The middle aged and the very young will be included eventually. The final result will be governmental medicine for all the population, or socialized medicine.

I should like to include in the record a reprint from the "Nation's Business," July 1961, entitled "I Quit Socialized Medicine" by Dr. E. Lloyd Dawe, a British physician. In it he reveals the potential dangers to the health of the patient if the Government runs medical

care.

Voluntary plans: There is ample evidence in the State of New York that the voluntary insurance plans are meeting the needs for medical care of persons of all ages, including the over 65 age group.

As of April 1, 1960, the U.S. Census Bureau reported that there were approximately 1,687,590 persons over 65 in New York State. According to reliable sources, approximately 1 million of this group had some form of voluntary health insurance. This estimate includes Blue Shield plans, Blue Cross plans, and commercial carriers. In other words, approximately 60 percent of those over 65 are covered by voluntary health insurance.

Two years ago the seven nonprofit Blue Shield plans in New York State offered a program to provide medical care coverage for those persons over 65 on an individual basis. At the present time, medical care coverage is being offered to practically every person in New York State over age 65 on an individual basis.

It must be pointed out that of the 7,150,000 subscribers now covered in New York State on a group basis under Blue Shield, approximately 570,000 are over 65 and may continue their coverage on an individual basis though retired.

The companion Blue Cross plan, with a membership of 9,670,000 has approximately 775,000 members over 65 and they may continue their coverage on an individual basis.

Recent surveys indicate that of approximately 16 million persons in New York State, 91 percent, or 14,560,000, of the population now have some form of hospital expense insurance. Approximately 83.5 percent have regular medical and/or surgical care insurance.

It should also be pointed out that approximately 50 percent of New York persons over 65 are gainfully employed.

Other activities concerning the aging: In addition to the work of the voluntary health insurance plans, the medical profession, through our State medical society, has inaugurated programs to further the interest of all people in regard to medical care, particularly those in the so-called old-age group.

Working in cooperation with the New York State Department of Health, our State medical society is sponsoring a plan for the improvement of nursing home services for the aged. The general objectives of the program are as follows: (a) to assist city and county health departments in developing or improving nursing homes and related facility services within the areas of their jurisdiction through the establishment and operation of adequate nursing home codes meeting the statewide requirements of the State department of social welfare and the recommendations for model local programs to be established by the State department of health; (b) to further assist such county and city health departments in providing training programs for health department personnel concerned with nursing homes and

also for the personnel of nursing homes and related facilities on a city, county, or bicounty basis, such training to be integrated with the statewide and area training institute sponsored several times yearly by the State department of social welfare; and (c) to carry out such demonstration programs and special studies as will develop new technical knowledge and methods that will enhance the maintaining of higher standards of service in these facilities.

It is interesting to note that the total number of nursing home beds in New York State is about 41,256, of which approximately 16,507 are located in the Metropolitan New York area.

Contracts already have been signed with official and voluntary agencies in four counties in regard to this program, namely, Erie, Monroe, Rockland, and Niagara.

The State medical society also is actively engaged in promoting the objectives of the New York State Joint Council To Improve the Health Care of the Aged. The membership is composed of the State medical society, the Dental Society of the State of New York, the New York State Nursing Home Association, Inc., the Hospital Association of New York State, and such other organizations whose interests are compatible with the objects and purposes of the council. The objects and purposes of the council are to provide a mechanism for (a) exchange of information of activities and plans of its members and other organizations in the field of aging, (6) coordination of related programs conducted by other member organizations, (c) development of jointly sponsored projects, and (d) dissemination of information on health care of the aged to the public.

Local activities for the aged: Time does not permit me to explain in detail the numerous activities in which our State medical society is engaged to promote the welfare of patients. Permit me, however, to cite a portion of the report of the society's committee on aging and nursing homes for June 1961:

The members of the committee summarized current projects in their respective communities. These included a "well oldster" clinic in Buffalo for persons 60 and over, not under medical care, and unable to pay medical bills. They receive a complete history, physical examination, and laboratory tests for purposes of diagnosis and referral to a physican. This is operated by the Erie County Health Department with full cooperation of the Erie County Medical Society. In Bronx County, there was scheduled recently a program on "Planning for Your Later Years," in which specialists, both lay and medical, participated; a health fair in the courthouse was attended by a very good segment of the aging population; a questionnaire to determine the definite health needs of the geriatric person in the community is being prepared by the two physician members of the Bronx Borough Committee on Aging and will be sent to 1,800 individuals.

The "extended courtesy" program of the Nassau County Medical Society will be described in an article in Medical Economics, it was reported. This calls for the lowering of fees for persons of small resources by mutual agreement among the physicians, the pharmacists, ophthalmologists, dentists, and pertinent agencies. It stresses the doctor's judgment about the economic status of the patient.

Also in Nassau County the mental health board has set up clinics, but they are run by psychologists and lay social work personnel, even though they are supposedly directed by psychiatrists. This is due to the general dearth of the medically oriented psychiatrist.

A third project in this county is aimed at construction by hospitals of buildings for the older patient who is past the critical stage of illness, and at urging the cooperation of the hospitals with nursing homes in relieving the crowded situation in the former. Nassau County Medical Society has also urged that the recently abandoned Air Force Base at Mitchel Field be utilized for a home for the aged, a medical school, and a hospital.

In Oneida County (Utica Academy of Medicine) there will be a program on aging (in November), which will include scientific advances in medical care, mental health, and scioeconomic factors. Lectures on preparation for retirement sponsored by the community planning council have been well attended. The committee on health of the community chest and planning council is working on a study of (1) meals-on-wheels program; (2) development of a loan system for wheelchairs, hospital beds, and other equipment for home use; (3) preparation of a pocket-sized directory for people over 65 as to facilities available to them. A physician is chairman of this committee.

Finally, in this connection, at its 1961 meeting of its house of delegates, the State medical society approved the following statements:

The State society should take the initiative in setting up an organization for cooperation with the proper representatives of voluntary health insurance plans, commercial insurance carriers, labor, management, and government. This or ganization should have as its purpose the provision of the best health care to all the people of New York State.

The State society must continue to interest itself in the care of the medically indigent through its public medical care subcommittee. It must encourage appropriate legislation for implementation of the Kerr-Mills law in New York State.

The State medical society has carried out both of these directives of the house of delegates.

Kerr-Mills law implemented in New York: On April 1 of this year the Kerr-Mills law was implemented in New York State. It is known as the Metcalf-McCloskey law, sponsored by Senator Metcalf and Assemblyman McCloskey. Although not perfect, this law if carried out in accordance with the intentions of the sponsors will meet adequately the needs of the people over 65 in New York State.

Attached is a booklet entitled, "Questions and Answers: Medical Assistance for the Aged," April 1961, put out by the New York State Department of Social Welfare, explaining the program.

One particular section of that brochure I should like to quote verbatim concerning the provision of the new law in New York State.

When a person is confined to a medical facility for chronic care such as a hospital or nursing home, he is allowed to reserve from his income and resources an amount for personal expenses, an amount to pay premiums on his outstanding health insurance, and an amount for the support of his spouse not to exceed $1,800 a year. The difference between his remaining income and resources and the cost of essential medical care determine his need for medical care. It that difference is insufficient to pay the cost of that essential medical care, the person is determined to be a needy person.

When he is not confined to a medical facility for chronic care, from his income and other resources he may reserve from his income $1,800 for his maintenance, if single, and $2,600 a year if married and living with his spouse. In addition, for a single person other liquid resources up to $900 plus premiums on his outstanding insurance policy up to $150 a year may be reserved. For a married couple these amounts are $1,300 and $250, respectively. After these reserves have been deducted, the difference between his remaining income and resources, and the cost of his medical care, determines his need for medical assistance. If the difference is insufficient to pay the cost of necessary medical care, the person or couple are determined to be needy.

Although there have been some difficulties in the administration of the Metcalf-McCloskey law, on the whole the statute is working satisfactorily. In order to make certain that the administration of this

law works out as well as possible, a meeting has been arranged with Senator Metcalf and Assemblyman McCloskey in early August with representatives of the State medical society. In addition, public hearings are scheduled to be held in early September concerning this law.

The committee probably will be interested in learning the reaction of some of the county medical societies within the State of New York concerning the implementation of the Kerr-Mills law. I therefore cite the following report which was received from one of the county medical societies:

The Metcalf-McCloskey law was implemented in this county on April 1, 1961. It applies to all medically indigent people over 65.

Welfare patients in nursing homes will be cared for under the bill.

To date there have been 55 applications for medical care. Forty have been accepted. Five have been rejected because investigation showed that they had ample funds. The remaining 10 objected to taking the means test. They were reluctant to have their children know that they had applied. Investigation of these patients showed that they had ample means. Apparently they did not want their children to know that they were trying to get something for nothing. The welfare commissioner, the medical adviser, and the person who does the screening, all are of the opinion that the law is working well and it is meeting the need in the county. No one who is in need of medical care is being rejected. In substance the following question was asked of these three officials: Do you feel that the King-Anderson bill would fill the same need as adequately as the Metcalf-McCloskey law? All three were of the opinion that it would not. They stated that it would not come near meeting the needs as well.

They admited that there were some kinks that had to be ironed out and they felt that this would be done at the next meeting of the legislature.

The main point seems to be that the means test is a stumbling block. Oddly enough, however, the opposition seems to be made not by those who really need care but by those who have ample funds and are trying to get something for nothing. Therefore, the means test seems to be necessary.

Rural areas in New York State: I should like also to point out that reports from medical societies in counties throughout New York State emphasize the fact that New York is not entirely an urban area. There are many rural communities in New York State. They stress the point that there are many people in rural areas who are not under social security and would not benefit from the proposed law, H.R. 4222.

Society opposes on medical grounds: While the Medical Society of the State of New York is very much aware that a major objection to the proposed law, H.R. 4222, is the tremendous cost with which this generation and future generations of taxpayers would be confronted should it become law, our steadfast opposition is primarily from the medical point of view. We feel that it would result in lower standards of medical care for patients through governmental regulation and overutilization of hospital facilities. Enactment of the proposed law, H.R. 4222, would mean governmental control of doctors' services in hospitals, control of interns, residents, pathologists, and radiologists, as well as control of the type and extent of treatment rendered to patients.

Under this proposed law short-term illnesses would be extended into long-term occupancy of hospital beds, depriving patients who really need it of such care. The society, therefore, is firmly convinced that this measure, H.R. 4222, would be detrimental to the interests of the people of New York State.

SUMMARY

This is the positive case for opposition to the proposed law, H.R. 4222. In brief, numerous projects have been undertaken in New York State including extension of Blue Cross-Blue Shield benefits, the implementation of the Kerr-Mills law through the Metcalf-McCloskey law, the activities of the Medical Society of the State of New York and other voluntary organizations.

The Medical Society of the State of New York, therefore, holds, in summary, (1) that the social security approach to medical care for the aged as embodied in the proposed law, H.R. 4222, is not needed in New York State, and (2) that the Kerr-Mills law, as implemented in New York State through the Metcalf-McCloskey law, should be given ample opportunity to prove that it is capable of meeting the medical needs of the aged population of the State of New York.

(The attachments to Dr. Lawrence's statement follow :)

Whereas there has been introduced into the House of Representatives a bill known as H.R. 4222, sponsored by Representative King, providing medical care for the aged under the social security system; and

Whereas the Congress of the United States has already enacted into law the Kerr-Mills statute which provides adequate medical care for the aged who need such care; and

Whereas this law is now being implemented in many States of the Union; and Whereas sound reasoning and practical business philosophy dictate that such a law should be given complete opportunity to prove its usefulness; and Whereas the Metcalf-McCloskey law, implementing the Kerr-Mills law, has been adopted in New York State and has been put into practice; and

Whereas the social security approach embodied in the King bill is totally unnecessary and would burden the citizens of the United States with an astronomical financial burden; and

Whereas the King bill would mean poorer, not better, health care for the aged with Government employees telling hospitals how to operate and telling nursing homes what they could and could not do; and

Whereas the King bill would lead to the decline, if not the end, of private health insurance which has made such great strides in recent years; and

Whereas the King bill would mushroom into compulsory national health insurance for every American as time went by and would be a direct step toward socialized medicine; and

Whereas the House Ways and Means Committee, which is to hold hearings on the King bill, proposed the Kerr-Mills law now being implemented throughout the United States; and

Whereas the Congress of the United States, in an election year, after complete debate decided against the social security approach for medical care for the aged when it adopted the Kerr-Mills law: Now, therefore, be it hereby

Resolved, That the Medical Society of the State of New York go on record as being in opposition to the enactment of H.R. 4222 (King) on the basis of the aforementioned reasons; and whereby it is hereby further

Resolved, That the opposition of the Medical Society of the State of New York be presented immediately to the House Ways and Means Committee and to the Members of the House of Representatives from New York State and the two U.S. Senators and the President of the United States; and be it hereby further Resolved, That said opposition of the Medical Society of the State of New York be presented by its representatives in person if possible at hearings of the House Ways and Means Committee when such hearings are held.