meet the lower middle groups' needs and so on, we should in fact be having a form of socialized medicine. You may or may not like that. It does not happen to worry me but it worries a great many people in the country. This is what the real implementation of the ideal MÂA would be, a publicly financed medical program with all medical care taken care of, very liberal eligibility conditions, practically no effective means test and no requirement to divest yourself of your resources. I think it is very curious, actually, that the doctors like this so much when they hate socialized medicine so much.

Mr. COLLIER. At the risk of disagreement, I would say the basis of socialized medicine as such is the matter of compulsion and those things which are compulsory are the things that lead to a socialized program. Those things which remain in the realm of choice by the very nature of a program is not socialized.

I think when we discuss socialized medicines we get into many degrees and aspects.

Dr. BURNS. I would like to take you on, sir, on that sometime. The CHAIRMAN. Are there any further questions of Dr. Burns? If not, we thank you.

Mr. Burton? We are pleased to have our colleague from the State of Utah, the Honorable Laurence J. Burton. You are recognized, sir.

STATEMENT OF HON. LAURENCE J. BURTON, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF UTAH

Mr. BURTON. Thank you, Mr. Chairman. I have presented a copy of the speech I gave under special order, Mr. Chairman, on August 20 and I would like to obtain your permission to have the body of this speech inserted in the record at this point as though read.

I call attention to the fact that there are several tables and graphs which may present some problems in printing. If they can be included it would be helpful to the committee.

The CHAIRMAN. I think they can be. Without objections, the material will be included. I have just one question in my mind. If we refer to this as a speech you made on the floor of the House it will identify, of course, the questions that were asked of you there.

I think it should be identified as a speech that was made on the floor of the House as Mr. Burton suggests.

Mr. BURTON. Yes, sir. I won't burden the committee by reading the whole thing but I have prepared a brief I would like to present. The CHAIRMAN. We will be glad to hear you.

(The speech referred to follows:)

WHAT ARE THE FACTS ON MEDICARE?

Because of the conflict which surrounds the President's medicare proposal, I decided to determine for myself the true facts concerning medical care for the aged. Following is a copy of a speech I delivered on the floor of the U.S. House of Representatives, August 20, 1963, in which I presented the results of this research.

LAWRENCE J. BURTON,
Member of Congress, Utah.

[From the Congressional Record, 88th Cong., 1st sess., Aug. 20, 1963]

Mr. BURTON. Mr. Speaker, the administration's medical care for the aged bill, more commonly referred to as medicare, has caused considerable controversy.

Many of us are convinced that the proposal to provide hospitalization insurance through the social security system is either politically motivated, designed wholly to appeal to the 171⁄2 million voters over the age of 65; or it is a deliberate and calculated plan to put the U.S. Government in the medical business one step at a time. The ultimate objective is to bring all phases of medical and dental care under the control of the Federal Government through the Department of Health, Education, and Welfare, and administered under the social security system; or a combination of the two.

These conclusions seem to be supported by examining the President's message, the proposed legislation, and the statistics which were gathered from several other sources.

In his message to the Congress on the 21st of February 1963, the President clearly pointed out the problems of the aged stating:

We have more senior citizens than any time in our history.

Life expectancy of 49 years in 1900 has increased to 70 years in 1963. Average annual income received by aged couples is half that of the younger two-person families.

Senior citizens are sick more frequently and for more prolonged periods than the rest of the population.

Cost of hospital care has risen much faster than the retired workers' ability to pay for that service.

All the foregoing generalizations are true. Many of our elderly people are in a difficult spot and need assistance. Of the two conclusions drawn by the President from the foregoing generalizations, I believe only the first is justified.

His first is one with which I agree.

"All levels of government have the responsibility, in cooperation with private organizations and individuals, to act vigorously to improve the lot of our aged." The sole responsibility is not on the shoulders of the Federal Government. His second:

"Hospital insurance for our older citizens on social security offers a reasonable and practical solution to a critical problem. *** It is based on the fundamental premise that contributions during the working years, matched by employers' contributions, should enable people to prepay and build earned rights and benefits to safeguard them in their old age."

This implies that the social security system is the most desirable means by which prepaid and earned rights and benefits can be acquired-which is not the case.

Extensive research has led me to four general conclusions, which I am convinced are supported by the facts rather than political considerations.

First: The proposed plan neglects to consider the individual, completely disregards his needs, desires, and ability to provide his own hospitalization or any arrangements previously made in this regard.

Second: The medicare program cannot and will not provide adequate medical assistance where it is needed the most.

Third: The problem cited by the President is transitional and the solution is now within sight.

Fourth: There are other proposed programs and plans that offer greater potential for solving the medical problems of the aged. These programs will give more assistance to more people, with less cost.

The following data and information support these conclusions:

I. THE PROPOSAL DOES NOT CONSIDER THE INDIVIDUAL

To justify the existence of a medical assistance program for a limited number of special group of American citizens, we must take into account all of the pertinent considerations. Among the most important is the desires of the individuals concerned. A solicited response from my constituents has indicated that only half of them feel that the Federal Government has any responsibility in the matter, and the large percentage of those who recognize a Government responsibility prefer a voluntary program or tax relief as an incentive to provide private insurance.

In approximately 14,000 replies, less than half of those responding felt that the Federal Government had any responsibility to provide medical assistance to persons over 65. Those that recognized a government responsibility preferred a vol

untary program or tax relief as an incentive to provide private coverage. Of the 45.5 percent who felt that the Federal Government had a responsibility, 39 percent favored the Kerr-Mills program, 23 percent favored the medicare program, and the rest favored the tax incentive type programs-source: Burton survey conducted in March, April, and May, 1963, throughout 25 counties in the First Congressional District, State of Utah.

Certainly the next most pertinent question relates to the medical needs of the persons concerned, together with an analysis of the economic and financial status of these same people, with special attention focused on their ability to pay for these services when needed. The President, and other proponents of medicare, considered only two factors. First, that the medical needs of the aged are greater; and second, that their income is smaller. I respectfully submit that there are numerous other considerations, including (a) employment status, (b) income, (c) assets, (d) debt, (e) insurance coverage.

Let us consider these factors in the order listed.

A. Employment status

The following table contains information taken from official Bureau of the Census publications. These figures point out very vividly that there are large numbers of our senior citizens that are physically capable of supporting themselves and assuming the responsibility for their own welfare, and who have the desire to do just that:

Source: Bureau of the Census Supplementary Reports, 1960 Census of Population; published by U.S. Department of Commerce, Bureau of the Census, Dec. 21, 1962, PC(S1)-35.

The report clearly shows that there are large numbers of the elderly employed on a full- or part-time basis. In fact, nearly 2 million are employed full time and over 1 million part time, for a total of 3 million employed full or part time. Those persons working full time are receiving good wages, and there is no reason to believe that they cannot meet their own hospital expenses as well as the younger persons. Note that 345,000 males between 70 and 74 are employed full or part time; 35,000 males between 80 and 84 are employed full or part time, and even 11,000 males over the age of 85 are employed.

B. Income

Income of the senior citizen is necessarily another area of consideration. Table 2 represents the most recent data available on disposable income. A study of this information will lead objective observers to conclude that there are large numbers of the elderly who very obviously cannot expend large sums of money for hospitalization or medical care. However, the same table indicates that there are many who do not need the assistance. Nearly 30 percent of them make in excess of $3,000 a year after Federal income taxes. Remember table 2 relates only to disposable income. You will observe in table 3 that 48 percent of all families with the head 65 years of age or over make $3,000 or more, with 36.1 percent making $4,000 or more.

TABLE 2.-Disposable income1 by age of head of spending unit, 1961
[Percentage distribution of spending units]

1 Spending unit annual income minus Federal income taxes. Source: University of Michigan Survey Research Center, 1962, Survey of Consumer Finances (news release, Oct. 24, 1962).

Proponents of medicare have consistently referred to median income in stating their case for hospital care for the aged through the Social Security System. In so doing, they use the figure of approximately $1,200 as the median income. This is grossly misleading, since the Bureau of the Census in its current population reports shows the median male income to be $1,758, and the median female income to be $854. This may very well average $1,200. But 72.9 percent of all families with the head of the family 65 years of age or over are two-person families, with the family median income $2,530 a year. (See table 3.) It is also interesting to note that where the size of the family increases, and the family head is over 65, the median income also increases, and compares favorably with the younger families.