Dr. ESSELSTYN. I don't remember whether they were or not. Dr. ESSELSTYN. I don't remember. Mr. DEROUNIAN. Well, it was. So you have changed your opinion on that phase of it? Mr. ESSELSTYN. On what basis? Mr. DEROUNIAN. On physicians' fees. The Forand bill covered them. Dr. ESSELSTYN. I just gave you the reason why they are not covered in this bill, as I understand it. Mr. DEROUNIAN. But you have no philosophical opposition to doctors' bills being included? Dr. ESSELSTYN. I have an objection to doctors' bills being included in this bill at the present time for two reasons: First, I do not feel that at the present time we know how to organize medical services; second, I don't feel that at the present time we know how to pay doctors for their services. Certainly it has been abundantly shown that piecework medicine is not anything but inflationary. I just think until we can develop a better organization of professional services, a better way of applying these services, and until we can devise a more perfect method of remuneration of physicians, it is well not to have these things incorporated in this bill. Mr. DEROUNIAN. Doctor, a few years ago when we had the Forand bill, we were less prepared to take action. Dr. ESSELSTYN. I don't think the evidence was as strong then against fees for service remuneration. Mr. DEROUNIAN. Thank you very much. The CHAIRMAN. Any further questions? If not, Doctor, we thank you for coming to the committee. (The following letter was received by the committee:) PHYSICIANS COMMITTEE FOR HEALTH CARE FOR THE AGED Hon. WILBUR MILLS, Chairman, Ways and Means Committee, Washington, D.C. THROUGH SOCIAL SECURITY, Washington, D.C., December 5, 1963. DEAR MR. MILLS: During the course of my testimony on November 20 before your committee in support of hospital insurance for the aged through social security, I answered Congressman Derounian's question regarding the inclusion or exclusion of physicians' fees in the King-Anderson bill. I am writing this letter to you in order to more fully document my remarks. I would like to request that this letter be inserted in the printed record of the hearings at the end of my oral testimony of November 20. In support of my feeling that remuneration of physicians should not be included in the current King-Anderson bill is the accumulating body of knowledge which causes increasing concern and is characterized by the excerpts from the three following reports: 1. The Health Information Foundation report showing that of those people with insurance, 11 out of every 1,000 had their appendix removed; of those without, 5-a difference of over 100 percent. Hospitalization rates for children, ages 1-17, for tonsillectomies were 30 per 1,000 among those insured, while for the noninsured, 9-a difference of over 300 percent. 2. The United Mine Workers of America report (prepared by Dr. Warren Draper, former Deputy Surgeon General of the U.S. Public Health Service) which showed that when group practice teams of salaried physicians provided services for beneficiaries of the fund, in a carefully studied area, hospital ad missions declined 32.5 percent; inhospital days, 36.8 percent; all surgery declined 16.5 percent, and appendectomy, 59.4 percent. 3. This report was followed by the recently published "Special Study of the Medical Care Program for Steelworkers and Their Families." This study of 1,250,000 workers corroborated the UMWA findings by revealing that the 38,879 who obtained their health care through a prepaid direct-service comprehensive group practice plan, where doctors were on salary, had similar experiences. Hospital admissions declined in this instance from 135 per 1,000 beneficiaries for those under the care of solo practitioners on a fee-for-service basis, to 90 per 1,000; hospital days per 1,000 declined from 1,032 to 570; and surgical cases per 1,000 declined from 69 to 33. Thank you very much for your cooperation. Sincerely yours, The CHAIRMAN. Dr. Stokes. CALDWELL B. ESSELSTYN, M.D., Chairman. Dr. Stokes, you, too, have been before the committee on several occasions in the past, but we will ask you once again to identify yourself for the record. STATEMENT OF DR. J. BUROUGHS STOKES, MANAGER, WASHINGTON, Dr. STOKES. I am very glad to. My name is J. Buroughs Stokes. I am manager of the Washington, D.C., office, Christian Science Committee on Publication of the First Church of Christ, Scientist, in Boston, Mass. My appearance before you has been authorized by the Christian Science Board of Directors, the administrative head of the Christian Science denomination. The CHAIRMAN. Dr. Stokes, we have assigned you 10 minutes. If you do omit any part of your statement, do so with the knowledge that the entire statement will be printed in the record. Dr. STOKES. I will be finished within 10 minutes, The House Committee on Ways and Means is to be congratulated on again holding hearings on the important subject of health care for senior citizens. It is indeed comforting and reassuring to know that your committee is exerting every effort to solve the complex problem involved. However, it is conceivable that no single solution exists. In fact, the various propositions which have been offered, upon study, show that they are far from perfect; and, if accepted, might even have a deleterious effect. On the surface, the suggestion that the solution is to be found by providing a compulsory program under social security appears promising. But here again experts have testified that this too is found wanting on several counts. For example, testimony before your committee by a responsible organization stressed that the workers might eventually be unwilling and unable to bear the cost of this proposal in addition to the tax increase required for the present social security benefits. Others have pointed out that the measure proposes a limited program of compulsory national health insurance for the aged only which would be expanded until it provides complete health services and coverage for people of all ages under a system of national health. If this were to result, we hesitate to think of the concomitant problems such a system would introduce. We believe that the compulsory social security approach of fixed service benefits infers that, in the field of health care, an individual, on reaching age 65, ceases to be a thinking, productive, and useful member of society. This approach suggests that such an individual is unable to plan for his future, make the proper selection of health services, or spend his money wisely. That this is not the case is borne out by the number of brilliant, productive members of society all around us who, despite being 65 years or older, are contributing so admirably to its advancement-the many Members of Congress, lawyers, physical scientists, educators, businessmen, farmers, laborers, and average workingmen. Why, without their mature thought, experience and ability, how can we, as a nation, go forward to help and bless mankind? We should not enact legislation which would tend to make or imply that those 65 years or older are "has beens." This, we know, would be more harmful to the dignity, freedom, and health of man than any single thing. The great majority of citizens, by their own individual ability and initiative, are already planning, meeting and solving the problem of adequate health care. They are doing this by means of private savings, cooperative family action, or individual and group health insurance plans, social service organizations, company and trade union health programs, retirement funds, and the like. We realize that, despite all of this, there is still an area in which the Government, both State and Federal, can be helpful in providing aid for the aged whose income and resources are insufficient to meet the cost of proper health care. It seems to us that the Kerr-Mills law (Public Law 86-778), properly implemented, provides an equitable means of aid for the needy aged. Whereas Kerr-Mills may not be the perfect solution to the problem, nevertheless, the Federal-State approach to it, with the State deciding for itself the scope and extent of services, does have more advantages than disadvantages. The system allows for local initiative, future progress and change, and the money to pay for the services is provided from all sources of income rather than that of merely the contributions of the self-employed, employer and employee. This seems to be just and equitable. The Hospital Insurance Act of 1963 (H.R. 3920) now before your committee, like its predecessor H.R. 4222 (87th Cong.), is designed to provide for the health care of all individuals 65 years and older who are eligible primarily for old-age survivors, and disability insurance and railroad retirement benefits. The provisions of the present bill (H.R. 3920) again constitute a wide departure from the normal practice under OASDI or the railroad retirement plan which provide benefits solely on a cash basis. Here, for the first time, if enacted, benefits would be afforded which all contributors could not use and accept. Particularly would this be true in the case of Christian Scientists who, because of their religious teaching and faith, do not employ medical treatment and care. As I explained to this committee when testifying on similar legislation in 1961 (H.R. 4222), Christian Science relies solely on spiritual means for healing, as did Christ Jesus. It respects sincerely the unselfish efforts of doctors, surgeons, psychiatrists, and others. It repects the right of each individual to choose that mode of health care which seems to him most efficacious and most nearly in accord with God's will, but when confronted with sickness or disability, a Christian Scientists turns to a Christian Science practitioner for help through prayer instead of to a doctor; when in need of hospital care it is only natural for a Christian Scientist to go to a Christian Science sanatorium rather than a medical hospital. Healing by prayer as understood in Christian Science has now been tested before the public for some 97 years. During this time a great body of evidence as to its efficacy in healing every sort of disease has been established. This care and treatment is known to be a safe, effective therapeutic system-so much so that Christian Science is practiced freely and without legal restriction in every State in the Union. Furthermore, today hundreds of insurance companies in the United States recognize and pay for Christian Science treatment and care in their group health insurance agreements and their various casulty and accident lines. Also, the Aetna Life Insurance Co., in its uniform plan for retired Federal employees, and in its Government-wide indemnity benefit plan for active Federal employees which covers some 6 million employees and their dependents, provides for Christian Science treatment and care. Again, when the Social Security Act was amended in 1960 by Public Law 86-778 (Kerr-Mills) to provide for medical care for the aged, it was worded so that Christian Science benefits could be included in any State program. In the area of health care for the aged, private insurance plans have been, as you are aware, providing new types of programs such as state 65 and other geographical group plans like Continental Casualty's Golden 65. These plans have a great deal of flexibility in providing the types of health care elderly individuals want and need. Also to be commended are the plans of the National Association of Retired Civil Employees and the American Association of Retired Persons, et cetera. Under all these private programs Christian Scientists are able to obtain coverage of the type they desire and can utilize. Through the years many have testified before this committee that one of the great advantages of OASDI is that it correlates cash benefits with an individual's contribution so that the contributor is given a sense of participation, of self-respect and self-reliance. However, H.R. 3920 provides only for a set, inflexible system of services which the Federal Government deems best. This seems to us to be depriving the individual of his right of free choice and of his dignity. This would make it extremely difficult for an individual, such as a Christian Scientist, who has religious and conscientious objections against providing himself with medically oriented hospital insurance. To summarize: We are opposed to the compulsory aspects of proposals such as H.R. 3920 which would require every citizen covered by Old Age. Survivors, and Disability Insurance and the Railroad Retirement systems during his entire working experience to make regular contributions, without exception, toward medical hospital insurance. If the committee should decide to vote out such a proposal, we ask that it consider the possibility of making coverage voluntary, providing for administration through private insurance carriers, and al lowing for a scope of benefits broad enough to benefit all of our senior citizens. This would not only be beneficial to the adherents and members of our denomination, but also to other citizens of our country who, for various reasons, we believe would not desire or need compulsory coverage. It would also do much to enhance and reemphasize for all the great value and contribution of senior citizens to the development and advancement of our country. We appreciate your courtesy in according us this opportunity to testify. The CHAIRMAN. Dr. Stokes, we appreciate your bringing to us this statement of the views which you have expressed. Are there any questions? Mr. ALGER. As I understand the entire import, you are particularly against the compulsory side and you think there should be a voluntary solution without compulsion? Dr. STOKES. That is correct. The CHAIRMAN. Thank you again, Dr. Stokes. Dr. STOKES. Thank you, Mr. Chairman. The CHAIRMAN. Miss Wickenden. You have appeared before the committee on numerous occasions over a period of years, and we appreciate your coming back again today. For the record, will you please identify yourself? STATEMENT OF MISS ELIZABETH WICKENDEN, TECHNICAL CONSULTANT, NATIONAL SOCIAL WELFARE ASSEMBLY Miss WICKENDEN. I think it must be at least 20 years. My name is Elizabeth Wickenden. I am appearing today in behalf of 14 organizations. We took quite seriously your request that organizations of like mind consolidate their positions. These are the national voluntary organizations in the welfare field that wish to support the principle of social insurance for health care for the aged. I, myself, am a technical consultant to a coordinating body, the National Social Welfare Assembly, which has not itself taken a position but which has assisted its member agencies that wish to take such a position. I am also consultant to the YWCA, which has taken a position. The 14 organizations in whose behalf I speak are as follows: The Council of Jewish Federations and Welfare Funds, which is the central body of all Jewish welfare agencies; the Family Services Association, which is the central body of the family; Private Family Counseling Service, Laurn Hyde Associates, a consulting firm in this field; the National Committee for the Day Care of Children; the National Conference of Catholic Charities. I would like to say here that while I am not speaking for them, I am authorized to say that the National Council of Churches of Christ in America, which does not sign joint statements, is of the same opinion, which means that the three welfare spokesmen of the large three faith groups are of the same mind on this matter. The National Council of Jewish Women; the National Federation of Settlements and Neighborhood Centers, which is the central organization of the settlement houses; the National League for Nursing |