needed health services to our older citizens. In a letter to President Johnson on January 8 of this year, this organization endorsed the President's position and supported the passage of the medicare bill. Our endorsement was offered because the need for adequate health protection for millions of our Nation's older citizens has been so long unfulfilled. We believe that those older citizens who are to benefit by this bill should have the American right of free choice to select the method of health care which they deem best. This choice does not appear to be granted to them in the legislation this committee is now considering. It appears to us that the provisions of the legislation are, in some areas, so restrictive of chiropractic services as to deny recipients the helpful and beneficial care of doctors of chiropractic. This is particularly true of the voluntary extended care portion of the bill. Therein we note that chiropractic health care is available provided the doctor of chiropractic is a member of the staff of a "home health agency" and that his services be classified "medically necessary." The fact that "home health agencies" are either wholly or to a great extent under the exclusive control of the medical profession tends to exclude doctors of chiropractic from membership and/or participation in the services performed by these agencies. We further understand that chiropractic care, if it is to be rendered at all by these agencies, must be specified by a doctor of medicine. The history of this type of arrangement has demonstrated it to be tantamount to an exclusion of chiropractic services. We respectfully submit that the voluntary feature of the bill should include chiropractic health service as a matter of the patient's choice. If there be a stipulation in this instance, it should be that the practitioner has been properly examined and duly licensed in that State in which he practices. Please bear in mind that in this section the patient pays part of the cost from his own funds. Under title XVIII, which expands those services now provided by existing Kerr-Mills statutes, we understand chiropractic health services are provided as an option to be accepted or rejected by a given State. Here we submit this option tends to diminish the value of the license issued for the practice of chiropractic in the various States. This optional inclusion relegates chiropractic to a secondary level of care. It is our contention that those fields of health care which are properly examined and duly licensed by the various States should participate under this section equally under the law. Rather than to limit inclusion of these legally recognized and licensed professions, their helpful ministrations should be permitted and encouraged. This legislation far surpasses any like social legislation in the history of our Nation. The benefits of this needed legislation have been withheld from the people in part through the efforts of the American Medical Association, its affiliated subdivisions, and agencies under its partial or direct control. Now, ironically, it seems that the opponent of the legislation has been given control of its administration. We most emphatically declare that this legislation must be evaluated in terms of the restrictions we have called to your attention. It is the aged population of our Nation for which this legisltaion is being considered *** not any segment of the health professions. If this legislation does not more adequately include services of other than medical doctors, their organizations, enterprises, and subsidiaries, it will fall short of the noble purposes for which it was conceived. The American Chiropractic Association and its thousands of members wish to devote such valuable talents as this profession possesses toward the betterment of the health and pleasures of our aged citizens. Our profession can accomplish these purposes only with proper recognition and fair participation assured under law. We are about to enter a phase of legislation which will possibly endure for the rest of our existence as a nation. This is the time and the place to make those changes which assure the right of citizens to express their free choice in the selection of their personal health care. There is no greater individual choice than that by which life itself is either bettered or maintained. Thank you. Senator ANDERSON. Thank you very much. We thank all the witnesses, and we are very sorry we had to run late. We will adjourn until 10 o'clock tomorrow morning. (Whereupon, at 12:30 p.m. the committee recessed, to reconvene at 10 a.m., Wednesday, May 12, 1965.) SOCIAL SECURITY WEDNESDAY, MAY 12, 1965 U.S. SENATE, COMMITTEE ON FINANCE, Washington, D.C. The committee met, pursuant to recess, at 10 a.m., in room 2221, New Senate Office Building, Senator Clinton P. Anderson presiding. Present: Senators Anderson, Long, Talmadge, McCarthy, Williams, Carlson, and Curtis. Also present: Senator Cooper of Kentucky; Elizabeth B. Springer, chief clerk. Senator ANDERSON. The committee will be in order. It is my very great pleasure this morning to welcome my colleague, Senator Javits to testify. I have publicly and privately expressed my appreciation to Senator Javits for the fine study which he and his group made on the whole health care question and I personally wel come you. STATEMENT OF HON. JACOB K. JAVITS, A U.S. SENATOR FROM THE STATE OF NEW YORK Senator JAVITS. Thank you, Mr. Chairman. May I express my thanks to the committe and to its principal administrative aid, Elizabeth Springer, to its chairman, Senator Byrd and the present occupant of the chair, Senator Anderson, and his colleagues for giving me this opportunity to testify. I know the tremendous time limitations, and so without further ado I would like to proceed. I am especially happy that the chairman today is my long-time colleague in arms in this struggle, and it is a historic moment, Mr. Chairman, because I am confident that we shall have a medical care for the aging bill in this session of the Congress. I know of no one who has a right to be more gratified than the present occupant of the chair. It really will be the crown of a great senatorial career. I sincerely hope that the bill will bear his name, as King-Anderson has for so very long. It certainly is well deserved. For my own part, my credentials are that I have been very active in this field since 1949 when the first bill was introduced in the House, in which I joined with a number of colleagues who since became very famous in my party, like former Vice President Nixon, Christian Herter, former Secretary of State, Thruston Morton, who is now in the Senate, and others. In 1960, together with other members of the Republican Party, I sponsored the bill for medical care for the aging based on general-revenue financing, which was the main alternative to the bill President Kennedy and the present occupant of the chair advocated in the Senate. Neither got anywhere until 1964 when, teaming up with the present occupant of the chair, and Senator Gore, the Senate did pass a bill, having very much the basic principles of the bill which is before us. Mr. Chairman, I support, in essence, the bill which is before us, and my testimony this morning is designed to offer certain constructive suggestions for amendment which I think could make the bill even more useful. The basic lines of principle upon which it is constructed are a socialsecurity-financed hospitalization plan, plus a complementary opportunity for insurance for full medical coverage. This was also the basic principle of the so-called Anderson-Gore-Javits bill. It is the basic principle developed by the National Committee on Health Care of the Aged, a very distinguished committee which reported in 1963, and which I had the honor of organizing. I ask unanimous consent to include the names of the members of that committee in the record and pertinent excerpts from their report. Senator ANDERSON. Without objection that will be done. When the American Medical Association testified yesterday a statement was made. [Reads:] To this day eldercare remains the only proposal before Congress for providing health care for the aged that was drawn up in consultation with the medical profession. I want to ask the distinguished Senator from New York if his group had the benefit of any consultation with the medical profession. Senator JAVITS. The answer is distinctly "Yes," Mr. Chairman. I would like, as long as the Chair will allow me-I am so concerned about intruding on time-to read into the record now the names of the members of the committee which unanimously reported in favor of a bill along the lines of the bill that passed the Senate in 1964 and this bill. Senator ANDERSON. Did you not have a former Nobel Prize winner? Senator JAVITS. Exactly right. May I just read the names, Mr. Chairman? Senator ANDERSON. Yes. Senator JAVITS. Arthur Flemming, who was the chairman, is the president of the University of Oregon and former Secretary of Health, Education, and Welfare. The others were Russell Nelson, president of the Johns Hopkins Hospital, an M.D. Dr. James Dixon, also an M.D., president of Antioch College. Dr. Vernon W. Lippard, dean of the Yale Medical School; Dr. Dickinson W. Richards, Lambert professor of medicine emeritus, of Columbia College of Physicians and Surgeons; and Dr. Russell Lee, founder of the Palo Alto Clinic. Now, in addition to these very distinguished doctors other members of the committee were Winslow Carlton, the chairman of Group Health Insurance; Marion Folsom, former Secretary of Health, Education, and Welfare, now treasurer of Eastman Kodak; Aurthr Larson, director of the Law Center at Duke University; John C. Leslie, a leading businessman and high official of Pan American Airways. His presence on the committee was as chairman of the Committee of the Community Services Society of New York; Thomas M. Tierney, a director of the Colorado Hospital Service, that is equivalent to Blue Cross and Blue Shield; Herbert Yount, who was former executive vice president of Liberty Mutual Insurance; and the study director was Dr. Howard Bost of the University of Kentucky. It was, as is evident from the distinguished membership, a very composite panel and had very distinguished medical advice. Senator ANDERSON. I thank the Senator for that statement, because a member of my staff is in constant touch with his work. We had a chance at firsthand to appraise the efforts that the Senator from New York and his panel made. It was a distinguished panel and I thought it was fine, the studies made by that panel. I knew they consulted the medical profession and had full regard for the medical profession and I objected to the statement of the AMA. It was not true that the AMA's plan was the only program with medical attention and I thank the Senator from New York. Senator JAVITS. May I have unanimous consent to include the excerpts from the report as part of my testimony? Senator ANDERSON. Without objection that will be done. Thank you. Senator JAVITS. Mr. Chairman, proceeding further, may I say that it took this committee a year to turn out its report but it was financed from private sources. (The excerpts and list referred to follow :) PROPOSED SOLUTION: A DUAL PUBLIC-PRIVATE HEALTH INSURANCE PROGRAM The central purpose of an American solution to the problem of financing the health care of present and future generations of the aged must be to encourage and protect the independence and dignity of the individual. In its basic approach to this problem, our Nation must aim at preventing dependency as a concomitant of the deterioration of health in the declining years of life. This requires a shift in public policy from placing major reliance upon charity and welfare assistance measures to placing emphasis upon the development within the Nation of health insurance for the aged. Public assistance programs present the prospect of great increases in requirements for public funds without accomplishing the objective of preserving the independence of elderly people or of reducing the economic hazard of illness as a threat to their independence. By their nature, such programs, including the Kerr-Mills program, deal with dependency after it occurs; health insurance, by reducing the cost which must be met at the time of illness to a level that is manageable, can prevent dependency and encourage self-reliance. Clearly, the solution required in America today and for the future lies in actions which will achieve the health insurance coverage called for by the risk of illness in old age. To accomplish the necessary development of health insurance for the aged, the committee proposes a dual public-private program, consisting of separate and distinct plans in the respective sectors of the economy. These plans are equally essential and should be complementary. Together they should provide balanced and effective basic protection covering roughly two-thirds of the aggregate health care costs incurred by the aged, leaving the remaining costs to be met by the individual on an out-of-pocket basis or through supplementary private insurance. The public plan, in the committee's view, should utilize the principle of contributory social insurance to cover all persons 65 years of age and over, with payments collected during the working years of all employed and self-employed persons. The most appropriate area of protection to be provided by the public plan is institutional care, which is the most frequent cause of financial shock loss to the aged. The extent of this protection under the proposed plan would represent approximately one-third of the aggregate health care costs of the aged. Another third of these costs, the Committee believes, should be the subject of special private insurance covering the largest noninstitutional costs that occur |