WYOMING STATE DENTAL ASSOCIATION, Hon. WILBUR D. MILLS, Chairman, Ways and Means Committee, House Office Building, Washington, D.C. DEAR REPRESENTATIVE MILLS: The Wyoming State Dental Association strongly opposes the passage of H.R. 4222. It is our thinking that the proposed HR 4222 is too broad in its aspects and is not in the best interest of the public. It is desired that this expression of opposition be included in the record of the hearing. Sincerely yours, T. J. DREW, D.D.S., Hon. WILBUR D. MILLS, CONGRESS OF THE UNITED STATES, HOUSE OF REPRESENTATIVES, Chairman, House Committee on Ways and Means, House of Representatives, Washington, D.C. DEAR MR. CHAIRMAN: I will be grateful if you will include the accompanying letter in the record of the hearings before your committee on H.R. 4222. With warmest personal regards. Sincerely, JOHN A. BLATNIK, Member of Congress. WASECA, MINN., June 30, 1961. Representative JOHN A. BLATNIK, Washington, D.C. DEAR MR. BLATNIK: I am writing you to express my opposition to the King bill (H.R. 4222), which will be under discussion in July. I hope you will insert this letter in the committee hearings. I can imagine it is very difficult for lay people to understand a physician's attitude toward the Federal Government entering even a part of the medical care field. Certainly the King bill is not all-inclusive coverage and I know that proponents of this bill argue that it is not replacing private medical care and never will, however I think experience in other countries has shown that these programs never go backward and generally become more-inclusive in time. My own attitude is one of definite opposition to the King bill. This attitude has developed over a period of years and has developed with an overall view toward Government health care generally. Over this period of time I have personally been involved with veterans hospitals and also with medical care to servicemen. I have also been in private practice long enough now to see the marked difference in attitude toward spending my own and the patient's dollars for supplies and care as contrasted to spending the Government's money. Even though it is the taxpayer who indirectly is paying I think this fact is obscured to almost everyone employed in a federally supported medical facility, as evidenced to me by the needless waste and reduplication that goes on, and there is no question about this. I think if you would talk personally to any physician who has been employed in Government medicine if he were honest about it he would have to admit that this is the case. From the layman's standpoint, he is clearly unable to evaluate much of this wasteful spending and I think any estimation of cost of a Federal program cannot avoid being grossly underestimated. I think the public attitude is "something for nothing" and this could not be further from the truth. I think a good hard look should be taken at government health plans existing in other countries, and particularly I think it is important to get the attitude of a good share of the doctors who are under that type of program. I have personally talked to doctors from England who have come to this country because they have been very dissatisfied with the program and also to a Canadian doctor who left Canada only because of their socialized medical care. I have had a good opportunity to see patients' attitudes toward the doctor under a Federal program and under a private program. In Government service many patients had the attitude that "I have it coming, give it to me, you're employed by the Government and you owe it to me." When the patient is paying himself he wants to look after his dollars just as I do. I enjoy private practice and am in private practice mainly because I am able to run my own business and I enjoy doing this. Any Federal program in the State of Minnesota would certainly be unnecessary duplication of care. With Minnesota's welfare program there is no limit to duration of care or the facility used for care whether it is a hospital, rest home, home, or the doctor's office. The program is administered very simply in that each month we submit our itemized bill to the county welfare director who administers it from there. There are no long forms to fill out and there is no redtape; it is as simple as sending the patient his bill. One feature of Minnesota's program I think that is very good is the fact that only people who really need the care qualify and people with property or some funds may qualify for the program nevertheless at the time of death those funds or that property is used to replace what they have taken from the program, and I think this is only right. Also I think this program encourages children to take care of their parents, and I think we are losing sight of this today. In short, my opposition against any Federal entrance into medical care is based not only on wasteful expenditure of funds but also on a rather intangible factor which keeps myself and I'm sure other physicians working and happily caring for people because our contacts with patients give us a very satified feeling. I am truly afraid that this physician-patient relationship would be disturbed and perhaps destroyed by Federal entrance into medical care. Very truly yours, Representative WILBUR D. MILLS, WAYNE L. CAMPBELL, M.D. BLUE EARTH MEDICAL CENTER. Chairman of the House Ways and Means Committee, House Office Building, Washington, D.C. DEAR MR. MILLS: I am writing to you about the King bill (H.R. 4222). Please be advised that I am opposed to the King bill which is an act to provide health benefits for senior citizens under the Social Security Act. After practicing medicine in Blue Earth, Minn., which is the county seat of Faribault County, it is my opinion that we have always been able to take care of our senior citizens that are in need of help; and it is my sincere belief that we should be able to do this in the foreseeable future. Granted that there are some of our senior citizens who are unable to provide for themselves medically, but we have always been able to take care of this on a local level without sacrificing their pride nor the caliber of medical care that they receive. We are in the process of building a rest home for our senior citizens, and this is being done by popular subscription. It is my opinion that this type of procedure could be done more widely and that if people generally had more pride in themselves and their local communities, it would be less necessary for Federal funds to be wasted or used inadvisedly. I hope that you will consider my plea, and I would like very much for you to insert this letter in the committee's hearings. Respectfully yours, LEO H. IRWIN, GEORGE W. DREXLER, M.D. ATLANTIC CITY, N.J., July 28, 1961. Chief Counsel, Committee on Ways and Means, DEAR MR. IRWIN: I am submitting this statement to the Committee on Ways and Means with reference to H.R. 4222, also known as the King-Anderson bill. It is desired that this statement be printed in the record in lieu of a personal appearance. My name is Leonard S. Ellenbogen, M.D., and my medical practice specialty is radiology. I practice at 1616 Pacific Avenue, Atlantic City, N.J., and have practiced in this city for 16 years. H.R. 4222 presents a definite and grave economic threat to me and physicians like me who provide diagnostic services on a private practice basis. Specifically, the provision that diagnostic procedures costing more than $20 be furnished by hospital outpatient clinics would result in the loss of a large 76123-61-pt. 4-30 segment of the practice of private diagnostic specialists. It would prevent free choice of physicians in that patients eligible for the benefits would be compelled to go to hospital clinics for diagnostic services rather than to private offices. If provisions for such diagnostic services is considered desirable, it is suggested that it would be more equitable and convenient to provide such services at either hospital outpatient clinics or in the offices of qualified diagnostic specialists. It would have further merit in preventing expensive duplication of equipment and office space and disrupting the practice of these diagnostic specialists by forcing patients into hospital outpatient departments and away from private offices. Many Blue Shield and combined Blue Shield-Blue Cross plans have been providing medical diagnostic benefits either in hospital outpatient clinics or in the offices of qualified diagnostic specialists for years. A substantial body of actuarial experience has been gained in the administration of these programs and their practicality has been demonstrated repeatedly throughout the country. In medical practice in America under the free enterprise system, patient flow has gone to those who offer the better medical service. H.R. 4222 would alter this fundamental concept by dictating that patient flow for diagnostic medical services go specifically to hospitals as such rather than to the physicians practicing these medical specialties under their own name. This statement does not concern itself with the broad principles and implications of this pending legislation but does ask that the obvious inequity of attempting to eliminate private medical diagnostic specialists be removed from its provisions. Very respectfully, LEONARD S. ELLENBOGEN, M.D. PAYSON, ARIZ., July 31, 1961. Mr. LEO H. IRWIN, Chief Counsel, House Ways and Means Committee, DEAR SIR: I take this opportunity to urge you wholeheartedly to oppose and defeat the King-Anderson bill, H.R. 4222. Here in the middle of the mountain country of the State of Arizona, our county is probably one of the least populated in the United States, yet not one of the indigent inhabitants goes without medical care. An abundance of funds are available from private organizations and the general county welfare fund to provide any and all of those aged indigents medical care. Therefore I wish to add my testimony to those previously recorded in your records to the extent that absolutely no Federal aid to the aged can by any stretch of the imagination be said to be needed. In order to preserve free enterprise, which is the lifeblood of America, I urge you to defeat such socializing tendencies that may crop up from time to time in Congress, whether in medicine, education, or whatever. Sincerely yours, Representative WILBUR D. MILLS, Chairman, House Ways and Means Committee, DAVID B. GILBERT, M.D. ZUMBROTA, MINN., June 28, 1961. DEAR SIR: I would like to express my firm opposition to the King bill. Please insert my letter in the hearings of your committee. I am not against Government aid for people who really need it, but I do oppose a general giveaway program for everyone regardless of their need. Sincerely, JAMES W. HALVORSON, M.D. (The following letter was forwarded by Congressmen Blatnik and Quie of Minnesota :) MINNEAPOLIS, MINN., July 5, 1961. DEAR CONGRESSMAN BLATNIK: Would you please insert this letter into the committee hearings on the King bill (H.R. 4222) and note that I am opposed to any health benefits for senior citizens under the Social Security Act. Sincerely, E. B. JEROME, M.D. MESABA CLINIC, Hon. WILBUR D. MILLS, Chairman, Ways and Means Committee, House of Representatives, Washington, D.C. Hibbing, Minn., June 28, 1961. DEAR REPRESENTATIVE MILLS: I am writing regarding the proposed King bill (H.R. 4222), which I understand soon will be discussed at a public hearing. While on the surface this legislation seems admirable, it is not difficult to envision its long-term ramification. Its proponents have clearly stated it is a foot in the door which will allow more restrictive and encompassing measures to follow. While the bill contains a supposed safeguard against interference by Federal officials with medicine or its allied services "except as specifically provided" in the bill, really no protection is afforded at all. Since the organizations covered by the proposed bill must meet conditions and participation as directed by the Secretary. Certainly this affords a certain degree of control by the Federal Government over medical services. We have the best standard of medicine in the world, and have recently been given adequate legislation to protect those needy individuals who want help. Let's not force all of us to pay more money to give blanket help to everyone whether needing it or not. I would appreciate it if you would insert this letter in the committee's hearings. I realize it is but a straw in the wind, but it reflects the opinion of a considerable number of lay and medical people in this area, and we hope may in some small way help prevent something we feel is harmful and potentially seriously dangerous. Sincerely, RICHARD R. MOYER, M.D. CONGRESS OF THE UNITED STATES, HOUSE OF REPRESENTATIVES, Hon. WILBUR D. MILLS, Chairman, Committee on Ways and Means, DEAR MR. CHAIRMAN: Enclosed is a copy of a letter regarding medical care for retired persons, sent to me by Dr. Karen Olness and 31 other medical students. Because of their direct connection with this problem and their desire to work out the best possible program, I am requesting that it be made a part of the hearing record when your committee takes up this subject. With kindest regards. Sincerely yours, WALTER H. JUDD. The Honorable WALTER H. JUDD, House of Representatives, Washington, D.C. MINNEAPOLIS, MINN., June 9, 1961. DEAR REPRESENTATIVE JUDD: We are junior and senior medical students who wish to express our opinions regarding present day care for senior citizens in the United States. We feel qualified to do this because we have made a special effort to determine needs of America's senior citizens, because we have spent considerable time working with patients in Government institutions, and because we are exceedingly interested in this problem. We believe that: (1) Needs of senior citizens for food, shelter, clothing, and medical care are not clearly defined on a nationwide or on a statewide basis. Surveys have been too smal Ito be significant and have indicated conflicting results. Legislation for assistance with no firm basis of fact is likely to be unsatisfactory. We suggest, therefore, that more efforts be made to determine these needs. (2) It may be difficult or impossible to determine such needs on a nationwide basis, because there is likely to be tremendous variation from State to State. We believe that needs must be determined on a statewide basis and that legislation for aid should be planned and controlled by State governments. We heartily endorse the recommendation of the White House Conference on Aging that local communities should immediately create committees on aging in order to make this problem meaningful to everyone. (3) Federal aid to States and local communities may be necessary; but it should not be legislated on such an arbitrary vehicle as social security. Such aid must be flexible in accordance with variant needs from State to State and most important, from person to person. We believe that medical aid to persons who cannot pay for it must not have such severe restrictions on extent of serv ice (i.e., days of hospitalization and nursing home care) or demand as high initial payments by patients as is planned by the King-Anderson bill. These limits are unrealistic. (4) Physical health of senior citizens is determined to a great extent by their emotional health. Financial assistance alone is not a panacea for all the problems and needs of our senior citizens. We believe that more efforts must be made to keep senior citizens busy with useful activity. We believe that re tirement should not be compulsory and abrupt. We feel that more senior citizens' clubs should be organized. The effect of such clubs on and health of senior citizens in Minnesota is proof of their efficacy. We wholeheartedly endorse the conclusions of the White House Conference on Aging which stated that rights to health and necessities of life entail obligations as well. Sincerely yours, Re bill, H.R. 4222. The CHIEF CLERK, KAREN OLNESS, M.D. HOUSE OF REPRESENTATIVES, Washington, D.C., August 15, 1961. Ways and Means Committee, House of Representatives, New House Office Building, Washington, D.C. MY DEAR SIR: I have been requested by Dr. Herbert M. Olnick, 724 Hemlock Street, Macon, Ga., to respectfully request that his views, as set forth in the within enclosure, be filed as a part of the record in connection with your hearings on the bill, H.R. 4222. If your hearings have been concluded at this time, then I would appreciate it very much if you would incorporate this statement in the record on this bill. Thanking you, and with best wishes and kind regards, Sincerely yours, CARL VINSON, Member of Congress. MACON, GA., August 7, 1961. COMMITTEE ON WAYS AND MEANS, Washington, D.C. MR. CHAIRMAN AND MEMBERS OF THE COMMITTEE: I am Dr. Herbert M. Olnick of Macon, Ga. I am a practicing radiologist and currently president of the Georgia Society of Radiologists. I wish to confine my remarks to the radiologic aspects of H.R. 4222. H.R. 4222 proposes to cover outpatient diagnostic tests on a deductible basis when performed in the hospital. Hospital departments are already overcrowded due to the provisions of commercial health insurance policies which require that the patient examined be hospitalized. The radiologists practicing in 1,500 private offices represent a bed of available talent for examining the clients of the proposed social security program. They have the time to do this work because these offices have been shunned by most commercial health insurance provisions. These offices represent an investment of over $100 million. If H.R. 4222 restricts the service to hospital departments, these private offices will eventually disappear. The public will have to expand hospital departments to the tune of $100 million as a replacement. The absence of a ceiling on the amount of diagnostic test benefits available after the deductible is paid will cause staggering expense. From my own experience, I would venture to state that the average patient would run a bill of over a hundred dollars in just X-rays alone. We practicing radiologists oppose the King bill because it is unfair to private office radiologists; because it will promote abuse and waste of medical talent; and because it will result in poor medical care for the people who are really sick. Overtaxing radiologic personnel causes the sick patient to be lost amid the vast influx of mildly infirm patients. The sick patient get slighted and the diagnosis |