so.

The CHAIRMAN. Thank you, Dr. Richards, for bringing to us the Connecticut State Medical Society's paper. We appreciate your doing You can be sure it is our intention to read the additional material that is put in the record. Are there any questions of Dr. Richards? Mr. ALGER. I just want to thank the doctor for the committee for this particular attachment. It is very helpful.

The CHAIRMAN. Thank you again.

Dr. Hesseltine and Dr. Mallory please come forward, gentlemen. Dr. Hesseltine, you are the past president of the Illinois State Medical Society, according to my information. If you gentlemen will identify yourselves for the record by giving us your name, address, and capacity in which you appear, we would appreciate it.

STATEMENT OF DR. H. CLOSE HESSELTINE, PAST PRESIDENT, ILLINOIS STATE MEDICAL SOCIETY; ACCOMPANIED BY DR. JOSEPH R. MALLORY, PAST VICE PRESIDENT

Dr. HESSELTINE. Thank you, Mr. Chairman.

Mr. Chairman and members of the committee, I am Dr. H. Close Hesseltine, past president of the Illinois State Medical Society and full-time professor of obstetrics and gynecology at the University of Chicago School of Medicine. Dr. Joseph R. Mallory is in the private practice of medicine in Mattoon and was vice president of the State medical society in 1962-63.

We appear before you today as the official representatives of the Illinois State Medical Society to oppose H.R. 3920 now pending before your committee.

The society was founded 125 years ago and is comprised of over 10,000 physician-members. Its main purposes are to promote the science and art of medicine; to protect the public health; and to elevate the standards of medical education. The society informs the general public and the profession concerning advancements in science and the advantages of proper medical care.

Activities of the society: Since last testifying before this committee, July 26, 1961, in opposition to H.R. 4222, the State medical society has sponsored a series of television films, several radio series pertaining to health care, and two newspaper series covering such important topics as "Why Family Physicians Are Needed Before Illness Strikes": "Physical and Mental Fitness”: “Modern Preventive Medicine and the Family Doctor"; "Cancer Control"; "Retinal Burns"; and the "Common Cold," to name but a few. Such programs are informative not only to the public in general, but to the aging in particular.

The Illinois State Medical Society sponsors Illinois Health Week for the purpose of demonstrating to individuals old and young alike, in every community, the total services available through the local health team. This program emphasizes local responsibility in matters of health and points with pride to local achievements and accomplishments without Federal Government assistance.

A lay speakers' bureau serves groups of all ages by providing speakers on medical topics to lay groups when called upon to do so. Speakers have been provided more than 125 times in the past 2 years, and the number of requests keeps growing for discussions on such matters as the physiological change in senior years, nutrition, exercise, and rec

reation.

Scientific displays on health topics have been created by the society in an effort to further inform the people. Displays have been exhibited before more than 2,500,000 people in the past 2 years at the State Fair, the Chicagoland Health Fair, the Chicago Healthorama, and small health fairs throughout the State.

Disaster medical care programs. Another important undertaking by the Illinois State Medical Society deals with disaster medical care. At the present time, we are distributing to all hospitals and county medical societies a 90-page disaster manual for hospitals, patterned after the nationally acclaimed disaster plan of Memorial Hospital of DuPage County, Elmhurst, Ill.

In cooperation with the Illinois Department of Public Health, our society is coordinating the medical self-help training program. Our objective is to train at least one person in every family to render emergency medical care in the event of disaster. This course is being televised each week over a major Chicago television channel with over 10,000 enrolled of the estimated 200,000 viewers. Plans are being made to produce films of the production for use throughout the State by the first of the year.

Scientific programs, speakers' bureau: The Illinois State Medical Society has organized many scientific committees, such as those on cancer and nutrition and numerous others, whose work has a direct bearing on the aging. The society publishes a monthly scientific medical journal which is distributed to all its members.

Numerous articles pertaining to the aging have appeared in the Illinois Medical Journal since our last meeting with your committee. Articles have been published on such topics as "Kerr-Mills in Illinois"; "Blue Cross-Blue Shield Plans for Over 65"; "Rehabilitation of the Stroke Patient"; "Advances in Geriatrics"; to name just a few.

A scientific speakers' bureau is an important on-going program that has sparked the interest of members in such topics as "Problems of the Aged"; "Psychological Problems of the Aging"; "Hearing Problems in the Older Patient"; and other medical problems directly connected with aging. The speakers' roster includes physicians representing every field of medicine who are available to speak on scientific subjects before county medical societies. These speakers are also used actively in the postgraduate training program.

Many scientific lectures delivered before medical audiences at our annual meeting are aimed at improving the health care of the aging; they have included papers and symposia on "Physical Medicine in the Treatment of the Stroke Patient" and "Physical Medicine and the Treatment of Arthritis." The annual meeting includes about 85 different programs of a scientific nature with numerous exhibits.

One recent exhibit was presented to develop interest in performing examinations regularly for detecting glaucoma in patients 40 years of age and over. Another important exhibit dealt with the regulation of dietary fat, indications for modifying the fat content of a diet and methods for doing so.

Rehabilitation of stroke patients: In terms of additional scientific presentation, the State society has been highly commended by governmental and private agencies for its activity and interest in the rehabilitation of the stroke patient. Just a year ago the State society

established a program on the postgraduate level for the purpose of instructing physicians and nurses in the early treatment of stroke patients upon admission to the hospital. This was carried out under the direction of the Committee on Aging.

The demand for the program was so great that the society, in cooperation with the department of public health, produced a film entitled "Stroke-Early Restorative Measures in Your Hospital." The film is directed toward physicians and nurses in all general hospitals, large and small, and illustrates a program of constructive rehabilitation which progresses through three stages:

(1) Proper positioning; (2) transfer activities and early ambulation; (3) training for self-care. The film indicates how these major steps can be conducted in any general hospital regardless of size, by using a minimum of equipment.

The motion picture is a part of the on-going program of the Committee on Aging under the State medical society to foster improved care of stroke victims. We are happy to announce that we have received requests for it to be shown from coast to coast; and it is being purchased by scientific organizations, medical libraries, State libraries, State departments of public health, and hospitals.

We are fully confident that the vast amount of attention now being given to the aged through the leadership of the medical profession will continue to provide solutions to problems concerning their health

care.

Incentive to continue and expand such programs would be reduced, if not destroyed, if Government medicine came into existence through enactment of H.R. 3920.

Kerr-Mills in Illinois: When we appeared before this committee 2 years ago in opposition to H.R. 4222, enabling legislation to establish Kerr-Mills in Illinois had just been enacted by the State legislature. It became effective August 1, 1961. The law authorizes the Illinois Department of Public Aid, the agency administering old-age assistance and other State welfare programs, to furnish inpatient hospital service; skilled nursing home services; physicians services; outpatient hospital or clinic services; home health care; private duty nursing services; physical therapy and related services; dental services; laboratory and X-ray services; drugs, eyeglasses, and other devices; diagnostic screening, and preventive services; rehabilitation treatment; transportation and other services that may be necessary; and additional essential medical services and supplies as recommended by a qualified practitioner.

A full program provided for by the Illinois law and supported by the State medical society, was limited by the administrative agency in an effort to gain sufficient experience before extending permissible services in order to stay within the initial $20 million biennial appropriation.

To acquaint its membership with program details, extensive fieldwork was conducted among physicians in all parts of the State by the officers and staff of our society. Substantial expenditures were incurred in the preparation and distribution of literature and newspaper releases explaining the programs to physicians, the public in general, and the aging in particular.

Provisions of Kerr-Mills program: Since August 1, 1961, qualified recipients have received hospital services without limitations on length of stay, including all in-patient hospital service and drugs without limitation: physicians' services while hospitalized (except in Cook County, where such services are available to needy patients at no charge in the Cook County Hospital): and physicians home and office calls for a 30-day recovery period following hospitalization. Single persons 65 years of age or over with annual incomes of $1,800 or less, and couples with $2,400 or less, may qualify for payment if they possess not more than a like amount of liquid or marketable assets. The homestead and contiguous real estate, regardless of value, and limited life insurance are exempt from these calculations.

Parenthetically, this is not in your copy of our statement, but reference was made this morning to those individuals who are not eligible and who have the misfortune to be ill and spend down to these qualifying limits, they become eligible for benefits under this program. During the first 24 months of operation, about 10.000 persons over 65 have received care under the Kerr-Mills program-with payments for individual patients ranging from a low of $4 to a high of $5,200. Of the initial $20 million appropriation for the Kerr-Mills program for the biennium ending June 30, 1963, just under $6 million had been paid out.

To provide for a sharing of responsibility, the original Kerr-Mills law in Illinois required the recipient to pay an amount equal to 10 percent of his income toward his medical bill. Kerr-Mills medical assistance covered the balance for qualified recipients.

At our request the 1963 State legislature, by amendment, changed the provision for deducting 10 percent of income in establishing eligibility, to deducting a portion of income or assets "in accordance with standards prescribed by the department." We are currently working with the department's administrators to liberalize this provision. Final details will soon be announced. The amendment also changed the amount of life insurance exempted as a resource from $1,000 face value to "life insurance having a cash value of $1,000 or less."

Benefits added, improved spirit of cooperation: At the conclusion of 23 months experience with Kerr-Mills in Illinois during the 1961-63 biennium, steps were taken to evaluate the program. Numerous joint meetings were held with the department of public aid to consider expansion of the benefits offered to recipients under the program within financial limits.

We are particularly happy to report at this time that the Kerr-Mills program has been extended to provide for the cost of drugs during visits within the 30 days post hospitalization. In addition, the extended program includes up to 90 days posthospital nursing home care, including physicians' services and drugs connected with such care: or up to 90 days rehabilitation nursing home care, also including physicians' services and drugs. A greater caseload and increasing expenditures may be expected as additional benefits are provided.

Since the Kerr-Mills program was first implemented in Illinois, administrative changes within the department of public aid have led to a greatly improved spirit of cooperation between its administrators and the purveyors of medical services. A firm feeling now exists that all

medically needy aged citizens in Illinois can be cared for adequately under this program.

Other welfare programs: In addition to Kerr-Mills, Illinois pays for comprehensive medical care for the indigent of all ages and not for just those over 65. This program, referred to as aid to the medically indigent (AMI) is operated at the township level and is financed through funds from general assistance in the State without financial assistance or controls from the Federal Government. The AMI program may finance services for the indigent aged that are not presently provided by Kerr-Mills, thereby dovetailing the two programs.

We also have Cook County Hospital where patients may receive care who are unable to pay for it. Old-age assistance recipients discharged in 1962 received a total of 51,052 days' care in Cook County Hospital. The Illinois State Medical Society actively cooperates with the Illinois Department of Public Aid in the operation of all medical programs by providing active advisory committees to the medical division at the State and county levels. These committees meet regularly to recommend standards of quality, quantity, and cost of the various programs.

The existing public programs provide medical care to those over 65 as well as those under 65 who need and want it. They are administered locally and are economical. The programs that we have in existence will maintain rather than discourage high-quality medical care and can be expanded, as we have experienced with Kerr-Mills, to meet the need when the need is indicated.

Community health activities: In addition to existing public programs, many community groups in the State have stepped up their activities in the health and hospital fields, particularly with respect to the aging. One specific example is a project at Hopedale, Ill., involving a residence for elderly people, known as Hopedale House.

This has been added to the Hopedale complex of medical facilities formerly consisting of a hospital and a nursing home. The project was financed on a voluntary basis through the sale of bonds to residents of Hopedale and nearby communities. This is an excellent example of what can be done for the aging without tax support.

There also are seven organized home care programs in Illinois. Three of the four programs in Cook County and one of the three downstate programs are operated by nonprofit community hospitals. Two of the downstate programs are operated by nonprofit groups through voluntary community financing.

These programs enable many of the aged to receive needed medical services in their homes without expensive bureaucratic organization and without the need for hospitalization. The Illinois State Medical Society's Committee on Aging continues to encourage and sponsor the development of more organized home care programs.

Such voluntary community effort would be, impeded by the Government's willingness to institutionalize patients under arbitrary rules and regulations, promulgated in Washington, without regard for patient requirements and community needs.

Countywide home nursing service has been jointly developed by the local health department and the Visiting Nurses' Association in three Illinois areas. These efforts are good examples of how voluntary effort can be supplemented by local government to provide health