services when the local community cannot do the whole job. Visiting nurses' services are available in many counties in Illinois and are financed by voluntary effort. In most cases, this is done through the United Fund. Cooperative action of this sort, at tremendous tax savings to individuals, is possible under a voluntary system as we know it today.

Policy on care of aging: The Illinois State Medical Society has demonstrated its concern for the health care of the aging by conducting a very active program on the aging as we have tried to indicate. The society has maintained an active committee on aging for many years. Our activities, interest, and concern are largely summarized in the 12-point policy statement issued January 1961, and presented before this committee July 1961; it is restated for the record:

1. The society is exerting its effort to maintain the older individual as a healthy participant in the family, civic, economic, and political life of the community.

2. The society feels that the responsibility for financing health care of the aged rests primarily on the individual, then his family, then voluntary community agencies. Should these be inadequate, the responsibility should rest with government on an ascending level with Federal participation limited to financial assistance to the State for locally administered and locally operated programs.

3. The society is taking active leadership in the development of prepayment and insurance plans for the aged in low-income groups. 4. The society reaffirms its position that no patient, aged or otherwise, need go without medical services because of inability to pay. 5. The society supports the extension of governmental programs for medical aid to the aged through the Kerr-Mills aproach.

6. The society is continuing its efforts to expand skilled personnel training programs at all levels in the health field.

7. The society is continuing its efforts to improve medical and related facilities and services for the aged.

8. The society strongly advocates health maintenance programs. 9. The physicians of Illinois support the development and wider use of restorative and rehabilitative services for all who need them. 10. The society endorses community activities for older people such as may be found in churches, senior achievement groups, "Golden Age Clubs," and day centers.

11. The society strongly supports the extension of research and is cooperating with organizations in undertaking research on numerous socioeconomic aspects of aging.

12. The society urges all county medical societies to form special committees on aging and to take local leadership in the development of specific programs to improve the care of the aged. Thirty-one county medical societies in Illinois currently have active committees on aging.

Support health insurance for aging: We continue to work actively with the private health insurance industry to improve coverage in all possible ways for those over 65.

A special medical plan for the aged was developed by Illinois Blue Shield in 1959. The Blue Shield over 65 plan was broadened and remarketed in October 1962. Membership rose to a new high. The addition of new subscribers now gives Blue Shield in Illinois a total membership of 225,000 aged individuals.

The fact that over 7,000 Illinois physicians have signed the Blue Shield participating physicians' agreement to accept reduced fees as payment in full for services rendered to beneficiaries, once again indicates that our system of voluntary health care is responding with vigor to meet the needs of the over 65.

The health insurance industry, supported by organized medicine, has shown remarkable progress, particularly in covering those over 65 who need and want such coverage. In fact, the proportion of the aged in this country with health insurance has more than doubled since 1952. In terms of absolute numbers, the 26-percent insured in 1952 represented only slightly over 3 million individuals whereas more than 10 million, or 60 percent, of the over 65 are covered today. Status of Illinois aging: The University of Illinois, in 1961, conducted a survey of the aged in Decatur. The results indicated that 68 percent of the over 65 had health insurance. Of those not covered, 13 percent indicated that they did not want to be.

Of the 995,000 individuals in Illinois over 65, it is estimated that 225,000 are employed or are the wives of employed persons; an estimated 100,000 receive veterans and other types of Government pensions such as railroad retirement or civil service; 109,000 are estimated to be receiving private pensions or annuities; and 50 percent are estimated to have some income from assets in the form of interest, dividends, and rent. Estimates are based on official U.S. Government data.

About 558,000 are recipients of OASI; 62,000-only 6.3 percentreceive old-age assistance benefits-a percentage significantly below the national average of 12.9 percent. The University of Illinois study of senior citizens indicated their median income to be about $4,000 per year; the 1960 census indicated their income to be over $3,700 more than a twofold increase since the 1950 census.

Approximately 12,000 older citizens in Illinois are inmates of the 12 Illinois mental institutions; others are inmates of prisons and State and Federal institutions where they receive their medical care from the Government. An undetermined number receive medical care from the Veterans' Administration; medical care programs for retired military personnel and their dependents; and homes for the aged financed by religious organizations, fraternal orders, and other groups where medical care is provided.

These data support the position that a large percentage of the aged in Illinois are able to provide for their medical care and that their economic position points to a constantly improving situation. Yet, H.R. 3920 postulates a future where all changes in the economic status of the aged are adverse.

Conclusion: One of the fundamental issues of providing medical care to the over-65 age groups is whether the supply of that care should be based on the principle of individual choice or be made the subject of collective provision; whether the providers of medical care to this group should charge for their services or whether medical services should be supplied free with costs being met from social security taxes and the quantity of services being regulated by Federal administrative decision.

The issues cannot be decided upon technical grounds; they lie bevond economics and are based on one's beliefs of what constitutes a

free society. The Illinois State Medical Society takes the position that the provision of medical care rests firmly on individual financial responsibility, then on local private resources to which have been added health care programs designed to meet the specific need financed by local government, State government, and finally, as a last resort, by the Federal Government.

In keeping with the principles of providing for those in medical need, the Kerr-Mills program is designed to finance the cost of health care for that segment of our population not on public assistance and who fall within certain need criteria.

We favor the Illinois Kerr-Mills law as a way of helping those who need help, and voluntary health insurance and prepayment plans for those who can afford them. Our society reaffirms its position that no patient, aged or otherwise, need go without medical services because of inability to pay.

In the interest of the general welfare, and the promulgation of programs sponsored by the Illinois State Medical Society and other voluntary groups, as well as for other reasons expressed here today, we strongly urge your committee to disapprove H.R. 3920.

On behalf of the members of the Illinois State Medical Society, Dr. Mallory and I wish to thank the committee for the privilege of presenting this statement.

The CHAIRMAN. Thank you, Dr. Hesseltine. Are there any ques tions?

Mr. ALGER. On page 8 of your statement you mention that Illinois has AMI-aid to medically indigent-and I think in Illinois you separated that group out of the mainstream of those over 65 and treat them specifically and not treat the whole group over 65 as medically indigent.

Dr. HESSELTINE. In some cases, they will be transferred where

necessary.

Mr. ALGER. If you can take care of the medically indigent the others are pretty well taken care of?

Dr. HESSELTINE. Yes, sir.

The CHAIRMAN. Thank you very much, Dr. Hesseltine and Dr. Mallory, for bringing us these views.

The CHAIRMAN. Mrs. Judy Coleman.

Mr. Alger.

Mr. ALGER. It is a pleasure for me to introduce Mrs. Judy Coleman, of Dallas, Tex., who represents 12,000 ladies in our country, women associated in this work, and she has Miss Alice Budny with her, but I will let her introduce her associate.

It is nice to have you with us and to recognize a citizen of Dallas, Тех.

STATEMENT OF MRS. JUDY COLEMAN, PRESIDENT OF THE AMERICAN ASSOCIATION OF MEDICAL ASSISTANTS; ACCOMPANIED BY MISS ALICE BUDNY, PAST PRESIDENT

The CHAIRMAN. We welcome you to the committee and we are sorry we kept you so long.

Mrs. COLEMAN. Thank you, Mr. Chairman. As Mr. Alger told you, I am Judy Coleman. With me is Miss Alice Budny, of Wilwaukee, Wis., immediate past president of our association.

The CHAIRMAN. We are glad to have you with us.

Mrs. COLEMAN. The American Association of Medical Assistants is composed of more than 12,000 members who are secretaries, receptionists, bookkeepers, nurses, and technicians in the employment of physicians in offices, clinics, hospitals, and nursing homes throughout the country.

Our membership is in a unique position to evaluate and comment upon the legislation which is now being considered by this committee. We are in close personal contact with the medical, social, and economic needs of patients every day of our professional lives. When a patient telephones or comes to the physician's office, we are the patient's first contact with the physician. Since we are also the bookkeepers, we know the costs of medical care and the methods by which these costs are met. Finally, as individuals and citizens as well as medical assistants, we are vitally concerned about the health care of patients over 65.

Our daily contact with aged patients has proven to us that the KingAnderson bill is based on the false assumptions that reaching age 65 renders an individual sick and incapable of independent action and that the aged are generally impoverished.

It has been demonstrated over and over that there are no diseases exclusive to those over 65 years of age, that the aged generally enjoy good health, and that they can continue to make a substantial and valuable contribution to their community. We see vigorous senior citizens 65, 70, and even 75 years of age who are still gainly employed and enjoying themselves.

We have learned never to underestimate or discount the tremendous influence that the emotional and psychological environment has on a patient's health level. This fact is more evident to us among the aged than among any other age group. The aged need to feel useful, selfsufficient and to remain in the mainstream of life. They need patience and understanding in meeting their health needs and not the mechanical and impersonal care that is likely to result under the Federal program which would begin with the King-Anderson bill. These people do not want to be pushed aside into an artifically created special group which must be cared for by the Federal Government.

Most senior citizens have been independent and self-sustaining during their adult life. Many have set aside money for their retirement years and can meet their needs from their own resources. Others receive benefits from pension plans or annuities.

The economic status of the aged has improved rapidly in recent years and it is more likely to continue to improve in future years. We know that most of the aged own their own homes. We know too that many of the aged we see have more spendable income than younger families. We can attest to the fact that most of the aged can and do promptly pay their medical expenses.

We have also witnessed the tremendous growth in health care coverage of the aged by Blue Cross-Blue Shield and the commercial insurance companies. Each day more and more of the aged are having their medical care financed by such systems. And, we have found that a rapidly increasing number of the aged are receiving health care coverage as a part of their retirement benefits from industry.

For those who cannot meet their medical expenses, we have witnessed the growth and capability of public and private programs. And, we know that physicians provide free care to patients, young or old, who do not have the resources to pay for such care. We see such care every day.

In 1960, the house of delegates of the American Association of Medical Assistants unanimously adopted a resolution opposing the then current King-Anderson bill, H.R. 4222. Just last month, our house of delegates again unanimously adopted a resolution opposing the bill before you, H.R. 3920. For the reasons stated, we are completely opposed to this bill.

Thank you for providing the American Association of Medical Assistants with this opportunity to present its views on H.R. 3920. The CHAIRMAN. Thank you, ladies, for bringing to the committee the views of your association. Are there any questions? Thank you again.

The CHAIRMAN. Dr. Parker. We will ask you to please identify yourself for our record by giving us your name, address, and capacity in which you appear.

STATEMENT OF DR. THOMAS PARKER, PRESIDENT, ASSOCIATION

OF AMERICAN PHYSICIANS AND SURGEONS

Dr. PARKER. Mr. Chairman and members of the committee, my name is Thomas Parker and I live in Greenville, S.C., where I am engaged in the general practice of medicine.

I was elected president of the Association of American Physicians and Surgeons on October 10, 1963.

The CHAIRMAN. We are glad to have you with us, Dr. Parker and if you omit any parts of your statement, do so with the knowledge that your entire statement will be made a part of the record. We apologize for keeping you so long.

Dr. PARKER. The house of delegates of the Association of American Physicians and Surgeons on April 6, 1963, unanimously adopted a resolution opposing H.R. 3920. On October 12, 1963, the assembly adopted a resolution in opposition to H.R. 3920, and on this same date, the delegates reaffirmed their position of opposition to H.R. 3920.

My testimony is in two parts: Part I, "The Basis for Opposition to King-Anderson Type Legislation (H.R. 3920)." Part II, offers statistical evidence that there is no demonstrated need for this legislation.

I will appreciate the privilege of reading part I which is comparatively short-but offering both parts for printing in the hearing record.

Part I: The premises of King-Anderson type legislation are that it is the duty of the Federal Government to provide medical care for the aged because the aged are sick and poor and unable to provide for themselves, and because their families cannot be expected to provide for them either; and that participation in such Government-provided care shall be compulsory, since it will, of course, be supported by taxation.

At present, the Federal Government proposes to provide incomplete medical care for a designated group of the population in institutions that meet standards set by the Federal Government, but surely it does