one too strict I have always believed. But the fact remains that, because of the strictness of that definition an extension at this time of the medical care provided in this bill to the some 910,000 disabled workers now drawing benefits would seem to be a relatively small but highly important addition to the legislation. It is hard for me to understand why those victims of a severely crippling accident or illness, arising out of circumstances beyond their control, have been so often overlooked in our consideration of social security legislation through the years. One of my first concerns, when I came to the Congress in 1949, was to extend the protection provided by the cash benefits program to these people. I introduced a bill into the Congress to accomplish this purpose into that, and subsequent Congresses. But not until 7 years later, in the 1956 amendments, were we able to prevail in that area. Now that we are reaching the final weeks of consideration of another very important broad step forward in the structure of our social security system-the addition of a health insurance program for the aged-I would hope that the disabled will not again be overlooked. I urge this committee, in its wisdom, to make this reasonable addition to the bill when they report it to the Senate. STATEMENT TO THE SENATE FINANCE COMMITTEE BY THE PRESIDENT OF THE MEDICAL SOCIETY OF THE DISTRICT OF COLUMBIA The Medical Society of the District of Columbia believes that House bill 6675 is a progressive step in the field of health care. The executive committee and a special committee of our medical society have evaluated H.R. 6675 in considerable detail. Being practicing physicians, we are not accustomed to legislative language; nevertheless we believe that any Federal legislation in the health field should have the following goals: First, simplicity of legislation so as to provide ease of administration. Second, provision for as adequate a program of medical, hospital, and related health services as is feasible. Third, a minimum of interference by any "third party," especially a Federal agency of large dimensions, between patient and physician. With these in mind this medical society has officially endorsed, as long ago as last November, a Federal program for those over 65 years of age based on a proven Federal Government program-the Federal Employees Health Benefits program. This program has been in operation for 5 years and covers not only Federal employees but also Federal retirees, roughly 6 million people. In comparing this program with the proposed bill, the following points seem important: The FEHB plan is more simple in administration than H.R. 6675. Experienced administrative agencies are already functioning. It has proved to be adequate "benefitwise," and when supplemented by an implemented Kerr-Mills law would cover practically all possible needs of health care. It in no way interferes with the patient-physician relationship, and leaves such controls of medical practice as are necessary in the hands of an experienced and proven system already in operation. Physicians, hospital administrators, and others in the health field are acquainted with the FEHB program-its benefits, limitations, and operations. Such a program would act as a buffer between the Members of Congress and their patient constituents. It is therefore the recommendation of the Medical Society of the District of Columbia that the Senate Finance Committee give consideration to the use of an FEHB type of program for both hospitalization and physicians' services. It is further recommended that provision be incorporated in the bill for payment of fees to be made in part or in full, depending upon the income status of each individual; the latter to be determined by a simple declaration or an income tax duplicate. PAUL R. WILNER, M.D., President. MANCHESTER MEDICAL SOCIETY, Senator HARRY FLOOD BYRD, Washington, D.C. DEAR SENATOR BYRD: The members of our society voted unanimously at its meeting May 4, 1965, to oppose attempts by Congress to classify or cover any portion of physicians' services as hospital services under S.I., and to oppose amendment of H.R. 6675. Hospitals, their administrators, and governing boards are not prepared to practice medicine or to furnish medical services; are not licensed to practice medicine; and Virginia's laws prohibit the practice of medicine by hospitals. Where hospitals are employing physicians so that the hospital controls and furnishes the services of physicians in radiology, pathology, and anesthesiology, the quality of medical care resulting is often inferior; and attempts by physicians to raise the quality of medical care in these hospitals are seldom successful. Sincerely, J. RUSSELL GOOD, M.D., Secretary. STATE OF ILLINOIS, DEPARTMENT OF PUBLIC HEALTH, Hon. HARRY FLOOD BYRD, Washington, D.C. DEAR SENATOR BYRD: With appreciation to Senator Douglas upon whose request I was invited to make written recommendations for your Committee on Finance, the following is suggested: Since title XIX makes it possible for medical care elements of H.R. 6675 to be separately administered, it is recommended that the legislation be modified in order to facilitate assignment of responsibility to State health departments working in cooperation with the State welfare agency. The principle of medical care administration in a health agency will increase the benefits to the patient and insure interdepartmental cooperation in tax-supported medical care programs. Yours sincerely, FRANKLIN D. YODER. M.D., SOCIAL SECURITY AMENDMENTS OF 1965 (H.R. 6675)-A STATEMENT BY THE NATIONAL CONFERENCE OF STATE SOCIAL SECURITY ADMINISTRATORS, SUBMITTED BY MISS EDNA M. REEVES, CHAIRMAN, LEGISLATIVE COMMITTEE, MONTGOMERY, ALA. Under section 218(c) (5) of the Social Security Act, relating to coverage of employees of State and local governments under social security, the individual States are allowed the option of electing to exclude services performed by students, including student interns. A number of States, with respect to State employees who are interns in State hospitals and institutions, and on behalf of local governmental entities, have elected such an exclusion, in good faith and relying on the good faith of the Federal Government to honor such an exclusion in the mutual agreements executed between the States and the Federal Government pursuant to section 218 of the Social Security Act. It is our understanding that the provisions of section 311(a) (4) of H.R. 6675 could have the effect of nullifying the exclusion of student intern services already obtained by the States and their political subdivisions pursuant to section 218 (c) (5) of the Social Security Act. We believe this to be an oversight; and if not, then a grave injustice is being imposed on State and local governmental entities; and it is further believed that the Congress desires to honor the provisions of agreements previously entered into between the States and the Federal Government. Therefore, we respectfully request that the following sentence or similar language be added to section 311 (c) of H.R. 6675: "Notwithstanding the provisions of paragraph (4) of subsection (a), where services of interns have been excluded from coverage under title II pursuant to section 218 (c) (5) of the Social Security Act under agreements, or modifications thereof, entered into between the Secretary and the States pursuant to section 218 of the Social Security Act prior to July 1, 1965, such services shall continue to be excluded unless coverage is extended pursuant to section 218(c) (4) of the Social Security Act." We wish to emphasize the intent of this request is strictly to retain the exclusion of services previously excluded and in no way relates to the overall intent of section 311 of the bill to cover services of doctors of medicine and interns generally, on which subject we have not taken position. Hon. HARRY F. BYRD, OHIO SOCIETY OF ANESTHESIOLOGISTS, INC., Chairman, Senate Finance Committee, DEAR SENATOR BYRD: AS president of the Ohio Society of Anesthesiologists, I write to solicit your committee's support in treating anesthesiology in the same manner as other medical services in the so-called medicare legislation, H.R. 6675, which is now pending before the Senate and under consideration by your committee. I am also director of the department of anesthesiology at Marymount Hospital, in Cleveland, Ohio. I am in charge of a residency training program in this specialty and I practice independently. In other words, I am in the private practice of anesthesiology. I have been quite active in the past decade in various official positions with the Ohio Society of Anesthesiologists, and have watched it grow from a neophyte, with a few members, to 20 times its original membership. It has been quite a struggle over the years for us to be able to not only encourage our members, but also our opponents that we should practice independently. At the present time, 97 percent of our membership are in private practice. Due to the fact that we have encouraged the private practice of our speciality, we have been able to influence many of the younger physicians to enter our specialty. The committee must realize that by this mode of practice, a patient-physician relation develops to the point that many times patients will request the services of a specific anesthesiologist. This is evidence that we develop a practice in the same manner as our colleagues in medicine. Most insurance carriers have recognized this fact and have made allowances for anesthesiologists' services in medical service contracts. For the above-mentioned reasons, anesthesiology must not be included in the bill as a hospital service. To do so, would result in a regression in the future of our specialty. Respectfully submitted. DEAR SENATOR BYRD: The services of pathologists, radiologists, physiatrists, and anesthesiologists are professional medical services performed by physicians. The fact that their practice is largely in the hospital is incidental. These are not hospital services, and they do not belong in a program designed solely to offer hospital benefits. As it stands, H.R. 6665 excludes from inpatient hospital services the services of pathologists, radiologists, physiatrists, and anesthesiologists. In any bill which is considered by the Senate, it is strongly urged that section 1861, subsection (B), page 63, be retained without modification. Approval of H.R. 6675 as now written would tend to lower the cost of medical care. Over the past 25 years, hospital costs have increased 405 percent, while physicians' fees have gone up only 100 percent compared to an overall increase in the cost of living of 115 percent. If physicians' fees in the four specialties cited above are stated separately from hospital charges, the cost of these services to patients will be reduced and hospitals will not be able to justify profits they are now realizing, particularly in pathology and radiology, if their charges are stated separately from the physician's fee. Combining the hospital charge with the doctor's fee as would be required if the Douglas amendment was approved, would obscure and hide the hospital profit in these departments. Any measure which taxes the sick to subsidize other patients or functions of a hospital operation without the patient's full knowledge is unjust. I would hope that the above comments indicate to you why no physician's services should be encompassed by the proposed "medicare" bill. There are many additional reasons which cannot be incorporated in this communication with which you are probably already familiar. In the best interest of continued high-quality patient care and in all justice to those assuming responsibility of patients' hospital bills, we respectfully urge that no measure even remotely resembling H.R. 6665 be enacted into law which includes any physician's services. Respectfully yours, JOSEPH L. CURRY, M.D., President. MAINE MEDICAL CENTER, Portland, Maine, May 5, 1965. Senator HARRY F. BYRD, U.S. Senate, Washington, D.C. DEAR SENATOR BYRD: We, the undersigned, respectfully and urgently request your support with regard to H.R. 6675. Efforts are being made to change this bill, as passed by the House of Representatives, so as to include within its section 1 the services of physicians who specialize in radiology, pathology, anesthesiology, and physical medicine. We feel that it is not the aim of the proponents of this legislation to interfere with the practice of medicine insofar as the patient-doctor relationship is concerned. Physicians in these specialties are an integral part of the practice of medicine in the same category as are those physicians who practice surgery, internal medicine, or any other designated field of medicine. The inclusion of the services of these or any other physicians under a hospital care program would have an undesirable effect upon the present and future availability of these vital specialists. If beneficiaries of H.R. 6675 were to be concentrated in hospital departments, there would result a poor overall usage of existing office facilities and a tremendous overload on hospital departments of radiology, pathology, etc. Such an inclusion would also increase the anticipated costs of providing these medical services by an overwhelming amount. Most importantly, the overall implications of including the services of these physicians under a hospital care program would be to unwisely restrict the freedom of choice of both patients and physicians in utilizing the necessary services of these four specialty groups. Despite all the facilities and superstructure of modern medical care, there is no substitute for the aggressive independence and sense of responsibility, which a good doctor must have in order to place the best interests of his patient ahead of any other consideration. Yours sincerely, Senator HARRY BYRD, Chairman, Senate Finance Committee, JOHN F. GIBBONS, M.D. ROBERT A. BEAROR, M.D. PLEASANT HILL, CALIF., May 5, 1965. DEAR SENATOR BYRD: I would like to compliment you on your decision to hold public hearings on the Mills bill. Since no public hearings were held in the House these hearings now in the Senate Finance Committee stand as further evidence of the openmindedness of its chairman. 47-140-65-pt. 2--41 I would like to register my opposition to the Mills bill. Since I have been speaking frequently to interested groups in this area about medicare, I had my arguments printed and I am enclosing a copy of the same for your perusal and consideration at this time. The most pertinent arguments begin on page 5. I would also like to register my opposition to compulsory inclusion of physicians into the social security as is provided for in H.R. 6675. I feel I could invest my own money more wisely and retain better control than under the social security system. Thank you for your consideration of these views. JOHN P. TOTH, M.D. MEDICAL CARE FOR THE AGED (By John Toth, M.D.) The entire concept of medical care for the aged has been lost in a sea of emotional confusion. Anyone who is against governmental compulsory aid to the aged is automatically equated as being against the old folks themselves. You may have seen the postcards circulated by COPE the last time medicare came be fore the legislature (spring 1964), showing an old woman bent over, with a cane in her hand and a pleading look on her face, the caption reading "Do not forsake me in my old age." I'd like today to paint a picture of medical care for the aged in its true perspective. I will attempt to show the true scope of the problem, the available existing solutions to the problem, and the new proposed solutions to the problems. These proposed solutions are many, but I will concentrate on medicare and eldercare. THE SCOPE OF THE PROBLEM An estimated 18 million Americans are over the age of 65.1 Many Government sources would have you believe that the great majority are practically destitute and although able to meet most of their daily needs, must have some financial assistance now to help finance a medical emergency. Let's look at the statistics a little more critically: Income range: Over 6.000_. 5 to 6.000__ 4 to 5.000. 3 to 4.000_ Under 3,000_ Average net worth: 3 30.718_. 25,459 19,412. Percent of over 65 in that range 2 25.3 7.9 8.9 12.8 45. 1 Age group 65 and over. 45 to 54. 35 to 44. True enough, the average income of persons over 65 is less than the average income of persons at the peak of their productive careers, but neither does the older man have the expenses of the younger man-his home is usually paid for (80 percent own their own home," 70 percent of these are mortgage free), his children have been raised and educated, and he has only to provide for his daily needs, recreation, and possibly medical insurance. So comparing his income/expense ratio you will probably find him much better off than looking at his income alone would indicate. For reference figures, see bibliography at end of article on page 1169. |