is more apt to be missed because a proper amount of time cannot be given to the one who needs it.

I recommend that this committee consider the weakness of this bill to which I can personally testify. While the administration claims that doctors' services are not covered under this bill, it is immediately evident that hospital doctors are covered in four specialties whereas their colleagues who attempt to serve the public from private offices are being forced into a corner by the provisions of H.R. 4222. The sponsors of this legislation look forward to the day when all doctors will work for hospitals.

I urge that the committee consider subsidizing an insurance program that would incorporate the above features without concentrating total discretionary power in the Secretary of Health, Education, and Welfare.

Respectfully submitted.

Hon. WILBUR D. MILLS,

Chairman, House Ways and Means Committee,

House of Representatives,

Washington, D.C.

HERBERT M. OLNICK, M.D. OLMSTED MEDICAL GROUP, Rochester, Minn., July 6, 1961.

DEAR REPRESENTATIVE MILLS: I would like to take this opportunity to express my extreme dissatisfaction with the King bill, H.R. 4222. I am surprised and disappointed that anyone who loves freedom would propose such a bill that could endanger our high standards of medical care and democratic way of life. Let me urge you to do everything possible to defeat this bill.

If it is possible, would you insert this letter in the committee hearings minutes? Sincerely,

STATEMENT OF R. B. ROBINS, M.D

DUANE L. ORN, M.D.

Mr. Chairman and members of the committee, I am Dr. R. B. Robins, a family physician from Camden, Ark. My good personal friend, Chairman Wilbur Mills, knows that I have a great interest in the question of medical care under Federal sponsorship and control. As a physician and as a citizen who has been active in governmental and political affairs (I served from 1944 to 1952 as the national Democratic committeeman from the State of Arkansas), I feel justified in appearing here today to present my views with respect to H.R. 4222. I have opposed in the past the Truman health program and the Forand legislation. Now you are considering the King-Anderson bill. They are all part and parcel of the same thing-programs providing for or leading to a system of government dominated medical practice.

You may recall that I testified before this committee 2 years ago, against the Forand bill. I had then just returned from England where I had the opportunity of studying, first hand, the British National Health Service. I stated then the faults and dangers which are inherent in a national health system, and I say to you now that my many contacts with friends in England confirm my conclusions that the British system becomes more and more distasteful to the people the patients and the physicians.

The British National Health Service, now 13 years old, is still being plagued with rising costs, greater inconveniences, increasing governmental redtape, and a diminishing quality of medical care. It is no wonder, then, that more and more doctors from England seek to establish themselves in the United States. It is no wonder, then, that more and more physicians in England are sending their sons to study medicine in this country. It is no wonder, then, that more and more British people are seeking private care at their own expense in lieu of the public care to which they contribute through taxpayments.

The experience of Great Britain in attempting to estimate the cost of the national health service at its inception and our experience in estimating costs of our social security programs indicate to me that it is extremely likely that the real cost of the program proposed by H.R. 4222 will greatly exceed initial estimates.

In a concise examination of the British National Health Service, Prof. John Jewkes, who occupies the chair of economic organization in the University of Oxford, writes in his recently published work "The Genesis of the British National Health Service":

"It is equally clear that the Government was taken by surprise at the high level of demand under the new conditions. No estimate made before 1948 had set the annual cost to the exchequer of the national health service above 170 million pounds. The cost at an annual rate came out at 377 million pounds for 1948-49 and 433 million pounds for 1949–50.”

Dr. Jewkes relates the difficulties encountered by the Government in its attempt to hold the cost line and of these attempts says:

"The steady and continuous struggle on the part of British governments to restrain the demands for medical service has led those who had assumed that the principle of 'the best possible medical service free for all' meant literally what it said and did not mean 'the distribution roughly according to the prin ciple of first come first served of the supply of free medical services which the Government thought adequate'-to complain of the 'tyranny of the exchequer.' Certainly the efforts on the part of successive governments to keep expenditures within what were deemed to be proper bounds, and at the same time avoid political unpopularity, have had some unfortunate long-period consequences."

Our Nation's medical societies oppose H.R. 4222. They represent the overwhelming majority of practicing physicians in the United States. While the task force report made made to President Kennedy on health and social security for the American people urged Federal action to increase the supply of medical and other health personnel, even consideration of bills such as you have before you, in my opinion, is today influencing young men against entering the private practice of medicine.

We doctors have strongly supported Kerr-Mills legislation. I know that by now you have heard repeated testimony on this subject. The proponents of H.R. 4222 have labeled this legislation (Kerr-Mills) inadequate or degrading.

But "catch terms" do not establish the value of any law. Kerr-Mills fills the gap between those who can well afford to pay for their health care, as they pay for everything else, and those who are unable to pay for such care and of necessity must seek public aid.

May I ask this committee to deliberate with caution.

Favorable action of H.R. 4222 will be irrevocable. The growth of private insurance, the value of Kerr-Mills, the unknown costs, the dangers of federally regulated medicine, must be carefully considered. This is not a political question. Certain groups, while condemning medical societies for their interest and their activity in educating their members and presenting their views to the public, have themselves been using medical care for the aged as the instrument for organizing our elder citizens into a political block.

These organizations are far more interested in using these groups in political campaigns than they are in the welfare of the aged or of the rest of us. May I say also that some appointed officers of our Government seem to be forgetting their responsibilities to all the people and have joined in the organizing and lobbying activities of these special interest groups.

Mr. Chairman and gentlemen of the committee, I want to thank you for allowing me to again express my sentiments. May I also request that my oral and written statements given 2 years ago to your committee be reinserted in the record. I believe them to be pertinent to your consideration of H.R. 4222.

Representative WILBUR D. MILLS,

Chairman, House Ways and Means Committee,
House Office Building, Washington, D.C.

ROCHESTER, MINN., July 4, 1961.

DEAR MR. MILLS: I am writing at this time to add one more voice in opposition to the King bill (H.R. 4222) which I believe is soon to come up for specific action. I am convinced that the Kerr-Mills bill is the best instrument currently available to help those senior citizens who need help in paying for their medical expenses. I hope you will be able to insert this letter in your committee hearings and that this undesirable King bill will be convincingly defeated.

Yours sincerely,

E. D. ROOKE, M.D.

Re King bill, H.R. 4222.

Representative WILBUR D. MILLS,

Chairman, House Ways and Means Committee,

House of Representatives, Washington, D.C.

OWATONNA, MINN., June 27, 1961.

DEAR REPRESENTATIVE MILLS: I notice that a hearing on the above bill is scheduled for sometime early in July. This bill, of course, is an act to provide health benefits for senior citizens under the Social Security Act.

I am opposed to this particular bill. I am for health benefits to senior citizens but not under the Social Security Act. You being in the position that you are know, of course, all of the arguments for and against this particular House report, I will simply say that I am against this bill for reasons that it would be horribly expensive under the Social Security Act and would not provide health benefits for our senior citizens equally. Under our American form of government we have always insisted from the start that everyone be treated equally. This is not so under the King bill. It s very discriminatory in that some would receive help that don't need it and others that need it or could use it would not be eligible.

On top of all of this it is one further and sure step toward Government medicine. In my opinion that is bad: I saw it in Germany years ago and also the type of decadent medicine it produced. Germany has never recovered from this change of direction in medical care. Germany was at one time one of the leading sources of great, outstanding surgeons and other medical men. It no longer is and has not been for two generations. A similar thing is happening in England.

So that you will understand my position, I will say that I am not talking from a selfish standpoint since I will not be practicing much longer. I am speaking as an American citizen who has always been proud in the essential equality with which our citizens have been handled and proud also in the terrific strides made in the science of medicine and its allied sciences due to the incentives under the American system. I am speaking also as a father and a grandfather who is very concerned with what kind of medicine and medical care his children and grandchildren and their offspring will receive. Not many people can justifiably say that our senior citizens are not well taken care of medically, either through insurance, local welfare boards, Veterans' Administration care, or out and out charity by practicing physicians.

Although this is a dictated letter (you probably couldn't read my handwriting anyway) it is not just a dictated letter. It is a written reflection of my thoughts and convictions.

I am emphatically against this bill. I request that you insert my letter in the record of your committee's hearings.

This letter is being sent to all nine of our Minnesota Congressmen.
Very truly yours,

J. F. SCHAEFER, M.D.

DULUTH, MINN., June 28, 1961.

Representative WILBUR D. MILLS,

Chairman of the House Ways and Means Committee,
House of Representatives, Washington, D.C.

DEAR SIR: I would like to express my opposition to the King bill (H.R. 4222), and would like you to insert my letter in the committee's hearings.

Yours very truly,

DEAR MR. MILLS: The attached resolution was passed by the Mississippi Society of Anesthesiologists by special poll on July 28, 1961.

We respectfully request that this communication and resolution be included in the printed record of the hearings.

Respectfully submitted.

CURTIS W. CAINE, M.D., Secretary.

RESOLUTION PASSED BY THE MISSISSIPPI SOCIETY OF ANESTHESIOLOGISTS BY SPECIAL POLL ON JULY 28, 1961, IN OPPOSITION TO THE KING-ANDERSON BILLS (H.R. 4222 AND S. 909)

Whereas the people of the United States have not conveyed to the Federal Government by the Constitution any authority to engage in their medical care;

and

Whereas it is the whole concept of the King-Anderson bills (H.R. 4222 and S. 909) that is contrary to the American heritage of individual right and responsibility, and not just the fact that anesthesiologists are relegated to hospitalservice status; and

Whereas a prominent anesthesiologist appeared before your committee and testified that the only objection anesthesiologists had to the King-Anderson bills was their inclusion in the hospital-dispensed medical services; and

Whereas recently conducted surveys conclusively disclose that there is no medical care problem for the aged or any other segment of the population, and thus no solution necessary for a nonexistent problem; and

Whereas the care of each person-medical and otherwise is firstly his own responsibility, secondly his family's obligation, and thirdly morally that of his relatives, friends, and neighbors (including physicians), but in no instance that of the Federal Government; and

Whereas social security is neither social nor secure but rather socialism; and Whereas social security is not and may not be insurance; therefore be it Resolved, That the Mississippi Society of Anesthesiologists, a component of the American Society of Anesthesiologists, by special poll on July 28, 1961, does hereby declare that it is opposed to the King-Anderson bills in toto; and be it further

Resolved, That we declare that we do not subscribe to the stand which was taken by the spokesman referred to above who was opposed solely to the provision of H.R. 4222 and S. 909 which designates anesthesiologists' services as a hospital service; while purportedly speaking for the Nation's anesthesiologists, he has not asked for nor was he given the authority to speak for the anesthesiologists of Mississippi, and be it further

Resolved, That a copy of this resolution be sent to the House Ways and Means Committee, the American Society of Anesthesiologists, the Mississippi State Medical Association, and the Committee for the Preservation of Medical Freedom.

MISSISSIPPI SOCIETY OF ANESTHESIOLOGISTS,
CURTIS W. CAINE, M.D., Secretary.

RESOLUTION

Whereas the American College of Chest Physicians is interested in the best medical care for all the people, including our aged citizens; and

Whereas it is the belief of the members of the American College of Chest Physicians that the King bill, H.R. 4222, would result in poorer rather than better medical care for the aged; and

Whereas it is the belief of the members of the American College of Chest Physicians that the King bill is a step in the direction of socialized medicine, which is not in the best interests of our people; and

Whereas the Congress has already passed the Kerr-Mills bill which would adequately take care of aged individuals who need medical service: Therefore be it

Resolved, That the American College of Chest Physicians express its opposition to the King bill and any similar measures which will lead to inferior medical care.

Adopted by the Executive Council and Board of Regents, American College of Chest Physicians, June 22 and 23, 1961, New York City, and adopted by the college membership at the open administrative meeting, June 23, 1961, New York City.

STATEMENT OF THE AMERICAN OSTEOPATHIC ASSOCIATION BY CARL E. MORRISON, D.O., CHAIRMAN, COUNCIL ON FEDERAL HEALTH PROGRAMS, WASHINGTON, D.C. The American Osteopathic Association appreciates this opportunity for comment on H.R. 4222. The association is a nonprofit, tax-exempt federation of divisional societies of osteopathic physicians and surgeons. Its objects as set forth in its constitution are to promote the public health, encourage scientific research, and maintain and improve high standards of medical education in the osteopathic colleges. Its policies are determined by an elective house of delegates chosen by the respective divisional societies.

The house of delegates on July 10, 1961, resolved as follows:

"Whereas the American Osteopathic Association, recognizing that increased cost of medical care creates a grave socioeconomic problem in certain groups; and

"Whereas preventive medicine has brought about an increase in the number of our aging population; and

"Whereas a significant number of these persons have insufficient income to meet the increasing cost of medical care; Therefore be it

"Resolved, That the American Osteopathic Association, recognizing the need for suitable health plans, offers its assistance and cooperation to all agencies concerned with providing adequate health care to our citizens and urges immediate steps be taken to alleviate these growing problems."

Implicit in the above resolution is the continuing desire of the osteopathic profession to work with private organizations and Government agencies for the advancement of the health care and welfare of the aged. The American Osteopathic Association established an Academy of Geriatrics for research on aging, and a National Committee on Health Care for the Aging to stimulate and coordinate corresponding committees at State and local levels.

The osteopathic schools of medicine, in common with the other medical schools, are participating in the research and training programs of the National Institutes of Health in such fields as cancer, cardiovascular diseases, arthritis and metabolic diseases, neurological diseases and mental health, which may be said to bear a primary relation to aging. Lectures and clinical courses are given in the care of the aged, under the subject of gerontology, and kindred subjects throughout the curricula in our colleges.

H.R. 4222 would establish within the social security system a program of hospital, nursing home, diagnostic clinic and home-care services for persons age 65 or over.

The osteopathic profession and institutions, as providers of health services in all the States, are manifestly interested in such a program. The osteopathic profession provides or staffs general medical and surgical care hospitals and related health facilities.

Included in the services for which payment would be authorized under the program would be inpatient hospital services rendered in participating hospitals. Inpatient hospital services would not include the cost of a physician's services except for the services of hospital interns and residents-in-training in approved hospitals, and except the cost of services rendered by physicians in four specialty fields-anesthesiology, radiology, pathology, and physical medicine where the physician furnishes his services to an inpatient as an employee of the hospital or where he furnishes them under an arrangement with the hospital which governs the provisions of the services.

With regard to identifying providers meeting conditions of participation, the statement of the Secretary of Health, Education, and Welfare of this committee on July 24, 1961, on the pending bill reads in part as follows:

"Conditions of participation by hospitals and home health agencies can readily be met by institutions that fulfill the standards established by accreditation bodies. No special administrative problems are anticipated, therefore, in obtaining agreements by providers of service who are both accredited and licensed. The Secretary would have authority to find that accreditation by a recognized national accreditation body provides reasonable assurance that some or all of the conditions for participation in the program are met, and accreditation could accordingly be accepted as evidence of such qualification."