Coordination of Testimony.-In view of the heavy schedule of the Subcommittee and the full Committee ahead and the limiited time available to the Subcommittee to conduct this hearing, it is requested and it is most important that all persons and organizations with the same general interest designate one spokesman to represent them so as to conserve the time of the Subcommittee and other witnesses, prevent repetition, and assure that all aspects of the subjects being discussed at this hearing can be given appropriate attention.

Written Statement in Lieu of Personal Appearance.-The Subcommittee will be pleased to receive from any interested organization or person a written statement for consideration for inclusion in the printed record of the hearing in lieu of a personal appearance. These statements will be given the same full consideration schedule, this will limit the total time available to the Subcommittee in which to conduct these proceedings. Thus, to assure fairness to all witnesses and all points of view, it will be necessary to allocate time to witnesses for the presentation of their direct oral testimony. Most witnesses will be limited to five (5) minutes for their verbal presentation. Exceptions to the rule will be severely limited and in any case only where broad national organizations are involved. Also, as indicated above, it may be necessary to ask certain witnesses to form panels in order to further consolidate testimony. If the witness wishes to present a long and detailed statement, it will be necessary for him to confine his oral presentation to a summary of his views while submitting a detailed written statement for the Subcommittee's consideration and for inclusion in the record of the hearing.

Contents of Requests To Be Heard.-The request to be heard must contain the following information, otherwise delay may result in the proper processing of a request:

(1) The name, address and capacity in which the witness will appear;

(2) a list of persons or organizations the witness represents and in the case of associations and organizations their total membership and where possible a membership list;

(3) An indication of whether or not the witness is supporting or opposing any specific proposal or proposals on which he desires to testify;

(4) If a witness wishes to make a statement on his own behalf, he must still nevertheless indicate whether he has any specific clients who have an interest in the subject, or in the alternative, he must indicate that he does not represent any client having an interest in the subject he will be discussing; and

(5) A topical outline or summary of the comments and recommendations which the witness proposes to make, which will form the basis for prepared summaries of the hearing.

Submission of Prepared Written Statements.-With respect to oral testimony, the rules of the Committee require that prepared statements be submitted to the Committee office at least 24 hours in advance of the scheduled appearance of the witness. Fifty (50) copies of the written statements would be required in this instance; an additional fifty (50) copies may be submitted for distribution to the press and the interested public on the witness' date of appearance.

As indicated above, any interested person or organization may submit a written statement in lieu of a personal appearance for consideration for inclusion in the printed record of the hearing. Such statements should be submitted by Thursday, November 6, 1975, in triplicate. An additional fifty (50) copies of written statements for the printed record will be accepted for distribution to the Subcommittee members, the press and the interested public if submitted before the final day of the public hearing.

Format of All Written Statements.-It will be necessary that all prepared statements contain a summary of testimony and recommendations and that throughout the statement itself pertinent subject headings be used.

Resubmission of Requests To Be Heard Where Requests Already Made.— If a prospective witness has already submitted a request to be heard on the subject of national health, the request should be resubmitted at this time furnishing the above information and otherwise conforming to the rules set forth for conducting this hearing.

Mr. ROSTENKOWSKI. Also, I wish to announce that the record will be kept open until December 5 for statements to be included in the record of these hearings.

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I would also like to announce that it is the intention of the Chair to work through lunch and try to conclude these hearings in the middle of the afternoon.

I would like at this time to welcome our first witness, Dr. R. Lowell Campbell, Association of American Physicians and Surgeons, and Mr. Frank K. Woolley.

If you will, introduce yourselves and proceed with your testimony, gentlemen.

STATEMENT OF R. LOWELL CAMPBELL, M.D., PRESIDENT, AND FRANK K. WOOLLEY, EXECUTIVE DIRECTOR, ASSOCIATION OF AMERICAN PHYSICIANS AND SURGEONS

Dr. CAMPBELL. Mr. Chairman, I am Dr. R. Lowell Campbell, a private doctor of Corsicana, Tex., appearing as president of the Association of American Physicians and Surgeons. Accompanying me is Mr. Frank K. Woolley, who is our executive director.

Do you wish me to continue my statement?

Mr. ROSTENKOWSKI. Yes, if you would, please.

Dr. CAMPBELL. 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. Of course, that claim is not supported by evidence.

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 Government to oppress individual liberty.

Also, this testimony can be used by candidates for Congress, and others, to help develop plans and platforms for the coming elections. We will look at the assumptions of the proponents of these so-called national health insurance schemes from various fundamental points of view: the assumption of the bureaucrats; politicians; labor union leaders; big business leaders; insurance companies; hospitals; hospital supply and equipment companies; and finally, medical organizations. It should be clear that I am not talking about any groups that are opposed to compulsory politicalized medicine but only those that are for it.

First, let's consider the assumptions by the bureaucrats who favor compulsory politicalized medicine. A key assumption of bureaucrats is that they 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."

Another assumption of bureaucrats is that the States of the Union have no independent authority under the U.S. Constitution which cannot be preempted by Federal employees by the devices of taxation, subsidy, and control.

A third assumption of the bureaucrats is that the Congress is an inferior branch of Government to be manipulated by the executive branch; the Constitution and courts are annoyances that must be

"mitigated or removed"; and that the bureaucracy exists to control citizens, not to serve them-in fact, to mold citizens' behavior as bureaucrats deem appropriate.

A fourth assumption of bureaucrats is that 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 ambiguous and tricky language, that the courts are repelled from trying to unravel the Machiavellian consequences.

A fifth assumption is that bureaucrats are more capable of deciding what is medically necessary and appropriate for individual Americans than doctors.

Sixth, bureaucrats assume that ordinary law-abiding citizens who are competent to vote and make choices among competing candidates for political 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.

Seventh, the bureaucrats assume that 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.

Now, let's consider an assumption by politicians who favor compulsory politicalized medicine: 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.

As you well know, gentlemen, in this connection, Senator Muskie recently, in talking to a group of liberals, let the cat out of the bag when he stated, and I quote: "Do we really expect the majority of Americans to support national health insurance when estimated costs range up to $100 billion a year?"

Mr. Woolley will later make more comments about this $100 billion figure.

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.

Further, they 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, and this is very important, they 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 Ellsberg case, but Congress will hand this authority to them on a silver platter.

Now, let's look at the assumptions of the labor union leaders who favor compulsory politicalized medicine. These assumptions are significant assumptions that the electorate should know about.

First, union leaders assume that 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.

They also assume that compulsory politicalized medicine paid out of taxes will release for union manipulation billions of dollars now tied up in union health and welfare programs.

Next, let's consider assumptions of insurance companies favoring compulsory politicalized medicine. They assume that Government medicine is inevitable; therefore, the salvation of health insurance companies lies in becoming the Government's fiscal agent to administer a nationalized system.

They also assume that 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 or they think that they will be on top.

Next, consider the assumptions of hospitals favoring compulsory politicalized medicine. They assume they must go along with Government and be willing collaborators of the Federal bureaucracy to interfere with the exercise of independent professional judgment by doctors in order to get Federal money for themselves.

They also assume that if they don't go along, the Federal Government will stop the big money flowing to the hospitals.

Next, assumptions of hospital supply and equipment companies are that when nationalized medicine becomes a reality, they can ride the multibillion-dollar Federal gravy train to riches. They also assume they can become involved with Government and retail their independence.

Now, gentlemen, both you and I know that that is a delusion; in fact, it is a delusion of grandeur.

Now, let's look at the assumptions of big business leaders favoring compulsory politicalized medicine.

First, they assume that compulsory politicalized medicine, more familiarly known as National Health Insurance will relieve corporations of the increasingly heavy burden of paying all or the lion's share of health insurance premiums. For example, the Washington Business Group on Health, a small group of professional lobbyists, recently purported to speak for a coalition of corporations and organizations such as the Health Insurance Association, and the Chamber of Commerce of the United States in advocating that "participation in a national health insurance program be mandatory for all employers with one or more employees."

Finally, let's examine the assumptions of some medical organizations that favor Government intervention. The first assumption is that compulsory politicalized medicine is inevitable and if doctors go along they will be able to control the Government system. Again, this is an illusion.

The second assumption is that the name of the game is money, and medical societies-some masquerading as foundations for medical care-may as well get their share.

These assumptions and attitudes on the part of the AMA and a number of its constituent State medical societies do not represent either the beliefs or the desires of all medical organizations. Most notably, the Association of American Physicians and Surgeons emphatically does not believe that medicine can get along by going along; it does believe that government subsidy means government control; that it is sheer naivete to believe that doctors will be able to control any part of any scheme of government medicine; it does believe that acceptance of Federal money by medical organizations is a violation of ethics and a sellout of the profession, as well as of the American people.

The assertion that socialized medicine is inevitable is a cop out, a rationalization, an excuse to justify capitulation to get Federal money. The AAPS does not buy that "inevitability" argument.

At this time I would like to call on Mr. Frank Woolley, who will present information regarding our association's court case, and statistics regarding the previously mentioned cost of so-called national health insurance.

Mr. WOOLLEY. Thank you, Mr. Campbell.

Mr. Chairman, the AAPS has a case pending in the U.S. Supreme Court challenging the constitutionality of a law passed by Congress in 1972, popularly known as PSRO, which gives the Secretary of HEW and the bureaucrats authority to substitute their judgment for the judgment of the attending physician on what is medically necessary and appropriate for a patient. I have the brief we filed with the Supreme Court with me. I would be happy to file it with the committee if they would like to have a copy of it. It won't be necessary to put it in the record of these hearings because it is too voluminous for that record.

Mr. ROSTENKOWSKI. Without objection that will be filed in the committee office.

[The document referred to may be found in the files of the committee.]

Mr. WOOLLEY. We will not drop this case. The PSRO law is bad, and we shall do whatever we legally can to see that it is abolished. Obviously, the assumptions Dr. Campbell just mentioned with respect to various groups who are pushing for compulsory politicalized medicine do not in any way prove that their schemes will make more and better medical care available to everyone at less cost. None of these groups is sufficiently concerned about the cost, although the dollar cost alone should be sufficient to keep any responsible person from favoring compulsory politicalized medicine.

The records of the Federal Government are clear that the schemes of political medicine in this country have been so costly that to apply them to all the citizenry would be the most irresponsible fiscal act that any legislator could perform.

What are the facts?

We have 10 years of experience with medicare and medicaid which clearly show that if such programs are applied to all the people, not only will New York be bankrupt, but the entire country will be bankrupt. If you are concerned about the effect of the financial collapse of New York City, which is the result of plunder by politicians and labor leaders, then you should be a hundred times more concerned about what total compulsory politicalized medicine would do to free institutions in this country.