Before medicare became law in 1965, the actuaries and the Secretaries of the Department of Health, Education, and Welfare, based on stacks of statistics, solemnly assumed the Congress and the public that their estimates were "conservative" and "safe," and that the first year of medicare hospitalization alone for everyone over 65 years of age would only cost $900 million. The truth is that it cost $2.7 billion. The estimates were not just 10 or 20 percent off, but 300 percent off. Medicare cost three times what the bureaucrats said it would cost.

Not only did the bureaucrats say that hospitalization alone would cost only $900 million the 1st year, but they said after the fifth year it would only cost $1.4 billion a year, and after the 10th year $1.7 billion. The truth is that the fifth year it actually cost $5.6 billion, which is four times as much as estimated. The 10th year cost is now over 10 times as much as was promised.

We are told now that the Kennedy-Corman bill, which is intended to force on the Nation complete compulsory political medicine for everyone from sperm to worm, will cost only $129 billion. Assuming that the HEW bureaucrats' estimate of costs and this, incidentally, was the estimate of HEW-assuming that the HEW bureaucrats' estimate of costs are equally as inaccurate as their medicare estimates have proven to be, then the cost of the Kennedy-Corman bill would not be $129 billion for the 1st year, but three times that_much-more nearly $387 billion; and the 10th year 10 times as

much.

These billions are so horrible, unthinkable and overwhelming that only bureaucrats and politicians who are used to dealing in billions can conceive of what is being done. However, this committee should know, as should the public, that presently-according to Federal statistics 48 percent of everything everybody earns in this country is now being taken and spent by Government. In the case of medicine, according to a bulletin of the Social Security Administration, $197 is being privately spent for every person, and $297 is being spent by Government for every person. The combined per capita expenditure for medicine is, therefore, $492 at present.

Under the Kennedy-Corman bill, HEW estimates per capita expenditures would be $600 the first year. However, if allowance is made for the fact that HEW bureaucrats never have estimated the cost of any program as high as it has actually turned out to be, and if we apply the same inaccurate understatement that the HEW bureaucrats made on medicare to the Kennedy-Corman bill, the first year cost per person of that program would be $1,784.

In order to get this into focus for a family of four, consider these facts: The present combined cost of medical care taking into account governmental and private expenditures, is $1,968. HEW estimates that under the Kennedy-Corman bill it would be increased to $2,400; but again, applying the medicare inaccuracies, it would turn out to be $7,136 the first year. Consider these horrible figures with the fact that, according to the Survey of Current Business of the U.S. Department of Commerce for April 1975, the average annual earnings per worker was only $8.031.

Talk about bankruptcy. We suggest that the curtain ringing on the bankruptcy of New York City is a dire warning to every U.S.

Government elected or appointed official that the Federal Gov ment can collapse if it, too, continues its reckless spending. Total c pulsory politicalized medicine in the United States would mean destruction of our system.

However, if we are smart, we will prove that Lenin was wrong when he laid out his Machiavellian plan for destroying a private capitalist system. John Maynard Keynes understood what Lenin was up to. He said:

Lenin was certainly right. There is no subtler, no surer means of overturning the existing basis of society than to debauch the currency. The process engages all the hidden forces of economic law on the side of destruction, and does it in a manner which not one man in a million is able to diagnose.

We have attached charts to our statement that show how inflation and Government spending is running amok, and why this plunder must stop.

Also, for the benefit of the committee, and others we have provided excerpts of the ridiculous, erroneous, misleading statements by Secretary Ribicoff made in 1961 in effect amount to fraud-statements made before the House Ways and Means Committee on H.R. 4222, the King-Anderson bill providing for health benefits in hospitals and other facilities. These statements were made when Mr. Ribicoff was trying to deceive the American people into acceptance of, and the Congress in passage of, the King-Anderson bill, which, in 1965, with many expensive "goodies" added to it, became the medicare-medicaid law. That law is now helping to bankrupt the Federal and State governments by costing $28.7 billion in 1976-which is over 15 times more than the top estimates originally promised when the legislation was considered.

This Congress, considering legislation to nationalize medicine, should not repeat the mistake made in 1965 when Congress passed the medicare-medicaid law on the basis of misrepresentations and falsehoods by the Feedral bureaucracy.

Thank you, Mr. Chairman.

[The prepared statement and attachments follow:]

STATEMENT OF R. LOWELL CAMPBELL, M.D., PRESIDENT, AND FRANK K. WOOLLEY, EXECUTIVE DIRECTOR, ASSOCIATION OF AMERICAN PHYSICIANS AND SURGEONS, IN OPPOSITION TO COMPULSORY POLITICAL MEDICINE (FALSELY LABELED NATIONAL HEALTH INSURANCE)

I am R. Lowell Campbell, M.D. of Corsicana, Texas appearing as President of the Association of American Physicians and Surgeons. Accompanying me is Mr. Frank K. Woolley, Executive Director.

The Association is a free, independent, non-governmental voluntary organization of members of the medical profession, united for the purpose of analyzing the profession's problems and formulating actions to improve medical care for all Americans, preserve freedom of choice for patient and doctor, protect the practice of private medicine, and educate physicians and the public to recognize and defeat schemes that would weaken or destroy our free-choice system of medical care.

The proponents of compulsory politicalized medicine claim their schemes, which are deceitfully and wrongfully labeled National Health Insurance, will make more and better medical care available to everyone at less cost.

Generally, the schemes are based upon assumptions which need to be carefully considered by citizens who value individual liberty and responsibility and who understand the economic and political system of the United States which, while not perfectly operated, has made this country the most free and prosperous on earth. The primary basis of this system is that you get what you pay for

in a free-choice, willing-exchange economy. It is our purpose here to bring the assumptions on which proposals for politicalized medicine are based into focus with the fundamental beliefs of most of the people in this country, who are opposed to those schemes and all other attempts to use governments to oppress individual liberty.

Most of the assumptions on which compulsory politicized medicine schemes rest would undermine our basic free-choice system, deny individual dignity and liberty and set our free choice political and economic system on a collision course with tyrannical totalitarianism, and thus put basic policies of government into condict wtih the fundamental beliefs of its citizens. Yet, most Americans have thought that opposing the tyranny of totalitarianism was what World War II was all about and that our military efforts against the communists since then have been for the same purpose. The question the American people need to answer is: "Are we now to blindly embrace schemes of totalitarianism in medicine and delude ourselves that we are making a free choice because the interventionists try to confine the arguments to 'who does the dictating and controlling and how' and not whether we want these schemes in the first place."

We will look at the assumptions of the proponents of these schemes from various fundamental points of view. The assumption of the bureaucrats; politicians; labor union leaders; big business leaders; insurance companies; hospital supply and equipment companies; and finally, medical organizations. It should be clear that I am not talking about any group that are opposed to compulsory politicalized medicine but only those that are for it.

ASSUMPTIONS BY BUREAUCRATS FAVORING COMPULSORY POLITICALIZED MEDICINE

Bureaucrats are infallible or, at least, so far superior to ordinary patients, doctors and hospital employees that all citizens should have a part of their earnings forceably taken from them and spent for them by bureaucrats because that way they will get "more appropriate and necessary medical care at reasonable cost." (See Public Law 92-603 and Regulations of HEW issued pursuant thereto.)

The States of the Union have no independent authority under the United States Constitution which cannot be pre-empted by federal employees by the devices of taxation, subsidy and control. (See speech of Madam Perkins in 1962 to HEW employees in which she tells how they struck upon the device of getting around the constitutional division of power between the states and the United States government by using the taxing power-The Roots of Social Security.) Congress is an inferior branch of government to be manipulated by the executive; the Constitution and courts are annoyances that must be "mitigated or removed," and the bureaucracy exists to control citizens, not to serve them-in fact, to mold citizens' behavior as bureaucrats deem appropriate. (See The Evolution of Medicare . . . from Idea to Law-HEW 1969; and see Senate Labor and Public Welfare Committee Report on Kennedy Bill S1466 on Health Education and Communicable Diseases. Also, see the 1972 Brookings Institution Report, Setting National Priorities, the 1973 Budget, particularly Chapter 15 on "A New Approach to Priorities" in which it is said: "Satisfying these new concerns requires finding ways of changing the behavior of individuals and institutions.") The bureaucracy has the right and duty to usurp the legislative function through the promulgation of regulations which exceed legislative intent and which are couched in such ambigious and tricky language that the courts are repelled from trying to unravel the Machiavellian consequences.

City and state governments can be easily bought and controlled by getting them hooked on federal money and dictating to them what they must do to keep from losing it. (This is so self-evident that no recitation of examples is required.) Bureaucrats should help labor union leaders, ex-politicians and academicians in manipulating and rigging elections of those congressmen who favor more spending and more power for the bureaucracy. (See proposed bills to remove limitation on 2.5 million federal employees from participating in electioneering. Also see bills to unionize postal employees and HMO legislation and supporting arguments for giving control of medical care to labor union leaders.)

Bureaucrats are more capable of deciding what is medically necessary and appropriate for individual Americans than doctors.

Ordinary law-abiding citizens who are competent to vote and make choices among competing candidates for public office are to be considered incompetent to make proper choices for their own medical care in a free market and, therefore,

should be denied the right to choose where, when, how and by whom they should be treated.

There is a definable need for medical care that government can identify and provide at reasonable cost and satisfaction to patients if only obstinate physicians would subordinate themselves to dictation and control mechanisms devised and operated by a centralized bureaucracy.

Every facet of life in the United States will be improved if regulated and controlled by federal bureaucrats.

Underlying all these assumptions is the basic assumption that bureaucrats have a right above the Constitution to do all these things.

ASSUMPTIONS BY POLITICIANS FAVORING COMPULSORY POLITICALIZED MEDICINE If they promise to vote for medical care for everyone paid out of the federal treasury, they will, on balance, gain votes for election or re-election. Socialized medicine won't lead to socialized anything else.

The American people are gullible enough to believe anything a politician tells them-especially if they are told they're going to get something for nothing.

The American people are really not bright enough to figure out the truth about compulsory politicalized medicine and, therefore, concealing the truth to get elected is the expedient thing to do because it's not very risky.

These politicians, in order to conceal the truth, must affirmatively dwell on promised benefits and paint glowing pictures of Utopia for those in their constituency who don't understand that you can't get something for nothing. Politicians also skirt the truth to avoid responsibility for the injury their actions will inflict on their constituents. For example, they will have to slip, slide and duck to avoid the truth about the terrible cost not only in money but in the deterioration in quality of medical care and in undermining the right of citizens to freely choose their doctor or hospital. Above all, they must avoid letting anybody know that they realize that by using federal power to deny citizens the right to choose their doctor or hospital, the precedent is being set to deny them the right of free choice of housing, clothing, food, recreation, transportation, and everything else.

Further, they will have to be careful that the truth is not exposed and fully appreciated by the voters about how political medicine will increase taxes; increase inflation; double the federal budget; increase the power of the federal bureaucracy to force employers, employees, doctors and hospitals to fill out millions more forms; force substitution of the judgment of far-removed, impersonal, indifferent government employees for the judgment of personally interested attending physicians or local hospitals. Additionally, they will have to confuse or dodge the fact that their votes will empower the bureaucracy to invade the sacred privacy of confidential communication of patients with their physicians and that no longer will the federal bureaucracy have to steal medical records as they did in the Ellsburg case, but Congress will hand this authority to them on a silver platter.

Not only will they carefully slide away from the truth about the additional thievery of government through taxes and inflation but, if need be, they will be prepared to hide that and other truths by trying to discredit the medical profession by attacking the doctors' lobby as being selfish and greedy. Those who are well schooled in the tactics of British Fabian Socialists and their American offspring, members of the League for Industrial Democracy, may copy the vicious attack on doctors by George Bernard Shaw in his 1906 book The Doctor's Dilemma which helped pave the way for so-called National Health Insurance in Britain in 1911. Others may use the tactic of Aneurin Bevan, British labor leader who forced the National Health Service through parliament in 1947, who would ask the coal miners: "Who is the fellow in the village who drives the Rolls Royce?" Of course, since labor union leaders have been the primary driving force in America in providing financing and manpower in recent elections, many politicians will be seeking to curry favor with labor union leaders, the overwhelming majority of whom favor politicalized medicine without regard to what such action may mean in destroying the American free-choice system.

Unfortunately, too many members of Congress either are willing collaborators in the freedom-zapping schemes of the bureaucracy, or beholden to labor bosses who could care less about the constitutional rights of patients and doctors (even though union members are patients) or are so mesmerized by the slippery semantics and political power of bureaucrats and labor bosses they can't see and won't admit the danger to individual liberty in these schemes.

ASSUMPTIONS OF LABOR UNION LEADERS FAVORING COMPULSORY POLITICALIZED

MEDICINE

Socialized medicine is a big step toward a socialist government and when that is achieved, labor leaders will call governments tune-in fact will be the government.

Compulsory nationalized medicine will shift health insurance from a fringe benefit of collective bargaining to a tax paid program and free up corporate funds that can be grabbed by unions for higher wages without bankrupting the corporations.

Compulsory politicalized medicine paid out of taxes will release for union manipulation billions of dollars now tied up in union health and welfare programs.

Corporate profits are becoming less and less available as a source of insatiable union demands for ever increasing wages and benefits for ever lessening productivity. Between inordinate union demands and oppressive federal laws and regulations, such as OSHA, and increased taxes on corporations (direct and through inflation), corporate profits after taxes have been stomped down until they now total less than half the amount of money being spent by a single agency of government-the Department of Health, Education and Welfare. Of course some labor union leaders who apparently want to bring about the dictatorship of the proletariat as rapidly as possible would not be interested in saving any corporation from bankruptcy, or the U.S. government either, for that matter.

ASSUMPTIONS OF INSURANCE COMPANIES FAVORING COMPULSORY POLITICALIZED

MEDICINE

Government medicine is inevitable; therefore the salvation of health insurance companies lies in becoming the government's fiscal agent to administer a nationalized system.

When insurance companies are in control of political medicine they will have won the struggle with hospitals and the medical profession for dominance over U.S. medicine. They will be on top.

Blue Cross and Blue Shield, the latter having grown powerful enough to become independent of the medical profession, vigorously maneuvered to become agents of government to carry out and exercise the controls inherent in Medicare and Medicaid. Some of their leaders are so attuned to the government take-over of their business that they are promoted at every turn by the bureaucracy and, in turn, they prate the collectivist line. For example, Walter McNerney of Blue Cross says that health care is no longer an individual responsibility but is a community affair (pure pro-collectivism and anti-individualism). Over the past few years, Blue Cross has had a decreasing percentage of the market for health care insurance.

ASSUMPTIONS OF HOSPITALS FAVORING COMPULSORY POLITICALIZED MEDICINE

They must go along with government and be willing collaborators of the federal bureaucracy to interfere with the exercises of independent professional judgment by doctors in order to get federal money for themselves.

If they don't go along, the federal government will stop the easy money flowing to the hospitals.

Collaborating is the way to achieve a higher place in the pecking order over the physicians.

ASSUMPTIONS OF HOSPITAL SUPPLY AND EQUIPMENT COMPANIES

When nationalized medicine becomes a reality, they can ride the multibillion dollar federal gravy train to riches.

They can become involved with government and retain their independence. These companies willingly promote government intervention because they can see dollar signs everywhere for selling a huge array of electronic and other equipment to a great new bureaucracy that will always hasten to spend the last dollar of its appropriations before the end of the fiscal year. They see fully