospitalization is adequately provided for by a system of 15 State maintained charity hospitals with 14,201 free beds. These beds are within the practical approach of any needy citizen.

The Department of Public Welfare provides for the medical needs under Federal-State funds and vendor payment programs for those among the aged who are in need and whose condition does not require treatment in one of the charity hospitals.

Of the remaining 117,000 aged, it is estimated that 50,000 to 60,000 have adequate resources for their own care, and the last 60,000 will be taken care of by the Kerr-Mills law. The operation of the means test in this law will not be regarded as any more degrading than the means test when it is applied as a preliminary to being admitted to a Federal housing project.

The Kerr-Mills law supplies aid to those aged who are medically indigent-where, when, and as needed-secures its funds from the taxation of all the people, and does not force a tax which is heaviest on those who make the least. It maintains the position of the States in community management and secures them in their rights.

ANSWERS TO CRITICISM OF OPPOSITION

Answering a few objections of those who criticize the position which or ganized medicine has taken, I would like to remark that the statement that the proposed bill could not be socialized medicine because it does not pay the detors is incorrect. It will pay those doctors who have contractual positions in hospitals. It will control the hospitals with whom it does business and expect the hospitals in turn to control the doctors whom it permits to practice in the hospital as members of its staff.

The statement that three-fifths of the people over 65 had less than $1000 in money income is not suported by the fact that there are only 25 million pec pie on oid-age-assistance rolls. This 15 percent of the aged population, and procably an equal number of those whose medical economies state is marginal can be taken care of adequately by the Kerr-Mills law. This law is being imple mented in the majority of the States at this time, and is proceeding more rapidly than most such laws, in spite of the fixed legal impediments. Twenty-one States have passed the laws or have the plan in action. Eighteen States have legislation in process. The legislatures of two States meet next year. Four have the program under consideration and seven have adjourned without taking action.

Organized medicine feels that the medical needs of the aged who are indigent or are marginally indigent medically should be met by the Kerr-Mills law, and not by a dangerous excursion into State medicine.

STATEMENT OF THE MEDICAL AND CHIRURGICAL FACULTY OF THE STATE MARYLAND, BY KARL F. MECH, M.D., LEGISLATIVE CHAIRMAN INTRODUCTION

Mr. Chairman and members of the committee, my name is Dr. Karl F. Mech. I am appearing as chairman of the Legislative Committee of the Medical and Chirurgical Faculty, the State medical society of Maryland. I practice general surgery in Baltimore, Md., and am a teacher-consultant to the Army and the Veterans' Administration. In addition to my membership in the faculty. I am a fellow of the American College of Surgeons, and a member of the Baltimore City Medical Society and the American Medical Association.

The Medical and Chirurgical Faculty represents more than 3.300 physicians in Maryland and has been in existence since receiving its charter from the State legislature in 1799. Since its inception, the organization has worked to advance medical science and knowledge within the State, to raise health standards, to promote satisfactory health care of the people, and to secure the enactment and enforcement of just laws relating to the practice of medicine.

In accomplishing these aims, the faculty serves both the people and physicians in Maryland. The faculty helped to initiate the present State medical care programs, which provide complete, free medical care for indigent and medically indigent people in the counties and medically indigent people over 65 and all indigent people in Baltimore City. It now works constantly to improve these programs and the services they offer. Faculty committees examine with vigor local and national medical problems and attempt to aid in their solution. Faculty officials also confer periodically with representatives of the State hospitals and medical agencies, and this coordination pays dividends in the form of better understanding of mutual problems, leads toward the settlement of differences, and results in more efficient and less expensive medical care for the people of Maryland.

In order to relieve the growing shortage of medical personnel, the faculty supports national education programs and has formulated its own State education programs. During 1960, the physicians of Maryland contributed more than $16,000 to the American Medical Education Foundation, an organization which supports medical schools throughout the Nation through the contribution of unearmarked funds. In Maryland, the faculty gives advice and support through the Student American Medical Association, and it recently endorsed a scholarship program of its own.

MARYLAND'S PROGRAM FOR THE AGED

Today you are concerned with medical care for the aged. The faculty has been concerned with medical care for all ages in Maryland for more than 160 years. Faculty members did research on this problem as early as 1900. In 1938, a letter from the faculty to the State planning commission triggered a study of existing medical facilities and laid the foundation for medical care programs for Baltimore City and the counties of Maryland. Since that time, the faculty has worked continually to expand and improve this medical care, bringing it to its present effective state.

The enabling legislation for the counties was passed in 1945 to cover both indigent people, who are recipients of public assistance, and medically indigent people, who would ordinarily be self-supporting but cannot afford the cost of medical care. The Baltimore City program, begun in 1948 on the advice of the medical profession, covered only indigent people initially, but now has been expanded to include medically indigent people over 65. Eligibility for these programs is determined by income scales, which are graduated according to the number of people in the family and the standard of living in the area in which the family resides.

Under each program, the patient receives hospital or outpatient care, the services of a physician either at the physician's office or in the patient's home, drugs, supplies authorized by the physician, and limited dental care, completely without cost. The patient has a free choice of physician and hospital, and there is no time limit on the care as long as the patient is periodically recertified by the State board of health.

The cost of this care is paid for by State and local governments, and I might point out here that while the physician receives a nominal payment for home and office treatment, there is no compensation for work performed in the hospital.

During 1960, more than 14,000 people over 65 in Maryland benefited from these programs, and the programs are under constant review and broadened as experience dictates.

The most recent and noteworthy expansion of medical care in Maryland took place on June 1 of this year when implementation of the Kerr-Mills Act (Public Law 86-778) went into effect. The faculty vigorously supported this legislation from the time it was introduced in Congress because it enabled existing programs to provide health care to additional thousands of persons previously not eligible for such assistance. Additional Federal funds now available have enabled Baltimore city to include medically indigent people over 65 in its program, and both the cities and the counties have been able to raise their income limits and make an additional 11,000 people eligible for care. This is an increase of 78 percent over the previous programs.

The faculty has devoted time and effort to the study of medical care for the aged in Maryland, and its committee on aging was recently commended by the State legislature for promoting "Check Up With Health Month," a period during which free medical examinations were given to elderly people who wished to take advantage of them. It also organized the Maryland Joint Council To Improve the Health Care of the Aged, a committee which works to improve the health care of the aged by coordinating the efforts of several groups in one main body. The membership consists of representatives from the faculty, the Maryland Dental Association, the hospital council, the Maryland Nursing Association, the Maryland Nursing Home Association, and the Governor's council on aging. It is now working to exchange information of programs and activities, to develop jointly sponsored projects, and to disseminate information on health care of the aged to the general public.

MEDICAL INSURANCE FOR THE AGED

The faculty has supported private health insurance plans and urged the public to make use of them. At the suggestion of the medical profession in 1959, Blue Cross and Blue Shield organizations began accepting applications from people over 65 on an individual basis and extending coverage available under group plans to this age group in October 1959. Elderly individuals are now accepted on the standard Blue Cross plan without a physical examination,