seem to agree that something should be done for the aged-the charge is made by the opponents of it that it is socialized medicine. When you consider the welfare of the Nation and of its individual citizens, the important part that they take economically as well as in our national defense and maintaining our security, we cannot believe that those things that you do to improve health and keep health are uniformly to be termed "socialized medicine." I am hopeful that during these hearings and as it is made plain to us by so many witnesses of the great toll that disease has taken and of the tremendous cost there is to provide proper medical attention, there will be a change in thought and a recognition of the necessity from a governmental standpoint that the problem be solved in a way that will promote the welfare of our people.

I am very hopeful that, as a result of these hearings, we will be able to develop a basis for the rendering of that help which under present conditions has become so necessary. I would like to see it as you do within the type of structure of Government that we have. But, just because it is helpful, not to consider it necessarily socialized medicine.

Dr. Loos. Of course, Mr. Chairman, we in the medical field feel that a system such as they have in England is not to better the health of the people as it should be.

The CHAIRMAN. What is that?

Dr. Loos. It is not bettering the health of the people because the doctors are not spending enough time on diagnosis and they are slighting their patients and, I believe, that that is our objection to a truly socialized medicine with the Government paying all of the costs. The patient would not get the care to which he is entitled.

The CHAIRMAN. I do not want to enter into a discussion of any particular Nation's policy at this time, but some members of this committee, after the adjournment of our hearings last fall, took upon themselves to visit countries that had outstanding health programs with a desire to ascertain whether they were satisfactory, and how they were considered by the people and by the doctors. I do not want to go into all that we learned. We learned a great deal all the way from England with its program, to the East, including Australia and New Zealand, so we did not overlook any place in that program. It was surprising that even in England where 4 years ago our committee found so much opposition to the program that was then being instituted that today much or almost all, it would seem, of the opposition had disappeared and that doctors were cooperating in the carrying out of the plan. Recognizing that at first perhaps some mistakes were made in the expansive program that had been adopted, but, nevertheless, with the elimination of those mistakes which some would term "evils," there had become a more general satisfaction on the part of physicians as well as the people with the service that was being rendered.

That was a bit surprising and I am not offering it here as a support to the plan that is in existence in England. This is not the time nor the place to consider that, but I do want to say that there had been a very considerable change of viewpoint in the 4 years that have transpired. I would say that in Australia and New Zealand, each of which have outstanding methods, there is the greatest amount of cooperation be

tween the doctors and the ministry in the administration of their health agencies. It indicates that if other consideration is given to this health program, it can prove beneficial. I do not want to go into all of the different types of legislation or I do not want to be assumed to accept all forms that in some instances could very probably be called socialized medicine, but I want merely to indicate that there comes a changing viewpoint as people become used to changed conditions that bring about these different opinions that exist today from what existed before. That is within our own Nation and within our own structure and without having socialized medicine, I am personally of the opinion that a program can be evolved that will be helpful to our people in carrying the burden of medical attention and hospitalization.

Dr. Loos. Mr. Chairman, I am sincerely hoping that this committee will bring that about. I spent the summer in Europe and I get rather a different impression than some of your committee people did. But, I hope that this commitee can decide upon something along American lines that will help the situation which needs to be helped, I will admit.

The CHAIRMAN. That is what we are endeavoring to do, and it is what we would like to have the help of the AMA on, and the help of all other individuals interested in this subject. I hope the time will come when the AMA will recognize this problem to such an extent that it will formulate a solution of its own, and it will come before Congress and ask for its adoption. I think that would be in accord with the duties and the responsibilities of a physician.

Preliminary to the next witness who will appear before us, Dr. Magnuson, and the report of his committee entitled "Building America's Health," a report to the President by the President's Commission on the Health Needs of the Nation, I have in that connection a statement on the report of that Commission by the board of trustees of the American Medical Association.

All through that statement of the board of trustees there are declarations of dissatisfaction. For instance, it says, without naming it, "The Commission has described the welfare state. It may be just as well to call it by its true name, the Socialist state."

Now, I could go on through this, and I have it marked and I will probably go into it further when the next witness appears, but the criticisms that are made in the report of the board of trustees of the AMA against this Presidential Commission, are strong objections. Yet I fail to find any solution that is offered by the AMA.

I am not a person who objects to criticism, but I do think we have a right to expect that criticism shall be constructive and shall be helpful. When you criticize what someone else has done with good intent, you could prove your good intent better and more surely by presenting with your criticisms something in its place as a solution.

I hope the day will come, and I mean it just as emphatically as I can express it, when the AMA will recognize this problem in a way to challenge it by coming to Congress and providing some means of solution.

My remarks have been sincere and have been from the heart and I will never apologize for anything that has that source.

Mr. HALE. On this question of advertising, does your organization not have any kind of solicitation of subscribers?

Dr. Loos. We never have; no.

Mr. HALE. Do you see any ethical difference between a solicitation of subscriptions and paid advertising?

Dr. Loos. Well, I think there would be a difference if we incited that nonpaid advertising.

Mr. HALE. What is that?

Dr. Loos. There would be a difference if we incited it, but if someone takes it upon himself to go out and tell what a great organization we are, that is not advertising.

Mr. HALE. I have no objection to a client of mine saying that I am a good lawyer.

Dr. Loos. We have no objection to that either. That is word of mouth.

Mr. HALE. You have raised some very interesting questions.

Mr. YOUNGER. I just have one question, Doctor, and that is about this matter of choice of physcians which appears to me to be only a matter of degree because when the AMA say that the Blue Cross gives a free choice of physicians that, in itself, is limited. It is limited to the physicians who are willing to accept the fees paid by the Blue Cross so that all free choices are a matter of degree; isn't that true? Dr. Loos. That is true.

Mr. YOUNGER. That is all.

Mr. BUSH. Doctor, did I understand that your members get free all medication?

Dr. Loos. They pay for their own drugs.

Mr. BUSH. They pay for their own drugs?

Dr. Loos. Yes. That went into effect about 3 years ago.

Mr. BUSH. Today, the cost of drugs is one of the big items in being sick.

Dr. Loos. Well, it is not an insurmountable cost. Drugs are not ordinarily too expensive.

Mr. Bush. I just happened to be sick a little bit last year and those drugs were just out of this world as far as costs were concerned.

Dr. Loos. Up to 3 years ago, we did not charge for drugs, but we had to do that because of the cost.

Mr. BUSH. Is it not the reason you do not provide for payment of the drugs that they are getting so costly and you would have to increase your membership rates?

Dr. Loos. That is true.

Mr. BUSH. That is what I thought.

Dr. Loos. However, I might state that the drugs they buy from us are at cost plus a handling charge, much less than they would get in a drugstore.

The CHAIRMAN. I have been requested to ask this question by a member of our staff. Under your plan, members pay monthly dues but their dependents pay on a fee-for-service basis. The question is why is that distinction made between members and their dependents. Is it not preferable for the head of the family to prepay for himself and his dependents?

Dr. Loos. You are quite correct, Mr. Chairman. We do not charge for the dependents on a monthly periodic payment plan because it would be so costly. It would price us out of the field. We would rather keep the costs of the subscription down to a minimum. Then, let those who have the big need for it, pay somewhat toward that need.

We do not charge a man who has no dependents a large amount of money to cover the man who has a lot of dependents. It is better to keep the price of the subscription down to make it salable in the first place and to make it within the man's means of paying. I understand there is one group up here in Washington whose monthly rate is very high and it handles the dependents also. That group is not growing. It is static as far as its growth is concerned. I think if they would do as we do and bring the subscription rate down and make a small charge for dependent services they would get out of that category of being too high-priced.

The CHAIRMAN. I think that there is some merit in what you have said as to the policy that you pursue. Are there any further questions? If not, then, Dr. Loos, I wish to thank you again for the interest that you have taken in this matter by coming the long distance that you have, from Califorina to Washington, in order to give this committee the benefit of your experience. I wish there were more like you. I wish there were more organizations such as yours. I believe the day is coming when there will be and I think that you can take great pride in the fact that you have been a pioneer in this field, that you saw the possibility 25 years ago and that you have persevered over opposition, unfair and unjust opposition, until you have come out into the bright sunlight that enables you to realize that for 127,000 subscribers and their families you are rendering a real service that is so necessary in these days.

The committee wishes me to express to you our very great appreciation for the interest that you have taken and the hope that we may feel free to call upon you in the future for guidance or advice as our hearings may formulate into legislation so that we could have the benefit of your many years of experience.

Dr. Loos. Thank you, Mr. Chairman. I wanted to state that we are ready to help the committee in any way we can. We want to see that some good comes for the efforts of this committee. Thank you. (The following material was submitted for the record by Dr. Loos:)

APPLICATION FOR INDIVIDUAL ENROLLMENT, INFORMATIONAL MATERIAL, AND CEBTIFICATE FOR INDIVIDUAL SUBSCRIBERS, SUBMITTED FOR THE RECORD BY DR. H. CLIFFORD Loos

Ross-Loos MEDICAL GROUP,
Los Angeles, Calif.

In response to your request for information, we are pleased to provide you with this material about Ross-Loose Medical Group service and Independence Insurance Co.'s family hospital plan.

This folder explains the services and benefits available to you, the cost involved and details regarding eligibility and enrollment.

A physical examination is required prior to enrollment. This examination may be conveniently arranged by requesting an appointment at any Ross-Loose office. Please complete page 1 of the application form and present the application when you appear for the physical examination.

Thank you for your inquiry.

Very truly yours,

Ross-Loos MEDICAL GROUP,
INDEPENDENCE INSURANCE CO.

Enclosure: Application, Information Booklet R-3, Specimen Health Care Certificate, Dependent Fee Schedule.

Ross-Loos MEDICAL GROUP

Ross-Loos Medical Group is a copartnership of physicians and surgeons duly licensed to practice medicine and surgery in the State of California. In consideration of the payment by the subscriber of the fees and rates established, Ross-Loos provides medical care and service to the subscriber and dependents in accordance with the agreement entered into by the subscriber and Ross-Loos.

The following constitutes a résumé of medical care and services provided by Ross-Loos Medical Group and statement of exclusions to services provided. A detailed explanation of services provided, definitions, and conditions will be found in the enclosed specimen Health Care Certificate. Please read this specimen certificate carefully, it is a duplicate of the certificate you will receive when you become a Ross-Loos subscriber. In order to be entitled to the medical care and service provided, the subscriber or dependent must place himself within 15 miles of any of the designated offices of Ross-Loos.

SERVICES PROVIDED

The subscriber shall be entitled to receive the following medical care and service, when ordered or approved by the attending physician.

Medical care.-Such care and treatment as is rendered necessary by reason of illness or injury, including necessary office consultations, physical examinations, and house calls, eye examinations and refractions for glass.

Surgical care.—All surgical operations rendered necessary by reason of illness or injury, including the services of assistant and anesthetist, together with preand post-operative care.

Obstetrical care.-Complete pre- and post-natal care, including office and residence calls all necessary tests during pregnancy, delivery and surgical procedures, and other services required in the event of miscarriage, ectopic pregnancy or cesarean birth.

Laboratory procedures, X-ray examinations, physiotherapy treatments.—When ordered or approved by the attending physician.

Dependents shall be entitled to receive the same care and service as is available to subscribers at special fees and rates prescribed in the schedule on file in the offices of Ross-Loos. (See enclosed schedule.)

MEDICAL CARE AND SERVICE NOT PROVIDED SUBSCRIBERS AND DEPENDENTS There are certain exclusions to the medical care and service rendered subscribers and dependents by Ross-Loos. They include, for example, service-connected disabilities, mental illness or conditions arising from acts of war or catastrophes. Medical care and service for which the subscriber or dependent is not entitled as a regular service may be rendered in certain cases, when ordered by the attending physician on a fee basis. Services not provided and accommodation services are enumerated in the section entitled "Services Not Provided" of the specimen Health Care Certificate.

Benefits are payable if an insured person or dependent incurs expense for hospital charges in a lawfully operated hospital either (1) while confined as a bed patient, or (2) for emergency treatment as an outpatient within 24 hours following accidental injury.