Pediatric Society, and presently professor of pediatrics, emeritus, Harvard University, and director of clinical services and chief of pediatrics of the Metropolitan Hospital and Clinics of Detroit. The Physicians Forum appreciates this opportunity to explain why we and many thousands of physicians favor the addition of medical care of the aged to the benefits of the Federal social security system. We agree with the vast majority of the American people that most aged persons have great difficulty in financing medical care and find charity or welfare medicine demanding and inadequate. The use of the Federal social security system is sound because it enables a person to contribute throughout his working life, regardless of place or job, in proportion to his income, and thus obtain with dignity and as a right paid-up medical care benefits at the time of retirement. Vigorous confirmation of the wide public support of the social security approach was given at the recent White House Conference on Aging. This occasion was selected by two former high-ranking officials of the Eisenhower administration, Marion B. Folsom and Arthur Larson, to join publicly the growing number of Republicans, including Governor Rockefeller, who endorse social security financing of medical care for the aged. In a last desperate effort to counter these well-justified demands of the people, the American Medical Association has again launched a vast, expensive public relations campaign. This includes large quantities of shockingly misleading booklets, radio spots, and newspaper ads or paid statements like one from the New York Herald Tribune of April 19, 1961. Typically, this ad claims to present the views of the 180,000 AMA members, claims to report "exactly where we doctors stand on the question of medical aid for the aged." We challenge this claim. The statements in this ad may indeed represent the views of the political and administrative hierarchy of the AMA; but we have too much respect for the physicians of the country to believe they represent the views of a large section of the medical profession; certainly not of those physicians who have given serious consideration to the problem of financing medical care of the aging and have read H.R. 4222. Major evidence that the AMA fails to represent "exactly where we doctors stand" is its obstinate opposition to the inclusion of self-employed physicians under social security. As you may recall from the report sent you in June by the Committee on Social Security for Physicians, a substantial majority of physicians favor social security coverage for themselves, according to 29 State polls by State medical societies and the Honest Ballot Association and according to national polls conducted by Medical Economics, an independent national magazine for physicians. If you wish, I have the report of these polls here to file with you. Mr. KING. Very well. (Document referred to follows:) RESULTS OF POLLS The following is a tally of the 25 social security polls conducted by State medical societies and 4 by the Honest Ballot Association. Dr. BUTLER. Despite this, the house of delegates of the AMA at its June meeting voted 147 to 29 against inclusion under social security declaring that "the traditional philosophical principles of the medical profession are opposed to any expansion of socialistic trends." We challenge the AMA to prove that any substantial number of American physicians believe that the Federal social security system is contrary to the traditional philosophical principles of the medical profession; though to my knowledge the AMA has never disavowed the statement of Dr. Morris Fishbein, on behalf of the AMA board of directors in 1939, which I quote as given in remarks of Representative John D. Dingell in the House April 10, 1961. "A Federal security plan *** will be the first step in the breakdown of American democracy," and "indeed, all forms of security, compulsory security, even against old age, unemployment, represent ***"— here for brevity, I quote only the last of four things "a definite step toward either communism or totalitarianism." We do not believe the AMA spoke for the medical profession 2 years ago when, with much fanfare, it embarked on a reduced-fee program for those over 65 with low incomes, increasing the already heavy burden of charity that many doctors now carry. We do not believe the AMA now speaks for the medical profession in advocating extension of charity medicine to this large segment of the population. And, as I reported recently to the Senate Subcommittee on Antitrust and Monopoly, we do not believe the AMA speaks for the medical profession in opposing the Drug Industry Antitrust Act. It is difficult to establish publicly the extent to which the AMA fails to represent the views of the medical profession or even of its own membership. Physicians hesitate to express opinions that differ from the official ones of the AMA and their State and local medical societies. This results from the vulnerability of most practicing physicians who need the good will of colleagues for a steady flow of referrals, for hospital staff appointments and promotions, and for necessary endorsements for specialty societies and accreditations. Nor can most practicing physicians ignore the attacks on physicians who espouse or join medical care plans which do not conform to the AMA's version of the "traditional philosophical principles of the medical profession." Such attacks even include pressure affecting the social relationships of wives of nonconforming physicians. Some physicians can afford to speak and act freely, but many who do so risk their professional and personal futures. Now, as to the substance of the statements in this ad, we find them generally irrelevant, inaccurate, and misleading. The AMA ad states: We favor a program of medical aid for the aged sensibly designed to help those who need help, that allows millions who can afford it to pay for their own medical care. We submit this AMA statement suggests that the several million aged that may be covered under the AMA-favored program covers the needs of those who need help, and that the majority of the aged can afford to pay for their medical care. We are not economists, but our experience as physicians fully supports the data you undoubtedly have or will receive from others which shows that "those who need help" are a large majority of the aged. They cannot afford to purchase individually the medical care incident to aging at the time of illness and they cannot obtain paid-upon-retirement or other meaningful health insurance coverage. As you know, existing health insurance meets about 25 percent of the private expenditures for medical care by all people; undoubtedly the percentage for the aged is substantially less. We submit that this AMA statement is a gross oversimplification and underestimation of the problem. AMA statement 2: It [the Kerr-Mills law] preserves the quality of medical care, maintaining the patient's freedom of choice and the doctor's freedom to treat his patients in an individual way. As the Kerr-Mills law at the local level is essentially a Federal support of existing public assistance medical care administered by welfare departments, it deals with the prevailing low quality of existing charity medicine, a quality that should not be preserved. We are not saying that individual medical services charity patients receive are uniformly poor; we are saying that charity medicine for a variety of reasons does not assure the prompt, effective, and continuous personalized care that should characterize medical care of a quality that the medical profession wishes to preserve. As to the freedom of choice the AMA wants to maintain in the program they favor, it is restricted to physicians willing to accept welfare patients. It is restricted to physicians willing to accept welfare patients in their private practice or to the assigned physician in a clinic, which is not considered freedom of choice by the AMA. Hence, there is not the freedom of choice the AMA indicates. AMA statement 3: Its benefits are unlimited, with medical aid authorized for any person over 65 who needs help. Although the Kerr-Mills law permits the States to offer a wide range of services to a vaguely defined group, as applied locally, the benefits may be limited and definitions of who needs help are very restrictive. In addition to the detailed information collected by the Senate's Committee on Aging and the Department of HEW on the local effectiveness of the Kerr-Mills programs, we have begun to receive reports from physicians who have not been able to get needed help for medically indigent patients under the Kerr-Mills programs. Thus we feel statement No. 3 is misleading. AMA statement 4: It is now being put into operation in 46 States. We do not understand how any objective person or scientific organization could examine the facts and summarize them in this inaccurate way. Information available to us suggests it is in operation in 18 States as of July 1 and a maximum of 25 States may have programs in effect by January 1962. If our information is out of date, we would like to have it brought up to date. Moreover, some evidence has come to our attention, for example, reports from New York City, which suggests that the program is primarily a mechanism for replacing local expenditures with new State and Federal money. In other words, only a few new aged people are receiving medical care and those receiving it are getting about the same kind of charity medicine they received before. AMA statement 5: It supplements the individual's right to participate in voluntary health insurance programs. The precise meaning of this statement is not clear, although what it suggests seems definitely misleading; for few, if any, of the aged who could afford the high premiums charged by available health insurance plans would be eligible under Kerr-Mills programs. In contrast, social security medical benefits would cover a costly segment of care, thus protecting the person's financial status and might enable him to continue with a supplementary insurance policy. AMA statement 6: It avoids waste of tax dollars, because it's geared to need * does not make Federal dependents out of all the elderly able to meet their own health care expenses. The small percentage who do not need the medical benefit under the King-Anderson bill, for example, will contribute more than the average person and are more likely not to use the benefits. We have a similar situation in the financing of public education that is not considered waste. Rather than avoid waste, the complicated administration of KerrMills programs results in waste of general tax funds. In contrast, no general tax funds are involved in social security and only those who have contributed are eligible for benefits. To stigmatize social security beneficiaries as Federal dependents is inaccurate and misleading. It is like saying that veterans holding Government insurance are dependents because benefits are paid for those who suffered misfortunes soon after becoming insured. So far, the AMA statements relate to why it favors the Kerr-Mills law, which as a welfare measure has many good features. The trouble is the AMA has blown it up beyond reason to stop needed supplementary and other legislation. The AMA statements that follow pertain to why it objects to H.R. 4222. AMA statement 7: We are not crying "wolf" when we apply that term (socialized medicine) to the currently proposed legislation which would establish a compulsory health care program for everyone covered by social security (regardless of need). There are many definitions of socialized medicine, but Representative Forand apparently has been unable to get the AMA to define the term it uses so freely to insinuate something bad and un-American. The King-Anderson bill conforms to the American tradition of people working together through private and public organizations to do things for themselves which they cannot do as individuals. It entails no more compulsion and no more socialization than our public education which we all support, including, I suppose, the AMA. Indeed, our education is more socialized as the teachers are paid salaries and the buildings are owned by government. And our education is more compulsory as all must have it or its equivalent. Blue Cross and Blue Shield and other health insurance plans are socialistic insofar as some people are helping pay the medical bills of others through a social mechanism. Government hospitals, public health services, research projects, financed by Government or private funds, are socialistic in a sense--but they make an important and well accepted contribution to America's outstanding position in medical science and practice. You, as Members of Congress, enjoy this kind of socialized medicine, and it doesn't seem to impair your Americanism. As to this word "compulsory," printed in capital letters, it has too many meanings, and it need not be as calamitous as implied here. Let's remember that our laws, our compulsory laws, reflect the wishes of the majority of the American people as expressed by their democratically elected representatives. AMA statement 8: Moreover, when the Federal Government enters the privacy of the examination room-controlling both standards of practice and choice of practitionerthe cost includes loss of freedom. Your doctor's freedom to treat you in an individual way. Your freedom to choose your own doctor. H.R. 4222, the legislation proposing social security medical benefits, has specific provisions prohibiting interferences in the practice of medicine and the choice of physician. To state the opposite is inac |