If it is true, as certain proponents of this bill have stated, that the purpose of this measure is to extend help to those aged people who cannot, under present circumstances, finance their own medical care, then what possible justification can be offered to explain that the bill would finance the medical cost of all aged people-and this would, of course, cover the extremely wealthy as well as the indigent. We recognize, Mr. Chairman, that there are certain needy people as well as certain people whose marginal income would classify them as near needy. This is, of course, no revelation to doctors. We are extremely proud of the fact that we have been caring for these needy and near-needy people without hope of reward for many, many years. However, this bill goes far beyond extending help to needy and nearneedy people. It completely ignores need as a justification for intervention in the private practice of medicine and proposes to scatter about financial assistance with no regard to the ability or willingness to pay of the great overwhelming majority of our aged population. In the name of humanity, need can justify many things. But, in the name of fiscal responsibility and maintenance of free institutions, need must exist to justify the expenditure of public moneys. In conclusion let me say just this. Public Law 86-778 is an existing, workable public law designed to meet the needs that do exist. It can do the job for caring of needy and near-needy aged people. In addition, it can do the job at far less cost to the American people than H.R. 4222. The Kerr-Mills law deserves a chance to prove itself. It will, in the estimation and judgement of the Medical Association of Georgia, prove worthy of the task. Accordingly, as the appointed spokesman for the doctors of Georgia, I urge you to reject H.R. 4222 as an invalid instrument for the care of our aged needy citizens, and as an instrument inconsistent with the American tradition of self reliance and individual responsibility. The CHAIRMAN. Dr. Mauldin, we thank you, sir, again, for bringing to the committee the thinking of the Medical Association of Georgia. We appreciate your appearance. Mr. DAVIS. I now take a great pleasure in introducing Miss Dana Hudson. She is the other witness from my Congressional District, and is well known in nursing and hospital circles in Atlanta and Georgia, and in nationwide nursing organizations. She is a past president of the Georgia State Nurses Association. She is chairman of the Committee on Legislation for the Georgia State Nurses Association. She was appointed by the Governor of Georgia to the State board of nursing examiners, in which capacity she has rendered outstanding service. She was recently appointed by the Georgia Association for the Aged to a standing committee to approve homes for the aged. She has served for many years actively as director of nurses at the Georgia Baptist Hospital, one of the largest hospitals in Atlanta. The CHAIRMAN. Miss Hudson. Miss Hudson, we are pleased to have you with us today, and you are recognized. STATEMENT OF MISS DANA HUDSON, R.N., CHAIRMAN, COMMITTEE ON LEGISLATION, GEORGIA STATE NURSES ASSOCIATION Miss HUDSON. Thank you, sir. I appreciate the opportunity of appearing here. Mr. Chairman, I wish to express my appreciation to you and the members of this committee for the opportunity of presenting a statement in behalf of the nursing profession in Georgia on H.R. 4222. I am Dana Hudson, R.N., of Atlanta, Ga. I am a registered nurse and I have been in the practice of nursing in Georgia for 30 years. For the past 20 years I have been director of nursing at Georgia Baptist Hospital in Atlanta, Ga. I am a member of the Georgia State Nurses Association and a. member of the American Nurses Association. At the present time, I am chairman, Committee on Legislation, of the Georgia State Nurses Association representing some 3,000 registered nurses in the State of Georgia. It has also been my honor to have been appointed by the Governor of Georgia to the Georgia Commission on Nursing representing a 15-member commission engaged in activities relative to the nursing-care problems in Georgia. I am also a member of the board of examiners of nurses in Georgia which is charged with the responsibility of administering the Nurse Practice Act. For 10 years I have served on the Hospital and Nursing Home Licensure Commission. Also, I am past president of the Georgia State Nurses Association having served in that capacity for 6 years. I have recently been appointed by the Georgia Association of Nursing Homes, on the Accreditation Commission for Nursing Homes, which is being devised to improve nursing home standards of health and nursing care. Therefore, Mr. Chairman, I believe that I am competent to testify on this bill, H.R. 4222. The Georgia State Nurses Association was founded in 1907, as a constituent unit of the American Nurses Association. Its primary purpose is― to elevate and maintain the standards of nursing-to protect the public-as well as to do all other things incident to the nursing profession. To this end, 13 district nurses associations are organized and dedicated to better serve Georgia's people and render better patient care and improved health standards for Georgia. As an allied member of the medical profession, I have observed with great interest the growth of prepaid voluntary health insurance. Ten years ago the medical profession in Georgia, under the leadership of its State organization, set up comprehensive standards for voluntary medical insurance for participating companies. To my knowledge, more than 30 insurance companies embraced these standards. In addition to statewide private insurance coverage, three Blue ShieldBlue Cross plans operate in Georgia providing coverage opportunity for the people of Georgia. Voluntary health insurance in Georgia during the past decade has grown at a tremendous rate. In fact, this one fact alone would seem to make the enactment of H.R. 4222 unnecessary and even unwise. If the growth of health insurance during the next 10 years equals the growth of the past 10-and all signs seem to indicate that the growth will be even greater then Congress should take a long, hard look at any plan which proposes to spend the taxpayer's money when such expenditures can't be justified by circumstance. Of a population of 3,395,116 in December 1959, 2,395,000 were covered by hospitalization insurance in Georgia. This two-thirds coverage of the total population of the State points out with real clarity the fact that most people in Georgia can afford and have availed themselves of hospital insurance. To me, Mr. Chairman, this simply means that voluntary insurance is doing the job and that a substantial majority of the people of Georgia are being relieved of the burden of hospital charges and medical costs. In behalf of the Georgia State Nurses Association, I want to place myself and the members of our association on record as being opposed to H.R. 4222 and any similar type legislation. Thousands of American boys died in two world wars to make the world "safe for democracy." We feel that this bill runs counter to democratic processes and cannot coexist with the democratic principles we believe in. We know if we are to keep with these principles, we will have to oppose this bill to the very end. We do not believe that legislation based on compulsion has any place in our system and because this bill is bedded in compulsion, we shall oppose it. Mr. Chairman, Georgia nurses believe in freedom, not just four freedoms, but freedom as it might apply to all phases of life. This concept has built of America the greatest and wealthiest nation on earth, and we believe further that no greater nation will or can be built apart from this basic principles of freedom-compulsion notwithstanding. Only free people can build-only free people can possess the drive and purpose and the willingness to make the sacrifice necessary to win two World Wars and to finance the rebuilding of nations destroyed by dictators. In my opinion, the inclusion of medical care for the aged under the Social Security Act would make America vulnerable to government by regulatory decree. Nationalized medicine through taxation is the arch of the socialistic state. Once medicine is Government-controlled the free American way of life will pass from the earth. The medical profession is at this moment fighting (and have been for 10 years) a battle to preserve the democratic processes just as real and just as important as was fought on the battle fronts of two World Wars. The American people have in the past and will continue to reject nationalized medicine and we oppose H.R. 4222 because we believe this bill would be an important step in the direction of the complete socialization of our country. Experience has taught us, and facts will bear out, that once a principle is incorporated in a law it is hard to ever eliminate that principle. Also, experience has taught us that regulatory rules prescribed by bureaucrats do in effect become law and there is no end to the number of regulations that may be added. There is a good example of this in Public Law 84-911-passed for the purpose of providing for the further education of professional registered nurses the law provides for scholarships for registered nurses to further their education. However, the advisory committee through the administration of Health, Education, and Welfare has ruled that nurses graduating from diploma programs must finance at least 2 years of education before they have the collegiate background required of candidates for trainee funds. This has cut down the number of registered nurses enrolling in colleges to further their education. This regulatory interference is, in my opinion, destroying and subverting the intent of the law. As a purely practical consideration, Mr. Chairman, we oppose the King bill because 47 percent of our over-age-65 population in Georgia would not be covered. Any legislation which is based on the idea of giving medical aid because such aid cannot be purchased by the individual and at the same time ignoring almost 50 percent of the possible beneficiaries is unsound legislation and would make for equally unsound law. The Georgia State Nurses Association endorsed Public Law 86-778. As nurses, no one knows better than we do that some of our over-age-65 people do have a problem meeting their health needs. However, the problem is not so great that the Kerr-Mills law should not first be given a chance to solve the problem before additional laws are enacted. We believe the Kerr-Mills law can, will, and in some instances, is already meeting our needs. We believe this because it provides(1) Inpatient hospital services. (2) Skilled nursing home services. (4) Outpatient hospital or clinic services. (6) Private duty nursing services. (7) Physical therapy and related services. (8) Dental services. (9) Laboratory and X-ray services. (10) Prescribed drugs, eyeglasses, dentures, and prosthetic de vices. (11) Diagnostic, screening, and preventive services. (12) Any other medical or remedial care recognized under State law. H.R. 4222 does not provide for private duty nursing. In my opinion, this is a discrimination against not only the patients who may need private duty nursing services but is also a discrimination against 44,125 private duty nurses in the United States. Therefore, Mr. Chairman, the Georgia State Nurses Association in good conscience cannot endorse a bill which would discriminate against the second largest section of its membership. Need for a program such as H.R. 4222 has not been established. In the absence of proving that such need does exist, how do the proponents of this legislation propose to justify spending this large sum of money? It would be interesting to know how they intend to justify increasing taxes on low-wage earners since these are presumably the people who sparked this legislation in the first place. Taxing the low-income group to pay for medical care for the wealthy and then saying to them you must provide for the indigent out of what you have left does not make sense. Mr. Chairman, nobody seriously questions the fact that we do have needy people or that we have people who, while they can provide themselves with necessary food, clothing, and shelter, would be hard pressed in the event of a major illness. These are, of course, the near needy. As a practicing nurse, I became aware of these groups many, many years ago. These are the people who need help and they are the ones that the Kerr-Mills law would help. But, Mr. Chairman, H.R. 4222 goes way beyond this. It would give financial assistance collected through taxes, chiefly from the low-wage earners, to those people who can help themselves. It makes no distinction between those who have a problem and the great majority who can finance their own medical care with no serious handicap to their own standard of living. Need and need alone is the only justification for the extension of benefits under a program of this type. But H.R. 4222 would help only those under social security. In closing, Mr. Chairman, let me make this one last point: Public Law 86-778 is already on the books. It is sound, it is logical, and we know it can do the job of caring for our needy citizens and our nearneedy citizens. Its cost to the taxpayers would be considerably less than the cost of H.R. 4222 because it will help only those who need help as opposed to across-the-board-type assistance as H.R. 4222 would provide. The Kerr-Mills law is less than a year old. If Congress thought well enough of it to enact it last summer, then it certainly deserves the chance to prove that it can solve the problem. Thank you again, Mr. Chairman. I want you and the other members of the committee to know how much I appreciate your letting me come here today. The CHAIRMAN. Thank you, Miss Hudson, for your statement and the views that you have expressed to the committee. Mr. DAVIS. Mr. Chairman and gentlemen, I thank you for two things for putting these outstanding citizens on your list of witnesses, and for putting them on the schedule so that they could appear one after the other. The CHAIRMAN. Mr. King? Mr. KING. Miss Hudson, the Georgia Nurses Association is affiliated with the American Nurses Association? Miss HUDSON. That is right. It is a constituent unit. Mr. KING. By what method, Miss Hudson, did the Georgia Nurses Association express its views? Miss HUDSON. In convention assembled. At that time the bill which was discussed was the Forand bill. And then the convention went on record as being opposed to the Forand bill or any type of similar social legislation. Mr. KING. So the association has not convened and determined its wishes with respect to H.R. 4222? Mr. CURTIS. Miss Hudson, of course, your views here are the opposite of these expressed by the national organization. That is true, is it not? Miss HUDSON. That is true; yes. Mr. CURTIS. And what reasons, I might ask, lead your organization to take an opposite viewpoint? Miss HUDSON. Mr. Chairman, as long as 10 years ago, the Georgia nurses recognized this national trend toward socialism, and we began to study, and give attention to this trend. And the Georgia State |