Dr. STEGER. We serve on the Blue Shield board, which is the medical end of it. Blue Cross, of course, we are represented by other areas. We are represented by labor representation that serves on the West Virginia Hospital Service, Inc., Blue Shield-Blue Cross. We have people from industry, because this is really a people's plan.

Mr. O'HARA. Would I be mistaken to say that the Blue Shield board is dominated by persons representing the medical profession? While it is true you have representation in industry and of labor and of various other groups, doesn't the medical profession still control it? Dr. STEGER. My words are ones of semantics.

Mr. O'HARA. Let us not say dominated, but the majority of the board consists of persons whose connection is with the medical profession rather than industry or what have you.

Dr. STEGER. That is correct. Actually that has very little to do with your trying to bring it in from the standpoint of what it has to do with the medical profession field.

These things have to be met and considered with the actual soundness of the policy. Again, I do not want to get into this matter too deeply, because I am not an individual versed in all the financing of Blue Shield-Blue Cross.

Mr. O'HARA. With regard to the earlier question, I would like to come back to it for a moment. Am I to gather that the refusal of a part of the medical profession in this county and other counties of West Virginia to cooperate with the MAA program during the months immediately following the action taken by the State agency to change the fee schedule was an expression of protest against the manner in which the program had been run?

Dr. STEGER. And Commissioner Bernard Smith directly. Yes, sir. Mr. O'HARA. Then would it be fair to conclude that the medical profession in this county and much of West Virginia would prefer no program to a program where they did not feel they were properly consulted on the fee schedules and on the method of administration, or what have you? What was the profession's protest designed to demonstrate?

Dr. STEGER. Let me put forth an example. How would you feel if you had a little private industry of your own and you had a man who represented you to run that industry; he had so many millions of dollars to run this organiaztion; you had no report from that organization until the 11th month and this man comes to you and says, "In another month we are going to be broke"?

I know what I would do.

Mr. O'HARA. I think your reaction was to stop taking money out of it.

Dr. STEGER. That is exactly right. That is exactly what we did. Mr. O'HARA. I am wondering now, Mr. Chairman, about the possibility of scratching the medicare program and the Kerr-Mills program

Dr. STEGER. In this area. I said we are proud of our area.

Mr. O'HARA. I wish to state that I think any area in which adequate medical and hospital services are provided to all of the residents, regardless of their income, would have reason to be proud.

However, I think I would doubt your opinion is shared by all of the residents of this area. I imagine there might be considerable dispute over what is adequate and what is not.

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Dr. STEGER. May I give you an example of our lady who testified, Mrs. Lulu Coole, who had $51 a month income. You asked how could she get medical care.

Mr. O'HARA. Yes.

Dr. STEGER. She can get all the medical care she needs at one of our two clinics. If she does not have a private physician and she needs hospitalization for an illness, she will receive it.

This lady, Mrs. Coole, would come under the Kerr-Mills principle, but not come under the King-Anderson bill. That is why we believe that people who need help should receive help.

Mr. O'HARA. You recognize there is no sentiment in the Congress, to my knowledge, or elsewhere to eliminate the covering of Kerr-Mills or similar programs designed to provide assistance to those who would not be covered under King-Anderson.

Dr. STEGER. I believe that has been more recently brought out as part of the philosophy. I do not think that was in the earlier part.

Mr. O'HARA. In the first place, if you ignore the Murray-WagnerDingell bills and other measures of the earlier Congress, which began in the 76th Congress with the Forand bill, which was tied to the Security bill and Mr. Forand never contended that this took care of the needs of all elderly persons, nor does King-Anderson claim we should take care of only those eligible for the King-Anderson benefits and ignore the rest.

Dr. STEGER. I would like also to interject one thing, just being in a small community and just a common ordinary citizen, I have patients from all walks of life. Some of these people have considerable means. They are retired. They have their own way of life. They have their own homes. They have their own means of transportation, and so forth.

I cannot get it through my head why the American people should pay for their hospital costs under the King-Anderson bill. I just

cannot see that.

Mr. O'HARA. Certainly you have to pay taxes for all sorts of things that you then thereupon enjoy or can choose not to enjoy if you do not wish to, and which persons of all ages and income levels can enjoy. You pay taxes, for instance, to support the establishment of public recreational facilities.

Dr. STEGER. Do they call it an insurance?

Mr. O'HARA. That is not an insurance program. But the president of the corporation pays social security.

What is your objection to that feature?

Dr. STEGER. It was ruled by the Supreme Court it was a direct tax and not an insurance program.

Mr. O'HARA. I do not think we claim it is an insurance in the sense of private insurance.

Dr. STEGER. I think it would be fair to all the people if we all understood that. I am not really here to argue with you. You are here for information. I am really trying to help.

I do not want to be a stumbling block to you or any of your committee.

Mr. O'HARA. In conclusion, Doctor, I want to thank you for coming before us and for offering your testimony. I would gather that it could be summed up by saying t] lo not believe there is any

PROBLEMS OF THE AGED AND AGING

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need for further medical care on the part of the Federal Government, that you believe all the citizens of this community are receiving adequate medical care regardless of their income and they were in fact receiving such medical care regardless of income prior to the passage and adoption of the Kerr-Mills program by the State of West Virginia.

Dr. STEGER. Might I take exception to the statement in the area it says they do not need the Federal program. We want to see the KerrMills implemented. We are not so selfish that we are going to think of our own little community only.

There are other communities. When Mr. Smith did mention the southern end of our State, I am sure he is right. I am sure there are other areas in this State that do have real problems.

I think these people can be helped. I think they can be helped through the Kerr-Mills principle, and I must say I can agree with Mr. Smith on another account, that it takes time to have this program evolve. It takes expenses in that no one knows its cost, and I think that is probably one of the many things that is wrong with the KingAnderson bill. That is, the cost.

But I do not want to get into that.

Mr. O'HARA. A final observation would be that you do not concede there are any areas that would be helped by the adoption of the KingAnderson approach.

Dr. STEGER. No, sir. I object strenuously to the King-Anderson approach.

Mrs. HANSEN. I think many areas in the United States are keenly interested in hospital finance. How are your hospitals owned?

Dr. STEGER. We have two hospitals. One is a Catholic hospital. I think that is owned by the church under the bishop. I do not know. The other is a nonprofit hospital, and our Ohio General Hospital absolutely makes no profit whatsoever.

For the cost of beds, that was asked earlier, I can only give you a rough estimate. Would you be satisfied with that?

It is somewhere between $22 and $26 a day. That is the cost per bed. That means a total cost of all the things that come into it. One of the reasons, of course, that these costs are high is that the man who works and scrubs up the hallways, and who is the orderly in our place, and when they have children they want to make a decent wage.

The inflationary measures that have gone along in our Government have made it so that these costs have gone up. We have wonderful laboratory equipment and trained personnel. We have excellent X-ray equipment and trained men who run the things.

If you have time when you get through, I will take you down and show you our hospital.

Mrs. HANSEN. Is West Virginia troubled by the lack of availability of doctors and nurses like many other States?

Dr. STEGER. I am sure there are areas in parts of this State that need physicians. I am also sure that in this community, outside of this county, for instance across the river in Ohio, some of the small towns there lack doctors.

We could have a whole discussion alone on medical education and why we have a decreasing number of applicants to medical schools.

I would like to say that if there is a social security approach, if there comes in this country a socialized form of medicine, then I feel the number of applicants will steadily decline.

Mrs. HANSEN. How about the young women that turn into the field of nursing? Is that ratio keeping up so that nursing fields are adequately staffed?

Dr. STEGER. If I had known a few days prior to the meeting of your committee that you were interested in this field, I could have had a symposium of people here to answer these questions.

Mrs. HANSEN. Perhaps women always stray off and ask irrelevant questions.

Dr. STEGER. Not at all. I think that is important. These young ladies work hand in hand with us. It is through their efforts that our efforts are successful.

Mrs. HANSEN. We have been very interested in many areas of the country in the scholarship programs, some of them sponsored by your own medical societies. But it seems to be a decrease from our young women choosing that profession, the same as they are doing in teaching.

I wondered if it were noticeable here.

Dr. STEGER. I wish I could answer that.

Mr. O'HARA. Perhaps the salary scale might explain it. I was interested in your comment that one of the reasons for higher per day cost in the hospital was the increase in the salaries of hospital personnel. Would you know offhand what the starting wage for a registered nurse is in the Wheeling area?

Dr. STEGER. No, sir. I do not.

Does anyone in the room know?

Dr. WARD. It is about $250 a month.

Mr. O'HARA. Would you know offhand what that fellow who sweeps the floor is getting?

Dr. STEGER. No, sir, but I bet it is pretty competitive.

Mr. O'HARA. On the average, hospital employees, other than nurses, are getting about 80 or 85 cents an hour. That is countrywide, and I do not imagine it is any higher in Wheeling.

A beginning nurse, after graduation from high school and with 3 and possibly 4 years of nursing training, is making $350 a month. I find it difficult to believe that the payment of that sort of wage scale has boosted hospital costs significantly.

I know they have gone up, but I am inclined to attribute it to other factors.

Chairman BAILEY. Would you mind an interruption? If you recall, in connection with the last wage and hour law, nurses in nonprofit hospitals were exempted from meeting the minimum wage law.

Mr. O'HARA. I know, because many of them are not receiving the minimum wage.

Chairman BAILEY. If you recall, a representative of the nurses association was protesting vehemently that they were not gettting the benefits of the law.

Dr. STEGER. I think that is one of the reasons communities lose nurses. Other areas pay more and nurses in an area will go to these

areas.

Chairman BAILEY. I have one question uppermost in my mind. In this area, which you say is pretty adequately taken care of from the

medical standpoint, I just checked a few days ago with the Bureau of Labor Statistics. You still have an unemployment ratio here of approximately 12.7 percent. It was in excess of 13 a few months ago. That means there must be several thousand unemployed men and possibly one or two or maybe as many as three individuals in that family.

Are we to understand that despite the fact they are not earning anything they are still able to pay their medical care and that they are being adequately taken care of?

Dr. STEGER. Yes. If those people are unable to pay for medical care, they will get medical care.

Chairman BAILEY. Knowing that he is unemployed, isn't the average father inclined, or the mother if she is in the labor field working, to pinch every dollar to the point of supplying the family with something to eat and bare necessities, clothing to wear and such? Don't they neglect their medical conditions and let it go to a later day in the hopes things will improve?

Dr. STEGER. They do not have to.

Mrs. HANSEN. Did you not feel there is a reluctance on the average individual who is?

Dr. STEGER. I think that is typical of an American person. I agree with you. Those, of course, who need it do comprise many of the acute or emergency situations where they have to have care and they get that care. Some of that comes out in these 7,003 patients who make a total of 10,603 visits.

Mrs. HANSEN. Do you still feel if they were not so blunt to go for medical care there might be, let us say, of themselves, some illness or expensive illness later? At least, I also gathered that was the feeling. Dr. STEGER. I am a medical man. I do internal medicine. I believe in the continuing medical care of an individual.

I believe these people should be seen periodically, either in a clinic or in a dentist's office.

Would you like to hear what happens to a free case in a hospital? This is another thing we are proud of. When a free case comes into the hospital they are put either on a medical or surgical service, depending upon the nature of their illness. A member of the staff, an attending man, has those cases for the month. He has a direct supervision on these cases and he has under him a staff of residents and interns.

Our hospitals are very choosy, too, in the way in which these doctors are selected to do that, because they use them for their capabilities and abilities as teachers and so forth and their backgrounds. They are specialists.

When these people need any other service in any other area of the hospital, they get it. They get it free.

That may be orthopedic consultation, general urinary consultation, or whatever consultation you want.

In fact, it has been an old adage in the medical practice that if you want the best care in the world go into the hospital free.

Thank you.

Chairman BAILEY. We appreciate that, Doctor. There is just one more thought, of the hospitals that have been receiving the grants of the Hill-Burton Act.