reduction of work-connected injuries in private industry was recently noted by President Johnson in a statement to all Federal departments and agencies requesting them to develop programs within their departments and agencies which would produce results similar to those being obtained in private industry. However, we feel that the most serious effect of this proposed change will be that it will constitute a major step toward the substitution of social security for workmen's compensation system. It is obvious that two systems of compensation for work-connected disability which duplicate each other will not be tolerated for a long period of time. As the area of compensation under social security is broadened, there will be great pressure for reduction in the areas covered by State programs. As this pressure mounts, it can only result in gradual elimination of the State workmen's compensation programs which has successfully protected injured workers for over 50 years. The Committee on Ways and Means of the House of Representatives of the U.S. Congress recognized the serious problem of duplication, and in its report on H.R. 6675 recommended that the Department of Health, Education, and Welfare conduct a study of the problem and report back to the committee next year. The American Bar Association strongly feels that no change in the definition of disability should be undertaken until ample opportunity has been had to fully consider the necessity for changing the definition and to fully explore the possible effect upon State workmen's compensation programs. If the definition is expanded before this is done, the duplication problem will be substantially increased, and could result in a severe blow from which the State workmen's compensation system may never recover. In February of 1963, the house of delegates of the American Bar Association adopted a resolution concerning duplication and overlapping of provisions of the social security law and the several States' workmen's compensation acts. As a matter of policy the association expressed its opposition to any further legislation which would discourage the States from improving their own system or would infringe on the rights of the States to enact and administer their own system of workmen's compensation benefits. The American Bar Association feels that the proposed change in the definition of disability is set forth in section 303 (a) (1) and (2) in H.R. 6675 would constitute such legislation resulting in irreparable harm to the State workmen's compensation programs. We strongly urge the aforementioned sections be deleted from the bill. PORTLAND, MAINE, May 4, 1965. Hon. HARRY FLOOD BYRD, Chairman, Senate Finance Committee, DEAR SENATOR BYRD: At the last meeting of the Maine Societies of Pathologists: the membership instructed me to communicate our objection to Senator Paul Douglas' amendment to H.R. 6675. It is our considered opinion as practicing pathologists that such legislation would result in a complete loss of control of the quality of laboratory medicine by the physicians responsible. It is our opinion that the control of laboratory medicine exerted by many hospitals has resulted in an appreciable lag between scientific research and its applications to clinical medicine. This society feels that the failure to utilize new knowledge will be increased by governmental controls of laboratories medicine. The Maine pathologists object to a professional-technical split of fees, as outlined in H.R. 6675. In our opinion. such legislation would tend to restrict pathologists in selecting and training technical personnel, purchasing equipment of their choice, instituting the methodology they consider best for a given procedure, and operating an adequate quality control program. We respectfully urge your committee to eliminate from the medicare bill H.R. 6675 all physicians' services, fully realizing that this may not be possible. If not possible this society requests the committee to recommend to the Senate passage of H.R. 6675 in its original form. Dr. GERALD C. LEARY, Secretary, Maine Society of Pathology. 47-140-65-pt. 2--38 THE IOWA HOSPITAL ASSOCIATION, INC., Hon. HARRY FLOOD BYRD, Senate Finance Committee, Senate Office Building, Washington, D.C. DEAR SENATOR BYRD: At the annual meeting of the House of Delegates of the Iowa Hospital Association held in Des Moines, Iowa, April 27, 28, and 29, 1965, the delegates heard a presentation of the Federal legislation (H.R. 6675) passed by the House of Representatives and now before the Senate Finance Committee. The hospitals of Iowa are deeply concerned about that portion of H.R. 6675 which seeks to distinguish payment to hospitals for the services of pathologists, radiologists, anesthesiologists, and physiatrists, from the remaining costs of operating the departments which these physician specialists supervise. During the course of a 5-year controversy between these physician specialists and hospitals in Iowa between 1954 and 1960, the practicality and other merits of this "professional-technical split" were thoroughly considered. Both sides to the controversy rejected this proposal as unsound, impractical, and potentially harmful to the quality of these services in hospitals. The reasons are as follows: 1. These four specialties of medicine always have been and must continue to be monopolies. Since the pathologist, for example, is the administrative head of a major department of the hospital, it is possible to appoint only one person for this responsibility. Employees cannot have three, four or more separate supervisors. 2. There is a severe shortage of these medical specialists and only in the very large cities of the United States would it be possible to have competition between these specialists, no matter how the charges for their services reached the patient. In the entire State of Iowa, less than 50 percent of the 173 hospitals have the services of these specialists. All other hospitals must depend upon a general practice physician for supervision of these departments. 3. The monopoly situation thus arises both from the hospital's need for one administrative head of the department, and from the scarcity of these specialists in the United States. Monopoly situations must be controlled. If these physicians are not under contract with hospitals, they will be tempted to take advantage of their preferential position in the form of higher charges for services rendered as compared with those charges now made under contract control. 4. Separate billings by these monopoly specialists will result in multiple billings to each patient instead of one charge rendered via the hospital as at present. For the four departments concerned, this will mean one charge from each of four specialists, plus one from the hospital, making a total of five bills instead of all being included in one hospital bill. Patients will be overwhelmed with bills from physicians they neither select nor recognize, and seldom even see. 5. The direct billing by the specialist to the patient will encourage nonspecialist physicians to administer anesthesia, to interpret X-rays, and even to examine laboratory tissues, blood smears, and cultures. No physician wishes his patient to receive multiple bills from several other physicians, and to avoid it, the nonspecialist will tend to provide these services himself. This will tend to lower the quality from the high level now common to American hospitals. Because of these considerations, the House of Delegates of the Iowa Hospital Association urges the amendment of H.R. 6675 to provide for payment of these four monopoly specialist physicians from the basic hospital benefits of the program. Sincerely yours, ROLAND B. ENOS, President. TESTIMONY PRESENTED BY DR. MACKLYN LINDSTROM, CHAIRMAN, COMMITTEE ON SOCIAL WELFARE, DIVISION OF ALCOHOL PROBLEMS AND GENERAL WELFARE, GENERAL BOARD OF CHRISTIAN SOCIAL CONCERNS, THE METHODIST CHURCH Mr. Chairman, we have requested this opportunity to present written testimony before the Senate Finance Committee on H.R. 6675 because the General Conference of the Methodist Church for the first time adopted policy statements related to medical care and public welfare at its quadrennial meeting in April of 1964. We do not pretend to be experts in these highly technical and complex fields. As we understand H.R. 6675, we feel that it is quite compatible in intent with the policy statements adopted by our church. The Methodist General Conference stated: "We stand for the provision of adequate medical care for all people, with special attention being given the aging, the young, minority,and low-income groups." It went on to affirm, "Our national resources should be mobilized to furnish health services to those in need. The principle and use of prepayment health insurance is good. Subsidies and administrative coordination by private, Federal, and State governmental agencies may be necessary to care for unmet needs." We see in the health insurance for the aged section of H.R. 6675 an attempt to meet existing need with minimum of hardship on persons and a maximum of respect for the dignity of the individual. The social security provision enables every person to "earn" his right to basic hospital and nursing home care upon reaching age 65. The voluntary supplementary plan providing payments for physicians and other medical and health services allows for individual participation, yet allowing Federal matching in order to more evenly distribute the cost on the basis of ability to pay, and taking care of needs that would be too costly if included in the social security program. We are not certain these programs will meet all the existing needs, but we feel this is a giant step. In the expansion of the Medical Assistance for the Aging Act (Kerr-Mills) we see a real attempt not only to more adequately meet the needs of medically indigent aged, but also to provide for the medically indigent child and his family, as well as the blind and permanently and totally disabled. This is a welcome addition as are the child health program amendments. The revision of the OASDI program will make it possible for more persons to live with dignity. Incomes under these programs will still be quite low, particularly for some, but improved. These provisions move in the direction of providing a more adequate base for persons to live as free human beings. We have recently become aware of the hardship created for a small number of older women who have been divorced and cut off thereby from the social security benefits accumulated by their former husbands. We feel that the provision for wife's and widow's benefits for divorced women is fair, although a little investigation indicates that the lowering of the number of years of marriage required for this benefit to 10 years (instead of 20 years) would add little additional cost to the program and would more adequately meet this need. In testimony presented to the Advisory Council on Public Welfare on April 30, 1965, we were pleased to quote our new general conference statement on public welfare which says, “We believe that meeting human need is both a private and a community responsibility. Adequate public assistance should be made available to all persons solely on the basis of need. Every individual should provide for his own needs and share responsibility for the needs of others to the full extent of his ability, but we believe that no person in an affluent society should be demoralized because of unmet need." We find in the public assistance amendments of H.R. 6675 provisions which move toward this objective as stated in our church policy. The greatly needed increase in the Federal share of assistance grants is to be passed on to the recipient. The inclusion of tubercular and mental patients in the old-age assistance and medical assistance for the aged programs will benefit many. So will the increase in earnings exemption. The Congress can give a big boost to many who are at the bottom of the economic heap through these public assistance amendments. It will provide an important step toward meeting human need. We believe that the recent action by the General Conference of the Methodist Church is an indication of growing public support for more adequate public programs in health and welfare and are grateful that the Congress of the United States is developing such programs. INTERNATIONAL ASSOCIATION OF FIRE FIGHTERS Submitted by William D. Bucke, President The International Association of Fire Fighters strongly supports the social security system. However, the simple truth of the matter is that social security cannot be extended to fire fighters and policemen, who are covered by a State or local retirement system, without in turn weakening or damaging such systems. For this reason, we are unalterably opposed to any effort which may be made to eliminate or repeal the clause (sec. 218(d) (5) (A)) which excludes fire fighters and policemen, who are under a retirement system, from coverage under the Social Security Act. As the committee will recall, last year section 11 of the House bill on social security revisions attempted to repeal this exclusion clause. Fortunately, however, your committee and the Senate in its wisdom adopted the Ribicoff amendment striking said section 11 from the House bill. The committee on conference agreed at that time that the exclusion clause should be continued. This year we are satisfied with the House bill (H.R. 6675) to the extent that it leaves the exclusion clause intact. We are not aware of any effort which is being made on the Senate side to tamper with this much needed exclusion. This, notwithstanding, since this matter was an issue in the last session of Congress, we would like to take this opportunity to set forth the following as the reasons why the firemen's and policemen's exclusion clause should remain unchanged: (1) The referendum section of the Social Security Act does not contain adequate provisions which will assure fire fighters and policemen that they will not be forced under social security against their will. To the contrary, section 218(d) (6) (C) permits certain States to divide the retirement system so that even if all the department members but one are opposed to social security coverage, that single member can vote for it and thus force all department members thereafter to come under the social security system against their will. (See supporting statement No. 1.) (2) The nature of the duties of fire fighters and policemen is such that it requires retirement at a far earlier age than that provided for under social security. (See supporting statement No. 2.) (3) Elimination of the exclusion clause would damage the ability of fire fighters and policemen to protect early retirement provisions in those communities where such provisions now exist. Further, it would serve as a bar against improving those retirement systems which do not measure up to the retirement standards required in the firefighting and police service. The inclusion of members of fire and police departments under social security in the States of Kansas and South Dakota has already started a movement backward toward the later retirement requirements provided for under social security as opposed to the earlier retirement requirements necessary to meet the needs of fire fighters and policemen. (See supporting statement No. 3.) (4a) Certain municipal administrators plan to use social security as a device through which retirement benefits of firefighters and policemen, provided for under State and local systems, will be reduced. Since these systems are, of necessity, more liberal than social security and therefore more expensive to the municipal employer, they hope to reduce the municipality's share of pension costs by substituting social security in lieu of these systems. (See supporting statement No. 4a.) (4b) The policy declaration of Congress which states that there shall be no impairment of benefits of State and municipal employees, is certainly well intentioned. Unfortunately, it carries no legal weight or influence with those municipal administrators who view social security as a means of escaping from their pension or retirement system obligations. (See supporting statement 4b.) (5) The effect on fire and police department pension systems by the intrusion of social security cannot be judged on the same basis as social security's impact on the retirement systems of other State and municipal employees. As previously stated fire and police department pension systems are, because of necessity, more liberal and therefore more expensive than the systems covering most other employees. In addition, because they were started before retirement systems were funded, fire and police department plans usually operate on a payas-you-go basis with the unfunded liabilities mounting every year. All of this causes municipal administrators to consider fire and police department retirement systems in a far different light than the systems covering other State and municipal employees. (See supporting statement No. 5.) SUPPORTING STATEMENT NO. 1-FIREFIGHTERS AND POLICEMEN FORCED UNDER SOCIAL SECURITY Except for the exclusion clause, firefighters and policemen enjoy no protection under the Federal law against being forced under social security against their will. Section 218 (d) (6) (C) permits 17 States to divide their retirement system so that a single department member can compel every future member of his department to come under social security. It is now being recommended by the Advisory Council that this authority to divide the retirement system be extended to the remaining 33 States. If the exclusion clause is eliminated, and the authority to divide the retirement system is extended to all of the 50 States, social security will be forced on every fire and police department in the Nation, even though the overwhelming majority of department members are opposed to it. One might question, "What is wrong with a system which forces new members under social security so long as the current members are protected?" The answer is that pension benefits are part of the total wage package, the greater the benefits, the higher the wages. Thus, if you have two different levels of pension benefits, you have two different levels of wages. In effect, the new firefighter or policeman covered under social security would be working for less wages than his counterpart who was covered by the State or local retirement system. This disparity in benefits or wages would surely destroy the morale of any department. You just cannot have two employees performing the same duties and exposed to the same hazards, yet pay one of them more than the other. The only practical solution to the problem is to strengthen the caluse in the Federal law which excludes firefighters and policemen from social security coverage. SUPPORTING STATEMENT NO. 2-WHY EARLY RETIREMENT FOR FIREFIGHTERS AND POLICEMEN? The nature of the duties of firefighters and policemen demands that they have great physical strength, ability, coordination, stamina, and endurance. Most men begin to lose a good part of these characteristics after they reach age 50, thus reducing their effectiveness in their job. Early retirement for those employees is necessary in order to maintain efficiency in the firefighting and police services. By the same token, the rigors of firefighting or police work have an increasingly damaging impact on the health of department members with each succeeding year after age 45. Medical science has established that advancing age and the work of firefighters frequently is the reason why such men suffer from heart disease. In order to afford reasonable protection to the health of the men engaged in these hazardous occupations, firefighters and policemen must be permitted to retire at an early age. One of the biggest difficulties of fire and police departments today is the recruitment of qualified men at the salaries the municipalities can afford to pay. An important inducement is a sound retirement program. If there is danger of this program being weakened this attraction will be lost and consequently the difficulty of recruiting satisfactory personnel will be greatly increased. SUPPORTING STATEMENT NO. 3-THE EXTENSION OF SOCIAL SECURITY DAMAGES, FIRE AND POLICE DEPARTMENT RETIREMENT SYSTEMS The intrusion of social security on fire and police department retirement systems in certain States which have been exempted from the exclusion clause, has had a damaging effect on the retirement systems of those States. In Kansas and South Dakota, social security has lent support to those who would unduly increase the length of service and age requirements for firefighters and policemen in those States. In many other such States, where the age and length of service requirements were too high to begin with, social security has served as a deterrent against reducing these requirements. The overall impact of social security on these States is to cause a shift from the retirement standards essential in an effective firefighting or police force to the more general standards of social security. It would be in the best interest of every community if conditions were restored to where they were in 1956 when every firefighter and policeman in the Nation, who was covered by a retirement system, was excluded from social security. SUPPORTING STATEMENT NO. 4A-MUNICIPALITIES TO USE SOCIAL SECURITY IN PLACE OF FIRE AND POLICE RETIREMENT SYSTEMS Many of our local unions have been challenged by efforts of municipal administrators to integrate social security with the existing retirement system for |