Mr. KING. Does that complete your statement, Mr. Blackburn? Mr. BLACKBURN. Yes, sir.

Mr. KING. The committee appreciates your giving us the benefit of your organization's views. Are there any questions?

Mr. Curtis? Mr. Curtis will inquire.

Mr. CURTIS. First, let me thank you for your statement and also for bringing these case histories because those are quite important and give us, just as you say, examples.

One observation. I have gone over these very rapidly as you were giving your main paper and in each instance each one of these people is receiving care now, and the problem is whether we can improve the system. Is that not a fair statement?

Mr. BLACKBURN. Most of them, I believe, are getting social insur

ance.

Mr. CURTIS. Now here is the statement that has been made to get this whole problem in context: Are there people in the United States today who are not receiving or could not receive medical care if their situation was called to the attention of the proper authorities? I have always maintained after issuing that challenge a number of times that that was not a true statement and here you have given us a number of examples of cases that are real problems, and I agree, but in each one of these they are getting health care.

Mr. BLACKBURN. I do not think they are.

Mr. CURTIS. Well, is there anyone here who is not getting it?

Mr. BLACKBURN. I do not see why these people have come to the agency if they are getting health care.

Mr. CURTIS. The point is your agency is giving it to them. I am not saying how, I am saying they are receiving it; that is all.

Mr. BLACKBURN. Our agency, sir, is a voluntary agency that really does not have the finances to give medical care. These people come to us, but we have an extremely hard time finding money to give them.

Mr. CURTIS. I know. We all have that. The point is there is no one here that is going medically destitute. In every one of these cases you have a physician in attendance. Some of them you say are getting free nursing home care and this and that. In other words, each one of these cases is presented as a problem, and I agree with you they are, of how we could improve our system, but each one in itself almost proves the point that I have constantly made, that we are taking care of them.

The question is, Can we improve that system? It becomes quite a different problem if you are talking about improving the system as opposed to one where the impression is created that we have many people who are not receiving health care.

Do you get what I am driving at?

Mr. BLACKBURN. I think so. I think a great deal of it is a matter of improvement.

Mr. CURTIS. You see, so much of the testimony and particularly the loose statements that go around are that there are people in this country who are not getting health care. If we get that in context, then we can approach the question with a great deal more ease, because in a number of these instances the King bill will not help at all. I notice some of these have dependents who would not be covered under the King bill, people that are under 65, one of them with a retarded son, and a daughter with a mental condition. That is one of the prob

lems in the King bill, that it limits it to a certain group on social security insurance, those over 65.

The disabled are not included. The dependents of a social security beneficiary are not included. There are a third of the people who probably need it the most who are on old-age assistance because social security had not come in in time for them to have been covered and they will not be included. So just by taking the case histories you have given us, we see how limited the King bill is.

I am not advancing that as an argument for or against the King bill. I am laying this groundwork, that there are many of us who feel that we must look at the King bill as a beginning, and therefore, the beginning of what we say will be the ultimate development, if we take this method through the social security insurance program of caring for them.

Can we limit it to just hospitals and private nursing? Do we not have to extend it to include doctors, as many of the proponents really want it to? Do we not have to extend it as time goes on to the disabled on social security? Do you follow what I am saying?

I think these case histories you give us drive that point home very forcefully, and so in considering this legislation I think we rightfully have to consider what it will lead to logically, and then come back and try to review the problem to see whether there are other ways of meeting it. Do you follow me?

Mr. BLACKBURN. It would seem to me what we need is the King bill plus the Kerr-Mills that we already have. Those two together, I think, would then do a good job.

Mr. CURTIS. I wonder if they would, because one of the greatest needs, I think, we have today is catastrophic health insurance.

The King bill is not that. I do not know what is going to happen. to these people, if the King bill becomes law, who had a catastrophic illness that would run into $10,000 or $15,000 medical and hospital bills, because the King bill benefits terminate. Yet in the private sector we are beginning to develop these catastrophic health policies and I think the premiums are within reason, and also for many of these people, these sons and daughters here, I think if they would look into the health insurance that is available for the older people today, they would find that these premiums are not beyond their means, premiums of $120, $150 a year, to take care of many of these cases that are cited here.

Mr. BLACKBURN. Most of these cases that are cited, sir, are living on social insurance and I think most of them would not be able to pay premiums.

Mr. CURTIS. No; you said their sons and daughters.

In one case you give us you have a granddaughter involved and in most cases you have relatives, and the problem that you present us, and it is a real one and a proper one to present, is the burden that is placed upon a married son and daughter who have their own families to care for and yet, they are contributing; and many of the insurance companies in their testimony pointed out that they felt that one of the appeals for taking out insurance for older people would be to the sons and daughters of those older people, and it would be very good economics for them to do it.

Mr. KING. Will you yield?

Mr. CURTIS. Yes, I yield to you.

Mr. KING. I would think, Mr. Curtis, that you have not paid attention to some of the detractors of this King proposal. They claim that this is only a foot in the door and that eventually we are going to cover everybody and everything.

Mr. CURTIS. Yes.

Mr. KING. You are evidentally not believing them because you are apprehensive about the ones that the present bill will omit from

coverage.

Mr. CURTIS. The gentleman misses the point.

I am apprehensive. That is why I am pointing it out. I am saying that the King bill is limited in this way and I have been trying to explore the logic that would prevent us, if we adopted the King bill, from extending it to these other groups, because I cannot see that there is any logic that should distinguish between a person over 65 who is on social security, and a person who is disabled who is on social security. In fact, the person who is disabled and receiving disability insurance almost by definition is one who is going to have high medical bills.

Mr. KING. You do not believe, then, many of the witnesses who say that we intend eventually, and as soon as we can, to cover everything? Mr. CURTIS. Yes, I do. I think that is the purpose.

I think that the people who are promoting that very definitely have that in mind. Some of them have said so publicly and I am sure that they have that in mind.

Therefore, I think we in Congress and this committee in considering this legislation must consider what it leads to, and it may lead to a perfectly proper thing, but that is the basis on which many people have felt that it is a foot in the door toward socialized medicine. That is the reason I raise the point now and do thank you very much for bringing these cases before us.

The one final comment I would like to make is this. As I pointed out to other witnesses, I think we have two problems. One is the problem of people who are over 65 now who are living 10 or 15 years longer than anyone anticipated, because of the success of our health system, and who did not have available during their working years the health insurance policies that now are available. Those people will phase out, of course. That still is a real problem, and I think that is largely the problem of these cases here.

The second problem, which is equally important, is the problem of people who in the future are going to become 65 and whether or not. our health insurance programs and health facilities will be such that they will have adequate care and have the financial ability to meet these. That is the long-term program.

I think by confusing the two we might hurt in trying to reach the proper solution for each. For the first problem, I think, the KerrMills bill was the right approach. The discussion here is for the second problem of whether or not we need a social security insurance program to prevent the people who are 65 in the future from being without health insurance. That requires a study into the health insurance programs that are available, and when we get into that area and see what is being done, and also know that we have prepaid insurance policies, prepaid policies at 65, which are now available to our younger people. I doubt very much if we will ever again have a

problem such as we have now of our over 65. In fact, I think we will

STATEMENT OF HON. WILLIAM H. MILLIKEN, JR., A REPRESENTATIVE IN CONGRESS FROM THE STATE OF PENNSYLVANIA

Mr. MILLIKEN. Mr. Chairman, I would like to present to the committee one of my constituents, Robert Abrams, who represents the College of Apothecaries. He is also a professor in the Philadelphia College of Pharmacy, and he is here to testify about the King bill this afternoon.

STATEMENT OF ROBERT E. ABRAMS, B. Sc., M. Sc., AMERICAN COLLEGE OF APOTHECARIES

Mr. ABRAMS. Mr. Chairman and members of the committee, I am Robert E. Abrams and I am appearing here today as the executive secretary of the American College of Apothecaries, an association of prescription pharmacists throughout the United States, an affiliate of the American Pharmaceutical Association with headquarters in Philadelphia, Pa. I am also professor of pharmacy administration at the Philadelphia College of Pharmacy and Science.

The American College of Apothecaries, has for some time been concerned with the problem of adequate health care for the aged citizens of our country as well as with the health care of citizens in all age groups, particularly but not exclusively, as it involves the use of pharmaceutical services and the important drugs which are part of the services. Numerous committees of our association, both`national and local have given much study to the area and translated to some degree, these studies into positive action.

After careful consideration and study, our association must register its opposition to H.R. 4222 for we are convinced that the bill would not provide the type of medical care truly needed by the aged today and in most instances would not provide it to those who are in actual need. In addition we cannot concur with the establishment of such a broad and potentially expensive program of Government assistance to a large group of persons when current efforts and programs have not been given adequate time to demonstrate what they can accomplish in this area.

We are not convinced that H.R. 4222 and the mechanism it provides is necessary. In January of 1960, 49 percent of those over 65, or about 7.7 million persons, had some form of health insurance. The number is increasing. Another substantial segment were receiving assistance through existing programs. The so-called Kerr-Mills bill (title VI, Public Law 86-778) passed by our last Congress, has not been given an opportunity to become completely operable. It is already providing assistance to some and will provide it to more. At least 8 States have programs in effect; 12 have enacted legislation; while at least 20 other States have such legislation under consideration which is truly an amazing record of action in so brief a period of time.

Our association wholeheartedly endorsed the Kerr-Mills approach and our individual fellows throughout the United States have lent their assistance in stimulating its implementation in their respective States. This approach we believe is a more sound one since it provides assistance on the only basis that a country such as ours should provide, namely, to those who need it. In addition, it authorizes the financing of complete medical care without limitation thus overcoming one of our specific and primary objections to H.R. 4222. We are not convinced that the real need of the needy aged is for hospital and nursing home facilities. Needed much more are the regular visits by physicians and the pharmaceutical service which many require. These are not provided by H.R. 4222.

The cost of implementing H.R. 4222 we believe would far exceed the estimates quoted and its provisions would lead to a serious overcrowding of existing hospital facilities requiring additional and expensive building of hospital facilities when in effect such facilities would not really be needed. Also an entirely new and expensive administrative procedure would have to be established in lieu of the Kerr-Mills approach which utilizes existing State mechanisms for its administration.

We are also opposed to the method which is proposed to finance the program under H.R. 4222 for it would add an additionally large burden on the low income worker and his family and his tax burden currently is one which we believe cannot stand such an increase, if our standard of living is to be maintained and even increased. If there is a real need, then such need should be met by general revenues and not by extension of the social security program and the introduction of an entirely new concept into this worthwhile program which could threaten its primary purpose. Social security was established to provide dollars to people who were no longer employed so that they might purchase the things they need and maintain their self-respect. It was not intended to replace individual judgment by Government judgment and provide services which people could and should provide for themselves. We hope it will be maintained that way.

Historically the pharmaceutical profession as well as the medical profession has seen to it that no person really needing their services has gone without such services. A mechanism has been in existence for a long time whereby when a physician encounters a patient who may not be in a position to afford the complete cost of the pharmaceutical service he so designates by a code on the prescription and the pharmacist will provide his services at reduced or no costs. This has gone on and will continue as a practice.

Over the past years programs have been established such as the program in St. Louis where the medical society and pharmacists, fellows of the American College of Apothecaries have joined in a program of providing medical and pharmaceutical services at reduced fees on the basis of need of the aged citizen. Here I submit an article from the St. Louis Post-Dispatch, which describes this service in detail.