Mr. MACHROWICZ. And does it not also say that a person cannot get hospital care under the bill unless his doctor prescribes hospital care and the amount of such care? Dr. SEIGLE. That is also correct. Mr. MACHROWICZ. Then what is this that you are telling us here? Dr. SEIGLE. What the bill offers to people is payment for hospitalization. When pressure is applied, when such an opportunity is held out before them, this pressure is transmitted by them, their relatives, to the doctor. This makes the doctor the stop man who puts up his hand and says, "No, you may not go into the hospital." When the patient says, "I want to go to the hospital," and his relatives say, "Why don't you put papa in a hospital," it is a difficult situation. We see it with private insurance and we would with something of this sort. Mr. MACHROWICZ. Under the Blue Cross plan the doctor also has to determine whether or not the patient goes to the hospital. Dr. SEIGLE. That is correct. Mr. MACHROWICZ. Do you oppose Blue Cross plan for the same reasons you are opposing this? Dr. SEIGLE. No, sir. Mr. MACHROWICZ. Why not? Dr. SEIGLE. I favor means of encouraging people to seek care outside of the hospital. Mr. MACHROWICZ. What is there in this bill which would discourage this? Cannot doctors tell their patients, "You do not need hospital care. I can give you care in my office." Dr. SEIGLE. I think he certainly could, but I am not sure that he can make the patient accept this. Mr. MACHROWICZ. He has to accept it; does he not, under the bill? Dr. SEIGLE. He does or he looks elsewhere to try and find somebody who will say, "No, I think you ought to go to the hospital." Mr. MACHROWICZ. Are you telling us that you do not have enough confidence in the doctors using their judgment in determining whether or not these people would go to the hospital? Dr. SEIGLE. Sir, I am only saying that economic pressures are potent ones. Mr. MACHROWICZ. Pressures against whom? Pressures against the doctor? Dr. SEIGLE. By people and directed against doctors. Yes, I should say. Mr. MACHROWICZ. Do you feel that the doctors are not able to withstand the economic pressures that may be put against them and may determine that persons should go to hospitals although in their opinion they should not go? Dr. SEIGLE. All I can say is that it is Mr. MACHROWICZ. Am I correct in that? Dr. SEIGLE. It is a difficult problem which you pose to the doctor. Mr. MACHROWICZ. I can only say that I have a lot more confidence in our medical profession than evidently you have. You complain about the fact that the Blue Cross has increased the utilization of hospitals; is that correct? Dr. SEIGLE. I did not say that. But I think I would agree that hospital oriented insurance does tend to increase utilization of hospitals. Mr. MACHROWIcz. It does, and so does the Blue Cross plan, and I agree with you. I want to ask you this, Doctor. Do you feel that increased utilization of hospitals is necessarily a bad thing? Dr. SEIGLE. No, sir. Mr. MACHROWICZ. There is nothing bad about the fact that either under the Blue Cross plan or under this bill, more people will avail themselves of hospital care if they really need it. Dr. SEIGLE. No, I have no objection to that at all. Mr. MACHROWICZ. And the bill does not intend to do anything else; does it? Dr. SEIGLE. No, sir. Mr. MACHROWICZ. The bill says that no one can get hospital care unless your own profession, the doctors, determine that such hospital care is needed. Am I correct? Dr. SEIGLE. That is correct. Mr. MACHROWICZ. That is all. Mr. BOGGS. Mr. Betts? Mr. BETTS. No questions. Mr. BOGGS. Mr. Schneebeli? Mr. SCHNEEBELI. I have no questions. Mr. GREEN. No questions. Mr. BOGGS. Thank you very much, doctor. Our next witness is Mr. Guy F. Fain, grand president, National Assoication of Retired & Veteran Railway Employees. STATEMENT OF GUY F. FAIN, GRAND PRESIDENT, NATIONAL ASSOCIATION OF RETIRED & VETERAN RAILWAY EMPLOYEES Mr. FAIN. Thank you, Mr. Chairman. I want to apologize for the mistake my stenographer made on H.R. 4222. She made it S. 4222, and I hope you will accept our apologies. Mr. BOGGS. We will do so. Mr. FAIN. I did not notice that until after the report had been sent in. Mr. Chairman and members of your committee, my name is Guy Fain; I reside at 235 Coral Avenue, Glendale, Ohio. I am grand president of the National Association of Retired & Veteran Railway Employees with over 100 local units throughout the United States with a membership of approximately 20,000. We are not a "one-man organization." The association is governed by a constitution and bylaws, adopted by delegates representing every unit in the association in convention assembled, and all grand or national officers are elected in the same manner. We are a nonprofit organization. I am appearing before your august body on behalf of our 20,000 members, and senior citizens in support of bills, S. 909 and H.R. 4222. Not being a lawyer, statistician, or an actuary, I would hesitate to burden this committee with figures in support of this bill, as I am quite sure your committee has all the necessary statistics in connection with this matter. I would rather bring to you the message of our old retired and senior citizens, and, I daresay, I have and still come in contact with more old people than any of you in this room. The records will show we have some 800,000 retired railroad employees, wives, widows, and dependents; 95 percent of them are 65 years of age or over. These, of course, are part of the 17 million over age 65, living on low income, and some have no income at all. In the thousands of miles I cover each year making contact, not only with my own members, but the thousands in the Golden Age Clubs, Golden Ring Clubs, and many of the other independent clubs, I feel that I can tell you with authority of the appalling conditions that exist among some of these old people. I can say to you in all frankness these old people were greatly disappointed when the Kennedy-Anderson bill was defeated last fall, and they were further disturbed with the enactment of the Kerr bill, better known as a pauper bill. I need not tell you the Kerr bill gave little or no relief to the millions of our senior citizens, and only those who had to get relief were compelled to take a pauper oath. Why should anyone in this great land of ours have to lower his dignity by having to declare himself a pauper? Regardless of how poor our people are, they still have dignity and pride, and would rather suffer and die than to seek relief under such conditions. Why, gentlemen, why should our old people be subject to the humiliation by bowing their heads in disgrace in order to be relieved of some of their sufferings, and God knows they have many. Who are these people who went through blood, sweat, and tears to make this country of ours so great. Was it the young generation of today, or was it our fathers, grandfathers, or we old people? Because of getting old, have we no equity in this land of ours? Or, is it because we are old and growing older, and someday you too will be old. Is that any reason that we should be cast aside to nurse our aches and pains in loneliness and become the forgotten man? Haven't we seen enough of poverty and misery suffered by these old people? Don't you gentlemen feel that it is high time this condition should be corrected? As we have waited a long time to correct this horrible condition, and all that we have received is promiseswait until next year something will be done. It is the same old story-wait, wait, wait. I come before your honorable committee with the plea of these old people to make their few remaining years a little happier on this earth. I feel, and they feel, you have the power to make their dreams come true; and please, gentlemen, don't underestimate the power of these old people. They are determined; they are fighting mad, and they are mobilizing to carry this fight to a conclusion. We are well aware of the fact we cannot match the power of the AMA with their generous contributions, and the cheap propaganda through the newspapers and other channels of publications, but we say to you we can and will deliver the votes that will bring you back to Washington. Thank you very kindly in allowing me to appear before your committee in behalf of these old people, and for the enactment of S. 909 and H.R. 4222. Mr. BOGGS. Are there any questions? Mr. Green? Mr. GREEN. No, except I want to congratulate Mr. Fain for his frankness and sincerity, and I agree with you. Mr. FAIN. Thank you. Mr. BOGGS. Mr. Betts? Mr. BOGGS. Mr. Schneebeli? Mr. BOGGS. Mr. Keogh? Mr. KEOGH. No questions, Mr. Chairman; thank you very much. Mr. MACHROWICZ. May I just say, "Me, too"! Mr. FAIN. Thank you, sir. Mr. BOGGS. Mr. Burke? Mr. BOGGS. Thank you very much. Mr. FAIN. Thank you, gentlemen. Mr. BOGGS. The next witness will be Dr. L. Henry, Garland, president of the American College of Radiology. Dr. Garland, will you kindly identify yourself and the gentleman with you? STATEMENT OF DR. L. HENRY GARLAND, PRESIDENT, AMERICAN COLLEGE OF RADIOLOGY; ACCOMPANIED BY DR. T. J. WACHOWSKI, CHAIRMAN, BOARD OF CHANCELLORS Dr. GARLAND. Mr. Chairman and members of the committee, I am Dr. L. Henry Garland, of San Francisco, president of the American College of Radiology. I wish to express the appreciation of the members of the college for your permission to set forth our views on H.R. 4222. I am accompanied by Dr. T. J. Wachowski, Wheaton, Ill., chairman of the board of chancellors of the college, who will assist me in answering such questions as members of the committee may wish to ask. The American College of Radiology is an crganization composed of more than 5,000 doctors of medicine in the United States who specialize in the use of X-rays and radioactive substances in the diagnosis and treatment of disease and injury. The college believes that there are better ways of accomplishing the aims of the proponents of H.R. 4222 than by that measure. It believes that any legislation appreciably increasing social security taxes, or adding sickness services to social security benefits is not in the public interest and would lead to impairment of good medical care. I. EXTENT OF NEED FOR THIS TYPE OF LEGISLATION (a) The need for federally paid hospitalization and medical care is estimated to be small. In 1960, of those over 65 years of age, about 7.7 million (or 49 percent) reportedly had some form of "health insurance.' By 1970, it is estimated that over 80 percent of those over 65 wanting such coverage will have it. Those who do not want to, or cannot, acquire such coverage will be taken care of as they are at present, at local community or county hospitals, at free clinics, or by various private agencies including the practicing doctor. 1 CMA Newsletter, 693 Sutter St., San Francisco, 1961. (b) The extent of indigency in the population over 65 is debatable. Certainly a high percentage own their own homes; their accumulated assets exceed those of any other age group; many have pensions and annuities. Some, however, are in need. (c) A national study of the total life situation of those age 65 and older by Wiggins and Schoeck shows the 90 percent of the respondents had no unmet medical needs of which they were aware. People usually have a fair idea whether or not they are sick. Ninety percent reported they were not sick. About 96 percent reported no medical debts. This would leave 4 percent with such debts.3 (d) We are not a sick and neglected nation. If the death rate is any guide, many of our basic medical care needs are being met. The U.S. crude annual death rate from all causes has dropped from about 15 per 1,000 in 1900 to about 9 per 1,000 in 1960. The age-adjusted rate is now even lower. 4 (e) Medical care is a broad term. According to the U.S. Department of Health, Education, and Welfare the 1959 "medical" care dollar was actually expended as follows: Doctors' services---. Hospital services____. Medicines and appliances- Dentists--- Other services, nursing homes, etc- Percent The small portion which the proposed legislation would cover is evident. The pressure which would develop to extend benefits to full coverage seems obvious. (f) Food, clothing, and shelter are necessities; so is medical care. Where individuals lack food, clothing, and shelter, there are State, municipal, and private agencies to which they can and do turn for help. This is also true of medical care. The Federal Government does not propose furnishing food, clothing, and shelter for all over 65. But it does propose Federal hospitalization and in-hospital medical services at public expense and regardless of the individual's ability to provide these for himself. II. EFFECT OF PROPOSED LEGISLATION The proposed legislation would swamp many hospitals with the unhappy and the mildly infirm; the seriously ill of any age would often find it hard to get a bed. In Great Britain and New Zealand, the patients are entitled to beds but the waiting period may be 6 months. Indeed for elective hernias in New Zealand today it is 14 months. (a) In Saskatchewan, over 94 percent of the population is covered by a compulsory tax-supported government plan. In Indiana, a large proportion is covered by a voluntary hospitalization insurance plan. For those 65 and over, the Saskatchewan hospital admission rate in 1957 was some 380 per 1,000; the Indiana about 220 per 1,000.5 Is this overutilization? Or need? 2 San Francisco News, June 29, 1961. Wiggins, J. W., and Schoeck, H., Science, May 19, 1961, p. 1625. Health Insurance Council Report, April 1961, Health Insurance Council, New York City. Health Information Foundation, quoted in Medical World News, Feb. 17, 1961. |