provide fair representation to the principal interested groups that furnish and receive personal health service." The Surgeon General, with the approval of the Federal Security Administrator, is authorized to negotiate and periodically renegotiate agreements or cooperative working arrangements with private persons or groups of persons, and with combinations thereof, to utilize their services and facilities and to pay fair, reasonable, and equitable compensation for such services" * * * "Every individual entitled to receive general medical benefit shall be permitted to select those from whom he shall receive such benefit, subject to the consent of the practitioner * the Surgeon General may prescribe maximum limits to the number of potential beneficiaries for whom a practitioner or a group of practitioners may undertake to furnish general medical benefit" "Services which shall be deemed to be specialist or consultant services shall be those so designated by the Surgeon General * * after consultation with the Advisory Council" * * * * * * "The Surgeon General shall publish and otherwise make known in each local area to individuals entitled to benefit the names of medical practitioners * * who have agreed to furnish services" * * "Payments from the trust fund to general medical and family practition* for services * shall be made: ers * * * "1. On a basis of fees for services rendered * schedule; * according to a fee "2. On a per capita basis, the amount being according to the number of individuals entitled to benefit who are on the practitioner's list; "3. On a salary basis, whole-time or part-time; or "4. On a combination or modification of these bases, as the Surgeon General may approve" This will happen It is evident that the Surgeon General and the Federal Security Administrator are to be the dictators of this compulsory health insurance scheme, since they are only obliged to "consult" with Council members of their own choosing. There is no assurance that physicians will not be outnumbered by lay individuals. In fact, if the bill means what it says, physicians will be outnumbered on a ratio of approximately 1,000 to 1. If physicians committed themselves to participation, their "fees or wages and working arrangements" would be at the mercy of the "periodical renegotiation." In the first instance, it is free choice of patient and of physician, if all physicians participate. In the second, the free choice privilege is eliminated. The Surgeon General is not bound to follow any advice received from his appointed group. This is tremendous responsibility and certainly dangerous authority to vest in one man and his chosen group of advisers. This is positive proof that the bill recognizes the legality and the validity of the AAPS principle, "that physicians have a right to refuse participation." In the final analysis, physicians' "fees or wages" are determined by one person. The purse strings are controlled by the Federal Government and whoever "pays the bill" will eventually control medicine. SUMMARY "Title 2-National Social Insurance System" of the Wagner-Murray-Dingell bill is a scheme for compulsory health insurance controlled by the Government. It would destroy the American system of the private practice of medicine. It would limit, if not eliminate, the important, democratic right of free choice of physician or of patient. Application of the bill would result in the physician's employer, his patient, being replaced by a Federal or State bureau. Bureaucratic invasions of the medical profession must be halted until voluntary health insurance plans, under the control of physicians, can be universally applied, wherever such plans are in the public interest. The most effective way of accomplishing this objective is for physicians to Join the Association of American Physicians and Surgeons and thereby contract not to participate in schemes of state and socialized medicine, which are inimical to the public interest. THE ASSOCIATION OF AMERICAN PHYSICIANS AND SURGEONS CAN GUARANTEE THE PRESERVATION OF THE PRIVATE PRACTICE OF MEDICINE IN AMERICA IT'S REASONING IS AS FOLLOWS State medicine is a system that operates to distribute medical care; Medical care cannot be distributed without the participation of physicians; Therefore a system of state medicine cannot operate without the participation of physicians. The courts have always upheld the right of an organization of individuals to do, at least in the absence of malice, whatever an individual may lawfully da Even the Wagner-Murray-Dingell bill respects the right of the individual physician to refuse participation in its scheme for state medicine. It makes provision only for our voluntary participation. Hence: An individual physician may lawfully refuse to participate in a system of state medicine; An organized group may lawfully do anything an individual may lawfully da Therefore physicians as an organized group may lawfully refuse to participate in systems of state medicine. And test this: Systems of state medicine require more medical service and therefore more physicians than systems of private practice; There are not more than enough physicians to supply the services required under the present system of private practice; Therefore a system of state medicine would require the participation of 1′ least a substantial majority of physicians. Final conclusion, based upon the above: Physicians may lawfully organize to refuse participation in systems of state medicine, which cannot operate without the participation of at least a majority of physicians; The AAPS is an organization of physicians who contract and agree not to participate in systems of state medicine; Therefore when a majority of the physicians of the nation become members of the AAPS, systems of state medicine cannot be operated. The best available legal advice concurs with the validity and legality of the actions proposed by this line of reasoning. Opinions of the legal counsel of the Association have been made available to attorneys of medical organizations throughout the nation, and there have been no disagreements with the firs objective of the AAPS: To so organize ethical physicians that they may determine and enforce the conditions under which they will or will not give their services AAPS IS A POSITIVE ORGANIZATION It is for American liberty and American freedom in medicine. It is for the universal application of the insurance principle to the costs medical care under voluntary plans organized and controlled by the medica profession, wherever such plans are in the public interest. It is for the American Medical Association and its contributions to the public health and the science of medicine. It is for complete democracy in medical organization, and provides that every member shall have a voice and a vote in its affairs. It is for the kind of positive action that will earn good relations with the public for organized medicine. It is for the preservation of American liberty for American physicians art American patients. THE PITTSBURGH MEDICAL BULLETIN HAS THIS TO SAY ABOUT AAPS * "The Association of American Physicians and Surgeons will do much to determine the condition under which physicians will give their services, bę their refusal as an organization to participate in any Federal or State-controlled practice of medicine. With such refusal, which is within legal procedures, politically controlled medicine can function in this country. This organizatim has shown more determination and courage than any other such organization in medicine. It does not oppose or interfere with the American Medical Associatio nor the National Physicians Committee. It is an aggressive organization which does not hesitate to show its teeth to the politicians who would control medicine as well as every profession and industry in this country if possible. It is the two-fisted organization which means to eliminate the negative and accentuate the positive as far as medicine is concerned. "If you believe in the American method of private practice of medicine and want to preserve it, why not join the Association of American Physicians and Surgeons!" Reprinted from The Pittsburgh Medical Bulletin-March 10, 1945. SPEAKERS ARE AVAILABLE You are urged to discuss the AAPS at hospital staff and society meetings. Upon invitation, speakers are available to address society and other group meetings of physicians. Since the first of the year these additional medical organizations have endorsed AAPS: Allen County Medical Society, Fort Wayne, Ind. Alameda County Medical Association, Oakland, Berkeley and Alameda, Calif. Lorain County Medical Society, Lorain, Elyria and Oberlain, Ohio. Christian County Medical Society, Taylorville, Ill. Allegany-Barrett County Medical Society, Cumberland, Md. Wayne County Medical Society, Detroit, Mich. Riverside County Medical Society, Riverside, Calif. San Diego, County Medical Society, San Diego, Calif. Orange County Medical Society, Santa Ana, Calif. Illinois State Homeopathic Association, Elk-Cameron County Medical Society, Ridgway and St. Marys, Pa. Wapeello County Medical Society, Ottumwa, Iowa, Executive Committee of the Council of the Michigan State Medical Society, LaPorte County Medical Society, LaPorte and Michigan, City, Ind. Adams County Medical Society, De San Bernardino County Medical So- catur and Berne, Ind. ciety, San Bernardino, Calif. Portage County Medical Society, Kent, Ohio. Weld County Medical Society, Greeley and LaSalle, Colo. Jackson County Medical Society, Jackson, Mich. Rock Island County Medical Society, Rock Island and Moline, Ill. DuPage County Medical Society, Elmhurst and Naperville, Ill. DeKalb County Medical Society, DeKalb and Sycamore, Ill. Fayette County Medical Society, Connellsville and Uniontown, Pa. Oak Park and River Forest Physicians Club, Oak Park and River Forest, Ill. Lower Snake River Physicians Club, Ontario, Oreg. Albany County Medical Society, Albany, N. Y. King County Medical Society, Seattle, Wash. Summit County Medical Society, Akron, Ohio. The CHAIRMAN. The American Medical Association apparently does not agree with this organization. I wish to read from an article from the Journal of the American Medical Association, February 23, 1946, volume 130, number 8, entitled "The Public Relations of American Medicine," Morris Fishbein, M. D., editor, Journal of the American Medical Association. It contains the following statement: The American Association of Physicians and Surgeons has, according to fairly well substantiated rumor, received $10 from each of 6,000 physicians who have subscribed to its principles. Just what it has accomplished other than to state its objectives and to get them out in the press is not clearly apparent. This group, however, proposes that the physicians of the United States strike against the sick public in case the Government of the United States should establish compulsory sickness insurance. Such an action would be contrary to all the tradition of medical science covering the responsibility of the physician to the sick. No official body of the American Medical Association has ever ventured even the thought that physicians would neglect to minister to the sick as evidence of their opposition to the law of the nation. The CHAIRMAN. I also wish to insert in the record some other literature showing the application forms of this Association of American Physicians and Surgeons. (The document referred to is as follows :) ASSOCIATION OF AMERICAN PHYSICIANS, AND SURGEONS, INC., Chicago 3, Ill., December 13, 1945. DEAR DOCTOR: President Truman, on November 19, issued a directive to Congress for a national health program. Senators Wagner and Murray and Representstive Dingell introduced bills S. 1606 and H. R. 4730 to carry out the President's recommendations. Regardless of statements to the contrary, the new measure provides for com pulsory health insurance and socialization of American medicine. In addition to the bureaucrats, the A. F. of L. and the C. I. O., other influentia individuals have raised their voices in support of socialized medicine. They include: Eleanor Roosevelt, the esteemed Bishop Hass, Paul Hunter, publisher of Liberty Magazine, and many others from every field of endeavor. The forces of political medicine are powerful and are well organized. They mean business. The American medical profession must act now. We must mean business, too, in order to stop the onslaught of these planners who would eliminate the American system of the private practice of medicine. There is a way: Join the Association of American Physicians and Surgeons and thereby contract and agree with thousands of your colleagues that you will not participate in schemes of politica. medicine. Systems of federal or state medicine cannot operate without the participati of a substantial majority of physicians. When a majority have joined AAPS. as it now appears they will, there can be no bureaucratic control of American medicine. Already thousands of your colleagues throughout the Nation have joined AAPS Hundreds of your fellow physicians in the State of Massachusetts are members of our association. Since the first of the year, more than 30 medical groups have endorsed the objectives of the association. Recent endorsements include the following: Middlesex East District, Melrose, Mass. | San Diego County Medical Society, San King County Medical Society, Seattle, Diego, Calif. Wash. Albany County Medical Society, Albany, The Columbus Academy of Medicine, Wayne County Medical Society, Detroit, Allen County Medical Society, Fort Alameda County Medical Society. Ou South Central Section of the America: Chicago Medical Society, Chicago, Ill These endorsements from your colleagues, and the society of your own Stat prove the objectives of AAPS and the soundness of its plan to guarantee te preservation of the private practice of medicine in America. Join today 2:3 add your strength to the thousands of physicians who have determined to remis free. ASSOCIATION OF AMERICAN PHYSICIANS AND SURGEONS Sign the application on the back of this letter and mail it today. (This letter is being sent to all eligible physicians, including members of AAPS for their information.) APPLICATION FOR MEMBERSHIP ASSOCIATON OF AMERICAN PHYSICIANS AND SURGEONS, INC. I agree to abide by the articles of incorporation, bylaws, and lawful orders and rulings of the Association of American Physicians and Surgeons, Inc. I further agree that my membership shall ipso facto terminate if and when I violate any lawful rule, regulation, or bylaw of this association. Except for members of the armed forces, interns, and students, dues ($10.00 annually) must accompany application. The CHAIRMAN. The first witness this morning is Dr. Cary. STATEMENT OF DR. EDWARD H. CARY, CHAIRMAN OF THE BOARD OF TRUSTEES OF THE NATIONAL PHYSICIANS COMMITTEE The CHAIRMAN. Dr. Cary, you may proceed. Dr. CARY. I want to thank you, Mr. Chairman, for the invitation to appear and offer testimony before this important Committee on Education and Labor of the Senate. My being present is the result of an interchange of seven or eight telegrams between Senator Murray and our headquarters in Chicago. In answer to the first invitation we requested the privilege of having seven witnesses appear, each one of whom would briefly cover a different aspect of the problem. We stated: We believe the issues involved in S. 1606 are of such importance that attempts to present all phases of our viewpoint by one person at one session would be grossly inadequate. In effect, Senator Murray replied that the overcrowded schedule of witnesses practically precluded the possibility of allowing more than one witness to appear. I should like to file for the record copies of the telegrams that finally resulted in my being here and undertaking the task of placing in evidence, the point of view and testimony on behalf of the National Physicians Committee on S. 1606. |