Mr. MACHROWICZ. May I say to you, Doctor, this is not my friend, I have no knowledge who Prof. Leon Leonard Green is except that I do know he was cochairman of the Congress of the International Association of Gerontology to whom this survey was presented. You have admitted to me that that survey did not take into consideration the nonwhite persons, did not take into consideration the persons receiving public assistance, did not take into consideration the institutionalized and the aged who died in the previous year. Yet you cite in your paper that according to the Wiggins and Schoek report "90 percent of the respondents had no unmet medical needs. of which they were aware," which would give anyone reading that paper the presumption that 90 percent of people over 65 had no unmet medical needs of which they were aware, but which by your own. admissions means that 90 percent of the aged excluding the nonwhite, excluding those receiving public assistance, excluding those that were institutionalized, and excluding the aged who died in the previous year were given the medical needs which they needed. That is a completely different picture, is it not, Doctor? Dr. GARLAND. In my opinion, sir, it is not; and I should like to have the privilege of leaving with you a copy of Wiggins and Schoek's reply to this criticism. Mr. MACHROWICZ. I do not think we need it. You have already told us that that report did not take into consideration these various groups that I just mentioned. Am I correct? Dr. GARLAND. Correct. Mr. MACHROWICZ. Well, then you are talking about not the people over 65, but only of those who did not need care. Am I not right? Dr. GARLAND. I do not think you are right, sir, but on this I would like to go into some detail with you with the original paper in hand and with the reply of the two authors in hand. Mr. MACHROWICZ. I do not really think there is much need of it. Of course, you may do that, but you have already given us all the information that I need to convince me that that report is, just as Professor Green has said, completely unreliable and absolutely of no value whatsoever. Dr. GARLAND. This is Salk's opinion of Sabin, too. Mr. MACHROWICZ. What is that? Dr. GARLAND. That is Dr. Salk's opinion of Dr. Sabin. Mr. MACHROWICZ. I do not know Dr. Salk's opinion of someone else, but I do know by your own admissions this statement should not even be included in the record. That is all. (The following letter was received by the committee:) THE AMERICAN COLLEGE OF RADIOLOGY, Chicago, Ill., July 27, 1961. Hon. WILBUR D. MILLS, Chairman, Committee on Ways and Means, DEAR MR. MILLS: Thank you again for the privilege of addressing your committee on the matter of H.R. 4222. Toward the end of my testimony yesterday I was questioned regarding the Wiggins-Schoeck figures on the approximate percentage of persons over age 65 with unmet medical needs. I stated that I would like to consider the answer to the question with the original report, the criticism, and the answer of the authors at hand. I have now done so and would appreciate this letter being inserted into the record immediately following my testimony. The Wiggins-Schoeck survey covered essentially the groups to be included in the benefits of the King bill. In other words, the groups omitted from their survey are generally the groups at present not covered by the King bill. About 75 percent of those receiving public assistance (OAA) would not be covered by the King bill. The vast majority of those institutionalized are in tuberculosis and mental hospitals, and are specifically excluded from the bill. Therefore, the data of Wiggins and Schoeck are regarded as highly pertinent for the very persons to be covered by the King bill. It has often been said that the chief mark of the scientist is that he even reports findings he does not like. The findings concerning the very small percentage of the aged with unmet medical needs is a surprise, and an important point in considering such sweeping legislation. The impartial and unbiased periodical Science carried in full in its May 19, 1961 issue, a thorough and convincing reply of James W. Wiggins and Helmut Schoeck of Emory University to the type of criticisms voiced by the Honorable T. M. Machrowicz. Yours sincerely, Mr. BOGGS. Any further questions? Dr. GARLAND. Thank you very much. L. H. GARLAND, M.D., President. (The following letters were received by the committee:) Hon. WILBUR D. MILLS, THE AMERICAN COLLEGE OF RADIOLOGY, Chairman, House Ways and Means Committee, House Office Building, Washington, D.C. Chicago, Ill., August 7, 1961. DEAR MR. MILLS: On July 26, I accompanied the president of the American College of Radiology, Dr. L. Henry Garland, to a session of the hearings of your committee on H.R. 4222, the King bill. In our testimony, we referred to activities of the American College of Radiology in the area of radiation protection education. It subsequently occurred to me that we should have submitted evidence of our efforts. For this reason, I enclose herewith a copy of "A Practical Manual on the Medical and Dental Use of X-Rays With Control of Radiation Hazards." (Manual in files of the Committee on Ways and Means.) As noted in our testimony, this was mailed to 175,000 practicing physicians in the United States (the largest mailing list we could obtain), and an added 36,000 have been subsequently distributed. (Simply for your records, I also enclose herewith Spanish and Portuguese versions that are currently being distributed in Latin America.) In addition, I am mailing under separate cover for the files of your committee both our radiation protection kit and radiation legislative kit referred to in our testimony. If you or any members of the committee are at any time interested in seeing the motion picture that has been exhibited to medical audiences of over 70,000, "Radiation: Physician and Patient," please so inform us. A showing will be arranged immediately. Perhaps we should have also mentioned the study we are to commence this September with the National Academy of Sciences-National Research Council on the long range effects of low levels of radiation on human beings. By studying illnesses, causes of death, and genital defects in progeny of our members who in their work are necessarily exposed to low levels of radiation over a period of many years, we hope to develop data useful in calculating the effects of radiation on all people. This has become much more important since the advent of the nuclear age in that ever greater numbers of people are now being exposed to small, additional increments of radiation. It is estimated that this study may continue for perhaps 50 years. The success of the study depends, of course, on the continuation of radiology as a speciality in medicine-something very questionable if H.R. 4222 is enacted. If the American College of Radiology can be of any further assistance to the committee, please feel free to call upon us. Sincerely yours, T. J. WACHOWSKI, M.D., Chairman, Board of Chancellors. THE AMERICAN COLLEGE OF RADIOLOGY, Hon. WILBUR D. MILLS, Chairman, Committee on Ways and Means, Washington, D.C. DEAR MR. MILLS: The American College of Radiology offered a statement to your committee on H.R. 4222 on July 26 as did a representative of the American Hospital Association. In response to questions by Representative King, the AHA spokesman offered opinions in regard to current arrangements between radiologists and hospitals for the practice of radiology in hospitals. Dr. L. H. Garland and I hoped to have the opportunity to answer the same questions, but this did not occur. For this reason, the American College of Radiology would appreciate your placing this letter in the record following the statement offered by Dr. Garland on behalf of the college. The trend in the practice of radiology in hospitals is away from salaried, employed arrangements. As was noted a number of years ago in the hospital trade journal, Modern Hospital, well-trained and thoughtful hospital administrators have become persuaded that such practice arrangements are neither in the best interests of patients, nor of hospitals. This trend is indicated by statistical studies available. A 1939 study (J.A.M.A., 1939, 113, 943–948) showed 37 percent of radiologists practicing in hospitals as salaried employees. A 1947 study (J.A.M.A., 1947, 135, 1078–1081) showed 32 percent of radiologists as salaried hospital employees. A 1960 study (Modern Hospital, March 1960) reported 11 percent of radiologists as salaried employees of hospitals. A 1961 study ("Hospital Management," August 1961) notes 28 percent of chief radiologists as salaried employees of hospitals, but in nongovernmental hospitals only 11 percent are so classified. Two studies by the American College of Radiology are also germane: in the fall of 1958, 36 percent of radiologists practicing in hospitals in which bills are rendered to pay, or part pay, patients indicated that bills were presented in the name of the radiologist rendering the service; in the fall of 1960, a similar survey showed that 69 percent of such radiologists were rendering, or having rendered, bills to patients in their names. It is quite possible that the power and authority of the U.S. Government can halt the trend toward the independent practice of radiology within hospitals. If this is the intent of the Federal Government, it is quite likely that the King bill will accomplish this aim both by destroying the practice of radiology outside hospitals and by weighting the scales in favor of the hospital control of medical practice in the field of radiology. If, on the other hand, it is the intent of the Federal Government to allow the trend toward patient and physician freedom to develop, the King bill should not be enacted. We would like to make one final point. It has been loosely stated by individuals who apparently wish medicine to be practiced under administrative authority that the private practice of radiology is more expensive to patients than radiological services offered by hospitals. This is not true. We would hope that members of your committee would check in their own districts to see if patients of radiologists in private offices, or of radiologists practicing independently in hosiptals, are paying more for like services than those obtaining these services in hospitals hiring radiologists to practice medicine on behalf of the hospital. We know that the answer is, "No," and are confident that any unbiased investigation will confirm this point. Sincerely yours, T. J. WACHOWSKI, M.D., Chairman, Board of Chancellors. Mr. BOGGS. Our next witness is Mr. Theodor Schuchat, member, board of directors, National Consumers League. You are recognized. STATEMENT OF THEODOR SCHUCHAT, MEMBER, BOARD OF DIRECTORS, NATIONAL CONSUMERS LEAGUE Mr. SCHUCHAT. Mr. Chairman, I will try to beat the bell. Mr. Chairman and members of the committee, my name is Theodor Schuchat, and I am appearing as a member of the board of directors of the National Consumers League. This organization is now in its 62d year. It was founded in 1899 in the belief that consumers have a responsibility to help improve the working conditions and living levels of those who produce the goods and services that we all con sume. The National Consumers League supports the principles embodied in H.R. 4222. At our most recent board meeting, the 45-member board of the league, which included representation from our various affiliated State organizations, adopted a statement of policy which includes the following: The consumers league will support the legislation * insurance for the aged under social security * providing health As many members of this committee are aware, the National Consumers League has long supported the development of a comprehensive system of social insurance. In 1935, for example, a spokesman for the consumers league appeared before this committee in support of the Wagner-Lewis bill, the original social security legislation. The consumers league endorsed the original bill as "a farsighted recognition of our needs and as a long step forward toward a stabilized social order." We reiterate our support at this time, and we see no reason to change either our views or our language. We still consider the contributory programs of social insurance that are primarily the responsibility of this committee as in our original words a "farsighted recognition of our needs and as a long step forward toward a stabilized social order." Through the years, Mr. Chairman and members of the committee, spokesmen for the consumers league have attended the hearings of this committee when changes in the Social Security Act have been considered. We have noted that, through the years, certain fears and doubts and misgivings have been expressed before this committee, whenever a major improvement has been contemplated. In 1935, for example, when the Wagner-Lewis bill was before this committee, a representative of the Illinois Manufacturers Association told this committee that the bill will eventually increase unemployment by further impairing the purchasing power of the consumer. The increased burdens placed upon productive enterprise by such a program must, unless industry is to be completely prostrated, be passed on to the consumer Today we again face a serious degree of unemployment, and many opinions differ as to the reasons for and causes of the unemployment that is a current source of public concern. But we do not believe that any responsible group will say today that the social security system of contributory social insurance impairs the purchasing power of the consumer and thereby causes unemployment. To the contrary, in times of recession today we look to social insurance benefits as a bulwark shoring up a faltering economy. Another reason that is frequently advanced in the hope of deterring this committee from recommending improvements in the Social Security Act is that the taxes necessary to finance the benefits provided are unduly burdensome. In 1939, for example, the National Association of Manufacturers asked this committee: "At this time should we add to these individual and employer costs?" As the National Consumers League has observed the development of the social security programs, we have noted that certain groups have never found a propitious time to increase the taxes that support these programs. They are in favor of the principles and objectives of the program, they have told you, but this is not a good time to venture to extend or improve the program. Nevertheless, these forecasters of gloom and doom to the contrary notwithstanding, this committee has through the years recommended increased taxes to finance expanded social security benefits, and there have been no discernible ill effects either upon individuals or employers. Despite inflation, despite the current or possibly recent recession, today both personal and corporate incomes far exceed the levels which some witnesses regarded in past years as being too fragile to withstand a modest social security tax increase. Members of the committee will recall also that some witnesses have claimed that expansion and improvement of the social security programs would undermine or impair the development of private pension and insurance programs. In 1949, for example, a spokesman for the National Association of Life Underwriters told this committee: It is very significant to note that the substantial expansion of the social security system in Great Britain, as sponsored by the Labor Party, was accompanied by an immediate and sharp decline in the sale of new private life insurance. The National Consumers League, on the other hand, believes that it is very significant that an allegation such as this is made with respect to the social insurance program of another country but not with respect to the programs that are primarily the responsibility of this committee. The facts are, as you well know, that life insurance in force has never been greater in amount and that, as a result of the floor of protection afforded by social security, plus the prudent provisions of private pensions and life insurance by individuals and employers, the American people have a greater degree of protection against the unavoidable, insurable hazards of life than ever before. Finally, Mr. Chairman, we of the National Consumers League recall that in 1950 the Chamber of Commerce of the United States, among others, told this committee * the chamber is opposed to the extension of the Federal contributory system to cover permanent and total disability *** the moral hazards and tremendous administrative difficulties, no matter with what guarantees it is surrounded, make such programs inadvisable Members of this committee have been told of "moral hazards" and "tremendous administrative difficulties" whenever they have considered improvements in or extension of the social insurance programs. This committee has not been dissuaded by these arguments, however, and we believe that the record fully justifies the committee's confidence in the moral fiber of the American people and their administrative efficiency. |