The proposed amendment would permit a temporarily disabled worker to receive dual benefits which in many cases would produce more than the worker's take-home pay if he were working. This is so patently wrong that it must have been an oversight when passed by the House. I understand, for instance, that a married man with two children, earning $5,000 per year, would receive $6,201.60 in tax-free benefits under the proposed admendment, as follows: I trust you will study this costly amendment with care and act to prevent the further extension, in this unreasonable manner, of social security into the workmen's compensation field, which has been operating successfuly over a period of 50 years. Respectfully yours, Hon. HARRY F. BYRD, Chairman, Senate Finance Committee, DEAR SENATOR BYRD: We, the commissioners of the Oregon State Industrial Accident Commission, respectfully request that you give careful consideration to section 303 of H.R. 6675. This section is a nonrelated amendment to the social security disability program and is not pertinent to the medicare program. The encroachment of the social security disability program through the overlap of disability payments to permanently and totally disabled workmen's compensation claimants has had a hampering effect on efforts to improve workmen's compensation benefits. If social security is allowed to further invade the workmen's compensation system through payments for time loss for occupational injuries, it will be impossible to increase workmen's compensation benefits to keep up with the need. We respectfully direct your attention to the danger to safe working conditions. The outstanding records in safety of today as compared to the times before workmen's compensation are clear proof that workmen's compensation has given greater impetus to safety than anything else. Records will show that the graduated premium rates, reflecting the effectiveness of employers' safety efforts, have saved untold numbers of occupational injuries and fatalities. All this will be lost if social security is allowed to absorb workmen's compensation. There is no distinction in social security payments made by employers that reflects the degree of hazard or the efforts made to reduce injuries to their workmen. This powerful incentive which is fundamental to workmen's compensation is totally lacking in social security. It is inevitable that occupational injuries will increase. To combat that unwanted condition it is almost certain that there will be a demand for the return of common law rights of the workman to sue his employer. This system was never satisfactory to the workers and would benefit only attorneys, while costing the public huge sums in providing the courts. We respectfully request that you use your influence to have section 303 amended in such a way that disability payments do not apply to workmen's compensation claimants. Efforts are being effectively made to upgrade workmen's compensation benefits now. Let us not nullify the system of having payments to workmen's compensation claimants paid as a cost of production to the employing entity and also tailored to encourage safety. DEAR SENATOR: It has come to my attention that under the present program for medical care for the aged about 2 million persons will be covered by the proposed legislation who are not now insured. It would seem to me that the principles contained in Public Law 87-693, with reference to the recovery of tortiously liable third persons, might be incorporated into the medicare bill now pending in your committee. As you will remember you were the author in the Senate of 87-693. As you know, the House is debating the bill with a no amendment provision, and I wondered if you might consider the possibility of adding the concept contained in Public Law 87-693 to the Senate version of the bill. A copy of a proposed amendment and a copy of 87-693 is attched for your consideration. With kindest regards, Sincerely, Enclosures. CHARLES E. BENNETT. MEDICARE BILL, P. 107, SECTION 103 (D) Notwithstanding any other provision of this act, or any other provision of law, the Secretary is authorized, with respect to any payment made to a provider of services on behalf of an individual whose entitlement to monthly insurance benefits under section 226 of the Social Security Act is authorized under section 103 of this act, and whose illness or injury was caused under circumstances creating a tort liability upon some third person (other than or in addition to the United States) to pay damages therefor, to recover from said third person any payment thus made and, for purposes of effecting such recovery, the provisions of the act of September 25, 1962 (Public Law 87-693, 42 U.S.C. secs. 2651-2653) shall be applicable to the same extent as if the United States had furnished the hospital and medical care and treatment to such individual under authorization or requirement of law; and all amounts so recovered shall be returned to the Federal hospital insurance trust fund established by section 1817 of the Social Security Act. Public Law 87-693 87th Congress, H.R. 298 September 25, 1962 To provide for the recovery from tortiously liable third persons of the cost of hospital and medical care and treatment furnished by the United States Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, That (a) in any case in which the United States is authorized or required by law to furnish hospital, medical, surgical, or dental care and treatment (including prostheses and medical appliances) to a person who is injured or suffers a disease, after the effective date of this Act. under circumstances creating a tort liability upon some third person (other than or in addition to the United States and except employers of seamen treated under the provisions of section 322 of the Act of July 1, 1944 (58 Stat. 696), as amended (42 U.S.C. 249) to pay damages therefor, the United States shall have a right to recover from said third person the reasonable value of the care and treatment so furnished or to be furnished and shall, as to this right be subrogated to any right 1 (S. Rept. 1945), overrule, U.S. v. Std. Oil Co. of Calif., 332 U.S. 301 (1947). or claim that the injured or diseased person, his guardian, personal representative, estate, dependents, or survivors has against such third person to the extent of the reasonable value of the care and treatment so furnished or to be furnished. The head of the department or agency of the United States furnishing such care or treatment may also require the injured or diseased person, his guardian, personal representative, estate, dependents, or survivors, as appropriate, to assign his claim or cause of action against the third person to the extent of that right or claim. (b) The United States may, to enforce such right, (1) intervene or join in any action or proceeding brought by the injured or diseased person, his guardian, personal representative, estate, dependents, or survivors, against the third person who is liable for the injury or disease; or (2) if such action or proceeding is not commenced within six months after the first day in which care and treatment is furnished by the United States in connection with the injury or disease involved, institute and prosecute legal proceedings against the third person who is liable for the injury or disease, in a State or Federal court, either alone (in its own name or in the name of the injured person, his guardian, personal representative, estate, dependents, or survivors) or in conjunction with the injured or diseased person, his guardian, personal representative, estate, dependents, or survivors. (c) The provisions of this section shall not apply with respect to hospital, medical, surgical, or dental care and treatment (including prostheses and medical appliances) furnished by the Veterans' Administration to an eligible veteran for a service-connected disability under the provisions of chapter 17 of title 38, United States Code. SEC. 2. (a) The President may prescribe regulations to carry out this Act, including regulations with respect to the determination and establishment of the reasonable value of the hospital, medical, surgical, or dental care and treatment (including prostheses and medical appliances) furnished or to be furnished. (b) To the extent prescribed by regulations under subsection (a), the head of the department or agency of the United States concerned may (1) compromise, or settle and execute a release of, any claim which the United States has by virtue of the right established by section 1; or (2) waive any such claim, in whole or in part, for the convenience of the Government, or if he determines that collection would result in undue hardship upon the person who suffered the injury or disease resulting in care or treatment described in section 1. (c) No action taken by the United States in connection with the rights afforded under this legislation shall operate to deny to the injured person the recovery for that portion of his damage not covered hereunder. SEC. 3. This Act does not limit or repeal any other provision of law providing for recovery by the United States of the cost of care and treatment described in section 1. SEC. 4. This Act becomes effective on the first day of the fourth month following the month in which enacted. Approved September 25, 1962. This amendment provides that where hospitalization benefits are paid out of the general revenues of the Treasury on behalf of a person who is not entitled to social security benefits, for an injury or illness caused by a tort, the Secretary of HEW is authorized to recover the cost of such benefits from the person causing (or contributing to) the tort and to pay the recovered amount into the hospital insurance trust fund. (I believe a conforming amendment should be made to sec. 103 (c) to reduce the amount of the appropriation by the amount recovered under this amendment.) MARCH 3-26, 1965. Congressman Bennett now says in his view it should be applied both to amounts paid through the general revenues and to amounts paid through the social security tax. It would have to be redrafted to accomplish this, though. PROVIDENT MUTUAL LIFE INSURANCE COMPANY OF PHILADELPHIA, H.R. 6675-Social Security Amendments of 1965. Hon. HARRY F. BYRD, Chairman, Senate Finance Committee, U.S. Senate, Washington, D.C. DEAR SENATOR BYRD: I am writing to express some concern about this bill which has been passed by the House and is now under consideration by the Senate Finance Committee. I am quite aware that it may be entirely fruitless to argue against passage of any medicare legislation whatsoever, but it does seem to me that if the legislation is to be enacted, there are certain fundamental objections to the present bill which should be corrected. First, with respect to the supplemental medical care benefits for persons over 65, I am afraid that these provisions would seriously narrow and perhaps almost eliminate the field for voluntary health insurance coverages offered by private insurance companies to persons over 65. I believe this is contrary to the spirit of the President's 1965 health message which advocated that insurance companies should play a major role in providing voluntary health coverages. For this reason I believe that the provision for the optional supplemental benefits should be eliminated. However, assuming that the Congress should refuse to eliminate this provision, then I think the optional feature violates a fundamental principle of social insurance. This is because it is offered on an optional basis, subsidized from general tax revenues, and thus would discriminate against persons who could not afford to subscribe for the supplemental coverage. With respect to the provisions for disability coverage, the bill certainly would invade the field of both short-term and long-term disability coverages now offered by insurance companies, and this again would seriously narrow the field now served by the private insurance companies. Furthermore, the bill contains no provisions to offset benefits provided by State workmen's compensation laws or State cash sickness programs. Thus there could be many situations where there would be duplication of benefits, often significant enough to result in greater total governmental indemnity than the employee's monthly earnings prior to disability. Experience shows that where there is a duplication of health insurance benefits, this reduces the incentive to return to work and encourages malingering or a mental attitude that it is easier to receive tax-free benefits than to try to earn taxable wages. Obviously, such duplication can prove quite costly in the operation of any insurance plan. I would also have serious doubts about the wisdom of increasing the taxable wage base from $4,800 to the projected $6,600 in 1971. It seems to me that the wage base should be more closely geared to current average wages and that it is unsound to freeze into the law an assumption that the average wage will be $6,600 by 1971. Possibly the $5,600 wage base would be reasonable, although I would think that $4,800 would be even more reasonable and more consistent with the social purposes of the legislation. I apologize for the length of this letter but I found it difficult to condense in any shorter space the points I wanted to bring to your attention. Sincerely, HON. THOMAS DODD, Senate Office Building, Washington, D.C. T. A. BRADSHAW. SOUTHINGTON, CONN., April 13 1965. DEAR SENATOR DODD: I urge you to oppose a possible amendment to the present medicare bill which would place radiologists under the directive of the hospital administrator. Senator Douglas has stated that he would propose such an amendment which would not only eventially ruin the private practice of radiology but would have the immediate effect of dampening any tendency a young medical student might have for our field. There are 7,000 hospitals in this country with approximately 6,000 certified radiologists. The training of a radiologist is as long or longer than most medical specialities. Since our services are being utilized more every day as we uncover new diagnostic X-ray and isotope modalities, it would seem that we will need more X-ray physicians in the immediate future. The amendment to be proposed by Senator Douglas would serve to accomplish the opposite. I wish to thank you for your consideration. HARRY H. BROWNE, M.D. HON. HARRY BYRD, WASHINGTON, D.C., April 28, 1965. Chairman, Finance Committee, DEAR SENATOR BYRD: This is in reference to the Douglas amendment (79) that would include anesthesiologist, patheologists, radiologists, and physiatrists in the medicare bill now under consideration by your Senate committee. I would like to explain why anesthesiologists should be considered differently than these other so-called "anciallary services." The specialty of anesthesiology (physicians trained in the specialty of anesthesia) is a young one. Its impetus was initiated during World War II. when the Armed Forces realized that technician anesthesia could not cope with the complicated medical problems that demanded comprehensive medical judgment as related to anesthetic management. Many of the more sophisticated operative procedures possible today are only possible because of improved anesthesia techniques devised by physician-anesthesiologists. Although all medical schools and most large hospitals have physician-anesthesiologists who head their respective departments of anesthesia, our members are too few so technicians are employed in some institutions to supplement anesthesia services. Nevertheless, approximately 85 percent of the physiciananesthesiologists in the United States perform a professional service and render a bill to the patient in the same manner as do surgeons, internists, and obstetricians. Washington, D.C., has been unique in that physician-anesthesia services have been rendered to patients, with rare exception, on a professional basis since 1909. Many anesthesia programs including our own, have only physicians administering anesthesia in the capacity of staff, residents, or fellows with no nonmedical personnel. Contrasted to this, radiology, pathology, and physical medicine of necessity have to have technicians to accomplish their workload in all institutions. I am not saying that physicians in these specialties do not render a professional service for I feel they do but they are not personally involved in every aspect of every examination done by their departments. Most anestheseologists are (85 percent). The present medicare bill, without the Douglas amendment, will pay for anesthesia services if it is defined as a hospital service. However, if the Douglas amendment is added to the present bill, the anesthesiologists (85 percent) who are presently engaged in the professional private practice of medicine will be suddenly classified as technicians (nonprofessional service) and subject to nonprofessional governing bodies-the American Hospital Association. This would be a severe demotion to those of us who have been practicing medicine for many years. Further such action would violate the statement in the medicare bill that indicates that its intent was not to interfere, in any way with the private practice of medicine. In my opinion, the inclusion of the Douglas amendment to the present medicare bill would sound a death knell to the medical specialty of anesthesiology. Why should a graduate of a medical school choose a specialty that is not considered the practice of medicine? I do not think many will. As previously stated, we have a shortage of American medical graduates in our specialty at the present time. This turn of events would seriously hamper our present recruitment program. Further, some anesthesiologists, in active practice would choose some other line of medical endeavor rather than be subjected to the humiliation of rendering a hospital anesthesia service (nonprofessional technician's service) and have such a service be considered along with such items as food cost, depreciation of equipment, etc. Frankly, I am opposed to the Douglas amendment and sincerely hope that it will be defeated. If, however, your Senate committee seriously considers this amendment, anesthesiologists should be deleted from it, for the reasons I hope I have made clear to you. If it is possible to arrange a personal meeting with you in the near future. I would like to explain other facets of our specialty that is difficult in a written communication. At present, I am attending an American Board of Anesthesiology meeting in San Francisco, Calif., but will be home on Tuesday of next week. Sincerely yours, WILLIAM E. BAGEANT, M.D., Chairman, Department of Anesthesiology, Washington Hospital Center. I am a registered voter in the Jefferson District, Loudoun County, Va. 47-140-65-pt. 237 |