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tatement of John H. Burkhart, M. D., Knoxville, Tennessee, to the Subcommittee

n Health, Committee or Ways and Means, U. S. ilouse of Representatives,

eptember 12, 1975.

r. Chairman, Members of the Committee:

I am Dr. John H. Burkhart of Knoxville, Tennessee, and I appreciate the pportunity to testify before you today.

You have been and will continue to be deluged with statistics, facts, and studies purported to demonstrate and prove either that there is a health are crisis in this country or that there is not, that some form of national health insurance is a necessity or that it is the worst thing that could appen to the American people, depending on who or what interest group utilizes various parameters to make their points. I would prefer in the tire allotted to me to offer an opinion based not so much on cold statistical numbers or surveys, but more on some 26 years of experience, knowledge, and attitudes acquired as a solo family physician engaged in administering medical care, advice, and treatment to a wide variety of individuals who have sought my services. I still consider myself a doctor, not just a provider, and those who come to me patients, not just consumers.

To establish some basic precepts let me first register what I presently believe. I believe that the vast majority, in fact virtually all Americans, today have access to good, even excellent, medical care, and that through private insurance, careful personal planning, existing local, state, and federal programs nearly all can afford this care. I admit that some people have easier access to care than do others, and some in fact have some difficulty obtaining it. There is unquestionably sone maldistribution of physicians and medical care facilities in our country, but more to the point there is also raldistribution of people themselves in the United States. Sone live too

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and that for all of us as members of the public

the level of national health will be raised when our individual efforts are combined with progress in

provision of adequate housing, environmental improvement, public hygiene and sanitation and their

health-related areas.

Government-supported health care insurance is on balance

a boon--it is not a panacea!

Sir, I will do my best to answer any questions you may have and I thank you once again for this opportunity.

Statement of John H. Burkhart, M. D., Knoxville, Tennessee, to the Subcommittee

on Health, Committee on Ways and Means, U. S. House of Representatives,

September 12, 1975.

Mr. Chairman, Members of the Committee:

I am Dr. John H. Burkhart of Knoxville, Tennessee, and I appreciate the opportunity to testify before you today.

You have beer and will continue to be deluged with statistics, facts, and studies purported to demonstrate and prove either that there is a health care crisis in this country or that there is not, that some form of national health insurance is a necessity or that it is the worst thing that could happen to the American people, depending on who or what interest group utilizes various parameters to make their points. I would prefer in the time allotted to me to offer an opinion based not so much on cold statistical numbers or surveys, but more on some 26 years of experience, knowledge, and attitudes acquired as a solo family physician engaged in administering medical care, advice, and treatment to a wide variety of individuals who have sought my services. I still consider myself a doctor, not just a provider, and those who come to me patients, not just consumers.

To establish some basic precepts let me first register what I presently believe. I believe that the vast majority, in fact virtually all Americans, today have access to good, even excellent, medical care, and that through private insurance, careful personal planning, existing local, state, and federal programs nearly all can afford this care. I admit that some people have easier access to care than do others, and some in fact have some difficulty obtaining it. There is unquestionably some maldistribution of physicians and medical care facilities in our country, but more to the point there is also maldistribution of people themselves in the United States. Some live too

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tightly together, some too far apart, and the result is a maldistribution of other services and conveniences, schools, supermarkets, highways, public transportation, banks, theatres, attorneys, churches, utilities and most other things Americans enjoy and depend upon. Until there is a homogeneous distribution of the population there will not be a homogeneous distribution of the advantages that make living more enjoyable and secure, and this includes medical care.

I believe also that the problems and difficulties we presently may have in the adequate provision of medical care to our people will not be solved by larger and more expensive Federal programs which attempt to provide a utopian system in a non-utopian society.

Reminiscing is generally a useless pasttime, but it is sometimes pleasant. I recall that in the early days of my practice, before Medicare, Medicaid, or even Kerr-Mills, all of the doctors I knew, including me, took care of anyone who sought their services regardless of the ability to pay, and the hospital always had some little fund or arrangement with the city or county welfare department to pay the expenses of those who needed hospital care and had no money or insurance. I never saw anyone who asked for it deprived of needed care because of lack of ability to pay for it.

But somehow in the early or mid nineteen fifties this rather disorganized but remarkably effective system of taking care of everyone, which had been traditional in medicine since it became an established profession, and which had prevailed in our country since the days of the first settlers, did not satisfy some who felt that it was too haphazard and that it depended too much on the generosity of the physician, the hospital, or the local welfare officer, and generosity to them was too intangible a factor to be depended upon. There must, they decided, be developed a plan, followed in due course by sufficient appropriations, then regulations, then administration, and above all the

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sine-qua-non of all governmental programs, the inevitable forms, the paperwork. And so that no one would be made to feel ashamed or embarrassed by having to expose his neediness, the best arrangement would be to make everyone eligible for whatever benefits were provided. This line of thinking eventually gave way to a dual system of determining eligibility, one based on financial insufficiency called Medicaid, and one based arbitrarily on age alone called Medicare. The first ignored the built-in incentives for abuse; the second ignored the elemental fact that one can be just as sick at age 64 as at age 65. But as I have said reminiscing has no real value unless the experiences and mistakes of the past are utilized to improve the present and more carefully plan the future. The real question before us all today is what is the present situation am how can it be improved in the future?

In my opinion, which I know is shared by most of my professional colleagues, there is no health care crisis. But there can easily be one if those who proclaim there is one keep proclaiming it. A recent poll found that a representative cross section of Americans ranked health as 15th in a list of national problems, and almost every person polled stated that he or she had no difficulty with access to all the medical care he or she needed or wanted. But if enough publicity of whatever kind is fed to the public insisting that a health care crisis exists and that medical care is in short supply, the public will eventually be convinced that this is true, and then the process so typical of human nature will take over. Anything thought to be in short

supply becomes more desired than ever, the demand for it grows out of proportion, and sooner or later a true shortage will exist. How is that problem to be solved? Surely not by encouraging more demand on the supply.

The vicissitudes of life are real and are a part of every day existence. It is not possible to insure or legislate against them and to thereby eliminate them from the hazards of daily living. Affliction with physical, emotional,

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