would submit that voluntary insurance, public assistance, and private philanthropy all have a role to play in the provision of health service-but they cannot do the job which is required for this age group in the population.

More older people are requiring more medical care at higher cost every day. Voluminous data have been and will be presented to this committee and its Senate counterpart. These data indicate that a large proportion of the aged cannot, through existing mechanisms, support the cost of needed care.

If we can pay for the care we need in later years by spreading it through our earning years, we add a substantial element of true social security, for medical care costs are the most threatening of all the costs of the later years of life.

Moreover, if we can do this economically, buying the most care for the smallest cost on a prepaid basis, and can thereby retain our self-respect and not feel that we are at risk of becoming public charges, we are fulfilling our need for independence.

Our experience of more than 25 years of social security has amply demonstrated that effectiveness of this mechanism in other spheres. Any serious student of this problem must arrive at the conclusion that there is no other alternative which can do the job as well or as economically as can social security.

Thank you for the opportunity of appearing before this committee. Mr. KING (presiding). Thank you, gentlemen.

Are there any questions? Mr. Machrowicz.

Mr. MACHROWicz. I just have one question of you, Dr. Lee. Are you a member of the American Medical Association?

Dr. LEE. No; I am not sir.

Mr. MACHROWICZ. I just wondered whether the American Medical Association ever made any attempt to get the views of its members, and I thought I could get that information from you.

Thank you.

Mr. KING. Any further questions?

Thank you, gentlemen.

Dr. LEE. Thank you.

Mr. LEVY. Thank you, Congressman.

Mr. KING. Dr. Hunter.

STATEMENT OF DR. OSCAR B. HUNTER, JR., CHAIRMAN, LEGISLATIVE COMMITTEE, COLLEGE OF AMERICAN PATHOLOGISTS

Dr. HUNTER. Mr. Chairman and members of the committee, I am Dr. Oscar B. Hunter, Jr., of Chevy Chase, Md., member of the Board of Governors of the College of American Pathologists, and chairman of the legislative committee.

Mr. Chairman, before I begin my remarks, let me say I am sorry that Mr. Machrowicz has left, but I would like to point out for the benefit of the committee that under that Wiggins and Schoeck report those excluded from that report are those largely without social security benefits. These individuals are primarily those which are excluded under the bill, H.R. 4222. Consequently, I do believe this report is a proper report to use in talking about H.R. 4222.

If I may proceed then with the rest of my formal presentation, I will do that.

I represent over 3,500 pathologists in hospitals, medical schools, and private offices throughout the country.

I appear before you today to clarify our position on H.R. 4222. As you are undoubtedly aware, we appeared before this committee 2 years ago in the hearings on the Forand bill. We are particularly interested in the present legislative proposal because we pathologists are specifically mentioned along with three other medical specialties offering medical services in hospitals.

H.R. 4222 is a negative type of legislation, in our opinion. Let us develop this argument for you.

First, we have worked diligently and at considerable sacrifice of time, effort, and money to explore and improve voluntary health insurance, for example, Blue Shield and commercial insurance coverage. We have done this by working with representatives of these insurance groups to set up fair and equitable fee schedules. We have accepted less than the usual fee in order to sustain these plans in time of difficulty. They are now growing at a rapid rate providing greater and more effective coverage for our people.

Second, we have aided the Government in working out satisfactory coverage for servicemen's families under the medicare program. We have done this in order to allow military dependents to enjoy the same good medical care available to employees of industry. We have assisted the Government to set up a medical program for Government employees for the same reason. All of this has been done not without considerable sacrifice and hard labor on our part.

Third, we recognized the fact that a relatively small group of our aged are medically indigent and could properly be helped by the provisions of the Kerr-Mills bill. We are now assisting in the implementation of the provisions of this law passed by you gentlemen and stand ready to cooperate with all State agencies.

Under these circumstances we consider the proposals under H.R. 4222 to be essentially destructive to the health interests and economy of our people because:

1. It will destroy the great good derived from the experience and efforts put forth in expanding voluntary health coverage of the aged. 2. It will destroy the effective measures now undertaken to implement Kerr-Mills legislation without first developing the necessary experience to properly evaluate the result of Kerr-Mills and voluntary programs.

3. H.R. 4222 will be destructive to our economy because it adds further increments to the heavy tax load already carried and by the very nature of the bill additional increments are inevitable.

This bill we feel will be many times more costly than the estimates that have been given by the proponents. In the area of pathology alone we can see the cost will be at least three times greater than that under the present method of handling such situations. This results from the fact that this bill encourages patients to go to the hospital to get care and will add to the cost because of room, board, nursing care, and hospital administration costs which are completely unnecessary for most pathology examinations. Consequently, we feel this bill will be destructure of good medical care.

Pathology costs have soared in the past 10 years. Previously, laboratory procedures that were done in a hospital and in physicians' offices were the complete blood count and urinalysis-these are the routine tests I am speaking of at the present time, which under ordinary circumstances would have cost approximately $8. Now commonly in hospital care of aged patients under Blue Cross and Blue Shield coverage, there are routine blood chemistries, including blood sugar, a test for uremia and cholesterol. These amount to approximately $15 in addition to the $8 previously charged, but a physician could in caring for persons over 65 order at least five times more laboratory work without being particularly selective. He could do this in clear conscience with a feeling that he was doing an extra good job.

This, in our opinion, would destroy any plan previously considered to be actuarilly sound whether under a voluntary or governmental program and it would not accomplish the great good that was originally conceived since the additional laboratory work would be in large part simply screening tests where the number of positive pathologic entities discovered would be less than one in a thousand.

Somewhere a line of demarcation must be selected to differentiate which tests will be done. This decision must rest with the physician and should not be determined by the Government on the basis of how much money is available for diagnostic services.

Two years ago, I described to the committee the circumstances whereby the College of American Pathologists had encouraged the use of cytologic examination of the female uterus to identify the presence of cancer. This screening test will uncover or discover one case of cancer in every 200 cases examined. Members of the college working in Canada indicated that they did not want the literature which we had sent because the Government was trying to restrict personnel and material costs in their laboratories. The Canadian pathologists felt that they would not be able to carry out the tests with the personnel and material available.

This is the Government reaction to the cost of screening procedures where the cost is considered by private medicine to be worthwhile. There are many types of screening procedures available today in the pathologic laboratory which could be made routine if the money was available.

Furthermore, we believe this bill to be poorly conceived in that it establishes that all of the aged under the social security system are in need of a Government program of medical care. The great majority of aged people can afford medical care and 50 percent are now covered by some form of voluntary health insurance. Others have the means to pay for the services needed and a smaller part of the aged need assistance in meeting their health costs.

Proponents of the bill argue that to provide medical care through a means test, for this latter group, is degrading. The argument used by those favoring the bill is that otherwise some will have to pass a means test. This argument is patently fallacious when one considers the fact that it is necessary for anyone to pass a means test even if he wishes to purchase other necessary items such as food and clothing. The argument against a means test for medical care seems somewhat faulty when dealing only with medical care.

In summary, I would like to address my remarks to each of you members of this committee who I am sure are approaching this task with a sincere and honest attempt to accomplish the greatest goal for our people in this area. This requires great wisdom. The program we now have available has been successful and is steadily satisfying more and more of the needs of our people. Pathology as a specialized practice of medicine, has grown very rapidly under the voluntary system. We have sought ways to control this growth.

In some respects we have sought ways to restrict our income by eliminating unnecessary tests, shortening procedures and making them more effective. We have been largely successful in our efforts but the impact of free, across-the-board in-hospital pathology care may well destroy all of our efforts to date.

We sincerely request you, the Members of Congress, to leave to us the task of taking care of our particular problems. Give us the assistance that we need only when it is truly necessary as you have done in the cases of indigents over 65 who are now covered under Kerr-Mills legislation. We believe that the necessary experience obtained with the new and experimental plans of health coverage that are now being effectively activated will allow us to supply all of the necessary care for the aged as well as the remainder of the population. This care will be satisfactory to both patient and doctor alike and moreover, it will fit the needs rather than force the needs into a fixed pattern.

Before concluding my presentation, I would like to recommend to the committee's attention a recently printed volume by Sir Earle Page, past Prime Minister and past Minister of Health of Australia, entitled "What Price Medical Care," which I have in my hand at the present time.

In this text Sir Earle takes up the history of the Australian program under federalized care which ultimately reverted back to a voluntary system. He gives a very lucid and clear description of the fallacies of federally sponsored medical care. The dangers of destroying voluntary means of paying for medical care and substituting compulsory care will be evident to those who read his book.

I wish to thank you gentlemen for the opportunity to appear before you and I will be happy to answer any questions that you may have at this time.

Mr. KING. Thank you, Dr. Hunter.

Are there any questions?

If there are no questions, thank you, Doctor.

Dr. HUNTER. Thank you.

Mr. KING. Dr. Hampton.

STATEMENT OF H. PHILLIP HAMPTON, M.D., CHAIRMAN, COUNCIL ON LEGISLATION AND PUBLIC AGENCIES, FLORIDA MEDICAL

ASSOCIATION

Dr. HAMPTON. I am Dr. H. Phillip Hampton, Mr. Chairman and members of the committee, a physician in private practice in Tampa, Fla., representing the Florida Medical Association, and I wish to thank the committee for the opportunity of presenting our views regarding tax-supported health services for the aged. For 10 years I

have been chairman of the medical association committee which has been instrumental in guiding the development of a State program of health services for the needy sick of all ages in Florida and in July 1959 presented a statement to this committee describing our plan.

I would like to briefly recall to the committee's attention the scope of the programs in Florida, outline who is eligible in our State, what benefits are provided, how many received these benefits last year, and how they were financed.

In Florida there are 450,000 individuals age 65 years or over. Of this group, only 69,000 are in such economic straits as to require aid. under the Federal old-age assistance programs.

In our State these individuals, as well as anyone else in need of health care, can receive it under existing programs. The determination of the need for such care is made by the local county government. There are no rigid State regulations governing eligibility.

Under programs using Federal-State, or State and county, or county funds alone, the aged individual in the State of Florida who cannot provide for his health care, whether he is on old-age assistance or not, can receive hospitalization, outpatient care, nursing home care, home nursing care, drugs, and other medical services.

I submit, Mr. Chairman, that an aged individual in the State of Florida is currently receiving better health care than is offered under the terms of the Anderson-King bill.

In calendar year 1960, at a cost of approximately $2 million, 1 percent of the aged recipients in Florida were hospitalized each month. In addition, the counties in my State in 1960 spent $12,523,846 for hospitalization of needy persons, approximately 50 percent of whom were 65 years of age and over. An additional $6 million was spent for other health care services for these needy sick. Therefore, the counties in Florida without receiving aid from either the Federal or State governments spent approximately $10 million last year for health care for the aged.

The point that I wish to make is that in Florida health care is not being limited to old-age-assistance recipients. It is being provided for all individuals in need, including the aged. Florida has, therefore, been operating an expanded "little Mills-Kerr program" since 1956.

It is for this reason that the Florida Medical Association heartily endorsed the committee bill which evolved from your hearings in 1959 and became the Mills-Kerr law, and we feel confident it will enable us to improve our health care program for the aged.

In general it can be said that the significance of the Mills-Kerr law is that it leaves to the States the determination of eligibility, benefits, and so forth. We believe the success of the Florida health care programs is based on the fact that the same determinations are left in the hands of the counties, but this idea has proved to be a hindrance in Florida's attempt to implement Mills-Kerr. The counties in our State, quite properly I think, resisted a change in Florida law which would be required under Mills-Kerr; namely, that 100-percent county participation be mandatory in order to obtain Federal participation.

Under our present State and county health care program 63 of the 67 counties are participating, which includes 97 percent of the State population. Therefore, the requirement of 100-percent county participation under Mills-Kerr is prohibiting an elaboration of existing programs to 97 percent of our aged population.