gard to need. This would be further usurpation of family and individual re sponsibilities by government with attendant erosion of the moral fiber of on people. (2) The Kerr-Mills legislation providing for Federal-State matching funds for programs of health care to the needy patient over age 65 is adequate to nee the need. It allows health services for those over 65 who develop a need although not under social security, or even State or local welfare programs. (3) H.R. 4222 would necessitate additional increases in the social security tax rate already scheduled to reach 91⁄2 percent on the employer and employe by 1969, and undoubtedly would cause a raise in the taxable wage base. (4) The cost under H.R. 4222 would be enormous. As one example, the Health Insurance Association of America estimates that the nursing home pro gram alone would cost $513.9 million a year to start and would triple within 14 years. It can be anticipated that H.R. 4222 would encourage many thousands of persons not actually in need of health services to insist on it as their right. as has been the result in England. This obviously would delay health services for those actually in need. (5) Voluntary insurance programs have made great progress in extending coverage to all Americans who need it and particularly progress has been made in programs for the over 65 citizen. It is our opinion and one we believe is shared by insurance experts, that the King-Anderson proposal would adversely affect the insurance industry which, after all, provides tax income which helps operate the Government. (6) We hold that care of the elderly is primarily a family concern and to remove this responsibility is to weaken the family structure of our society. When families are no longer able to aid its members, the problem then is one of community concern, then of State and lastly of Federal concern. (7) We contend that health care needs of the elderly are being met largely on a local basis in Alabama with some State-Federal assistance. This, we feel, is the proper relationship for the welfare of the public and our democratic system of government. Local physicians give about $3,300 worth of charity service each annually in their offices and in the public clinics. They make no charge for this charity service. Local government in Jefferson County now is providing around $3 million a year for health services to the sick-poor. Alabama already has in operation a medical care program for the elderly under the Kerr-Mills Act. Some 728 received hospital and nursing home care amounting to $112,502 in May 1961. The current session of the State legislature is expected to provide additional funds to expand this program. Also, it should be noted that State welfare payments have been raised from $38 a month to $60 and are expected to reach $75 shortly. (8) We take specific exception to the provision in the King bill which states that nothing in this title shall be construed to authorize any Federal officer or employee to exercise any supervision or control over the practice of medicine or the manner in which medical services are provided, “Except as otherwise specifically provided." (9) We believe that to inject Government even further into health care via the King bill than it is already, would jeopardize the close physician-patient relationship which has been an important basis for the high quality of medical care this Nation enjoys. For these reasons, therefore, we strongly urge that the House Ways and Means Committee oppose H.R. 4222 which action we believe sincerely would be in the best interest of the public, members of the modern health team and of our democratic system of government. Yours sincerely, S. BURFORD WORD, M.D., President. STATEMENT ON MEDICAL CARE OF THE AGED BY THE NAUGATUCK VALLEY In an atmosphere of freedom and private initiative, the doctors of America are providing our senior citizens with the best medical care available anywhere in the world. When treatment in a modern community hospital is required, the cost of this hospitalization is often high and some of our senior citizens definitely need financial help in meeting these hospital costs. To help those who need financial aid, the Naugatuck Valley Medical Society endorses the use of the Kerr-Mills legislation, Public Law 86-778. This law provides Federal grants out of geenral tax funds to each of the States to finance the hospitalization and medical care of those elderly citizens who need help. This legislation is determined locally, administered locally, and is responsive to the special needs of local citizens. A social security method has been proposed, the King-Anderson bill, H.R. 4222. From 1957 to 1959 the social security fund had a net operating loss of over $20 billion ($2,378 million). The social security tax on the first $4,800 of income is scheduled to increase to 9 percent by 1969. However, it has already been necessary this year to consider revising the tax rate with an immediate increase in both the percentage and the amount. Present commitments alone could eventually require a 15 percent taxation on the first $10,000 of income under the social security tax program. A wide-sweeping medical care program to include all the elderly citizens regardless of need would immediately require still another addition to the tax and this would be increased each year. A worker of 21, therefore, would pay these increasing taxes for hospital care for all the aged regardless of their need for at least 41 more years before he himself retires. The NVMS opposes the social security method. The society opposes it because of the unrealistic financial burdens it would place on the taxpayer, and because it feels that medical care and all other needs of our citizens should be provided only for those who need financial help. The most critical issue, however, is whether or not the patient, doctor, and hospital will be socialized. Today, the Government has a firm hand in much of that which our citizens do. The Socialist Party of America supports the proposed social security legislation. This is the beginning of the socialized medicine for which they have been working. If passed, the Federal Government will begin to enter the doctor-patient relationship and influence the kind of care patients will receive according to bureaucratic rather than medical standards. Free choice of physician and hospital with its personal, private, and confidential benefits will eventually be lost. In effect, the choice is between voluntary enterprise and Government planning. The voluntary method has been most successful. To entertain Government planning would be unwise. Because of its lower cost, local administration, and its provision of help to only those but definitely all of those who need help, the Kerr-Mills legislation, Public Law 86-778 for medical care of the aged is supported by the medical society. The King social security bill is opposed because it represents a higher and unneeded cost and because it is the initial step in the socialization of health care, which the Naugatuck Valley Medical Society believes would lead to poorer medical care at greater expense to the taxpayer. COWETA COUNTY MEDICAL SOCIETY, Hon. WILBUR MILLS, M.C., Chairman, Committee on Ways and Means, 1102 House Office Building, Washington, D.C. DEAR MR. CHAIRMAN: This testimony is presented in behalf of the Coweta County Medical Society, Newnan, Ga. The Coweta County Medical Society is composed of 17 physicians engaged actively in the practice of medicine in Coweta County. This county is a partially industrialized, primarily rural political division in northwest Georgia. Its population is approximately 32,000. All physicians practicing in this county are active members of the county medical society. The membership includes eight general practitioners, two otorhinolaryngologists, one general surgeon, two obstetrician-gynecologists, two internists, and two pediatricians. Eight of these physicians are enaged in group practice. The Coweta County Medical Society was founded in 1882. Accomplishments in behalf of community well-being by the medical society as a group have centered largely about (1) hospital construction and operation, (2) public health programs, and (3) maintenance of a high order of professional and ethical competence among its members. Since the early part of this century, the Coweta County Medical Society has been active, often as the vis a tergo, in movements for new hospital construction. The most recent example of this is the society's active and vocal influence on local civic forces which resulted in the construction of the Coweta General Hospital to be opened in March of 1962. In the second regard, the society has never failed to answer the requests of the local or State health departments in communicable disease control and often has sponsored of its own volition such projects as polio vaccination clinics. In regard to the currently widespread discussions on the medical needs of the elderly, the Coweta County Medical Society feels that its membership is the most qualified (indeed, the only qualified) group to know the medical needs of the aged ill of Coweta County, Ga., and that we are the only group capable of understanding the infinitely complex problems involved in satisfying these needs. We, therefore, feel justified in presenting the following testimony. We can offer no valid set of statistics as to the per capita income of Coweta County citizens over the age of 65. In this county such figures have very little pertinence to the amount or quality of medical care these aged-ill persons receive. In this part of the benighted South the family unit is still largely intact. Our people still hold to the curious 19th century notion that children have the pri mary responsibility for indigent and/or ailing parents. It is a rarity to encounter an aged indigent for whom there is no child to assume responsibility for medical costs. There are, of course, exceptions. We feel that medical care for these exceptions is adequately handled at the present time by county (Coweta County hospital authority) subsidy of the Newnan Hospital or by budget adjustments of the Newnan Hospital, an essentially eleemosynary institution. In 1960 over $200,000 was spent by these two agencies for hospital care of the indigent. Approximately 50 percent of these funds were spent in the care of indigent persons over the age of 55. Free medical care afforded by physicians (as a purely individual service) cannot be assessed because no effort on our part has ever been made to advertise these facts. When budget appropriations are made by the State of Georgia to secure funds under the Kerr-Mills Act, the problem of availability of medical care to Coweta County's indigent-ill oldsters will be virtually nonexistent. The membership of the Coweta County Medical Society realizes the Hebraic injunction to children regarding honor due parents is less heeded in the more enlightened parts of the United States where a more progressive society is in step with history and demands social reforms. We further realize that special local problems such changes in traditional attiudes and family organization have produced required special (local, we would hope) solutions. Inasmuch as our Victorian situation in this regard provides our oldsters not only with medical attention but also values they need a great deal more, respect, affection, a place, we prefer that New York City, Detroit, Los Angeles, and so forth, solve their aged-ill problems in their way and that we be allowed to solve ours in our way. The membership of the Coweta County Medical Society has read in toto S. 909, 87th Congress, equivalent of H.R. 4222. We find that the text of this legislative proposal contains numerous contradictions to its vital opening thesis: "*** nothing in this title shall be construed to authorize any Federal officer or employee to exercise any supervision or control over the practice of medicine or the manner in which medical services are provided or over the selection, tenure, compensation, or any officer or employer of any hospital, skilled nursing facilities, or home-help agency, or, except as otherwise specifically provided to exercise any supervision or control over the administration or operation of any such hospital facility or agency." We call special attention to section 1603, paragraph A. subparagraph 4: to section 1606, paragraph A. subparagraphs 5 and 7; section 1606, paragraph B, subparagraph 2, 6, and 8: section 1606, paragraphs E and F; section 1609, paragraph A, subparagraph 1, and same section. paragraph B. Anyone who has ever had any but the most casual experience with the operation of institutions for the care of the ill immediately recognizes that the provisions cited above effectively insure thoroughgoing Federal control of any cooperating institutions. It is not difficult to control the practice of medicine: Any hospital tissue committee or records committee know this. Under the cited provisions of this proposed legislation, it is preposterous to state that the bill does not authorize any Federal control over the practice of medicine or the manner in which medical services are provided. It is even more preposterous to state (as has been done repeatedly by proponents of this and similar legislation) that this bill will not involve physicians themselves. In summary, the Coweta County Medical Society submits the following items of testimony: (1) There is no significant lack of medical care for the older citizens of Coweta County, Ga. (2) For at least three decades, the medical profession, the local city, and county governments, and society at large have provided adequately for the indigent aged ill. (3) Any default in provision of adequate medical care for our aged ill that has escaped the attention of the agencies cited above or that will arise in the future can be more than adequately dealt with under the provisions of the KerrMills Act. (4) The membership of our society has read and studied the provisions of the so-called Anderson-King bill, and we find its provisions in direct contradiction to its own section 1601. Further we are especially alarmed by the closing section of the companion title IV, section 402, as promise of further Federal encroachment upon a domain which we know from years of personal experience represents one of the most private and intimate relationships between individuals. Respectfully submitted. ERNEST E. PROCTOR, Secretary, Coweta County Medical Society. FLOYD COUNTY MEDICAL SOCIETY, Rome, Ga. The undersigned identifies himself as a practicing physician in the specialty field of obstetrics and gynecology certified by the American Board of Obstetrics and Gynecology and holding membership in the Floyd County Medical Society, Georgia Medical Association, American Medical Association, Georgia State OB-GYN Society, Southeastern OB-GYN Society and American College of Obstetricians and Gynecologists. I am currently serving as president of the Floyd County Medical Society, an organization of some 57 physicians who practice in Rome and Floyd County and whose purpose is the assurance to the lay public of ethical medical protection through the stimulation of high standards of quality in the medicine practiced in this community. The relationship between the lay public and medical profession in this community and trade area of approximately 85,000 people has been excellent and each group has shown great respect for the other. The society has as one of its aims the assurance of the people of this area having readily available medical care regardless of background. It has the responsibility of staffing the emergency call rotation at the hospitals and indigent clinics for the county in which all needy patients, regardless of age, are seen and cared for without limit and without restriction. The Floyd County Medical Society would like to voice unanimous and serious objection to the legislation now before your committee, H.R. 4222 (King bill). Our obpections are based on what we feel to be logical fact and are enumerated for your consideration: (1) The bill would remove the voluntary aspect of health insurance and thus prevent freedom of choice and free enterprise from this area. (2) The bill would be available to only those aged persons who are eligible for social security and leave unprotected those who are not. (3) The King bill would definitely lower the caliber of medicine practiced because it would be under the jurisdiction of Federal control, a control which would dictate the procedures and treatments to be carried out and the institutions in which they could be carried out. (4) The King bill would be extremely costly in that social security taxesalready scheduled to become 9 percent of payroll in the years ahead-would have to be further increased, and it would necessitate the creation of a vast new bureacratic task force to supervise this workings from Washington, D.C. (5) The King bill indicates to us a mere beginning toward completely socialization of medicine because we feel that when this compulsory insurance for the aged is implemented it will be gradually expanded to include all age groups. (6) The legislation before the committee is not necessary because the KerrMills bill enacted last year and already being implemented in 46 States is sounder and more desirable than the present bill being considered. The medical profession favors the Kerr-Mills bill because: (a) It would preserve the quality of medicine by maintaining the present freedom of patients to choose their physician, and freedom of doctors to treat his patient as he sees fit. (b) The medical benefits afforded by the bill would be unlimited and be applicable to all persons in the age group, not just those eligible for social security. (c) It affords the individual the opportunity to continue in a voluntary health insurance program. (d) It avoids the waste of tax dollars. (e) It is administered from a State or local level rather than from the Federal or national level. 76123-61-pt. 4-27 We, of the Floyd County Medical Society, are heartily in favor of the people of our area and those of the State and the Nation continuing to get the medical care which they need and want. We feel that those who can pay for this care should do so, and those who cannot should be able to get it through assistance. We favor the assistance being given not as proposed by the King bill, but through the Kerr-Mills bill which is already enacted and maintains the important features and rights as enumerated above. Thank you for your kind consideration of this statement of our testimony. HOBART C. HORTMAN, Jr., President, Floyd County Medical Society. August 1, 1961. Sworn to and subscribed before me this the 2d day of August 1961. [SEAL] JOY CHAMBERS, Notary Public, Floyd County, Ga. STATEMENT BY J. G. MCDANIEL, M.D., PRESIDENT, FULTON COUNTY MEDICAL SOCIETY, FUlton County, Ga. Mr. Chairman, I am Dr. J. G. McDaniel, a practicing physician in Atlanta, Ga. I am past chairman of the council of the Medical Association of Georgia and currently it is my honor to serve as president of the Fulton County (Atlanta) Medical Society. The Fulton County Medical Society, representing over 900 doctors of medicine, is vigorously opposed to the enactment of H.R. 4222. It is equally opposed to the philosophic concept on which the bill is based. The doctors in the Atlanta area, and I feel certain that this would be the case over the entire State, regard any bill which attempts to legislate preferred status to a single segment of the population is pernicious and destructive on its face. This bill would restrict the benefits it proposes to administer to those persons covered by title II of the Social Security Act and to those covered by the Railroad Retirement Act. In so doing this, it seems to make an arbitrary assumption that these are the people who need help in meeting the costs of certain specified but limited health needs. Such an assumption has no basis in fact. The very people which this bill proposes to subsidize are the ones least in need of help. In Georgia, we have approximately 290,000 persons over age 65 and, of this number, approximately one-third are classified as financially indigent, that is, they are presently on the relief rolls of the welfare agencies. These people are not covered by social security and it should seem obvious to anyone seeking the truth in this matter that these are the people who actually need help. We feel that across-the-board medical assistance to all recipients of benefits under the Social Security Act and the Railroad Retirement Act, regardless of need, constitutes a dangerous precedent and could threaten the total collapse of continued high-quality medical and hospital care in this country. We believe that a locally administered health care program, such as would be possible under the Kerr-Mills law, provides the best solution to the problem. It will provide complete medical care on the basis of need as opposed to providing less medical care on an indiscriminate across-the-board basis, without regard to the ability or willingness of the great majority of our people to provide for themselves such medical care as they may require. It is our belief that the Federal Government should be restricted to those things which the States and the people cannot do for themselves and the proponents of H.R. 4222 have failed to demonstrate that the States and the people are unwilling or incapable of handling their own health needs. In addition to this, it is our firmly held conviction that such legislation as H.R. 4222 represents a real and present threat to the quality of medical care in this country. We are further of the opinion that the enactment of this bill would merely be the beginning of a program the very nature of which must be expanded from time to time. For if age alone, rather than need, is to be the criteria by which an individual becomes eligible for benefits, then we submit that there can be no logical argument made against the extension of this program to include groups other than the over-age-65 group. This bill, in the opinion of the physicians I have the privilege to represent, is an unwarranted intrusion into a sphere of human problems that can more expeditiously and less costly be handled on the State and local level. The practice of medicine is and should be an intimate and personal thing. It does not lend it |