the social security program will prove to be a tax monster, devouring and crushing the average wage earner as income tax never has or should. (4) H.R. 4222 is an inadequate and misleading measure because its benefits would still involve serious out-of-pocket expenditures for those recipients who really need to be helped. Under it, every hospitalized patient would be required to pay $10 a day toward hospital charges for the first 9 days. This poses for the recipient a total potential liability of $90-a formidable amount to the needy beneficiaries who deserve to be helped, but an amount of relative inconsequence to the well-to-do recipients who, in justice, should pay their own way. It is the position of the members of the Medical Society of New Jersey-speaking as citizens who love their country and as physicians whose lives are dedicated to the welfare of their fellow citizens-that H.R. 4222 is unsound and unacceptable legislation because it ineffectually and inadequately prescribes for the condition it is seeking to ameliorate. We believe that citizens of the United States should want, and should be encouraged, to develop their own strengths and to make their own security; and we believe that it is the duty of Government to maintain a social, political, and moral climate that will enable and induce them to do just that. We believe that no one should be denied necessary medical services because of inability to pay. We believe that it is properly the responsibility of society and Government to help those citizens who are in need to attain the necessities which they cannot themselves provide. We believe that only those in need should be thus helped, and then only to the true measure of their need. We believe that any policy or program which would encourage in citizens an attitude of dependence where independence should exist, and would impart to Government responsibilities and powers of determination and action which should be reserved to the citizens, is subversive of the character and true good of both our citizens and our country. That is why we oppose H.R. 4222 and the principles for which it stands. That is why we ask the members of this Committee on Ways and Means of the House of Representatives-and indeed, all the Members of Congress-to reject this measure and all other measures of its kind. CONGRESS OF THE UNITED STATES, Chairman WILBUR MILLS, HOUSE OF REPRESENTATIVES, Washington, D.C., July 28, 1961. Ways and Means Committee, House of Representatives, Washington, D.C. DEAR MR. CHAIRMAN: Enclosed are copies of statement presented by Dr. William E. Badger, president, New Mexico Medical Society. I will appreciate you incorporating Dr. Badger's written testimony in your committee hearings on medical care for the aged. Respectfully yours, THOMAS G. MORRIS. STATEMENT OF THE NEW MEXICO MEDICAL SOCIETY BY WILLIAM E. BADGER, M.D. Mr. Chairman and members of the committee, I am william E. Badger, M.D. I practice surgery in Hobbs, N. Mex., and I am president of the New Mexico Society. The New Mexico Medical Society was founded in 1886 to bring together all doctors of medicine in the territory to exchange medical knowledge and experiences. Membership in the society is voluntary to all physicians in the State who have a license to practice, physicians in Government service, and to those in training. Ninety-seven and six-tenths percent of the licensed physicians in the State are members of the New Mexico Medical Society. We have 619 members. The society began publishing health materials to assist the citizens of the territory through local newspapers in 1891. In 1907 the society made the first move toward the establishment of a department of public health in the State to protect the people against various diseases and in 1924 the first resolution was passed by the delegates in annual session to cause a board to be established to certify to the credentials of all physicians who moved to the State. The primary concern of the society was and is the citizens of the State of New Mexico. The New Mexico Medical Society has long been interested in the various prob lems of the aged in New Mexico. Through the department of public welfare in New Mexico, the members of the society have rendered care to the medically indigent and old-aged-assistance programs for a great number of years. It is to be noted that our welfare program is perhaps the most comprehensive medical program of any State and has been for a number of years. It should further be pointed out that the physicians of the State render care to welfare clients at approximately one-fourth of their usual charges to those not on welfare, and in one period they provided free service in order to keep the program solvent. Our members are certain that they have had sufficient experience with State and Federal types of programs to speak authoritatively. The Mexico Medical Society serves as the fiscal administrator of the Medicare program in New Mexico as a service to the Government and to the wives and children of military personnel. The new board of the department of public welfare has asked the society to assist them in working out a plan for implementing the Kerr-Mills law in this State. Our committee is working with this board and we can assure you an amicable program will be worked out pending the board's ability to allocate funds for this program. The New Mexico Medical Society sponsored two statewide conferences on the problems of the aged: one in November 1959, the other in January 1960. These conferences were well attended and a free exchange of ideas was experienced. It is believed that the consensus of the majority was that aid for the needy aged should first begin at home, then the community, next to the State and, as a very last resort, the Federal Government. The New Mexico Medical Society was most active in the Governors' White House Conference on Problems of the Aged and indeed on each county level. A service insurance contract for the low-income families has been sponsored by the society since 1946. Our society further reduced the fees of its members for contracts to be written for all over 65 years of age by both voluntary and commercial insurance companies. The Blue Shield program of New Mexico has contracts with over 7,000 citizens of our State who are 65 years of age and older. These contracts are standard Blue Cross-Blue Shield contracts that can provide for up to 365 days hospital and medical care for each illness. The cost of this insurance coverage to the patient varies from $8 to $8.82 per month. These contracts may never be cancelled by the company for any cause other than failure to pay the premium. The physicians of this State are sure that the needs of our older citizens have been grossly exaggerated. We are cognizant that there are some who need help; however, the Kerr-Mills law is specifically designed to care for these needs. Attached to this letter are two exhibits, marked "A" and "B," of two different independent surveys made in New Mexico to point out the average costs of both hospitals and physicians to these older citizens. Our State society and many of our county medical societies have made it known through their offices and newspapers that no one need go without medical care because of inability to pay. Our society has a firm conviction that if Congress is convinced that our older citizens can be cared for medically only by establishing a service feature to the social security program that this will be the longest step toward socialization, both of medical and industry, that has been taken by our Government to date. The need for a drastic approach such as this is definitely not indicated in reality. In New Mexico, the older citizens who need assistance are not covered by social security. These people would be covered by the Kerr-Mills law. It is of interest to note that the overwhelming majority are taken care of now through our comprehensive welfare medical care program mentioned in the fourth paragraph of this letter. Our opposition in general rests on the premise that the Anderson-King bill is compulsory in nature covering all those covered by social security whether there is need or not and also neglecting some who have need. It seems obvious to us that such a program under social security is but an opening wedge with built-in pressures for expansion and eventually ending with the socialization of our profession, no matter how sincere the present backers of the social security approach are in disclaiming any intention of such a result. In New Mexico we are at present attempting to find the means to implement the Kerr-Mills legislation this year and have reason to believe we will be successful. We have, as a society, recently called on our Congressmen to give us all the aid in their power. The possible enactment of H.R. 4222 has been a deterrent to implementation of Kerr-Mills legislation in our State. The New Mexico Medical Society appreciates the opportunity of presenting its viewpoints to your committee for the record and we trust our statements will assist the committee in their deliberations. EXHIBIT A.-Admissions of patients 65 years of age and over in St. Mary's Hospital, Roswell, N. Mex. 1. Number of over age 65 admissions during period Sept. 25, 1960, through Dec. 31, 1960. 2. Number of patients over age 65 admitted (2 multiple admissions). 3. Admissions: Surgical Range. 5. Total hospital bill (average per illness). Hospital bills larger than $500_ Hospital bills paid by private sources. Hospital bills paid by insurance or Government sources- 6. Total physician bill (average per illness). Physician bill over $500. Physician bill over $300. Physician bill paid by private sources__ Physician bill paid by voluntary insurance sources. 7. Comparison with other data: 100 98 40 60 Total $1,000.00 499. 13 456. 23 481.00 305. 67 EXHIBIT B.-Admissions of patients aged 65 and over in the Presbyterian Hospital, Albuquerque, N. Mex. Beginning Jan. 1, 1961, the first 100 patients aged 65 and over were taken at the time of discharge from the hospital. (Hon. Harold D. Cooley, Member of Congress from the State of North Carolina, submitted the following statement for inclusion in the record of the hearings received from the Medical Society of the State of North Carolina :) STATEMENT OF THE MEDICAL SOCIETY OF THE STATE OF NORTH CAROLINA, BY HUBERT M. POTEAT, JR., M.D. Mr. Chairman and members of the committee, I am Dr. Hubert M. Poteat, Jr., of Smithfield, N.C., where I am engaged in the medical practice of general surgery. I am chairman of the committee on legislation for the Medical Society of the State of North Carolina. I emanate from that substantial Baptist family of educators whose name I am privileged to bear. I recollect a youthful impression gained from my grandfather, Dr. William Louis Poteat, who, as president of Wake Forest College, was evaluating the progress of the public health in North Carolina when he recognized that the late Dr. George M. Cooper and the now eminent Dr. Watson Rankin had laid the foundation for a great State in the public health system founded upon the premise of close liaison with the leaders of the private practice of medicine in the State. He philosophized that the basic laws sought by these leaders, enacted by the North Carolina General Assembly in 1917 and so administered by Rankin and others so as to invite the interest and the cooperation of the medical profession with the people of the State would set North Carolina apart as a people noted for its public health achievements and progresses, and as I now undertake to review parts of the progress that has. transpired since his day, I can look with pride upon his prophecy. In forming this statement, I am representing 3,300 society member physicians from my home State in opposition to H.R. 4222. Our opposition to this proposed bill is based on three major principles: (1) The success of present health care programs and services and the lack of any need for such legislation in North Carolina. (2) Existing Federal legislation and State programs provides adequate coverage for those who are in need of assistance. (3) The expense of the proposed program in H.R. 4222 is too great to justify its limited benefits. The philosophy contained in H.R. 4222 is not supportive of the experiences and actions which have characterized progress in health in our State. While our population is increasing, our life expectancy has increased and will continue to be lengthened, and our population 65 and over has increased even faster than our population as a whole. We also submit that the quality of health and medical care in America far exceeds that of any other Nation, as evidenced by the fact that America today is the world seat of medical knowledge and training and perhaps the healthiest nation among nations. My research and practiced controls, we have reduced the incidence of disease and so controlled acute infections to the point that today among our major health problems are left those of chronic illness creating the need for a change in focus on the care and treatment of these illnesses. Physicians know best what the health needs of their patients are and because of the close relationship between physician and patient can better guide and direct the regime of health maintenance for each patient through our present system of free enterprise and the proper utilization of community facilities and services. Medicine has proved in the past its ability to cope with new or increased scope of health care problems, and it accepts the challenge today to continue serving the people of our State in meeting the new demands placed upon physicians and allied health services by our expanding total population and our older citizens. Few States and no other country has so effectively assumed this responsibility for all of its people. Organized medicine was among the first groups to recognize the problem of health care services created by the increasing numbers of older-age people who, because of improved medical care, treatment and supportive services, modern medical research, and other important health protections, are experiencing a longer lifespan, now averaging 23 additional years beyond that of our grandparents. The span of life expectancy one can predict will continue to be lengthened by similar advances under our present system of health and medical care in future years. Likewise medicine, first to recognize and to stimulate individual and public interest in ways and means of planning toward these added years, continues to take the initiative in practical concern at the National, State, and local levels. It is to this point of interest that I submit this statement to you in opposition to H.R. 4222 as a proposition for improving health care services for our older people. Allow me at this point, to review for you actions and progresses in North Carolina in proof of our concern with these problems and that we are meeting needs in this area as I shall designate by item: (1) We believe that our present private enterprise system, comprised of voluntary insurance and savings is providing health and medical care to all persons, including the provisions of the Kerr-Mills Act as now implemented. This system should be given every opportunity to prove its value in all States before Congress considers any additional changes to foster Government nonmedical-oriented programs of medical assistance to the aged or to any group. With the recognizable youthful population and consequent expanded industrial growth we have a paucity of older people in North Carolina; therefore there is no necessity for H.R. 4222 as we are meeting our own health care needs through cooperative efforts. As of January 1960, North Carolina had 6.9 percent of the total population 65 and over, as compared to national average of 9.2 percent 65 and over, and the youthfulness of our population differentiates our situation in North Carolina. (2) The average per capita income in North Carolina in 1960 was $1,582, or an aggregate sum of $497,331,250 annually accruing to this segment of our population (65 and over). Of the total 314,000 older citizens, an estimated 12.2 percent are certified beneficiaries of the diminishing old-age assistance program. Of the aged (65 and over) 100,000 are already enrolled in forms of voluntary prepayment insurance programs, either of the (recently embraced by choice of civil service employees in North Carolina) Blue prevailing contracts of our types of commercial protection. It is reported through divers agencies of aid (as discussed at pp. 6, 7, and 8) that some 30,000 receive some health care services through public-private programs (statewide in character) designed for the medically indigent. Generally, there are others who receive assistance through VA hospitals, certain religious orders, specialized State institutional care, county general assistance, and private resources providing some aid for the medically indigent. Therefore, the residue of older persons needing assistance in meeting health and medical costs is not a major problem in North Carolina when we weigh the level of income of those still employed, the factors of cash savings, and retirement earnings. Any increase in expenditure of public tax funds should be made at the local or State level with local administration and control, as provided in the Kerr-Mills Act. We know by physicians' records of payment for services rendered that 85 percent of the white population purchase their own care and 65 percent of the nonwhite purchase their own health and medical care, further justifying this reasoning. North Carolina physicians have always rendered medical services in their offices, clinics, and hospitals to indigent patients without charge and without accepting vendor payments. If the need for medical care is recognized and reported-the service is made available to anyone for any type of service. County medical societies have publicly reiterated the guarantee that any citizen in need of a doctor's service and unable to pay for it can get the service without cost by calling the local medical society information service or the local hospital. (3) Insurance programs are available to aged individuals and families with limited incomes. The doctor's plan, a noncancellable Blue Shield service insurance program, underwritten by North Carolina physicians was designed to give protection to families with small incomes. The Physicians accept scheduled fees for service as full payment for persons having this type of insurance coverage whether contracted to do so or not. The rapid increase in the number of persons 65 and over now enrolled in prepaid senior certificate insurance programs gives further evidence that once the protection was made available to persons 65 and over, they welcomed the opportunity to purchase insurance policies, and this trend is increasing daily. enrollment in 1960 doubled that of 1959, the first year it was introduced by volunteer associations in North Carolina. Nationwide surveys and the National Health Insurance Council report 72 percent of the total population and 49 percent of those 65 and over today participate in voluntary health protection programs. There continues to be a significant trend in business, industry, professional, trade and fraternal groups to provide paid-up hospital insurance coverage for retired members and their families. This trend characterizes the new industrial growth in North Carolina stimulated by the regime of our former Gov. Luther Hodges. The exaggerated needs of the older citizens today will be met in the future by retirement earnings gained by the working individual today. This factor of economy did not exist 20 years ago. (4) Facilities and services: In North Carolina for the past 12 years there has been a blanketing of the 100 counties of the State with general medical-surgical hospitals constituting an increase of 268 percent of acceptable hospital beds; so that anywhere in the State at any moment the 154 general hospital services are readily available to all segments of the people, whether old or young. There is no shortage of beds anywhere. We have in 3 years (1958 to now) increased the number of licensed nursing homes in North Carolina by 440 percent with increased capacity of approximately 400 percent. This trend is so significant that uniformity of available services of this type in the counties is now being approached and may be completely realized within another 3 years. It is also significant that these trends and acquisitions have been accomplished by private enterprise on the whole. These nursing homes are now standardized and licensed by a single medically oriented State agency confirming the quality of care offered to groups by these increasing facilities. At present there are more than 500 domiciliary homes licensed to provide extrafamily individual care to more than 6,000 older people, which serve to augment the general capacity of the individual family in North Carolina to provide the setting for the care of older people as an intrafamily obligation of normal life. It should be interesting to note of the domiciliary homes licensed the majority are institutional in nature, but that more than 200 of these are constituted as foster family homes. It is in this area that the mandatory licensing system provided by recent law has gained and will maintain a suitable standard of care for the aged. 76123 0-61-pt. 4--23 |