have less time to devote to sick people because of paperwork incidental to regimentation and the inevitable excessive utilization of services by those not sick enough to warrant medical care, but jealously seeking to exercise their "right" and get "their share.” At this point it seems appropriate to mention the official position of the Massachusetts Medical Society on the problem of medical care for the aged. On February 3, 1960, the council, the legislative body of the society, recognized the fact that there are certain individuals among the aged population who are unable to finance the cost of medical care despite the successful progress that voluntary health insurance programs are making to provide suitable care for the aged and advised its representatives in Congress to design legislation to provide hospital, medical, and surgical services for those 65 years of age and over who can demonstrate financial need and to study a means of making public grants to voluntary insurance agencies so that they can provide hospital, medical, and surgical services to the extent of the need of those in this age group. We believe that Public Law 86-778 affords a mechanism for providing the services described in the first of these recommendations, and furthermore that the action of Massachusetts as outlined in the first part of this presentation demonstrates conclusively that this law can be successfully implemented at a State level. In closing, I should like to repeat the opinion previously expressed that Public Law 86-778 has pulled the teeth of urgency from the problem of medical care for the aged and then to point out that this country has problems far more urgent than this disputable mechanism for financing the medical care of the aged (I know of no aged person in Massachusetts who sought medical care and was denied or deprived of it because of inability to pay.) MISSOURI STATE MEDICAL ASSOCIATION, Re King bill-H.R. 4222, 87th Congress. Chief Counsel, Committee on Ways and Means, St. Louis, Mo., August 1, 1961. DEAR MR. IRVIN: Speaking for the Missouri State Medical Association, composed of almost 4,000 physicans, I submit the attached statement (4 copies) for consideration by the Committee on Ways and Means, House of Representatives. We understand that our statement will be printed in the record of the hearing. We are opposed, vigorously, to H.R. 4222 and any similar proposals using title II of the Social Security Act as a mechanism for financing a Federal program of health care for the aged. Reasons for opposition are outlined in the attached statement. We support programs for helping the aged who need help. We believe that the Kerr-Mills medical aid for the aged law (Public Law 86-778) provides such means. Details are outlined in the attached statement. Respectfully submitted. J. H. SUMMERS, M.D., President. STATEMENT OF THE MISSOURI STATE MEDICAL ASSOCIATION The Missouri State Medical Association is the official organization of the medical profession in Missouri, composed of almost 4,000 physicians. The broad purpose of the association, as with other State medical associations, is to promote good health care for the public, and in this, its interests are not limited to the scientific phases of medicine. It is intimaetly concerned with the social and economic aspects of medical care as well. We have programs, for example, to help insure an adequate supply and distribution of physicians so that medical care will be available. We have recruiting programs to encourage qualified young people to take up medicine as a career. The association and its members cooperate with the University of Missouri Medical School in a general practice preceptorship program to interest new physicians in practicing in the rural areas of the State where the need is greatest. The association operates a placement service for doctors, with the same objective. VOLUNTARY VERSUS COMPULSORY HEALTH CARE Fortunately a striking example of the difference between our highly successful system of health care based on voluntarism and a less successful system based on compulsion is available here in North America to compare and study. The following facts are indicative of the waste to be expected when individual responsibility is usurped through Government paternalism. The foregoing figures show that: A compulsory system compared to a voluntary system creates an artificial demand for more hospital care which ultimately means the local community will be forced, directly or indirectly, to finance additional unneeded beds and facilities. There has been some criticism of overutilization of hospital facilities under voluntary plans. Obviously these types of complaints which are minor under a voluntary plan would swell to major proportions under a compulsory plan. Knowing how the private competitive free choice system here has shown a capacity and drive which achieves progressively higher levels of efficiency and lower costs, in the absence of inflation generated by Government, we anticipate the Indiana Blue Cross comprehensive voluntary plan will continue to improve. Indiana is deeply concerned about the effect of diverting savings from private channels of banks, insurance companies, and other private institutions which are much closer and more responsible to the communities they serve than the huge, ponderous, far-removed Federal Government. TAXES With over one-fourth of the income of the people now being absorbed by Federal income taxes it is unthinkable to further increase the power of the Central Government by channeling another one-fourth of the income of the people into the control of Government through so-called social security taxes. The present Assistant Secretary of Health, Education, and Welfare, Mr. Wilbur J. Cohen, made it clear on March 23, 1961, before the Senate Committee on Finance that he feels social security taxes should exceed what a citizen is currently paying as Federal Income Taxes. Such a doubling of Federal taxes would greatly reduce the supply of private capital and further increase dependence on an all-powerful Central Government. This is not only socialization of medicine but this is monopolization of finance with a vengeance. This exposes the naked grab for complete power over the economic life of the Nation which is being deliberately manipulated under the disguise of taking care of the medical needs of the aged. Newspaper reports appearing in Indiana on Monday, July 24, state that the President has requested Congress to increase social security taxes another 10 percent to provide medical care of the aged under social security. INFORMATION MISLEADING Here is an example of the misleading information being given to the people of our Nation by those who would centralize all facets of Government under one director in order to create Government paternalism and dependency. Any person who gives the time to study similar plans in other countries quickly comes to the conclusion that even the 10 percent, while it may sound not too high, is merely the beginning of increased taxation which will eventually, if not unchecked, drain off the very lifeblood of our Nation. Secondly, the public is led to believe that this program will provide complete medical care for all over 65 years of age. This, under the terms of the bill, is not true inasmuch as only those eligible for, or receiving, social security would qualify, and then only for hospital and nursing home care under certain conditions, with medical care limited to provision of professional services in the hospital diagnostic department. In other words, this legislation does not legislate, nor can any legislation be written which will provide for, the complete health care of the peoples of our Nation. Many times we forget the fact that health is a state of being which cannot be legislated or made compulsory. Health is dependent upon the individual's following good health practices to develop and maintain his own state of good health. AGED FINANCIALLY SOUND You will note in the attached table that 71 hospitals within the State of Indiana participated in supplying us with figures concerning the admissions and payment of hospital charges for those over 65 years of age. It is interesting to note that out of 4,357 admissions during a given month, only 84 patients, or 1.93 percent, had been unable to or had not as yet paid their bills. Yet the proponents of this measure magnify the problem of less than 2 percent of our population as though it were a problem of the vast majority of our population over age 65. Logically, then, we can ask the question, "What will this bill do that is not already being done or available to be done, other than to provide another avenue for taxation of the American public, further centralize Government, with further Government domination of free enterprise, and make our population poorer from increased taxation until they reach the point where they have no recourse other than to become wholly dependent upon Government?" Yet these proponents of this measure say it is not socialism-if not, what is it that such a program will lead us into? In the history of any nation, where the people have become wholly dependent upon central government, we find the development of a dictatorship along either communistic or socialistic lines. Is it necessary then, we ask, to further increase the tax burden of already overburdened taxpayers, to provide what is already being provided through local effort and local initiative? CARE ALREADY AVAILABLE All people, whether they be 65 and over, or younger, today have access to necessary medical and hospital care, when actually needed, regardless of their ability to pay. This care is today being provided at the expense of the individual rendering the service or the community in providing the hospital and nursing home facilities. This measure is designed to stop this philosophy of "the good Samaritan" and instead to transfer this responsibility to the Federal Government at the expense of the workers of this Nation who are trying desperately to provide the basic necessities of life for their growing families over and above their continually growing tax burden. The last session of Congress adopted the Kerr-Mills bill, which, while not a dire necessity. was nevertheles adopted into law. If we must have a law on this subject, then the Kerr-Mills legislation constitutes a sensible and realistic approach to the problem as seen by the proponents of this type of legislation. The only difference is, and I suspect the main objection to, the Kerr-Mills method is that it retains local jurisdiction rather than Washington dictation, and provides a mechanism for providing financial assistance on a basis of legitimate need, instead of a blank check to all regardless of need. The planners do not like the welfare program as operating in Indiana, but to us it is a plan which could well be adopted by the Federal departments if they have a sincere interest in actually assisting those in need, rather than developing a huge bureaucracy which no doubt covers up a waste of the taxpayers' hard-earned money. WELFARE BURDEN ALARMING Even today as these hearings are being held, the Federal bureaucracy is critical of the people of Newburgh, N. Y., who have taken a hard, long, honest look at what was happening to their community under the presently advocated paternalistic approach. This is. also, the objection the Department of Health, Education, and Welfare places upon the Indiana program. In our State, we still believe in States rights, and by the same token, we believe the local community has the right to develop and operate its own welfare programs, developed on the basis of existing need within the respective communities. Therefore, each of our 92 counties develop and administer locally their own welfare programs, staying within the framework as laid down by Washington mandate. H.R. 4222 UNNECESSARY We believe this new proposal is unnecessary, and, from our discussion with many older people, is unwanted. It is another attempt to regulate, and, therefore, socialize our people and those rendering services to the people. It is another attempt to restrain individual initiative, to pauperize the youth of our Nation to the point where they cannot help even their own families, let alone their parents. It is an attempt to legislate a condition of well-being which cannot be legislated, to publicize a need which does not exist, and to duplicate services already being given without expense to the taxpayers of the Nation without the cost of expensive Federal administration. In addition to these points, it is still admitted by the proponents of H.R. 4222 that the Kerr-Mills approach is still necessary. This is true. The present law provides a method of providing assistance to all regardless of their ability to pass the means test of being eligible for social security. It provides a system of rendering assistance on the basis of need, as judged by the people of the local community in which the need might arise. It provides a system of Federal grants-in-aid to the States, without the development of a larger and more expensive addition to our present Federal administrative bureaucracy. WHAT IS OUR FUTURE? Therefore, unless it is the avowed intent of some of those in Government to bring to an end an era of freedom for the people of a Nation, through a system of taxing them beyond their means, then we see no need for this legislation. The job is already being done by the people themselves through their own initiative and through their local communities. Let us encourage this system of solving our problems and not develop any further the philosophy of Washington's being the only place where problems can be solved. It is difficult for us to understand how these burgeoning "cradle-to-the-grave" domestic programs are going to be paid for from tax funds when this Nation faces now-right now-one of the most grave international crises in its history— a crisis which, by the best estimates, is going to call for even more financial sacrifice on the part of the already overburdened populace. Most thoughtful persons, we are sure, have little or no objection to meeting whatever cost may be necessary to preserve our way of life from foreign ideology. We do believe, however, that they do have serious objection to piling atop taxes necessary for our proper defense still additional amounts for needless domestic programs. Even if programs such as the current proposed legislation were necessary (as this one is not) it seems foolhardy to try for their implementation at a time when the future is so dark on the international scene and the prospect is great for sacrifices never before demanded of the people of this country. Back in my home community, one of our local newspapers recently carried a series of articles relating the foolhardiness of many peoples in buying, on credit, many major items which they did not need and for which the sum total of payments far exceeded their ability to meet from their paychecks. The ultimate outcome, of course, was financial chaos and total bankruptcy. How could a person be so foolish, we ask? Yet, we now have before us a proposal endorsed by the Federal Government suggesting that exactly the same thing be done--that is, living beyond taxable means to purchase a program for which there is no need. WHAT PRICE PROGRESS The doctors of this country long have been accused by the social plannersthe group behind the legislation now under study-of being against anything progressive. It is not our intent here to dignify that charge with an answer-we will let the advances in medicine speak for us and the record in that instance is clear for all to see. We do categorically deny that physicians are opposed to progress. But if progress means endorsement of unneeded schemes and plans the cost of which cannot even be calculated with any degree of accuracy, then the doctors plead guilty to being against progress. 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 the problem. TABLE I Hospitals reporting admissions of people 65 years of age and over for a 30day period--- 71 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__. NOTE. No figures available on additions by remodeling or new construction. 1, 521 388 84 4,357 30, 004 1,088 486 31, 578 9, 512 STATEMENT OF THE IOWA MEDICAL SOCIETY IN OPPOSITION TO H.R. 4222, 87тH 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, |