The provision of benefits to the permanently disabled would surely lead to the extension of such benefits to the dependents of disabled persons; and also to those who are temporarily or partially disabled; and finally, perhaps, to everyone who is incapacitated, in whole or in part, either permanently or temporarily. This would all add up in the end to a compulsory sickness program of national dimensions.

In the second place, I am convinced that the permanent and total disability provisions of H. R. 6000 would lead to at least partial duplication with workmen's compensation programs in all those cases where the disability is occupational in nature.

In the third place, since total and permanent disability is frequently a condition over which both the individual, who is disabled, and his attending physician, may and can exercise some control, either consciously or unconsciously, qualifications for benefits will be very difficult to determine, the issue will be highly controversial in each case or certainly at least in border-line cases, and certainly for this reason it will be very expensive.

In the fourth place, since the definition of permanent and total disability as formulated in section 107 of H. R. 6000 does not require that disability be proven by objective tests, the proposed program, if adopted, would be wide open to abuse by dishonest claimants, through malingering, and to even greater abuse by unscrupulous doctors and lawyers working with such malingerers.

A disability program of this type would also be open to exploitation by another and far larger group of individuals, who are neurotic rather than dishonest, and who are for this reason bent on deceiving themselves rather than on defrauding the Government.

This program would make the flight of the neurotically ill individual away from self-responsibility and health and into illness profitable for himself and for his lawyer, and, by rewarding illness, it would make his return to health and self-responsibility very difficult and, probably in some instances, quite impossible.

In the fifth place, the failure of H. R. 6000 to require proof of disability by objective tests would, if the bill were enacted into law, involve the social-security program in enough controversy and litigation to keep all of the psychiatrists and lawyers in the country busy and for this reason would probably bankrupt our economy.

In the sixth place, H. R. 6000, like most of the legislative proposals favored by the Social Security Administration, gives the Social Security Administrator discretionary powers so great as to make him a threat to our democratic pattern of government, and further to make him a menace to the private practice of medicine.

Under the provisions of this act, the Administrator would be permitted to decide what physician or group of physicians could be used to determine disability and benefit rights. He would have the power to entirely exclude private practitioners from participation in such a program, notwithstanding the fact that the family physician surely would be the one best qualified to make such determinations of disability.

Under the provisions of this bill the Social Security Administrator could employ physicians on a full-time basis, to carry out this function of the disability-benefits program.

He could, as the previous witness has testified, have this work done entirely by full-time employees of Government.

But regardless of whether the work were done by a full-time employee of government, such as a public-health officer, or by the private physician, it would certainly place the physician so employed in a position of serving two masters-his patient on the one hand and the Administrator of Social Security on the other.

Since the physician's salary would not be paid by the patient, it is not too difficult to guess what would happen in such a splitting of loyalties. If the physician resolves such a conflict of loyalties in favor of the patient in a debatable case, he would run the risk of minimizing his chances for promotion and advancement in his department or bureau. If he habitually favored the Social Security Administration, he would soon incur the hostility of his patients and hence create a negative relationship with them which would destroy his effectiveness as their physician.

The treatment of illness and the work of the physician is accomplished in large measure through the relationship of trust and confidence and even of affection which has to exist between a doctor and his patient. When the doctor is placed in a position like this, and finds against the patient, he destroys his relationship with his patient, as we have pointed out.

In the seventh place, all of us in the medical profession who have had any experience with State industrial commissions and workmen's compensation programs realize that the official classification of an individual as a totally and permanently disabled person is sometimes a life sentence to invalidism.

The power of suggestion associated with an official declaration of total disability, plus the cash benefits that would accrue to the disabled person by remaining disabled, would, we think, create a psychological pressure great enough in many cases to rob the disabled person of all incentive to recovery.

The disability provisions of H. R. 6000 would, then, in fact, in the case of tens of thousands of neurotic individuals, tend to establish incentives in the opposite direction toward neurotically determined disability. The ultimate cost and waste of a disability program geared to incentives to illness rather than incentives to recovory would be enormous and would, in our opinion, jeopardize the economic, the psychological, and the moral stability of our social order.

Now, these are just some of the main reasons, Mr. Chairman, why the officers and trustees of the Colorado State Medical Society are opposed to H. R. 6000 in its entirety and especially to section 107 of this proposed legislation.

Like the sponsors and the proponents of H. R. 6000, we are interested in providing security for the aged. We are interested in providing security for disabled persons. We are interested in helping the defenseless and the neglected child. But we are convinced that the means and the methods proposed in H. R. 6000 for providing such security are by their very nature far more of a threat to our free society than the social ills that they seek to cure.

We think, sir, that the responsibility of Government at the local, at the State, and at the National level is to protect property and life and to maintain a climate and an atmosphere of fair play in which people can work out their own destiny and through their own sweat and effort make provision for their own security. When Government

attempts to do what the individual should do for himself, it must resort to compulsory methods that would involve the degredation of the individual, and that would also place too much power in the hands of the people who would have to administer such programs. Thank you.

The CHAIRMAN. Any questions?

Senator MILLIKIN. Dr. Murphey, in Colorado, let us assume that John Doe, by objective tests, becomes totally disabled.

Let us assume that he is indigent. What are the means available to him to have his case taken care of?

Dr. MURPHEY. In an industrial case, we have our State industrial bureau, and he will be taken care of through that mechanism. In a nonindustrial case, we have private organizations in the field of philanthropy, numerous health and welfare agencies, and in addition to these we have city and county and State programs for assisting those who are destitute and unable to provide for their own care. Senator MILLIKIN, And their dependents?

Dr. MURPHEY. And their dependents; yes, sir.

Senator JOHNSON. Dr. Murphey, you heard the colloquy between Dr. Sensenich and Senator Kerr a moment ago. It seems to me that Colorado has a better system even than Indiana, if that were possible. We have a very fine general hospital in Colorado, with which you are connected. You are connected with the mental-illness section of it. We have this very splendid general hospital, to which citizens of Colorado may be sent by their communities, and the county commissioner pay the bill. Many of the counties-in fact, almost all of the counties either have a hospital of their own in the counties, such as Greeley, which has a very large hospital, or they have arrangements with private hospitals in their counties to take care of indigent patients. So that Colorado is in pretty good shape so far as taking care of illnesses and medical cases on the part of citizens who were unable to pay their own way is concerned. Would you not say

that? Dr. MURPHEY. That is true, Senator Johnson. Any person in Colorado, even in the most sparsely settled counties and those most remote from medical-care facilities, can be and usually are, certified by their board of commissioners as elegible for care and treatment in the Colorado General Hospital, one of the finest hospitals of its kind in the Nation. It is a teaching hospital associated with the University of Colorado School of Medicine. It is well staffed and the people who come from the counties for medical care get the best kind of care; not only the physical aspects of such care, but they get the personal attention and the kind of personal relationship they need with doctors who are interested in people.

I have not said anything about our various pension programs for providing aid to needy people in our various industries, like the Colorado Fuel & Iron Co., and other industrial and commercial concerns, but I want to point out that Colorado workers are well protected in matters of this kind.

Senator JOHNSON. Then we have a very fine rehabilitation program for assisting the handicapped, amputees, and others that may be taken care of and trained so that they may become self-supporting. We have care for the blind. We have a very good program. Of course, it could be greatly improved and expanded, no doubt, but it is an excellent program as it is.

Dr. MURPHEY. I am glad to have the opportunity to plug my State, because I think that Senator Johnson is understating it ratther than overstating it. I feel that we have one of the finest State hospitals for the care of mental cases that there is in the Nation. We give the mentally ill, in our State hospital at Pueblo, care comparable to that provided by any State in the Union. And, as Senator Johnson has pointed out, a great many of our more populous counties have hospitals of their own, and in nearly all the counties where there is a hospital at all, the county commissioners have a working arrangement with the private hospital to provide care at the county or local level. Some of the more difficult cases, that require more expensive diagnosis and treatment, are sent on to the Colorado General Hospital at Denver, which is a teaching hospital connected with the University of Colorado School of Medicine.

Senator JOHNSON. And is it not true that the physicians in Denver take turns in serving that hospital and donate their services free?

Dr. MURPHEY. Yes, sir. At the present time the Denver General Hospital serves the city and county of Denver. And most of the physicians in Denver are very proud indeed to accept a place on the staff of that hospital, and they give their services freely without any kind of remuneration, and they give their services very happily. Senator JOHNSON. Thank you.

Senator MARTIN. Mr. Chairman, may I ask a question?

The CHAIRMAN. Senator Martin.

Senator MARTIN. How is the expense divided between the State and local levels of government?

Dr. MURPHEY. In the city and county of Denver, all cases that require public assistance of a medical nature are taken care of by the Denver General Hospital.

Senator MARTIN. How is the expense divided between the State and the local levels of government?

Dr. MURPHEY. Senator, most of the cost of medical care at that level falls on the city and county of Denver. In the case of a county outside the city of Denver, the cost is split between the State and the county. Colorado General grants to the counties a very low per diem rate, thus assuming part of the financial burden at the State level. The counties, however, are required to pay a certain rate to Colorado General.

Senator MILLIKIN. Dr. Murphey, many of us are interested in the gap that seems to fall, in our voluntary systems, caused by long chronic illness, what you call catastrophic illness, and these total disability cases, which seem to tax the abilities of the voluntary systems to take care of them. What is the medical answer to that problem? How can we reach this goal that we are all interested in, of adequate medical care for all people who need it, to fit the size of their pocketbooks?

Dr. MURPHEY. I think in the case of chronic illness of catastrophic nature, such as tuberculosis or mental disease, we already have the pattern very well established. It is recognized by most doctors everywhere that illness of that kind simply is too burdensome for the average wage earner to meet alone, and the State of Colorado provides assistance to such people, with tuberculosis programs and also with programs for the care of mental illnesses.

We feel even in such cases, however, it is morally necessary to be sure that individuals who can afford to pay for their care be required

to do so and that they should not be permitted to shift their obligation to do so to the State.

Senator MARTIN. Does the State of Colorado assume the full cost of, we will say, tubercular patients, or mental patients, or does the local level of government share in the cost?

Dr. MURPHEY. Again, it is customary to split the cost between the counties and the State, and aid is only, of course, given when the individual can certify his need for such care and his inability to provide it himself.

If I may repeat what the previous speaker has said, we believe very strongly in a needs or means test. We think that that is important in order to prevent people from exploiting the taxpayer. We can see nothing illogical or undignified about a means test, because we all submit ourselves to a means test every time we pay our income taxes. The CHAIRMAN. It is sometimes painful, too, Doctor.

Dr. MURPHEY. Very.

Senator MARTIN. Does the State of Colorado provide so much per diem for patients at, as we will call them, private hospitals?

Dr. MURPHEY. They do, sir.

Senator MARTIN. How much is that per diem?

Dr. MURPHEY. I am sorry, sir. I can't give you the exact figure. Senator MARTIN. Has that plan been imposed upon by certain localities?

Dr. MURPHEY. Generally speaking, there has been very little abuse. The CHAIRMAN. Senator Kerr, any questions?

Senator KERR. I have no questions, Mr. Chairman.

The CHAIRMAN. Thank you very much for your contribution, Doctor.

(The prepared statement of Dr. Murphey follows:)

STATEMENT SUBMITTED BY BRADFORD MURPHEY, M. D., ON BEHALF OF THE
COLORADO STATE MEDICAL SOCIETY

Mr. Chairman, for the record, my name is Bradford Murphey. I am engaged in the private practice of medicine in Denver, Colo. I am appearing before your committee as the official representative of the officers and board of trustees of the Colorado State Medical Society. My specialty is psychiatry and the greater part of my professional experience has been in the two related fields of child psychiatry and community psychiatry. I am an associate clinical professor of psychiatry at the University of Colorado School of Medicine. I have been deeply interested in social welfare for many years, and in this connection am a past president of the Colorado Conference of Social Welfare. At the preesnt time I am vice president of the Denver Area Council of Social Agencies and chairman of the Colorado White House Conference for 1950 on Children and Youth. My testimony will reflect the unanimous thinking of the officers and trustees of the Colorado State Medical Society and is offered in opposition to H. R. 6000 in its entirety and especially to that section of the act which makes provision for permanent and total disability insurance benefits on a compulsory basis. The officers and trustees of the Colorado State Medical Society are opposed to H. R. 6000 in its entirety because:

1. It is based on an un-American, paternalistic theory of government which assumes that the moral and social responsibility of the citizen to provide for his own personal security can and should be shifted to the Government.

2. It is dishonest, in that it leads the unwary, the improvident, and the opportunistic members of our society to believe that they can achieve social security for themselves by simply exercising their right to vote instead of exercising their minds and muscles in personal effort and hard work.

3. It would expand and tend to perpetuate the unsound theories and follies of the present social-security system, which already costs us $50,000,000 a year