The CHAIRMAN. Are there any physical facts in the development of a man's medical career that cuts off his usefulness at 65? I hope that isn't true. I have met several doctors upon different occasions who are well beyond 65 who seem to me to be in possession of their faculties. They have the benefit of vast experience and tested judgment. I come back to the question, is there some fact in the strain and pressures of the profession that, in the average case tends to disable a physician when he is 65?

Dr. BLASINGAME. The same laws of nature apply to physicians as all other members of society. Nature makes no attempt to make us all alike. If an individual has his capacity and will to do, we think it is penalizing society to encourage him to retire for some particular reward which society intends to dangle in front of him. He should be encouraged to utilize his facilities as long as they are valuable to society.

I was just interested here in a picture of Dr. White, 77, who operates seven times a day here in Washington, D. C., and I believe recently repaired an injured Member of Congress when he was shot during the fracas not so very long ago. He is a man 77 years of age and they called him out to do the job.

The CHAIRMAN. I hope you physicians don't get too much experience from that particular kind of occurrence.

Dr. DICKINSON. There is a great deal other information we can present to the committee which rounds out this picture of the inapplicability of the social security system as it is now before you, to a great group of people who start earning late and who quit late. Those are the essential characteristics of the self-employed physician. You see the percentage of physicians below 30 years of age is very small. They start late in life and they quit late in life. That appears to be what the public wants of physicians.

The CHAIRMAN. I know in my own profession, which is that of law, I don't know of any association between 65 and inability to practice law. In fact the older a man gets there must be some limits to thatbut the older a man gets, he may lose some energy but his wisdom and his brain power-I have noticed by experience on this committee that as the years go on, the older men on the committee get wiser, instead of losing their capacities.

Dr. BLASINGAME. I do want to reemphasize the importance in our minds of this waiver of premium issue, too. We consider it very vital in the long run. Our statement summarizes in general our

reasons for it.

The CHAIRMAN. I haven't been able to attend these hearings but exactly what is it that frightens a doctor about what you are talking about now? What is the feature of it that impinges upon the proper attitude toward the profession that should be held by the public and the professional man?

Dr. BLASINGAME. I appreciate your asking the question, Senator Millikin. The point is, if you establish a system of State physicians or Government physicians across the country to act as agents of the Government in determining total and permanent disability, and the Government pays for that examination, you establish a habit pattern in society and you establish a large number of doctors known to a body of the public as Government doctors. Then that individual

patient finds that the fee for the examination is paid for by the Government. When that individual is ill, he then wants to know why the Government can't pay for the examination of him for a given illness and for the treatment of that particular illness and it is the subject of extension not only for the permanent and totally disabled but for partial disability and finally to all illness.

We think in the first place it will establish a clumsy, bureaucratic method across the country of determining total and permanent disability and it places the physician in the enviable position of having a patient come to him and he happens to be turned down and he goes to another doctor and finally another doctor, to obtain an examination which the patient thinks is in keeping with his condition, and then finally, of course, the opinion of the physician may be turned down even by the authorities who rule on it. But the main thing it does, it puts an antequated and clumsy bureaucratic, costly system across the country in determining total and permanent disability and we think by taking the best 5 or 10 years of a man's employment regardless of the reasons of why he is out, whether or not he is partially employed or employed for 20 hours a week and so on, all that can easily be taken into consideration at the end of his employment period and when he comes to retirement simply by picking out the best 5 years or best 10 years on an IBM machine and calculating his pension at that time, regardless of the details and causes of what made him disabled at the particular time.

It is not a necessary part in calculating total and permanent disability but it can be a mechanism by which the social security system begins, shall we say, the establishment of a compulsory sickness insurance or socialized medicine and we fear it. We wanted to warn you and caution you about this aspect of the program because once it is established it could be expanded.

The CHAIRMAN. In taking the best years which you mentioned, you think in using that, it is not necessary to consider whether the man's health has been good or bad?

Dr. BLASINGAME. That is right. It doesn't enter into the determination of his pension calculation which is said to be the issue involved. We claim if that is the real issue that the social security people are after, the mechanism they have suggested is most clumsy and antiquated and dangerous of expansion to compulsory health insurance. We think much more modern methods can be employed such as you use in your own civil service retirement calculations and also in many of the retirement plans of private concerns.

Senator GEORGE. Thank you very much, gentlemen.
Dr. J. Claude Earnest.

STATEMENT OF DR. J. CLAUDE EARNEST, AMERICAN DENTAL ASSOCIATION, ACCOMPANIED BY DR. FRANCIS J. GARVEY

Dr. EARNEST. Mr. Chairman and gentlemen of the committee, I am Dr. J. Claude Earnest, a self-employed practicing dentist of Monroe, La. I am here today to present the views of the American Dental Association with respect to H. R. 9366. In presenting these views I believe that I can speak with considerable knowledge of the attitude of dentists toward inclusion under OASI for, not only am I a self-employed dentist myself, but I am also vice chairman of the association's

council on legislation and a member of its house of delegates. Both personally and officially, I have had a good deal of experience with the discussions leading to the association's position in this matter.

I might also state that I am a member of the Executive Council of the Louisiana State Dental Society and that the position of the dentists in my State is identical to that of the American Dental Association.

As a preliminary remark let me say that old-age and survivors insurance is based on assumptions that do not necessarily obtain in professional groups in that it is designed to assist those whose economic conditions are vastly different from those found in a profession. This I will illustrate later in my testimony. Professional persons are self-employed and self-determining and are not limited by the economic considerations which compel retirement at age 65 in general industrial employment.

It appears to us that there are two fundamental questions before the committee today: (a) Is the OASI system to be one of universal coverage? (b) If not, what groups should be excluded from its application?

Upon examining the bill before you today, together with the existing law which will not be affected by that bill, we find that the first question is clearly answered by the fact that certain groups, both employed and self-employed, will continue to be excluded. In the first place there are still a number of types of excluded employment including service as a Member of Congress. In the second place, by determination of the House of Representatives, a self-employed group, physicians, is excluded.

Since it is clear that OASI is not to be a system of universal coverage, there remains only for determination which groups are to be excluded. The House has already determined that physicians constitute a proper group for exclusion and with this we agree. We submit that self-employed dentists likewise constitute a proper group for exclusion and this we shall demonstrate. Accepting as valid the points in the House of Representatives in favor of the exclusion of physicians, let us examine the debate in that body to see what reasons were advanced for including dentists.

At page 7021 of the June 1 Congressional Record—and all citations will be to the Record of that day-it was said:

It was also pointed out that in the case of physicians they do not retire at age 65. They continue working, therefore they did not think it would be fair for them to be required to pay the tax when they did not expect to retire and get benefits. On the other hand, some evidence was presented that the dentists being on their feet and working at their chairs, it frequently resulted in their having to retire at an earlier age than physicians.

I have carefully read all of the hearings before the House and I do not find that this latter contention is borne out. As a matter of fact, in testifying for the American Dental Association, I used the following language:

Except in unusual cases, dentists continue working throughout their lives. Since they cannot continue to work and simultaneously derive benefits from their contributions to this scheme, they prefer to be omitted from it so they can invest their funds in retirement plans of their own choice from which they will receive at least the return of their investment.

I, personally, know many dentists who are still in practice after 50 or more years and, since the average age of dentists at graduation is

26

years, these men must be over 75 years of age. However, to confirm my own information I requested a statement from the Bureau of Economic Research and Statistics of the American Dental Association which keeps careful track of such matters. It reported as follows:

It is estimated that the mean age of retirement for dentists is between 68 and 70 years and probably closer to 70. There are more than 8,000 dentists, or approximately 10 percent of the profession, between the ages of 65 and 75 years, the majority of whom are still in practice.

The Bureau accompanied its statement with a table of the age distribution of dentists 65 and over. As you will note from that table, which is included for your convenience, there are approximately 12,000 dentists, now living, who are 65 or more.

Since the Bureau has arrangements with the various States departments of vital statistics to furnish it with copies of the death certificates of dentists, and since we know the age distribution of dentists, by checking the two lists against each other, the association can readily keep track of the ages of living dentists.

The point is substantiated by quoting from a letter from a Colorado dentist to the Council on Legislation dated June 16, 1954, protesting against the inclusion of dentists in OASI. He said:

Dentists do not retire-a few move their offices to their homes and have a net income far beyond $1,000. I am the only Denver dentist I know who is really retired. I closed my office last January at age 81. Dentists should have been cut out when physicians were eliminated from social security.

A further reason given for excluding physicians is found in the statement on page 7031 of the record:

It would be a rare experience for a doctor

they refer to a physician

even in his late years to have an income of $1,000 or less. Therefore they would be paying social-security tax with no chance in most instances of ever receiving any return from it.

If this is part of the reason for excluding physicians while including dentists I would like to submit income figures on income derived from dental practice by dentists aged 65 and over. According to the 1953 Survey of Dental Practice conducted by the association's bureau of economic research and statistics, average annual net incomes of selfemployed dentists from the practice of dentistry, in the upper age groups were as follows:

Age 65-69 was $7,192; age 70-74 was $5,842; age 75 was $2,975. Certainly few dentists will retire to live on social-security benefits of $1,296 per year if they are physically able to produce an income such as that listed, nor will they ordinarily retire on the maximum benefit of $1,944 including the wife's portion, should she be the same

age as the dentist, when even at age 75 they can exceed the dual benefit by more than $1,000.

These income figures are important, not only because they indicate income from the practice of dentistry well above social-security benefits, but also because they prove conclusively that dentists in the seniorage groups do continue to work and to produce incomes which make them self-supporting. This income can be understood more readily if one realizes that dentists tend to concentrate their practice on patients in their own age group. These patients tend to remain with the dentist and, in the later years of both patient and dentist, require more prosthetic work than any other type of dental treatment. Since his work is not nearly so fatiguing physically as general operative dentistry it is possible for dentists to continue working until relatively late in life.

We have been talking about money but there is more than money that keeps the dentist working. The average dentist who has practiced dentistry more than 25 years, he has a lot of patients who have been with him ever since he has been practicing. They have never been to another dentist. They have utmost confidence in him. Lots of them have moved away and they'll drive back hundreds of miles to have you do their work. They will brag on you and they built up your ego and it just does something to you that you don't quit work. Reverting to the statement quoted earlier that dentists retire earlier because they are on their feet more than physicians, I think that the committee should be informed that this hazard has been considerably reduced by the conditions of present-day practice with modern equipment, offices designed for maximum convenience, and the growing use of auxiliary personnel to relieve the dentist of much of the nervous strain and physical effort formerly associated with the practice of dentistry. The effectiveness of these modern conditions of dental practice is established by the figures which I have quoted showing the number of practicing dentists over age 65 and the earning power of such dentists.

The association believes that the committee will want to consider another important factor. It is well recognized that the oral health condition of the American people is such that a continuing large supply of dentists is needed."

The consensus among those who have studied the problem is that there is no surplus of dentists today. The defense needs of the country, for example, require the services of some 6,000 younger dentists. Assuming, for the sake of argument only, that the inclusion of selfemployed dentists in OASI with its proposed benefit structure might encourage a substantial number of dentists to retire at age 65, to that extent the requirements of the people of this country for dental health service would suffer.

We are presently producing about 3,000 new dentists each year with a resultant net increase of about 1,100 over deaths and retirements. The vast majority of these new dentists are siphoned into military service for 2 years shortly after graduation.

To encourage the retirement of dentists at age 65 would be to lose the services of a great number of dentists fully capable of maintaining active practice and, since the median age of all dentists is about 46.68