These increases in the social security payroll tax on the individual must also be met by the employer, thus making him raise his prices to offset this increase in overhead. This only adds to the already existing inflation of our economy. We do therefore urge that you use your influence, position, and vote to alter or defeat H.R. 6675 in its present form and find a more economical plan of caring for our elderly who actually need help. Sincerely yours, WILLIAM O. MOORE, R. PH., Secretary-Treasurer. Six Flags Pharmaceutical Association. Senator HARRY BYRD, Senate Building, Washington, D.C. ST. LOUIS 8, MISSOURI, April 14, 1965. DEAR SENATOR BYRD: The Missouri State Medical Association just completed its 107th Annual Convention and passed with slight modification and without opposition the enclosed resolution. The accompanying statement with minor changes was made in support of the resolution and when presented in subcommittee met with enthusiastic endorsement. This attitude represents a great change in thinking among physicians as a whole and portends a more cooperative and constructive attitude in the future. The representation of physicians in the AMA has tended to represent the hard core conservative element, which has dominated local medical politics, rather than the mass of physicians who, as in all groups, lie mostly in the middle between left and right. We do believe, however, that medicare is a bad bill since it covers the entire society over a certain age without concern for need. The experience of the British has been so costly. it has been suggested that a means test be introduced to prevent bankruptcy of their plan. The administration of such a national plan will be horribly expensive and establish a new empire in Washington. It is the greatest step toward a socialized society yet to be made and assuredly will be only the first. Enclosed is a clipping' from the AMA news on a survey of public opinion by the Opinion Research Corp., Princeton, N.J. into the beginning of a fantastic change in demonstrated to be the will of the people. medicare are by no means synonymous. What a shame to plunge forward our society that has never been Being a Democrat and wanting The Curtis-Herlong bill is a much gentler entry into a new field. With all the spending that is now being approved and the present crush of taxes which has contributed to our national disease of anxiety, I urge you to oppose the medicare bill. I am writing to you rather than my own Congressmen because I think you are more openminded and the only person with sufficient stature to resist Presidential pressure. Thought you might also be interested in the enclosure from Roch Labs, which arrived today. Yours very truly, EDWARD D. KINSELLA, M.D. PROPOSED RESOLUTION Whereas over the years the American Medical Association has frequently been blamed and criticized for a national image of reactionary opposition to federally sponsored public health plans; and Whereas the AMA is frequently accused of failure to represent the opinion of the majority of physicians: Now, therefore, be it Resolved, That we of the MSMA publicly endorse the basic precepts enunciated by the AMA in its opposition to these plans, currently and specifically medicare, and reaffirm our support of the American Medical Association; be it further Resolved, That regardless of the outcome of pending health care legislation, the AMA be encouraged to exhibit a progressive imaginative leadership in the study and furthering of attractive alternatives to a socialized system of medicine 1 Not inserted in the record. which will otherwise follow in the evolutionary sequence of events; and be it further Resolved. That notification of this action be forwarded to the AMA and all State Medical Societies. Reasons for this motion are: 1. To exhibit unity of opinion and support of AMA opposition to measures which sanction or promote socialized medicine. 2. To express a large body of medical opinion which favors a leadership interested not only in opposition but one leading the way in constructive alternative proposals that will block the evolution of socialized plans. 3. To see the AMA become identified with progress not counter reaction. 4. To imply the belief that an attitude of persistent opposition eventuates in a greater loss of desired ends than does active participation in planning to mold the future. 5. By taking positive action, to prevent a massive spirit of defeatism that will split physicians into two groups and weaken medical doctor opposition to socialized medicine. 6. The AMA has come out with eldercare only because they have been forced into a last ditch, defensive position and not as a result of forward looking leadership. It is this approach to planning that should be changed. Eldercare, however, does represent constructive, national, health care planning by the AMA and for this the AMA is to be praised. There must be continued planning on a national level. It is not possible to maintain the status quo in our changing society and physicians must become identified with energetic leadership. Physicians are by nature a laissez faire, conservative group which has succeeeded around the world in losing its stature in the morass of socialized medicine. We are as vehemently opposed to this as any among you with strong feelings but do believe the way to avoid socialized medicine is to endorse a leadership with imagination for alternative changes in keeping with the demands of our restless society. Old-age legislation is only the first step. The next has already been introduced, namely, to cover the young. And who is to say that the needy in between the young and the old should not also be covered by a national health plan? Are physicians going to sit back and wait to be told what to do or again hope for a last minute alternative, or will they plan a better plan to block the call for an extension of socialized medicine. 8. You have seen yourselves evolve from the position of refusing to accept Government money for your services to the point where the AMA through eldercare now proposes precisely such a plan. Here we are introducing payment of doctors' fees on a Federal level. You criticize medicare as "hospicare" because it left out doctor care. Apparently, many Washington legislators were shocked and so were many physicians. The views of the rigid right have become strangely quiet and one senses already some spirit of defeatism. 9. The reactionary attitude that has typified our body and the AMA is engulfed in the natural consequence of its own rigidity. When a reactionary opposition is beaten, it is through, and its voice becomes weak. But, if we help plan for the future and can inculcate a new enthusiasm for imaginative leadership in the AMA then the prospects for our future and a continuation of the best medical care of our patients will be ever so much brighter. It is not too late except for defeatists and for those who would hold the line. 10. This is the philosophy of progress that should be carried into the presidency of the AMA. EDWARD D. KINSELLA, M.D., St. Louis. SUBMITTED BY MRS. JOSEPH WILLEN, PRESIDENT, NATIONAL COUNCIL OF JEWISH WOMEN, INC., NEW YORK, N.Y. The National Council of Jewish Women urges early favorable action by the Senate Finance Committee on H.R. 6675, the Social Security Amendments of 1965. We believe, with President Johnson, that this bill is indeed a "landmark" in social legislation, providing for the first time in our country's history medical care for the elderly and disabled under social security. The position of the National Council of Jewish Women was reconfirmed at our national biennial convention last month "to work for a social security pro gram which will provide social insurance as the basic method for financing the costs of medical care for the aged and disabled." This current statement of our view, adopted by elected delegates representing our 329 affiliated local units across the country, has developed naturally from our history of support of the principles of social security dating back to 1935 and from our work with the elderly. For the past decade we have been working with older people through some 200 varied service projects across the Nation. We know from them and from a survey of medical costs among members of council golden age recreation centers, that fear of illness and anxiety about meeting large medical bills is widespread and constant. Since only a small percentage of Americans are able to save enough during their working lives to sustain the cost of protracted or catastrophic illness in old age, medical care financed through social security is the program most likely to meet health needs and remove a primary cause of poverty among the growing group of elderly in our population. The National Council of Jewish Women considers medical care financed through social security the best way to meet these acknowledged needs. We still believe, as we stated in May 1962, that "Far from being an infringement of freedom, it enables the individual to preserve his dignity ***. Unlike plans through which the Government appropriated public funds to pay for medical care for people who can't afford it, a social insurance plan keeps the Government out of the medical field by enabling each individual to provide for himself." THE MARY FLETCHER HOSPITAL, Hon. WINSTON L. PROUTY, DEAR WIN: Hospital board members and administrators have requested me to express to you our united and vigorous opposition to the exclusion of the professional services of radiologists, pathologists and anesthesiologists from the definition of hospital services as contained in H.R. 6675 “Social Security Amendments of 1965." This provision means that these professional services must be billed for separately from the hospital bill. In Vermont, the hospital is the base for all X-ray diagnosis and treatment performed by radiologists. The hospital is the base for practically all laboratory tests done on patients. The patient expects these X-ray, laboratory, and anesthesia services to be part of the hospital services and, in practically every case, one bill covers the services of both doctor and hospital. Exclusion of the services of the pathologists from the hospital bill, for example, would completely upset the relationship worked out over a long period of time between the Vermont College of Medicine and its primary teaching hospital in respect to pathology and laboratory service by the 12 pathologists on the college faculty. These pathologists have voluntarily limited their personal income under a three-way agreement in order to aid the teaching and research program of the college. Patient care is bound to suffer if this inequity is not corrected. In the teaching hospitals, where many residents are trained, the anesthesiologists have agreements with the hospitals and their income is not dependent upon whether a patient is rich or poor. Thus a ward, or service patient receives the level of skilled anesthesia indicated by the seriousness of his condition, whether he can pay or not. We do not like to think that the excellence of anesthesia could be pegged to the size of the patient's pocketbook. In Vermont 43 percent of the people are covered by Blue Cross which covers practically all X-ray and laboratory costs. If the radiologists' and pathologists' compensation is excluded from the hospital bill, the entire Blue Cross-Blue Shield arrangement will be shattered after 25 years of long service to the public. This will create a chaotic condition which people will just not understand. Exclusion of payment for the services of hospital-based specialists from the hospital bill is bound to increase the cost to those people not under provisions of H.R. 6675. Many under this act undoubtedly cannot or will not pay the doctors fees as billed by the specialists. That means increase in charges to others to offset the losses. The paperwork involved in separate billing for laboratory and X-ray would be enormous and increase the cost of doing business at a time when we are all concerned about the continuing rise of hospital and medical care. There are certain facts that we must face. The radiologist, the pathologist, and the anesthesiologist have a captive practice because the hospital is there and the patients are admitted by other physicians. The patient has no choice of radiologist, pathologist, or, generally, the anesthesiologist, nor can he bargain on charges for the reason that these specialties are monopolistic. Under existing practices, the hospital governing body exerts a certain measure of control over charges and is definitely concerned about quality of practice. The governing board has the legal obligation to protect the patient's welfare. We should not lose these checks and balances that have worked so well for so many years. The seemingly inocuous section which excludes the services of hospital-based specialists from the definition of hospital services would revamp our entire system as it would not, perhaps could not, be limited to medicare alone. Is that what is really intended? Win, I hope you will do all in your power to protect the medical-hospital relationships that have been so successful and effect the revision proposed by Senator Douglas. I am enclosing a reprint of his remarks and the telegram from Dr. Crosby as contained in the Congressional Record-Senate, page 6830, April 6. 1965. As member of the board of trustees of the American Hospital Association, I am pleased that Dr. Crosby has expressed the position of hospitals so well. I am sending a similar letter to Senator Aiken. If either you or Senator Aiken feel that you need more information or if we can be more persuasive by a personal visit, we would be pleased to have a small delegation of hospital trustees and administrators meet with you in Washington at your convenience. Thanks for all your consideration. Les, LESTER E. RICHWAGEN, Executive Vice President and Administrator. THE ISSUES The issues involved in the exclusion of the medical specialties (radiology, pathology, anethesiology, physiatry) from H.R. 6675 are clearly apparent to hospital administrators and boards of trustees throughout the country. 1. The American Hospital Association has a long history in support of the position that the services of radiologists, pathologists, anesthesiologists, and physiatrists are integral parts of hospital care. In 1957 the board of trustees of the association gave recognition to this fact when they officially endorsed the inclusion of these services in Blue Cross contracts as hospital services. 2. The provision of these services is inherent in the years of efforts to improve the quality of patient care in hospitals. Even though the individual physicians involved were accorded full professional stature in every sense of the word, the administration and provisions of these specialty services developed within the sphere of hospital services. The removal of such services is a backward step and one which may jeopardize continued efforts to improve the quality of patient care in hospitals. 3. The legislation under consideration, in order to provide basic assurances, makes a strong avowal that the Government will not interfere with the provision of hospital and medical care and in the organization and administration of hospitals. The removal of these specialists' services is contrary to this purpose and tends to dictate a nationwide pattern prescribed by the Federal Government. We have continually urged that the Federal Government not interfere in the relationships which are worked out locally between the hospital and the physician-specialists. The language in the bill passed by the House does interfere in such relationships and could force a nationwide renegotiation of all contracts between physician-specialists and hospitals. In addition, widespread renegotiation between hospitals and Blue Cross plans and between Blue Cross plans and the million of their subscribers would be necessary. 4. It is unlikely that the aged beneficiaries will understand the significance of the deletion of these physician-specialists' services until they are in hospitals. Then they will be informed that these physician services are no longer included in the costs to be borne by the Federal Government, and they will receive multiple billings from the physician-specialists. We believe this constitutes a large reduction in anticipated benefits and will constitute a major change in practices to which the public has become accustomed. 5. Administrative difficulties inherent in this change will be formidable. The administrative problems within hospitals will be greatly increased; administrative difficulties in connection with the administration of the overall program as well as that of the physician-specialists themselves will be greatly increased. 6. It is believed that the removal of the specialists' services will tend to increase the overall cost of care to aged people. 7. It is believed that the removal of these services will undermine the quality of care in small hospitals where the volume is such that it is not possible to arrange continuous full-time specialist services. The quality of care in such hospitals has been markedly improved by arrangements with physicianspecialists visiting on "circuit rider" arrangements. The economic problems involved in obtaining such physician services in the future, if hospitals were forced to withdraw their guarantees to such specialists, would seriously curtail such services. Specialists would have to make individual billings and collections with considerable uncertainty as to any assured income for his services. 8. Overall it is believed that if this division in specialist services remains for aged beneficiaries under this legislation it will certainly lead to an extenson of the practice to all other patients and the necessity of renegotiating nearly all existing arrangements for the remuneration of physician-specialists in hospitals. [From the Congressional Record, Apr. 6, 1965] AMERICAN HOSPITAL ASSOCIATION STRONGLY URGES REINSTATEMENT OF SERVICES OF MEDICAL SPECIALISTS AS REIMBURSABLE COSTS UNDER AGED HEALTH CARE BASIC PLAN Mr. DOUGLAS. Mr. President, on March 29 I urged, in a Senate speech, that the Senate restore to the House committee approved plan for expanded medical and hospital care for the aged reimbursement under the basic plan of the in-hospital services of medical specialists. While I dislike the barbaric English usage of some of the titles, the official designations of these specialties are radiology, pathology, anesthesiology, and physiatry. After making this speech, I sent a telegram to Dr. Edwin N. Crosby, executive vice president of the American Hospital Association, asking the position of the association on this matter. The telegraphed reply of Dr. Crosby on behalf of the association speaks for itself, but I point out in summary his evaluation that the exclusion of these services: First, would seriously retard the continued development of the modern hospital as the central intsitution in our health service system; second, not only will confuse the public through a multiplebilling approach and cost them more, but could endanger the quality of patient service; third, interferes with existing relationships between hospitals and physicians and tends to dictate a nationwide pattern prescribed by the Federal Government; fourth, is certain to face aged beneficiaries with a substantial reduction in the benefits they will receive; fifth, will imperil the longstanding arrangements developed by many Blue Cross plans; sixth, will make the administration of the overall program enormously more complicated; and seventh, will require nationwide renegotiation of contracts between hospitals and specialists and between hospitals and third party agencies. I earnestly hope the Senate will act to correct this exclusion, and I ask unanimous consent that the text of Dr. Crosby's telegram be printed in the Record. There being no objection, the telegram was ordered to be printed in the Record, as follows: Senator PAUL DOUGLAS, Washington, D.C.: APRIL 5, 1965. In reply to your wire the American Hospital Association takes the position that radiology, pathology, anesthesiology, and physiatry services in hospitals are essential to the provision of high quality patient care in the hospital and thus are basic hospital services. Exclusion of these services would seriously retard |