As chairman of the Committee on Social Security for Physicians, which is supported by and represents the point of view of many thousands of physicians throughout the country, I respectfully urge the Senate Finance Committee to leave intact the provisions for social security coverage of self-employed physicians which was passed by the House of Representatives in accord with the recommendation of the House Ways and Means Committee.

I urge further that physician coverage be made retroactive by covering self-employed physicians for taxable years which begin during the year of enactment of the pending legislation; and by covering interns effective the first calendar quarter subsequent to the enactment.

I am encouraged to believe that the evidence which persuaded the House Ways and Means Committee and the House of Representatives, both Democrats and Republicans, to vote so overwhelmingly in favor of extending social security to self-employed physicians, will likewise convince this committee of the justice and wisdom of this legislation. When I testified before this committee in August 1964, I based my statement on the amply demonstrated facts that doctors of medicine both need and want social security coverage. The evidence for our need of such insurance will be presented by Mrs. Gertrude Rost, the wife of a physician.

Evidence for the fact that we physicians want social security protection has been demonstrated over and over again by many statewide polls the results of which have been taken and are set forth in the accompanying table, which is with the mimeographed copy of my

statement.

You will observe that 62.5 percent of all the physicians voting are in favor of social security coverage. In 1963 as a delegate to my State medical society house of delegates instructing our society to accept the mandate of our poll, our State poll, and to present and support at the next meeting of the House of Delegates of the American Medical Association a resolution favoring social security for physicians.

The house rejected my resolution demonstrating again that the voice of the grassroots is not heard in the meeting halls of the delegates. These proceedings are documented in a letter I have here from a physician's wife, which I will be happy to submit to the committee.

It is crystal clear that the American Medical Association does not. represent the desires of American physicians on this issue; and cannot claim to represent its members since the association has never taken a national poll on this question as did the American Dental Asssociation and the American Bar Association, which before their members were admitted to social security did take such national polls.

Inclusion of self-employed physicians is strongly recommended in the 1965 Report to the President of the Advisory Council on Social Security copy of the significant section attached. This report states: Self-employed doctors of medicine should be covered on the same basis as other self-employed people now covered.

The Council states that it sees no reason why self-employed physicians should be discriminated against as the only professional group not covered by social security. It is further pointed out by the Coun

47-140-65-pt. 2--28

cil that social security is not only a mechanism in which a person participates because of the benefits he as an individual expects to receive, but it is an institution through which all Americans together promote economic security by financing from the contributions of all a continuing income to families whose earning are cut off by old age, death, or disablement of the worker.

Like all other Americans, we self-employ physicians benefit in decreased taxes for welfare purposes because of the social security system-but without contributing so much as a dime. Also, the Advisory Council on Social Security shows how we have an additional unfair advantage over other Americans in that we need only work in a part-time salaried position for a few years in order to qualify for retirement benefits. Many older physicians, anticipating retirement, do exactly this so that they may receive the benefit of a monthly social security check. Since such part-time salaried employment usually represents only a very small fraction of the income of the practicing physician, we obtain the advantage of the weighted benefit formula designed not for us but the truly low-income group. A physician who qualifies for social security as a result of a few years of salaried work thus gets a disproportionate and unfairly large return in relation to the contribution he makes to the social security

system.

Less than a month ago the policy planners of the U.S. Chamber of Commerce refused to accede to the American Medical Association that it oppose physician coverage. Dr. DuPuy presented the point of view of the American Medical Association and he was answered by Mr. Marshall, former chairman of the chamber's security committee. Mr. Marshall argued that social security is not a private insurance plan but a combined tax system and benefit program. This is a social insurance scheme to protect society as a whole from mass poverty and indigency in old age, he pointed out.

Finally then, I ask this committee to consider objectively the evidence that we physicians need and want to be included under social security. I ask further that you recognize the validity of the statement made on this subject in the 1965 Report of the Advisory Council on Social Security, that until we are brought under the social security umbrella, we are freeloaders who are taking financial advantage of all of the other citizens of this country. Physicians should be included in the social security system and pay their share in fairness to all other American workers.

Thank you very much.

(The attachments referred to follow :)

NOTE. The remaining State medical societies, which represent 58 votes in the AMA House of Delegates, have not held social security polls.

THE STATUS OF THE SOCIAL SECURITY PROGRAM AND RECOMMENDATIONS FOR ITS

IMPROVEMENT

REPORT OF THE ADVISORY COUNCIL ON SOCIAL SECURITY, WASHINGTON 1965

11. DOCTORS OF MEDICINE

Self-employed doctors of medicine should be covered on the same basis as other self-employed people now covered, and interns should be covered on the same basis as other employees working for the same employer

Self-employed physicians, numbering about 170,000, are the only professional group whose self-employment income is not covered under social security. The Council sees no reason why this dscriminatory treatment should be continued. There are no technical or administrative barriers to the coverage of doctors. Nor is there any question that many doctors have a need for coverage as great as that of other professional self-employed people. A provision for covering selfemployed doctors was approved by the House of Representatives in 1964.

Apparently physicians have been excluded up to now because spokesmen for the profession have indicated opposition to coverage. The Council believes that the wishes of a particular group are not a sufficient basis for the continued exclusion of the group. Social security is not only a mechanism in which a person participates because of the benefits he as an individual expects to receive. It is an institution through which all Americans together promote economic security by financing, from the contributions of all, a continuing income to families whose earnings are cut off by the old age, death, or disablement of the worker. Physicians, like all other Americans, benefit in general tax savings and in other ways from the prevention of dependency through social security. Like other Americans, they should share in its support. In fact, failure to cover the self-employment income of physicians has the effect that many of them have an unfair advantage under the program, since it is possible for them to acquire insured status through working for a time in covered employment, and then, because those who do so have low average monthly earnings under the program, they get the advantage of the weighted benefit formula that is intended for low-income people. Thus many of those who do qualify get a very large return in relation to the contributions they pay, in comparison with selfemployed people who spend all of their working lifetimes in covered work.

The present exclusion from social security coverage of interns employed by hospitals is closely related to the exclusion of self-employed physicians. The Council believes that when self-employed physicians are covered, coverage should be extended to interns on the same basis as that on which coverage is now made available to other employees of hospitals.

Senator DOUGLAS. Doctor, I am much interested in the results of these polls that you give in the appendix to your testimony. Do you want to have those made a part of your testimony?

Dr. SCHAMBERG. Yes, indeed; I do.

Senator DOUGLAS. You say that these are the results of State medical society social security polls. Were these taken by the State medical societies?

Dr. SCHAMBERG. In most cases, Senator Douglas. In a few cases a poll was taken by the Honest Ballot Association which I understand is a very reputable organization with no bias, and there is one other exception and that is in New York State. Many county medical societies in New York State took individual resolutions, in some cases polls, and the vast majority of those resolutions and polls favored social security and for that reason we feel that even though we don't have numbers it is proper to place New York State in the category of the States whose physicians, the majority of whose physicians, wish social security.

Senator DOUGLAS. This is a very important point and I would like to go into the question of these polls in some detail.

I notice that in California you say this was a poll by the Honest Ballot Association, taking 1 name out of every 10, is that true? In other words, it was a sampling poll?

Dr. SCHAMBERG. Yes, sir.

Senator DOUGLAS. And that seems to be indicated by the fact that the total number of votes was about 1,100, and in a State of 17 million, you would normally expect to have somewhere around 15,000 to 17,000 physicians. And similarly in Missouri this is stated to be a 1 in 5 poll by the Honest Ballot Association.

Do I understand that all the other polls are pollls taken by State societies?

Dr. SCHAMBERG. You understand correctly, Senator Douglas. Senator DOUGLAS. No, have you tabulated the total votes in favor as opposed to the total votes opposed in all the States?

Dr. SCHAMBERG. I believe, but I cannot be certain at this moment, that the total votes in favor constitutes 6212 percent of all those voting

in these State polls.

Senator DOUGLAS. Now, on these State society polls, have you examined the procedure in detail there?

Dr. SCHAMBERG. Frankly, only in my own State. Our State medical society in Pennsylvania held two polls, and in each of those a post card was mailed to every member of the State society on which he was asked to indicate his feelings.

Senator DOUGLAS. Was that a secret ballot or do the doctors who voted sign their names?

Dr. SCHAMBERG. I should know the answer to that but that was several years ago.

Senator DOUGLAS. There is a very important question.

Dr. SCHAMBERG. I think I may have some answer here. This is a letter from the David M. Small, the administrative assistant of the Pennsylvania Medical Society, this is a letter dated April 28 of this year to the wife of an New Jersey physician in replying to her letter requesting information. He says:

The last poll of the membership on this issue was conducted in 1961 at the direction of our house of delegates. Cards were mailed to the then 10,350 active members of the society, and a total of 8,636 physicians replied.

I, of course, received one of these post cards. I honestly cannot recall whether I signed my name.

Senator DOUGLAS. Well, my memory is imperfect on this but, as I remember, the poll of the Illinois society was one in which the physicians identified themselves.

Dr. SCHAMBERG. I might say

Senator DOUGLAS. Is a representative of the Illinois society here? Does anyone wish to speak to that?

Mrs. Rost. I think in Illinois, if I am informed correctly, the cards were numbered or something so if the State society wanted to identify the physicians they can do it. But they did not have to sign their names. In most cases it was an anonymous poll.

In New Jersey, for instance, I know that it was. But I think in Illinois the cards that were sent out could be identified if one wanted to by some means.

Senator DOUGLAS. That is my memory, and if my memory serves me also there had been a previous poll by the Honest Ballot Association which instead of showing a majority against showed a majority in favor of coverage.

Mrs. Rost. This was taken before the Illinois State Society poll and shows the spontaneous reaction of the physicians.

Senator DOUGLAS. I am going to ask that a copy of what purports to be a certification by the Honest Ballot Association dated May 23, 1960, be included in the record at this point, and I would like to read the salient passages here. It is signed by George J. Abrams, executive secretary, Committee on Labor Elections of the Honest Ballot Association.

I hereby certify that 11,942 ballots were mailed as certified to us by the U.S. Post Office Department and, of these, 5,967 ballots were returned untabulated. I further certify that the following is true and accurate count as taken from the 5,967 ballots as to the outcome of the vote.