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Hospital Governing Boards, Georgia Dental Association, and other organizations. As a result of this activity, proposed legislation for introduction to the Georgia General Assembly was drafted to provide a statewide program of health care assistance for all indigent patients to be financed by a joint State-county matching fund. The medical association then sponsored this health indigent care bill, declaring publicly that none of the moneys for such a program should be used for payment of physician services-as such indigent care would be furnished without charge by doctors of medicine.

This health indigent care bill was enacted into law by the general assembly and is presently under consideration by the State and county fiscal authorities for implementation. It is my belief that as soon as the necessary administrative machinery can be provided and funds become available for this program, it will be activated forthwith.

The Medical Association of Georgia just 2 years ago assisted the Governor in the preparation of mental health legislation providing for new and numerous programs financed by the State for the care of the mentally ill. Some five separate pieces of legislation were enacted and fully implemented with State funds as a result of this activity.

I specifically mention these two examples of legislative activity because they have a direct bearing on medical assistance for the aged in that our older citizens will receive benefit from both these measures-and these examples emphasize that Georgia is responsive to the health needs of her people.

Our association 2 years ago had the opportunity to submit testimony to this same committee in opposition to H.R. 4700-yet subsequently all the doctors of Georgia endorsed, supported, and vigorously campaigned for the Kerr-Mills bill which was later enacted as Public Law 86-778. I point this out to clearly indicate that our association supports medical assistance for the aged under those circumstances which would allow our State to meet its obligation to our indigent elder people and direct such programs for maximum benefit of the recipient.

Immediately after the enactment of the Kerr-Mills legislation, our association asked the Governor of the State of Georgia to appoint a study committee to draft enabling legislation for introduction at the 1961 session of the general assembly so that Georgia could initiate its medical assistance for the aged program under the provisions of Public Law 86–778.

Governor Vandiver did appoint such a study committee; enabling legislation was introduced at the 1961 Georgia General Assembly; and after an intensive information campaign led by the Medical Association of Georgia, such enabling legislation was enacted and signed into law by the Governor.

This activity again clearly indicates the desire of the doctors of Georgia in support of medical assistance for the aged. Governor Vandiver has twice publicly stated that funds will be made available for matching Federal grants under the provisions of the KerrMills law. Our State welfare department has been so instructed by the Governor and Georgia will meet this obligation to her indigent and semi-indigent senior citizens. Governor Vandiver is presently scheduled to make a public announcement on this matter on August 8, just 7 days from now.

Gentlemen, let me again restate that the legislative record of the Medical Association of Georgia is clear. Our governing body representing the physicians of Georgia has taken repeated action to insure adequate medical care for the residents of our State. The health indigent care law, mental health laws, and implementation of KerrMills-all of these programs initiated and supported by the medical profession certainly are evidence of medical assistance for the aged.

In the interests of brevity, I wish to merely list other ancillary activities undertaken by our association in the field of health care of the aged. The medical association organized the Georgia Joint Council To Improve the Health Care of the Aged comprised of representatives of our association, the Georgia Dental Association, the Georgia Hospital Association, and the Georgia Association of Nursing Homes. Suffice to say this active organization has undertaken numerous projects in improving the health care of the aged. Most noteworthy is an activity under consideration by the Georgia Hospital-Medical Council. This organization comprised of physicians, hospital administrators, governing board trustees of hospitals, State department of health officials, and so forth, presently operates a smaller hospital (under 25 beds) accreditation program. In cooperation with the Georgia Association of Nursing Homes, an accreditation program for nursing homes is being devised to improve nursing home standards of health

care.

Each of the 70 component county medical societies of our association have a committee of physicians on health care of the aged. These committees work on local health care problems with State health and welfare service people; with their local hospitals; with senior citizens clubs, and so forth. The association also had the privilege of having a representative serve on the Governor's commission on aging and being so represented at the White House Conference on Aging. The Medical Association of Georgia is on public record as stating that no person in Georgia shall be denied necessary physician care because of their inability to pay for such care. I firmly believe this tenet of our profession has been carried out in Georgia.

Another field of endeavor undertaken by the Medical Association of Georgia concerns voluntary prepayment insurance plans for health care. In 1951 the medical association instituted a set of comprehensive standards of insurance including participating physicians' services and guarantees of full "doctor bill" coverage for persons within certain income limits. Our association recognized the need for easing the financial responsibility of patients in lower income brackets. The plan is presently being underwritten by approximately 31 major insurance carriers. Georgia has three Blue Cross-Blue Shield plans covering the State and the largest of these three plans has instituted "service coverage" for both inpatient and outpatient medical procedures. The association's component county medical societies cooperate and participate in these plans.

The medical association has been active in participation with other members of the Georgia Health Insurance Council in promoting the growth of low-cost voluntary health insurance based on various types of prepayment plans. We have not felt that an arbitrary age limit of 65 years old should be used as an index of eligibility but rather have supported those insurance plans that include both young and old alike. Many of these plans are available in Georgia, either on a group

basis convertible to individual coverage after retirement or on individual basis regardless of age.

The growth of private medical insurance in Georgia during the past 10 years has been spectacular and represents the kind of progress in this field which renders H.R. 4222 totally unnecessary at this time. Indeed, if similar progress is made in the extension of coverage over the next decade, and there is every reason to believe that it will be greater, then there can be no justification for the outlay of such large sums of public money as the enactment of this bill would require.

The 1960 census in Georgia reveals a 14.5-percent increase in total population. In actual numbers this is a growth of slightly less than a half million people. However, accompanying this 14.5-percent population growth was a 116-percent increase in the number of persons covered by private hospitalization insurance during the period 1951-59. These figures were furnished by the Actuarial Department of the Life Insurance Company of Georgia and verified by the Health Insurance Council, a New York-based association.

The latest available figures which are of December 31, 1959, indicate that there were 2,395,000 people covered by hospitalization insurance in Georgia. This is slightly in excess of 60 percent of the total population of the State which is 3,943,116 (1960 census). This hospitalization coverage figure is up by 1,286,000 over the total coverage figure for December 31, 1951.

This tremendous increase in coverage reflects the popularity and availability of private insurance at rates well within limits that the majority of Georgia people can afford. It is, in fact, ample proof that private insurance, free enterprise if you will, can and is doing the job of easing the burden of medical and hospital care cost for the majority of the people in Georgia.

In Georgia we have 411,000 veterans of the armed services-more than 10 percent of the total population-many of whom are eligible to receive inpatient and outpatent hospital treatment, medical benefits, drugs, and domiciliary care under programs promulgated by and financed by the Federal Government. At the present time we have approximately 3,700 hospitalized and domiciled veterans in Georgia. In addition, we have another 40,109 veterans receiving outpatient treatment from VA clinics and another 16,849 receiving treatment. from fee base physicians. This brings to a total approximately 60,658 veterans receiving some type of medical aid in Georgia.

In addition to this as of March 31, 1961, there were 55,635 civil service employees in Georgia, the great majority of whom qualify for medical and hospital insurance under Public Law 86-382, the Federal Employees Health Benefits Act, which became effective in July 1960. This insurance covers not only those civil service workers actively employed by the Federal Government, but is also carried over to civil service retirees who left the Federal service after the enactment of this program. Retirees from the Federal service have conversion and continuation rights which do not require evidence of insurability as a condition of coverage. In this instance neither age nor condition of health is a determining factor.

In addition, under the provisions of Public Law 86-724, effective July 1, 1961, retired civil service employee and survivor annuitants are eligible for medical and hospital insurance. In Georgia, as of June 30, 1960, there were 9,156 such retired employees and survive

annuitants. According to the fifth regional office of the Civil Service Commission in Atlanta, approximately 90 percent of these people would be eligible for this insurance coverage.

Under Public Law 84-569, the so-called medicare program, 7,723 claims were processed and paid during the calendar year 1960 in Georgia. In dollars and cents this represents a cash outlay of $642,990.01. This program is, of course, for the benefit of dependents of active duty servicemen. It is not applicable after retirement. However, it does provide us with an index of the extent to which medical care will remain available for service personnel retirees and their retirement from active service. The above figures were furnished by the administrator of the medicare program in Georgia.

These last three programs I have mentioned have no direct bearing on the bill under consideration by this Committee. However, as the veterans of Georgia reach age 65 many will have their medical needs met by a continuation of existing programs; as civil service retirees reach age 65 they are eligible to continue their coverage under the Federal Employees Health Benefits Act; and, as service personnel retire from active duty, they and their dependents will have their medical requirements met under the provisions of sections 1071-1085 of the United States Code. This information was supplied by the Adjutant General's office, 3d U.S. Army. It would appear then, Mr. Chairman, that the people covered by these last three programs would have their medical needs accommodated in such a manner as to negate the effect of hospital and medical cost either now or in their old age. Statistically, Mr. Chairman, the picture of Georgia's ability to provide for its own medical care is not one that indicates any need for the enactment of H.R. 4222. In fact, just the opposite is true. For this reason. I appear here today as the spokesman for the Medical Association of Georgia to urge you gentlemen to reject this bill.

In behalf of our association I want to place the doctors of Georgia squarely on record as being thoroughly opposed to the enactment of this legislation. We feel that if we are to keep faith with our individual code, indeed, if we are to keen faith with those individual principles which distinguish the United States from the balance of the world, we must oppose this bill on both philosophical and practical grounds.

As free citizens dedicated to the continuation of free institutions we soundly reject any legislation proposal based on compulsion. As physicians who have taken our pledge to provide to all who seek it, the very best possible medical care, regardless of ability to navy, we reject any plan which would place the Federal Government between ourselves and our patients.

I do not come armed with statistical data to support the widely known fact that doctors render annually many millions of dollars of medical service for which there is neither hope nor expectation of being paid. It would perhaps be rhetorical for me to recite such statistics were they available. Suffice it to say that in Georgia medical attention is given where medical need exists. The care and treatment of our patient is our paramount concern and we view with equal standing those who can pay and those who cannot.

Mr. Chairman, in Georgia we believe as a matter of principle, that the closer to home that a government is the more accurately it reflects the feelings of the people and the more responsive it is to their wishes.

I have no desire to revive the ancient rivalries between the Federal Government and the rights of the States from which all power in this country sprang. I would like to point out however, that to control a program as vast as this bill envisions would, in the opinion of the Medical Association of Georgia, entail regulations so detailed and so exacting as to seriously jeopardize the quality of medical care in this country. We submit that it would be impossible to maintain high standards of medical care where both the recipients and the vendors of services are remote from the seat of authority and control. Bureaucratic regulation can never replace sound local control nor can administrative directive supplant the wisdom of local people administering to a local program.

When the doctors of Georgia endorsed the idea of the Kerr-Mills bill they were subscribing to the theory that local jurisdiction is more responsive, more efficient, and in the long run less expensive. We feel that authority should be vested first in the lowest level of government and should be extended to the next highest level only when it has proven that the job cannot be handled at the lowest level. Specifically, we question the wisdom of permitting the State to perform any governmental function which could be performed by the county. By the same token we reject the idea that the Federal Government can perform the task of providing medical assistance to the aged in a manner comparable to that in which the States could perform the same task.

As the duly elected representatives of all the people of Georgia, the House of Representatives of the Georgia General Assembly just last year adopted a resolution stating its deliberate and determined opposition to the use of the social security mechanism as a method of financing medical care for our aged population.

Among other provisos of this resolution, H.R. 538, it was resolved that "this house hereby expresses its opposition to Federal legislation designed to increase social security taxes by encroaching on the legitimate and most effective function of the community in caring for its own problems of the health care of the aged." A copy of this resolution was mailed to the members of the Ways and Means Committee following adoption by the General Assembly of the State of Georgia.

By endorsing Public Law 86-778, or the Kerr-Mills law, we have publicly recognized the existence of the problem which some of our older citizens faced. However, this frank recognition that some of our senior citizens do have a problem in meeting the cost of their health needs, in no way suggests that the problem is so widespread or so acute as to justify the enactment of additional legislation without first giving the Kerr-Mills law a chance to solve the problem.

There has been no demonstrated need for such a program as H.R. 4222 would establish. Aside from the philosophical concept that the Federal Government has no legitimate right to embark on such a program there is a very practical consideration to be reckoned with, which is the justification for spending huge sums of money raised through increased taxation at a time when this would seem ill advised and unwarranted. It is particularly hard to understand the fact that this bill proposes to increase taxes of low-wage earners whose inability to pay is cited as the reason for this legislation in the first place.

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