Mr. ELLSWORTH. May I ask one more question?
Chairman BAILEY. Yes.

Mr. ELLSWORTH. Testimony was given this morning and this afternoon that the people in West Virginia can get the medical care they need and that nobody should be without medical care.

Dr. Thomas went on to indicate that from the public health standpoint he does not get people who come in to say they cannot get medical care, but that in his own private office people do tell him they are a burden to their family.

As a labor leader not too far removed from the day-by-day activity in a union office, do you feel when a person says he does not want to be a burden or the fact he does not get medical care, do you find these same people come to you and complain because they cannot get medical care because they have to mortgage their house to get it or they feel they are a burden to their children if they buy expensive drugs? Returning to the testimony of the doctor, which I am sure was true, that most of the doctors are willing to give the necessary care. But is there a gap in between what is necessary and what is good for them? Did I make the question clear?

Mr. STANLEY. There certainly is a gap. As a matter of fact, I am serving on a committee in Charleston now that is studying the needs of the medically indigent, those people who have enough to maintain the bare necessities of life, but if a major illness of any kind is imposed on them it is catastrophic for them. But there is most certainly à void between those two types of people you mention.

I have served in many types of labor movements and used to be much closer to the people than I am now. In my career I have received literally hundreds of complaints of various types in regard to medical care. I administered a health insurance program for 9 years.

Mr. ELLSWORTH. This was the testimony we got in California last week from one of the labor people there, that there are many people who do not get the medical care because they are too proud to go in under the present program.

Mr. STANLEY. They are not going to do it. How many of us have had members of our own family who had money to go to the doctor or hospital and you almost had to drive them to go because they have this feeling of insecurity?

"This is going to take so much of my savings. I just cannot afford to do that because I may need it for something else later."

It is the remedial or preventive care that these people are not getting and this thing of just meeting something when the person is ready to die "You are going to die if you don't get medical care now" this is not the kind of medical-care program we should have.

We should have a program that will lend itself to them, taking care of themselves and having preventive treatment, instead of waiting until they are ready to pass on before they accept it.

Chairman BAILEY. I know, Mr. Stanley, that it would cost a tremendous amount of money to bring under coverage the millions of aged people we have above retirement age who have not paid into social security. But do you not feel that the future generation of older people who have participated in social security by withholding a small percent of their wages and having it matched by employers' shares would make these people feel more receptive and not look on it as charity, if they have not paid anything in?

Do you not feel that if they have paid something in they would feel more like taking that and applying for it and taking advantage of it if they had participated in the fund like they would have to do in the social security?

Mr. STANLEY. Are you asking me, Mr. Chairman, if I believe people would be more willing to participate in the program for medical care if it were on a prepaid health insurance basis instead of on the basis of need as it is now set up?

Chairman BAILEY. After all, isn't the social security more or less on a prepaid basis?

Mr. STANLEY. Yes.

Chairman BAILEY. You are throwing into the fund a tremendous number of people who have not paid into the fund.

Mr. STANLEY. Now?

Chairman BAILEY. If you bring these elderly people under coverage of social security. A lot of them have never participated and never been under coverage.

Mr. STANLEY. If they have never been under coverage?

Chairman BAILEY. Yes.

Mr. STANLEY. Under social security coverage, they would all be eligible under the King-Anderson bill.

Chairman BAILEY. They have to be prior members of the social security.

Mr. STANLEY. Yes. You have the Kerr-Mills bill-to fill up the majority of them.

Chairman BAILEY. As a supplement to the major legislation?

Mr. STANLEY. Yes. I indicated we subscribed to the Kerr-Mills as a subscriber, but not as a frontline defense.

Chairman BAILEY. Mr. Stanley, we thank you very much for your informative presentation.

Do you have a formal copy to give to the reporter?

Mr. STANLEY. Yes.

Chairman BAILEY. We thank you very much.

Are there any other people present who desire to make an informal statement before the committee?

Did I see a hand back there?

Dr. THOMAS. I wanted to add, not in the form of testimony but Mrs. Hansen asked me a question which I did not answer completely. We do have a limited housing going on now which the aged group in certain income brackets can be set aside.

Chairman BAILEY. Would you like to file something supplemental to your previous remarks?

Dr. THOMAS. Yes, sir.

Chairman BAILEY. With no objection you can file with the clerk of the committee such a supplemental statement. He will give you instructions of where to forward it.

Dr. THOMAS. It is merely an answer to the question to me that Mrs. Hansen asked.

Mrs. HANSEN. I would also be interested in the type of lease agreement or rental agreement and the rates and so on, so that we will have some kind of an answer to many of these problems that arise.

Mr. THOMAS. Right now the floor was just laid on this. This is why I was a little lax in giving it. It is under construction now, but I do not know much about the particulars.

It will be that type of housing, partially.

Mrs. HANSEN. I am speaking for myself, but I think many times Members of Congress, when they are in areas other than their own, ask questions which may be helpful in discussing affairs in their own district and where you have seen or are watching a program work or development being made you are interested in securing that information and passing it along to people in your own area, because all of us have seen or are watching some of these developments in the housing areas take place and we are keenly interested in the way they worked out.

Chairman BAILEY. Again, the Chair is asking if there is anyone present who has any oral comment they would like to include in the record?

Dr. BRANDFASS. I am Dr. Robert Brandfass, a practicing physician here in town. This problem has been bandied back and forth locally. We have had a representation from the Health, Education, and Welfare Department here. This has been a topic among the doctors and a lot of us have taken the opportunity to discuss this with our patients. It may well be we are getting a one-sided viewpoint when we discuss it with them. It may well be they are giving us answers which they think we want to hear.

But it is my own consensus that the average younger laborer is against this bill. I disagree wholeheartedly in the fact the younger group is for it.

When the significance of section 1601 of this bill is explained to the patients, they are horrified.

In case you are not familiar with that exact wording, and I cannot quote it verbatim, in that section it gives the power of the Secretary of Health, Education, and Welfare, and I do not mean to delve into politics, but I think I am one of the few Democratic doctors in town. But the Secretary of Health, Education, and Welfare has the power to limit what hospital participates and when the significance of this is pointed out to the patient, they may be restricted from going to a hospital of their own choice and that they are required to go to another hospital where the doctor is not a participating member of that staff, then they cannot participate in their own free choice of their physician, they are against it.

When it is further pointed out it is estimated at $12 a year, that is grossly underestimated. I do not know where they ever came up with that figure, but it has been bandied about. They begin to realize they are not buying a bed of roses.

I cannot personally see any more efficient way to administer the medical care for the aged than under the present Kerr-Mills bill. It is done on a local basis, which I am sure you all realize, and avoids the semibureaucratic system. I think it can be much more economical. For the same reason I am against incorporating all the Blue Cross and Blue Shield programs. We run our local program. We know the patients and know when they are trying to cheat and when they are not. It could be much easier to supervise it.

I would like to go on record as knowing that the great majority of the actual labor union members are not wholeheartedly in favor of this. I think that if the president of the State federation did get a little bit closer to his group he would realize that.

There is no

It is the union or labor worker who is going to take the beating. They are paying the same percentage for their care. guarantee in this bill that their old age is cared for.

This has been proven in the Supreme Court that it is a tax. If the bill goes broke, where is the money going to come from?

The money taken in today is spent today. Unless there is some change in the whole supervision I am against supervised medical care. Mr. O'HARA. Would you care to come up and sit down? Perhaps the committee would like to ask a few questions.

Dr. BRANDFASS. I might add that listening to the gentleman from the Mine Workers, I am on the miners' welfare list as of today. What it will be tomorrow I do not know. When it gets to Pittsburgh it may be a different story.

I am one of the few doctors on the list for my particular specialty. It doesn't help patient relationship.

I had one patient sent to me.

She wanted her own doctor out in

Ohio. There was no hospital over in that area.

She was sent to me and referred to me from the offices in Bellaire. She was unhappy. It made a very difficult situation.

I have had patients and I have written to Pittsburgh and made some suggestions as to how they might become or it might save some money.

Some cases we have treated have been ridiculous. A patient comes into the office and says, "I have a boil."

I said, "Fine, we will open it."

They said, "No you won't. I will go to a hospital."

"What do you want to go to a hospital for something like that for?" "I am on the Welfare and I am entitled to go."

That patient, I remember, was in the hospital for 1 week to get a boil opened.

When we talk about differences between necessary medical care and what is ideal, certainly there is a lack. But on the other hand, if they have an opportunity to go to the doctor's office for every welt, then the patients who do need it cannot receive the help, we have too

many.

You cannot go to the doctor for everything unless you have to expect and accept the responsibility and pay a certain amount. You cannot provide free medical care for everybody for everything.

Mr. O'HARA. With regard to your comments about what assurances you would have when you had paid your social security tax, the addition of one-quarter of 1 percent that you would actually get medical care, you pointed out that this is a tax and you made a statement that the money is spent when it is received and there is no money in the social security fund. I think that was your statement. What do you say, with regard to that, has equal relevance to the entire system of social security? All the old-age survivors and benefits, that is.

Dr. BRANDFASS. I think that is true. But I think that putting a large burden of medical care on the present social security system is going to drive it that much further in the red. I do not know the exact figures. I did not come prepared to testify. If I recall, it was up until the last year or so that the social security has been paying out more than they have been taking in.

With the raise in rate I think we are straining to break even this year.

Where are they building up the fund to pay for the future medical care? I don't begrudge the medical care. I would give it to them for nothing. That is not the point.

The point is, the people who are going to get the medical care today have paid nothing into it. So that is going to put that much more on the burden of the whole social security system.

Mr. O'HARA. I want to take these things one at a time.

First, in regards to the social security system, to go to the whole nature of the system, do you think we ought to continue the system at all?

Dr. BRANDFASS. Certainly.

Mr. O'HARA. Why?

Dr. BRANDFASs. It is all all right in effect.

Mr. O'HARA. You do not think it is sound, do you?

Dr. BRANDFASS. Exactly. I do not think it is sound. I do not want it in.

Mr. O'HARA. Most medical societies have been polled. The majority of doctors want it in.

Dr. BRANDFASS. I think that is geared to the older doctors who plan to get something for nothing.

Mr. O'HARA. I think we ought to straighten out.

First, with regard to the method of operation of the social security system, a certain portion of FICA taxes are collected each year.

I do not want these people to go away from this hearing with the wrong impression. The FICA taxes are taken in by the Treasury. They are assigned to the social security.

The question arises to what you are going to do with them. I do not think you would advocate they be kept around and those that got moldy after a while would be tossed out.

There is some need for investing this money. There are two possible ways to invest it. You can invest it in private securities, in which case the social security fund, because of its size, might end up owning the General Motors Corp., and I do not think you would want that; or you could invest it in Government bonds.

Those people that run around telling you that the social security system does not have any fund, that the money has actually been spent by the Government, are really referring to the fact that the social security system, rather than investing in private stocks and bonds because of the reaction this would have on persons who felt this was detrimental to this form of economy to invest it in Government bonds. I think it is a gross misstatement of the situation to say that the social security system is in the red or was in the red or that it is broke or its money is all spent.

Dr. BRANDFASS. I did not mean to intimate that the fund is not— I think it is paying out more than it was putting in up until recently. The outlay per year was more than the intake.

Mr. O'HARA. No. I am confident that is not the case.

Mr. ELLSWORTH. It was for a short period when they brought in a lot of new people, just as the doctors came in. They were not paid. They retroactively gave them credit so there was a short period of, I think, 3 years when the income was exceeded by the outgoing. Then it sprang up again. But the reserve has been built.