Your kind consideration in considering opposition to the King bill will be most appreciated. Please insert this letter into the committee's hearings. Thank you very much. Kindest regards. JOHN VERBY. COOK COMMUNITY CLINIC, Cook, Minn., June 27, 1961. Re H.R. 4222. Representative WILBUR D. MILLS, Chairman, House Ways and Means Committee, Washington, D.C. DEAR SIR: I am most definitely opposed to the King bill. I feel it is impractical and antagonistic toward the practice of good medicine. I wish this letter to be inserted in the committee's hearings. Sincerely, Representative WILBUR D. MILLS, WM. C. HEIAM, M.D. CUT BANK, MONT., June 29, 1691. Chairman, House Ways and Means Committee, U.S. House of Representatives, Washington, D.C. DEAR REPRESENTATIVE MILLS: The following resolution has recently been passed by the local medical staff. The medical staff of Glacier Memorial Hospital endorses wholeheartedly federally passed legislation in 1960 for the medical care of the aged. This legislation is the Kerr-Mills bill which entitles State supervision of Federal and State funds for medical and surgical care for needy older people. This medical staff is opposed to the administration's current proposal, the King bill, H.R. 4222, which is a compulsory Federal aid supervised medical care program for older people who are entitled to the social security benefits. Our medical staff wished you to be aware of this resolution and also would appreciate it if you would make it a part of the permanent records of the hearings which are to be held, we understand, in the near future. Most sincerely yours, ROBERT K. WEST, M.D., Chief of Medical Staff, Glacier Memorial Hospital. TO THE STATEMENT OF THE TEXAS HOSPITAL ASSOCIATION IN OPPOSITION PASSAGE OF H.R. 4222 BY F. R. HIGGINBOTHAM, PRESIDING OFFICER, HOUSE of Delegates, TEXAS HOSPITAL ASSOCIATION, SAN ANTONIO, TEX. Mr. Chairman and committee members: This statement is presented in my capacity as presiding officer, House of Delegates of the Texas Hospital Association, a voluntary nonprofit association representing 698 members of which 492 are institutional members, accounting for 55,191 hospital beds in the State of Texas. The prime objective of our association is that we are dedicated to improving the health care of all Texans. I submit this statement in behalf of that objective. The Texas Hospital Association has vigorously opposed any legislation or action that in our view will damage the outstanding health care provided our people. The most recent affirmation of the action of our membership occurred May 17, 1961 when a resolution was unanimously adopted by our house of delegates (the official policymaking body of the association) opposing further encroachment by the Federal Government in providing for health care of the aged through the social security mechanism. LACK OF NEED FOR THIS LEGISLATION We are convinced that this legislation is not required. Studies in Texas by various organizations and individuals indicate that Texas residents 65 years of age and older are not the poor, sick people described by those people advocating H.R. 4222 and similar legislation. For example, the average length of stay in short-term, general hospitals for all types of cases, nationally, is 7.6 days. The average length of stay for all patients in Texas in short term, general hospitals during 1960 was 6.1 days. The experienece of one large voluntary prepayment organization covering 78,000 persons aged 65 and over in Texas indicates a median length of stay of only 7.66 days-only 1.56 days in excess of all Texas patients and .06 of 1 day in excess of the national average for all patients. The aged population in Texas (approximately 745,000) represents approximately 8 percent of the total population. Numerous studies conducted by our member hospitals indicate from 8 to 12 percent of admissions to short term, general hospitals are aged persons-in other words, the medical needs of the Texas aged are not greatly in excess of the general population. EFFECT OF H.R. 4222, IF PASSED The effect of unnecessary legislation is difficult to measure; however, an apparent side effect is the provision of free care for those eligible for social security regardless of need. I shall not dwell at length on the philosophy of the social security program, but it has been proven that it is not an insurance program or annuity paid for in advance by an individual, thus making anyone who is eligible for social security automatically eligible for benefits, regardless of need. In other words, we object to providing free care to all over age 65 persons regardless of need. We likewise object to being forced to submit to regulation and supervision by an agency of the Federal Government. This is provided through the centralization of power of inspection, regulation, and approval by the Secretary. The broad latitude afforded the Secretary in prescribing that a hospital must "meet such other conditions of participation as the Secretary may find necessary" is unwise, unwarranted and places too much power in the hands of one individual or of the Federal Government. Much has been said against the means test by proponents of H.R. 4222. May I point out that H.R. 4222 contains a means test by providing a deductible feature on hospital and outpatient benefits. This feature works to the advantage of the wealthy aged and to the disadvantage of the indigent aged. COSTS OF H.R. 4222 Based on facts available, the costs of H.R. 4222 in Texas would vary considerably the mean cost in the Tarrant County, Tex., survey indicates $384.51 per hospital stay. The Blue Cross-Blue Shield of Texas statistics reveal average cost per case of $176.70. Travis County, Tex., reports an average cost per case of $289.03. Based on an average length of stay of 7.66 days at $30 per day cost in the short term, general hospital, we project an average cost per stay of about $229.80 in the short term, general hospital. May I point out, however, that the above costs are presently being borne voluntarily by our people, our hospitals, and our physicians without compulsion through social security or similar taxing devices. Many of our aged have provided for prepayment health care coverage (approximately 25 percent). Many of our hospitals have reported that hospital bills for the aged are not major problems. For example, one small hospital that annually provides in excess of $50,000 charity care each year reported that only 3.9 percent of the discharged charity patients were 65 years of age or older. SUMMARY We view H.R. 4222 as a proposal for providing socialized medicine for one segment of our population-the so-called aged. We are presently and can continue to care for our own, and firmly believe that this unwarranted centralization of regulation and control in an agency of the Federal Government will lead not only to a deterioration of the excellent care now being provided, but will tend to spread to other segments of the population. We believe that with continued cooperation between hospitals, physicians, nursing homes and the local citizenry, we can continue to provide quality health care without Federal interference through the social security program. We fear that the Federal Government as a purchaser could exercise the power of the purse in many ways that will tend to ultimately destroy our voluntary, free enterprise hospital system and seriously restrict the continued growth and service of our voluntary prepayment insurance plans. We are of the opinion that overutilization, misuse and abuse of our hospital and health facilities and personnel will occur should this free care program as presented in H.R. 4222 or any similar legislation be adopted. These dangers are inherent and apparent in all free programs and would greatly reduce our ability to provide adequate care for all who truly have such a need. For these reasons, the Texas Hospital Association vigorously opposes passage of H.R. 4222 or any similar legislation. Thank you. TENNESSEE NURSING HOME ASSOCIATION, June 23, 1961. Congressman WILBUR D. MILLS, Chairman, House Ways and Means Committee, DEAR CONGRESSMAN MILLS: As a component of the American Nursing Home Association, and acting on its own behalf, this association has consistently opposed health care legislation tied to the national social security system. Presently before your committee is H.R. 4222, the Health Insurance Benefits Act of 1961, which incorporates some of the objectionable features of previous such measures, notably, the Forand bill. Accordingly, the executive committee of this association has instructed me to convey this view to you and your committee. Permit me to make three points: 1. The King bill would provide care to all those eligible for social security benefits, regardless of individual financial circumstances. 2. It would not provide for those persons in need of medical care, but ineligible under the social security system, yet without sufficient resources to provide for their own medical care needs. 3. U.S. Public Law 86-778 which is just now becoming effective in several of the States has not had sufficient trial at the present time to warrant consideration of additional legislation for medical assistance to the aged. Until 86-778 has been thoroughly tested by experience in the several States, other plans should be held in abeyance. One final thought Mr. Mills: Medical care legislation, we believe, should be on the basis of need rather than age, and our first attention should be to those without sufficient resources. Public Law 86-778 will provide for their need. It is our view, therefore, that the King bill should be laid aside, at least until the present law has been thoroughly tested. Sincerely, DEAR MR. CHAIRMAN: The Mississippi Farm Bureau Federation has forwarded me the attached statement in opposition to H.R. 4222. I would appreciate your having this statement included in the record of hear ings on this legislation. Thanking you, I am, Sincerely yours, JOHN BELL WILLIAMS. MISSISSIPPI FARM BUREAU FEDERATION, Hon. WILBUR D. MILLS, Chairman, Committee on Ways and Means, DEAR MR. CHAIRMAN: This letter is a formal expression of the views of the Mississippi Farm Bureau Federation with respect to H.R. 4222, which we understand is before your committee for formal hearings beginning July 24, 1961. It is respectfully requested that this statement be considered by your committee and included in the printed record of the hearings. The Mississippi Farm Bureau Federation, representing approximately 50.000 farm family memberships in Mississippi, expresses its opposition to H.R. 4222 a proposal to amend the Social Security Act to provide payment of the costs of hospital care, nursing home care, certain diagnostic outpatient care, and some home health care services for those persons 65 years and older eligible to receive old-age and survivors benefits. We are keenly interested in rural health. In the late 1940's our federation worked in concert with others to organize the Blue Cross-Blue Shield plan in Mississippi. We are conscious of the costs and necessity for the services which H.R. 4222 proposes to cover not only for the aged but for all citizens as well Our experience convinces us that an understanding of and solution to health care problems can be reached through conferences between those who provide the services and those who use them without Government intervention. This bill proposes a radical departure from the original intent and philosophy of the Social Security Act. Under the program as it now exists, a beneficiary may use the income derived from taxes on his wages during his working years in any manner he chooses. H.R. 4222 proposes to place new and additional taxes upon the individual and to designate use of this revenue for health care approved by the Secretary of Health, Education, and Welfare. We believe this paternalistic approach is foreign to a society which counts among its basic freedoms the freedom of choice. The present rate of social security tax on income of the self-employed is 4 percent on a $4,800 income base, with scheduled increases of three-quarters of i percent in 1963, 1966, and 1969. The increasing costs of liberalized benefits now in the law are a serious financial burden on the self-employed. H.R. 422 would further increase these costs by three-quarters of 1 percent and raise the income base to $5,000. We believe these increasing costs result from using the Social Security Act to replace individual thrift and personal responsibility rather than supplement them as intended by the sponsors of the act. H.R. 4222 has in it the element of Government determination of the costs of hospital care, nursing home care, diagnostic outpatient services, home health care services, certain physicians' services, and Government determination of reasonable standards of medical care. For some years, we have been having very unsatisfactory experiences with Government determination of certain aspects of our individual farming operations. Based on these experiences, we have serious doubts and misgivings about a proposal which would give the Federal Government power to buy and control certain aspects of our individual medical and surgical needs. The Mississippi Farm Bureau Federation respectfully requests your committee not to give favorable action on H.R. 4222. In behalf of our federation, permit me to thank you for your consideration of this statement. Sincerely, BOSWELL STEVENS, President, Mississippi Farm Bureau Federation. STATEMENT OF THE GEORGIA FARM BUREAU FEDERATION RELATIVE TO H.R. 4222, MEDICAL CARE FOR THE AGED, PRESENTED BY HARRY L. BROWN, PRESIDENT The Georgia Farm Bureau is a federation of 157 county farm bureaus with a voluntary membership of 36,451 farm families. We appreciate the opportunity of presenting our members' views in opposition to H.R. 4222. The voting delegates, at our last annual meeting, had this to say about social security: "We are strongly opposed to any further legislation which would increase the social security taxes beyond that now outlined in the present law. We further oppose liberalization of benefits which would require any extra or additional taxes." The Georgia Farm Bureau certainly recognizes that medical care for the aged is a serious problem, and we have worked at the problem for the past 15 years. We do not believe the answer or solution rests with the Federal Government. We submit the following reasons for our opposition to H.R. 4222: 1. The vast majority of Georgia farmers are self-employed and the increase in proposed social security taxes to finance this program would create a hardship on farmers as it relates to employed persons. 2. Net farm income is already at a very low level and any increase in taxes of any kind would put farmers in a weaker position in providing food and fiber for our people and providing medical care for themselves. 3. Young farmers desiring to farm are finding it very difficult now to enter the farming profession because of the tremendous investment, and to increase social security taxes would make this problem more acute. 4. Farmers, through their own farm organization, have made available to themselves and others voluntary prepaid health programs of hospital and medical care, including a program for senior citizens. For the Federal Government to enter this field would for all practical purposes eliminate such programs. Also many of our people have private or commercial protection. 5. Provisions of H.R. 4222 would tend to eliminate private or commercial health programs because people would sit back and wait for the Federal Government to move in. America did not become great with this type of philosophy. 6. Farm Bureau believes that children of parents should assume some responsibility in seeing to it that their parents are properly cared for. In the event an elderly person has no children to lean on, private organizations, such as churches, can render a service in this area. 7. If the Federal Government enters this field for a certain age group, the tendency would be to lower the age from time to time and include other persons. We would appreciate very much the members of the House Ways and Means Committee giving our views serious thought and reject H.R. 4222. AMERICAN BAR ASSOCIATION, Columbus, Ohio, June 30, 1961. STANDING COMMITTEE ON UNEMPLOYMENT AND SOCIAL SECURITY, Hon. WILBUR D. MILLS, Chairman of Ways and Means Committee, DEAR CONGRESSMAN MILLS: At its annual meeting in August 1959, the American Bar Association went on record as opposing the Forand bill (H.R. 4700) and substantially similar legislation. This action was communicated to your committee shortly thereafter. We understand that hearings have been tentatively scheduled before your committee on the King-Anderson bill (H.R. 4222). Since this bill is subtantially similar to the Forand bill, it is desired to record the opposition of the American Bar Association to H.R. 4222 and that this letter be made a part of the record of any hearings on this legislation. Respectfully yours, EARL F. MORRIS, Chairman. ILLINOIS STATE BAR ASSOCIATION, Hon. WILBUR D. MILLS, Chairman, House Ways and Means Committee, DEAR REPRESENTATIVE MILLS: The Illinois State Bar Association opposes enactment by the Congress of H.R. 4222, the Health Insurance Benefits Act of 1961, introduced by Representative King of California. This association favors an approach to this problem through the legislation enacted at the last session of the Congress which was implemented in Illinois by appropriate acts in the 72d general assembly this year. I will appreciate your making this statement of the position of the Illinois State Bar Association a matter of record before the House Ways and Means Committee when the hearings on H.R. 4222 are held. Sincerely yours, OWEN RALL, President. |