Page images

Senator KERR. Well, that is encouraging.

Dr. SENSENICH. The majority report of the Advisory Council perhaps realized that much discretionary power would be conferred on the Administrator if its recommendations were enacted into law, for the report suggested on page 2 as follows:

We believe further that it would be desirable to establish a public advisory board to counsel with the Federal administration particularly during the early years of the operation of this new program. Such an advisory group could assure that a variety of viewpoints are considered in the formulation of policy, The advisory group might appropriately later review and make recommendations on the conduct of operations and the extent to which the program achieves its purpose.

That is a quote from the recommendation of the committee. And again, the Council recommended a decentralization of administrative procedure in order to prevent too much concentration of administrative action and decision in Washington. Here again, however, the provisions of section 107 depart from the recommendations of the majority report, for there is no reference to the creation of a public advisory board nor is there any indication that the administrative functions will be decentralized.

4. It is a fact well known to physicians that the mental attitude of a patient is a most important factor in his recovery. We may call it the will to get well. Disability benefits may well remove from many disabled workers the incentive to become a contributing member of society, the incentive, in other words, to recover from his disability.

5. As indicated in the statement on H. R. 6000 formulated by our board of trustees, which I read to you earlier, no apt parallel can be drawn between the existing old-age and unemployment programs and the proposed disability benefits program. They are not comparable. A worker either is or is not aged and he has no control over the fact. A worker is either unemployed or he is not and, possibly with a few exceptions, he has little or no control over the fact. There are no border-line cases, generally speaking. Little if any exercise of discretion in awarding benefits, particularly on account of old age, is necessary. These two programs lend themselves somewhat readily to mass treatment. That is not true with respect to disability benefits. Highly personalized equations must be considered in individual cases and that necessity precludes the administration of the program on a mass basis.

Senator Kerr, I am referring there to that question of yours a while ago as to objective proof. We have a wide borderline of those who have no objective proof. As to the insurance companies, I think someone from one of the insurance companies appeared before the committee not very long ago. I know I have had personal experience with the individual who is financially able, is about able to retire or has retired, and has a coronary attack which may be of minor character and may possibly not disqualify him even for the continuance of the business to which he has been accustomed. But he frequently decides that that constitutes a disability, and from that time on he claims to recover disability from the insurance company, even though he is not in financial need, and the program he is following is what he would have followed even had he had no illness.

Too, total and permanent disability is often a condition over which the individual and his physician may exercise some control and that fact would seem to remove the program from the insurance category.

6. These, Mr. Chairman, are some of the reasons that prompted the board of trustees to express opposition to the program outlined by section 107 of H. R. 6000. The board is convinced that that program is the forerunner of a completely federalized system of compulsory sickness insurance, such as has frequently been advocated by the Commissioner of Social Security, Mr. Altmeyer. It believes that any such nationally directed and controlled program will inevitably result in the socialization of the practice of medicine and in a marked deterioration in the quality of the medical care that the American people has been accustomed to receive. While American medicine is interested in the rehabilitation of the disabled, it believes that rehabilitation can best be accomplished on a local level without direction and interference from a Federal administrative agency remote from the problem. Furthermore, the proposed Federal disability program will call for a certification of a medical condition which, as defined in the bill, will invite abuse and fraud and the ultimate cost of the program cannot be predicted with any degree of assurance.

Insurance companies have taken a very, very serious beating on their full disabilities.

Several States have initiated programs in aid of the disabled worker but the period of duration of these programs has been too short to justify a final appraisal at this time. More experience in this field is necessary and should be gained before attempting even the somewhat restricted program contemplated by section 107.

May I add to this that we are all, I think, of one mind, certainly, that we feel that the disabled individual should have the proper kind of care.

He should have medical care. He should have every opportunity for rehabilitation.

Senator KERR. That is an interesting observation, and as one member of the committee I would be very grateful to you if you could tell us how you thought that might be obtainable.

Dr. SENSENICH. I shall be very glad to. May I just complete this statement here? The difficulty, however, in the administration of this bill is this—and let us be realistic—most of the people, the larger number of the people, whom you and I know, who are disabled, are the individuals who would not be touched by this bill at all, for the simple reason that this is attached to the pay roll. The crippled child, the individual who has been disabled from childhood, the individual who is not in covered employment, who has an injury, has a disability, would not be eligible for any help under this bill. And that includes a far greater number than the others. As for those who were injured in industry and are in covered employment, provisions are made for them under State laws. They can be sustained for long periods of time. In fact, as long as they live, if they are completely disabled. And they are under the State acts.

So, after all, the number of individuals involved here would not be sufficient to justify the setting up of a program which is so essentially difficult to administer and offers so many opportunities, and I might even say incentives, to irregularity and to claims that constitute in the main fraud, the attempt to gain something to which they are not entitled.

Senator KERR. Then do I understand that you are objecting to it because it covers too few? In other words, do you just make the objection that it covers too few?

Dr. SENSENICH. No; it is too difficult to administer. And it is setting up a means which is very difficult to administer, which is in a bad direction, which is subject to malingering and a great many things, to cover a few individuals, when the rest of the individuals are taken care of through other mechanisms. If there were a meeting of a need which could not otherwise be provided for, then there might be some reason for experimentation with it, which is not true.

Senator KERR. I understood a while ago that you objected to it on the ground that it would lead to too many.

Dr. SENSENICH. Too many frauds.

Senator KERR. No; you said it might come to be applied to everybody.

Dr. SENSENICH. Oh, no; that this would lead to an expansion beyond this bill, an expansion into compulsory sickness plans.

Senator KERR. Now answer the question I first asked you, on your observation, there, where you expressed the belief or the thought that it would be wonderful if this medical care were available to all. You said that you would answer the question I asked you as to how that would be brought about.

Dr. SENSENICH. Oh. I am glad you reminded me of that. I would say this: That, so far as the care of the individual in need of medical care is concerned, regardless of whether he is crippled, whether he has an acute illness, a chronic illness, or what, medical care should be available to him; and it is.

Senator KERR. Then our problem is not in providing it, but just in advising him as to the fact that it is already available to him?

Dr. SENSENICH. And the improvement of the functioning of the agencies which are responsible for him in the event he is unable to provide the care for himself.

Senator KERR. It is amazing how such an important fact is so little known, Doctor.

Dr. SENSENICH. I might observe, Senator, that there are a great many men who make it their business to say, contrariwise, if I am understood.

Senator KERR. Well, that would not be particularly persuasive to those who need the care; would it, Doctor? If it were available to them, they would not be particularly impressed by statements of those who said that it were not.

Dr. SENSENICH. I think that is true.

Senator KERR. Well, would it not be equally true that, if they needed it and it were not available to them, they would not be too much impressed by statements of men that it was available to them?

Dr. SENSENICH. Yes, but they do not enact the bills into law, and they do not administer the law, and they are not those who have to do with the public.

Senator KERR. Well, I thought we had left the legislative field and were talking about the matter that you said you thought this medical care should be available to them and is.

Dr. SENSENICH. And is. Now, then, as to the individual who is in need, the agency and the local government who is responsible for the care of the individual in need should function, and I think in the main does. If it does not, then it should; and means should be taken to stimulate that effort.

Senator KERR. Which local agency of government is it that is charged with the responsibility of making medical aid available to this group?

Dr. SENSENICH. It differs in the States. In some States it is the welfare agency.

Senator KERR. Let us take Oklahoma. I know a little more about that.

Dr. SENSENICH. I don't Senator Kerr. I don't know what your situation is.

Senator KERR. I thought you said it was available in all of the States.

Dr. SENSENICH. I cannot go into the detail of it, though. May I ask you a question? Is it true in Oklahoma, Senator Kerr, that you do not have a public agency that is responsible for the care of the individual who needs medical care!

Senator KERR. Amazing as it may be, that is true. And, so far as I know, it is likewise true in every State I know anything about.

Dr. SENSENICH. Oh, I couldn't agree with that, sir. I wouldn't argue

with you as to Oklahoma. Senator KERR. Well, then, let us talk about some State that you do know about.

Dr. SENSENICH. In my own State, Indiana, the responsibility for the individual is in the township trustee. Many of those needing care are already in a situation where, by age or otherwise, they are eligible for care under the welfare department. And those who are not cared for under the welfare program are cared for under the township trustee, who has funds for that purpose and is responsible. He may hospitalize them and give them any medical care they need as long as they need it.

Senator KERR. That is true in the State of Indiana?
Dr. SENSENICII. In the State of Indiana.

Senator KERR. Well, that is wonderful. I am delighted to get that information. Now, what other State do you know about that has it?

Dr. SENSENICH. Well, in the main-
Senator KERR. Did you say "in Maine"?
Dr. SENSENICH. No; I said "in the main."

Senator KERR. Well, let us leave the realm of general discussion and be specific.

Dr. SENSENICH. I am not sufficiently familiar with all the individual States.

Senator KERR. Oh.

Dr. SENSENICH. I have been told about them but I hesitate to make detailed statements simply as the result of information given me by people in those States. I have been interested in this for a long period of time, and I am amazed to hear you say that there are many States who do not have provision for those in need of medical care. My neighboring States-Michigan, Ohio, Illinois, and WisconsinI know all have the legal mechanism for doing that. It is almost unbelievable, if you did not say so, Senator, that even Oklahoma does not have that provision.

Senator KERR. Well, I am not amazed greatly that the situation is as I have pictured it in Oklahoma. I am more amazed at what you tell me the ample medical care available to the people of Indiana is than you are at my telling you that such care is not available in Oklahoma.


Well, may I say just a word in conclusion? We have other men who will appear before the committee.

This program, or this bill, if it were enacted into law would add considerably to the funds required by a department which I am told at the present time is already approximately $7,000,000,000 in arrears of the predictable commitments. That amazed me. I understood they had $11,000,000,000, and I now understand they should have $18,000,000,000. I don't see how the Nation can assume responsibility without the determination of need for so many individuals, even though it should, in the judgment of the Federal Government, be advisable that they take over.

Senator KERR. Especially is that true if no need exists, Doctor.

Dr. SENSENICH. Well, that is true, sir. And may I say just this, in passing, Senator George.

With reference to the matter of complaint if need must be demonstrated in these areas where medical care is provided by a governmental agency, that seems to be a very distressing matter to a certain group, who constantly say all service should be provided as a matter of right, and that the matter of determination of need is a very painful and undesirable thing. I am a bit surprised at that, at the inconsistency of it, because everything that we have had to do with is determined upon need.

If we turn to the social-security system as it is—and I have no complaint, except that I should like to be perfectly factual—the socialsecurity system at the present time rests upon need to this extent: Even though the individual has paid in to old-age pension funds all the years in covered employment, when he arrives at 65 years of age if he actually earns, in my own State I think in excess of 50 cents a day, he doesn't get a pension. Is this determined on right or need?

So I am not so much concerned about this need” definition. I don't think it should be embarrassing to the individual and in any way harmful; and properly administered, certainly it would be far more realistic.

Thank you, Mr. Chairman.
The CHAIRMAN. Thank you, Dr. Sesenich.
Are there any other questions?
(The prepared statement of Dr. Sensenich follows:)


ASSOCIATION It is customary, I believe, for each witness at the start to identify himself for purposes of the record. I am Dr. R. L. Sensenich. My home is in South Bend, Ind., where I have practiced medicine for many years. I am the immediate past president of the American Medical Association and have been deputized by the board of trustees of the association, an organization of over 144,000 physicians, to bring to your attention the action taken by the board on certain parts of H. R. 6000, a bill now pending before your committee to extend and improve the Federal old-age and survivors insurance system, to amend the public-assistance and childwelfare provisions of the Social Security Act, and for other purposes.

The following statement with respect to the bill was adopted by the board of trustees on December 8, 1949 :

"In the past, the American Medical Association has made it a practice to take a stand on legislation involving medical care and the health of the American

« PreviousContinue »