to have information in order to know what we are doing in this field, and if I may, I would like to make this a part of the record at this point.

The CHAIRMAN. Without objection, it will be included in the record. (Mr. Curtis' letter referred to follows:)

Hon. WILBUR D. MILLS,

Chairman, Committee on Ways and Means,
House of Representatives,
Washington, D.C.

HOUSE OF REPRESENTATIVES, Washington, D.C., May 24, 1961.

DEAR MR. CHAIRMAN: This letter pertains to your press release announcing that the Ways and Means Committee would hold hearings on the so-called King bill, H.R. 4222, to provide certain health programs for the aged through the Federal social security program. My purpose in writing to you is in the interest of assuring the availability of maximum information on several relevant issues.

I trust that it is the intention to hold hearings on the entire subject of health care for the aged and not limit them merely to this particular proposal. The press release referred only to the King bill although I realize the release was not a formal notice of a public hearing.

I wish to urge that the following points at issue be investigated by the committee. If the witnesses scheduled to appear before the committee are not in a position to bring sufficient evidence bearing on these points, the committee itself should undertake to gather what evidence there is on the points.

1. What is the actual budget situation of our older citizens? Such a budgetary analysis should not be limited to the one item cost of health care. It should include the other items of the budget as well as the equity ownerships and savings of the aged. There has not to date been an objective and factual congressional study and report made on this matter.

2. What is the actual situation with respect to availability, cost, and adequacy of health facilities for older people; i.e., hospitals, convalescent homes, nursing homes, home care facilities, and skills?

3. What is the actual situation on availability of health insurance and what are the various kinds available to older people; consideration should be given to the quality, the cost of these policies, and the extent to which older people are covered? This study must be as up to date as possible because health insurance for the aged has been one of the most rapidly growing areas in our entire society. 4. What is the situation with respect to provisions in labor-management contracts for health insurance which are not terminated when an employee retires? Information should also be obtained in regard to other types of employment related health protection and care. Inquiry should be made into health insurance of this type which has the payments prepaid by the worker so that he does not pay premiums when he retires.

5. What is the situation relative to quality and availability of health care in the United States compared to some of the other countries where socialized medicine prevails? There has been so much loose talk on the subject that I think it would be well if this committee or designated members thereof go to England and a few of the countries which have adopted compulsory health insurance to learn firsthand the quality of health care the people are receiving.

6. In looking into the aspects of the quality of health care in the United States we must pay attention to research and developments in all aspects of health care to see if we are preserving the climate for continued improvement in all the fields and not just those that deal with geriatrics. In this connection we should examine into the impact that an extensive compulsory medical care program would have on

(1) Hospitals.

(2) Home care.

(3) Nursing homes.

dical

(4) Medical training. (Does the United States offer the best education in the world today so that students come here from abroad as our students once went to Western Europe to get the best medical training?)

(5) Drugs.

(6) Rehabilitation.

(7) Insurance.

76123-61-pt. 1-15

7. If a medical care program is undertaken on a compulsory payroll tax basis, what population groups should be eligible for benefits? What is the incidence of the social security tax?

In making these studies it is of course essential that the information obtained be as comprehensive and as objective as possible. The implications of any proposal for governmentally provided medical care for a large segment of our aged population, regardless of the existence or absence of need, are so serious that the strength of our free enterprise system may depend on the wisdom with which we act. Therefore, I think it important that the Congress not rely solely on the staff of the Department of Health, Education, and Welfare to gather information. Instead, I would suggest that the committee staff be augmented by the temporary employment of four or five knowledgeable persons of professional competence in research and who need not necessarily be technically expert with respect to the OASDI program. These individuals could assist in the preparation and compilation of information for committee consideration.

Sincerely,

THOMAS B. CURTIS.

Mr. CURTIS. One of the things that I thought we needed to know, Mr. Secretary, was the actual budget situation of our older citizens, primarily because what I regard as misrepresentations because of an out-of-context presentation by the Department of Health, Education, and Welfare, and a concentration on one item of the older person's budget, which is health cost. There is no question by age brackets it is higher than for any other age bracket, but so is every other item in an older person's budget less, like rent, like recreation, food, shelter, and clothing, for very obvious reasons. We need to have that in context, so I ask that that be developed.

Second was what is the actual situation with respect to availability, cost, and adequacy of health facilities. There has been some mention of that in here in the two bills that you have mentioned that you are recommending in regard to some facilities, but I think we need to know a little more as to what actually we do have.

I happen to think that facilities is one of our greatest problems in this field.

Third, what is the actual situation on availability of health insurance, and this is something that has to be studied and updated constantly because I have seen nothing in our economy that has been moving as rapidly as health insurance for all our people, including the aged, so even figures of 2 years ago are not adequate to give us the picture today.

I happen to think that the progress made in that area has been remarkable. I tried to direct your attention through a letter, and also by putting it in the Congressional Record, what your State of Connecticut did in this area, which I thought was great, in permitting the insurance companies to pool so that they could offer health insurance for people over 65 at reasonable cost. I would have thought that the Department of Health, Education, and Welfare would have hailed that as a fine step forward, but at least we need to get that information on the record here.

(The following material was filed with the committee:)

CONNECTICUT MAJOR MEDICAL PLAN FOR AGED PERSONS

Legislation permitting any or all the insurance companies doing a health insurance business in Connecticut to join together to offer insurance through which and Connecticut resident 65 or older can buy mjaor medical coverage for himself and his spouse was signed into law in May. Sponsored by the insurance companies, it allows them to experiment in pooling their experience and under

writing capacities, operating a program where any excess of premiums over losses, expenses, and a small risk charge will be used for the benefit of the people insured. Six major insurance companies took part in the active planning of the proposal.

As reported in the Eastern Underwriter, May 12, 1961, at the time the bill was passed, the companies, banded together in a voluntary association, planned to offer two major medical options, one with a $5,000 and one with a $10,000 maximum lifetime benefit. Any Connecticut resident aged 65 or over would be eligible to particpate in the plan if he had not been in a hospital or similar institution within the 31 days immediately preceding his enrollment. The monthly cost would be $7.50 for the low option and $10 for the high option, for those who already have basic hospital and surgical insurance. For those without such insurance, the monthly cost would be $14.50 for basic insurance and the low option plan and $17 for basic insurance and the high option plan. Thus, the high option plan and basic insurance would cost $204 person per year.

Mr. CURTIS. Fourth, what is the situation with respect to provisions in labor-management contracts for health insurance which are not terminated when an employee retires, and this involves this prepayment situation, which incidentally, is the one aspect and the only one, in the use of the social security system that seems to me to be meritorious. But I know nothing unique about the social security system over the private insurance system that allows it to have a prepayment situation.

It can be done and is being done in the private sector and is being done in labor-management contracts today.

Fifth, what is the situation relative to quality and availability of health care in the United States compared to some other countries where socialized medicine prevails?

Sixth, in looking into the aspects of the quality of health care in the United States we must pay attention to research and developments in all aspects of health care to see if we are preserving the climate for continued improvement in all the fields and not just those that deal with geriatrics.

Then I listed several other items and I am satisfied this committee is going to have to get those answers.

Now, I would like to ask a general question. Is it your judgment that we in the United States today have the greatest health care program of any society in the world, or do you contest that?

Secretary RIBICOFF. I think there is no nation that has health serv ice comparable in quality to that of the United States of America. Mr. CURTIS. That is my judgment, too. Let me say this: That, of course, the people who contribute the most to that are the very people that are in the health field, our doctors, our hospital people, our nurses, our drug companies, all the people dealing in this health field, and I surely believe that they are deeply concerned about continuing the quality of health care in our country.

I have been distressed to see this public abuse that has been heaped upon them. I have criticized them for a lot of things, but I like to criticize them in context, that is, in context that they overall have done such a tremendous job that they have extended the life span of our people 10 to 15 years, and that is the very thing that has created the problem here, the success of the system, not its failure.

Secretary RIBICOFF. While that is correct, Congressman Curtis, much of this research has been done by funds that you people have voted to NIH. Many of the funds have been used in the university and medical centers. It would be very interesting to see a survey

taken of the researchers in medicine who give of themselves for the benefit of all mankind and society to see whether they would be for this program and against the practitioners of the AMA.

Mr. CURTIS. I do not know whether they would know the facts. I am not dealing in epithets and I wish we would get away from them. Why do you try to set one group of people against another, Mr. Secretary? We are concerned, or at least I hope we are, about what the facts are. A person can have all the good will in the world and propose a program that is very poor, and that is what disturbs me. I understand, Mr. Secretary, you have to leave. There is one comment I have, but I would want to continue the interrogation afterward, and that is with regard to the Gallup poll. I saw that and I thought it was so disgraceful that I put it in the Congressional Record along with some comments, because it did the very thing that you, Mr. Secretary, accused the AMA of doing.

The question asked, and it was a limited one, as to whether or not you would be in favor of the medical care insurance, and what is proposed here is not medical care insurance, by proper definition. Medical care usually refers to primarily the doctors' costs and physicians' costs. There, indeed, has been a lot of misinformation given to the public from all sectors, and this committee has a job of trying to get out not what people have said, but how best we can determine the truth of the matter so that we can legislate intelligently. I would be happy to continue this later.

The CHAIRMAN. Mr. Secretary, will it be possible for you to return at 2 o'clock this afternoon?

Secretary RIBICOFF. It certainly will, Mr. Chairman.

The CHAIRMAN. Without objection, the committee will adjourn until 2 o'clock this afternoon.

(Whereupon, at 11:45 a.m., the committee recessed, to reconvene at 2 p.m., the same day.)

AFTERNOON SESSION

(The committee reconvened at 2 p.m., Hon. Wilbur D. Mills, chairman of the committee, presiding.)

The CHAIRMAN. The committee will please be in order.

Mr. Curtis will resume his questioning.

Mr. CURTIS. Mr. Secretary, I am interested in developing to some degree some of the arguments that have been advanced as to why certain people feel that this program that you are advocating could lead to socialized medicine.

There was a remark that you made right at the close of your paper, where you were saying that we faced some of these problems 25 years ago, and

We chose, as our basic solution then, a system of social insurance, under which the people, with their employers, would build their own old-age security while working by paying social security contributions into special funds from which payments would be made to them when they were no longer working. Now, after 25 years, few would question the wisdom of the decision made by your predecessor committee.

I

I think many of us are questioning the wisdom of that decision. put in the record about 2 or 3 months ago a speech I gave on that subject, pointing out that social security now has about reached one

third of its maturity, and it is very dangerous to assume that a program that has only gone that far in development is as sound as we all hoped it would be. And the one area which I questioned in particular was the compulsory aspect of it. I think even there we are certainly concerned, and I know I am concerned, about the retirement provisions of our people.

Now, the arguments, as I understand, that have been advanced by AMA and others-and I must say that I share them-as to why there is danger of socialized medicine in the approach you take, is because of its compulsory aspect. That is the basis of it.

I was disturbed to hear you say you thought the Mills-Kerr Act was more socialistic than the present program.

Secretary RIBICOFF. This is not socialistic; neither was the KerrMills legislation socialistic. My feeling is that the Kerr-Mills legislation is here to stay. The Kerr-Mills concept is a good concept as long as it is used as a supplement. My feeling is that Kerr-Mills will become a problem if you expect the entire health care costs of the aged to be met under Kerr-Mills.

Mr. CURTIS. That was never its intention. It was very definitely limited to the needy or those who might become indigent because of health cause. So you identify a group; and therefore it does not have the compulsory aspect.

Secretary RIBICOFF. The point I make about Kerr-Mills is that since we have got a basic health problem that does not affect just the indigent, and since the Kerr-Mills plan is written in such a way that it is up to the States to write the formula, Kerr-Mills can be a vehicle under which you are trying to do the basic health job.

And what bothers me about Kerr-Mills if it tried to do the whole job would be having the entire cost borne out of general revenues instead of through a contributory program.

But I would like to make this clear for the record, that if and when Congress passes the plan for meeting health care costs for the aged under social security, I would not advocate the repeal of KerrMills. The Kerr-Mills approach is a valuable instrument to supplement the social security approach.

There could be cases where catastrophic illness would go far beyond the benefits that we advocate in the King bill. And I foresee the necessity of an instrument like the Kerr-Mills plan coming in and taking up the difference.

I would say that the Kerr-Mills plan has a place in our overall health care picture, sir.

Mr. CURTIS. The point I want to drive home is that I do not believe the Kerr-Mills bill ever was written as a base for health care for the aged or any group in our society. As a matter of fact, my approach is that the basic program, health program, in our society is in the private sector. And that is what really disturbs me about the approach of your Department, coming in here, in my judgment, not having analyzed what our present health care program is in detail, so that you know where its strengths and weaknesses are, but coming in and in effect substituting a basic plan in law, which I think is the social security approach for all people, and on a compulsory basis. There is no choice in the proposal which you present, is there?