Minimum standards of organization and practice for hospitals staffed by osteopathic physicians and surgeons were first established, and inspection and approval procedures adopted, by the American College of Osteopathic Surgeons about 1928. In 1935, the Bureau of Hospitals of the American Osteopathic Association assumed joint responsibility with the American College of Osteopathic Surgeons. Since 1949 the American Osteopathic Association has had full responsibility, which it now exercises through a committee on hospitals.

The committee on hospitals of the American Osteopathic Association is composed of four representatives of the osteopathic profession at large and a representative from each of the specialty colleges of surgery, radiology, internal medicine, and obstetrics and gynecology. They are thoroughly familiar with all phases of hospital administration and are charged with the formulation of hospital standards which are formally approved by the Board of Trustees of the American Osteopathic Association.

Any hospital desiring accreditation must submit to a rigid annual examination by the committee. If the hospital passes this examination it can be officially listed as registered. Hospitals which are approved for internship or residency training must pass an annual inspection even more comprehensive than that for registered hospitals. State and Federal agencies have recognized AOA accreditations.

Even though some hospitals cannot at present be officially registered or approved because they are too small to maintain separate departments of obstetrics, surgery, and radiology as required, many choose to maintain professional standards by joining the American Osteopathic Hospital Association. This national service organization, an affiliate of the American Osteopathic Association, helps hospitals solve a wide variety of administrative and operational problems and, indirectly, helps them to become qualified for registration and approval.

The 1961 Directory of the American Osteopathic Hospital Association lists 392 hospitals, with a total of 15,557 hospital beds, a sizable number of which were constructed with the aid of Hill-Burton funds; 98 are losted as approved for intern training and 112 as registered, a total of 210 hospitals approved or registered by the American Osteopathic Association.

Most osteopathic hospitals particiapte in Blue Cross and commercial insurance programs. They are also utilized in the medicare program for dependents of members of the uniformed services and by the Federal Employees Compensation Commission and as participants in the Federal employees health benefits program.

It is understood that hospitals staffed in whole or in part by physicians and surgeons of the osteopathie school of medicine would be eligible on equivalent bases as hospitals staffed in whole or in part by doctors of medicine for participation under H.R. 4222.

It is also understood that the only limitations on the patient's choice under the bill are what they are today for those who are able to pay: that a hospital may reject a patient if it wishes and that not all physicians (M.D. or D.O.) enjoy hospital privileges.

Whether further Federal action to meet the health needs of the aged takes the form of health benefits attached to our social insurance system, or tax incentives such as repeal of the maximum limitations on deductions for medical care including health insurance premiums and for employment of older persons which are pending before this committee, or liberalization of the Federal medical percentage of amounts expended by the States for insurance premiums for coverage of medical assistance for the aged under the Mills-Kerr program, or some combination of these or other methods are adopted, the osteopathie profession (14.349 as of December 31, 1960) and its institutions can be relied upon to employ their best efforts to provide and safeguard quality care and to pursue their traditional role of cooperation in the public interest.

TESTIMONY ON MEDICAL CARE FOR THE AGED, SUBMITTED BY EDWARD C. MAZIQUE, M.D., PRESIDENT, AMERICAN ASSOCIATION FOR SOCIAL PSYCHIATRY

We are confronted with the solution of a mammoth problem that we ourselves have created through our intellect, ingenuity, technology, scientific research, medical discoveries, and industrialization. There has suddenly appeared on the American scene 17 million old folks who never expected to be around, “in a way” for so long a time. For it was only a fortnight ago that the lifespan of the average American male was placed at 58.7 years and that of the female at 62.8 years.

Indeed at the turn of the 20th century the life expectancy was about 50 years, today it is rapidly approaching the "three score and 10" that's written in the printed word. This increase in the lifespan was largely due to improved socioeconomic factors of the individual and recent advancements in science and technology. Thus, in the case of the lower socioeconomic group, the "culturally deprived" such as the American Negro and American Indian, the period of longevity was much lower.

This has consequently created a new and expanding medical frontier that constitutes about 10 percent of the population of the United States. This number has grown in such proportions that they can no longer be sent to the provencial "poor house," overcrowded hospitals, and convalescent homes, for such facilities are lacking in numbers as much as they are undesirable in quality. Our highly industrialized way of life with increased urbanization and spiraling economic demands make it imperative for both parties in a house to be employed out of the home to meet the cast of our high standard of living. There is no room in the average family, no provision for the old man who, debilitated by arthritis, cardiovascular disease, arteriosclerosis, or senility, cannot "carry his own weight."

The vast majority of these 17 million citizens cannot obtain adequate medical care because they simply cannot afford to purchase it. Those who built nest eggs during their productive working years, 30 years ago, are the chosen few who failed to go down with the crash in the depression years for this was 1931 the era of breadlines, apples, flagpole sitters, and march on Washington movements. This group was further prohibited from "saving for old age," because immediately following the depression we shifted into a war economy in the early forties where manpower was mobilized for security of the national defense instead of personal financial security.

Today 80 percent of our senior citizens 65 years of age or older have incomes less than $2,000 annually; 60 percent have incomes less than $1,000 per annum. The liquid assets of 7.6 million of this group amounts to less than $500. The income of the aged is generally considered inadequate for the 1961 standard of living in the United States. The latest income data published by the Census Bureau showed that one-third of the facilities headed by an aged person in 1959 had a total money income of less than $2,000; 80 percent of aged unrelated persons had an income of less than $2,000, and further that one-half of the unrelated individuals had incomes of less than $1,000 per year. The income status of the aged has not improved in the last decade at the same rate as it has for the younger aged groups. Of all aged groups with income less than $3,000, 47 percent had less than $200 in liquid assets.

The vast majority of the aged are dependent on social security, private pensions, and public assistance for their income. There are nearly 12 million aged persons receiving social security benefits which on the average amounts to $74 monthly. Public assistance is received by 15.3 percent of the aged; the average old-age assistance payment in October 1960, was $69.45. By the end of 1960, less than one-fourth of the aged (4.1 million) were receiving income from either full- or part-time employment as earners or their wives. Again these figures are altered when applied to certain groups on the lower socioeconomic rung of the ladder. According to a survey conducted by Fortune magazine in December 1947, only 4 percent of the Negro families in the Nation had an income from $1,000 to $3,000 and 75 percent had an income below $1,000. The 96 percent of American Negro families with substandard income are not able to afford healthful diets, or housing conducive to healthful living and cannot afford to call the doctor when they get sick. For example, 70 percent of Negro houses in the South in 1940 were without running water or electricity. In 1940, 70 percent of the Negro wage earners in the country were unskilled workers, 24 percent were workers, and only 6 percent were nonmanual workers, in spite of the fact that the defense program was in full swing at the time. This group could hardly be expected to save enough for food, clothing, and shelter, to thrive on today's elevated economic standard of living, much less pay for medical care.

It might be well to contrive this controversy as a travesty against the "10 percenters." There is projected two standards for health, one for the 90 percent movable bodies of our population who can afford to match good health with good dollars; the other of the 10 percent of our population that constitutes the aged 65 years or older, who value for value on today's market the dollar he earned 25 years ago, but must accept an inflated value of 27 cents.

This becomes even more ridiculous when the second line "10 percenters,” the Negro population that constitutes 10 percent of the population in America reasonably represent 10 percent of the existing aged group 65 years of ar or approximately 7,000 aged Negroes are considered. This group, because f discriminatory practices in the three E's, economics, education, and environment finds itself in its golden years with virtually no eggs laid by the golden gone The eggs that are fertilized with squalor, prejudices, and inadequacies, e hatch out only human misery, poverty, diseases, and words of charity. Hosever, they represent the children of a sick society that made them this way. It therefore, becomes the duty of that same society to care for the children it his produced, fully cognizant of the fact that if they are undesirable, they are st the product of a warped society possessed of dim visibility into the heart of social consciousness.

However you look at it, the distribution of health facilities and the availability of good health is a question of money. It is ironic that we lead the world in the eradication of epidermological diseases; in the techniques of modern medcine; in program of research; in surgical skills; in the vast production of patent drugs such as the antibiotics, the hypertensive agents, hormones, antidiabeti. and antiarthritic drugs, and yet have not conceived of a way to make the health services available to all people in America in all segments of life. It is inconceivable that America recommends this health package to free emerging nations as a way of life with such glaring shortcomings in the distribution and availability of health services to her own people at home. It is time to equate good medical care with human need and not dollars and cents. Medicine is a profession, the only business it has, is to get busy and practice the art of good medicine for the good of humanity.

I heartily endorse a program of health and medical care for the aged through a contributory plan administered under social security.

H. L. Beales, in his book, "The Making of Social Policy," states that: "BasiIcally what we confront is a problem in the control of the social environment. Such control is exercised through the implementation of social policy, which may be defined as those public provisions through which we attack insecurity, and endeavor to prevent or repair social losses produced by a competitive market and industrial economy."

As President Kennedy recently stated in his health message to the Congress. "the health insurance for the aged program will meet the needs of the millions of the aged who do not want charity, but where entire financial base for security and often that of their children may be shattered by an extended hospital stay." Social security offers a more economic manner of financing health care for the aged. Once this program comes into effect, medical insurance premiums would taper off, and the insured would receive wider benefits."

COMMERCIAL INSURANCE

Statistics reveal many times over that commercial insurances are incapable of providing an all-inclusive policy to adequately take care of the medical and health problems of the aged.

Only 2 out of 5 aged 65 years or older have any form of health insurance, and much of this is inadequate. Only 46 percent of the aged were covered by some form of hospital insurance as late as 1959, according to the U.S. National Health Survey. Commercial premiums are fixed regardless of income. Even though the incomes of the aged are less, their premiums are higher than the younger age group, because they require more medical care. The usual fee for the average premium is $7.50 a month, and this provides a $10 maximum allowance per hospital day which does not provide half the average hospital cost, which today is $25.

Actually, many commercial policies are really not as available as theoretically they profess. This is true, because such factors under requirements lead to complete exclusion of preexisting organic conditions. It is also factual that a great number of the insurances will not admit Negroes as a beneficiary, because they are regarded as poor health risks. Hence, the average aged Negro is loaded down with small industrial policies that pay from $5 to $10 weekly. For these he pays weekly premiums of 35 to 50 cents. Even if the Negro were an acceptable insurance risk, only a very small segment would be financially capable of purchasing such a policy. It is noteworthy that it was not until 1947 that even professional Negroes were insured by such big companies as Metropolitan and New York Life unless they had a "rider's" clause, refusing payments for a greater number of conditions than those for which they would benefit.

Under the present King-Anderson bills, the small increase in social insurance under the socal security system can be financed by a slight increase in social security taxes of $12.50 a year. This amount approximates the monthly premium for a commercial policy that does not even provide half the benefits as the more comprehensive social insurance policy.

The cry of socialization of the administration health bill is fallacious, for it is plainly stated that this legislation shall not permit the Federal Government to tamper with hospital administration or with the practice of medicine. It is important to quote from the bill the following:

"PROHIBITION AGAINST INTERFERENCE

"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, or compensation of any officer or employee of any hospital, skilled nursing facility, or home health agency; or, except as otherwise specifically provided, to exercise any supervision or control over the administration or operation of any hospital, facility, or agency. "FREE CHOICE BY PATIENT

"Any individual entitled to have payment made under this title for services furnished him may obtain inpatient hospital services, skilled nursing home services, home health services, or outpatient hospital diagnostic services from any provider of services with which an agreement is in effect under this title and which undertakes to provide him such services.”

It is further pointed out that government programs for care of the aged should impose no governmental controls on the operation of hospitals. However, the American Hospital Association, in a statement approved in 1958, made the point that Government should see to it that these are reasonable criteria for determining the eligibility of hospitals to participate in such programs.

In its statement of August 20, 1958, the American Hospital Association disclosed: "Such a program (Government participation to meet the hospital needs of the retired aged) should provide reasonable criteria to determine the eligibility of hospitals to participate, but the Federal Government should be precluded from interfering in the administration and operation of hospitals providing the services."

Could it be that one of the principal objections to the social security program for the aged is that this would permit the Negro doctors to put their "foot in the door" of all hospitals that for so many years have excluded them from their staffs because of race? Such opposition to social progress distorts the inevitable climate of social changes that lags so far behind, it may already be too late.

Another scare word so frequently used by the opposition is the misuse and careless abuse of the term "freedom." One's freedom is on trial when he is hungry and is not free to eat because he has no food; or he is cold and has no clothing because he is not free to wear them; or because he has no freedom to quench his thirst because of lack of water. The freedom of securing good health for the aged is in danger only when there are stockpiles of drugs and unused storehouses of health services that are unavailable, when he is sick and not free enough to secure good medical care. Freedom must be planned, it must be worked for and fought for. Planned freedom means freedom from restrictions to a more orderly way of doing things within an accepted restricted planned economy.

Dr. Wilbur Cohen, Assistant Secretary of Health, Education, and Welfare, best summed this up in a recent statement to the Jacoki Medical Society in Washington, D.C.:

"It seems to me that a program which would lift unmanageable cost burdens from an aged patient needing hospital care would also be a relief to the physician, for he could hospitalize his patient when necessary without fear of the economic consequences to the patient. It would give added substance, it seems to me, to the freedom of doctor and patient together to choose the kind of care best suited to the patient's needs. This freedom of choice is inevitably compromised when an aged patient needs but cannot afford hospital care and is unwilling to plead pauperage to obtain it."

Our success in adequately providing good medical care for the aged in todays complex society requires much more deliberate patterning, which will be based on looking ahead to envisage possible consequences. Society sets limits to what can be done at any given time, unless these limits are transcended by evolution

or violent change. It is a travesty on human justice when social inefficiency which results when human resources are not adequately utilized are permitted to go in want when there is ample supply to meet the needs of all with proper distribution.

In medicine, as in agriculture, we already reached the point where our pro duction exceeds our consumption.

The people of America have a professional and moral obligation to create a social and cultural environment in which human beings can live a full, healthy, and happy life.

Tribute must be paid to the dedicated men of science for their many advances that have lengthened the lives of our peoples. History will record how this new emerging human resource may best be utilized to strengthen the concepts and principles of adaptation in an ever-changing society.

RESOLUTION OF AMERICAN ASSOCIATION OF PUBLIC HEALTH PHYSICIANS OPPOSING H.R. 4222, THE HEALTH INSURANCE BENEFITS ACT OF 1961

Whereas the American Association of Public Health Physicians represents a large proportion of the health officers of the Nation, most of whom, because of the very nature of their work, have an intimate knowledge of the medical care requirements of the aged; and

Whereas great progress is being made by voluntary health insurance plans in extending coverage for those over 65 years of age; and

Whereas sufficient time has not elapsed for the various States to initiate and evaluate health programs based upon the Kerr-Mills law which was passed by Congress last year; and

Whereas H.R. 4222, the Health Insurance Benefits Act of 1961 which is now before the Congress of the United States would completely destroy all incentive for expanding voluntary insurance plans, would cover all beneficiaries whether or not they needed assistance, and would also be very costly: Now, therefore, be it

Resolved, That the American Association of Public Health Physicians express opposition to H.R. 4222, the Health Insurance Benefits Act of 1961 which proposes to place a Federal medical program for the elderly under the social security system; and be it further

Resolved, That voluntary health insurance be supported and urged to accele rate its progress in extending coverage to that group of people over 65 years of age; and be it further

Resolved, That the American Association of Public Health Physicians urge each State to initiate and expand as rapidly as possible health programs for the aged based upon the Kerr-Mills law.

Passed by the trustees of the American Association of Public Health Physicians assembled June 27, 1961, in New York City.

STATEMENT OF THE ASSOCIATION OF AMERICAN PHYSICIANS & SURGEONS, INC., BY DR. ROBERT J. MOORHEAD, PRESIDENT

We are pleased to have this opportunity of testifying against the Health Insurance Benefits Act of 1961 (King-Anderson bill, H.R. 4222).

The Association of American Physicians and Surgeons represents ethical physicians in medical economics, public relations, legislation, and freedom. Our objective of "freedom" can be defined by stating that we oppose the socialization of all segments of the economy just as vigorously as we oppose socialized medicine. Eligibility for membership in the American Medical Association is prerequisite for membership in AAPS.

We oppose H.R. 4222 because:

(1) There is no demonstrated need for such legislation. (See app. No. 1—our own reprints of surveys in Tarrant County, Tex.; Renville County, Minn.; two surveys in New Mexico to refute loose figures used by some propenents of the measure in their discussions of costs to the elderly.) For every survey figure that purports to show a need, there is another survey figure to show just as strongly that no need exists. For instance--the study conducted by James W. Wiggins and Helmut Schoeck, both members of the sociology and anthropology department, Emory University, Atlanta, Ga., revealed that 92 percent of the aged