This is where Medicredit (AMA), compulsory catastrophic governmental insurance (scare word for comprehensive) schemes, etc. come into consideration. Legislative compromise being the reality of politics what is likely to evolve is a mixture of the various proposals-but most importantly and finally fatal to liberty is more intervention. We want this Committee and the public generally to know the American Medical Association is NOT speaking with the knowledge and consent of many practicing physicians and surgeons when advocating more subsidies for medical care. There is no argument about the fact that government controls anything that it subsidizes. When anyone asks for $13 billion more subsidies, as AMA does, in order to pay hospital and doctors bills, in whole or part for everyone, they're asking for more controls. We believe this is unsound. Suggestions for limiting the program to "catastrophic" coverage, as AMA has done, would not minimize government intervention. Once the government takes over it will do essentially the same things to exert control under a $13 bi lion dollar program that it would under a $100 billion dollar program. "If physicians want to oppose any form of national health insurance that is a legitimate position. But those who are for a so-called catastrophic program to protect themselves from future government control are wasting their time." Accordingly, we believe Medicredit, catastrophic illness coverages, or what have you, are all traps and must be avoided. The special p`eaders from domestic academic circles, labor union officials, and government clerks seeking more power do not have a monopoly on understanding the direction in which government in the U.S. should go. BRITAIN WARNS AGAINST POLITICAL MEDICINE AND FOR FREEDOM Upon reflection Britian would have more patient satisfaction with medical care, more physicians and more hospitals if it had not nationalized medicine in 1948. The Honorable J. Enoch Powell, British Minister of Health (1960-63), told the doctors attending the Association's Annual Meeting in St. Louis (Clayton), Missouri on October 8, 1971: "Nationalization kept Britain from building any hospitals for 15 years, giving priority to housing." His observations are based on experience not theory. Politicalized medicine he said has "two inherent evils-centralization of decision making and damaging the relationship between the doctor and patient." If medical care is offered in any country as it is under the British National Health Service "free at the point of consumption or at less than market price at point of consumption then for practical purposes demand is unlimited." Under such a system individuals do not ration demand through their purse. Continuing, Mr. Powell said "the service then must and does apply covert rationing devices in order to bring demand to the actual amount of supply.” This is accomplished by waiting lists. "Generally, the waiting list can be viewed as a kind of iceberg: the significant part is that below the surface--the patients who are not on the list at all, either because they are not accepted on the grounds that the list is too long already or because they take a look at the queue and go away." “. . . short of dying, however, they frequently get bored, or better, and vanish." It follows that doctors and hospitals are put in the impossible position of being expected to fulfill promises that cannot be met while the government which created the illusion and the problem lets the patients blame the doctors and hospitals for the dissatisfaction. The credentials of the Former British Minister of Health are enough to cause any wise person to listen to him. Powell has been a Member of Parliament for over 20 years. He speaks eleven languages, and during a seven year period learned one a year. At 24 he was a Professor of Greek. When 27 he had written four books. At the outset of World War II he enlisted as a buck private, and advanced rapidly to the rank of Brigadier General. UNDER "POLITICALIZED" MEDICINE NON-DOCTORS MUST AND DO DECIDE MEDICAL QUESTION Powell criticized the "inherent absurdity" of one man, himself, establishing a fixed pattern for medical care and for hospital operation and construction. "The absurdity of it still is with me," said Powell. "With the single stroke of a pen, by making deletions in one column and additions in another my will was done." "The point here is not one of good will or bad will. The point is the substitution of one will and purpose for I don't know how many wills and purposes.'' Powell said centralized medicine "obliterates the existence of an infinite variety of sources of initiative and judgment." "A whole nation is wiser than any government can ever be. The decisions of myriad minds working out answers to personal and local situations are far better than those aspired to by even the most progressive of reformers." COLLABORATION WITH GOVERNMENT THROUGH MEDICAL FOUNDATIONS WILL NOT PROTECT DOCTORS FROM BUREAUCRATIC INTERFERENCE Doctors in the United States are being led to believe that groups of them, organized as Medical Foundations collaborating with government as its agents to hold down on utilization, could control how medicine is practiced and avoid government interference between doctors and patients. Mr. Powell was asked: "Does your experience lead you to believe that politicians here are anymore likely to permit this to happen than they did in Britain?" Mr. Powell answered"I doubt that it can happen anywhere, because it seems to be a contradiction for a doctor whose essential function is doing his best for the individual and at the same time to endeavor to control a total budget of the cost of the care which he gives. This seems to me to be something which a computer couldn't do and which a doctor oughtn't attempt to do." "Perhaps of all the professions that ought not to be nationalized, the medical profession is at the top." (Attached is a summary of wisdom by Mr. Powell from his book "A New Look at Medicine and Politics." Appendix I.) GOOD AND BAD SERVICE PAID THE SAME Dr. Quinlan from Galway, Ireland, now in private medicine in Chicago, formerly served under Britain's politicalized medicine in Northern Ireland. He described in St. Louis how a general practitioner in Britain is forced by governmentally imposed regulations and controls to neglect patients. "Unfortunately for patients," he said "doctors are paid less for taking adequate time to practice good medicine than doctors who see too many patients and collect the same amount of pay per capita for inferior service." Mrs. Maurice W. Peterson, a housewife and mother, related to the Meeting what patients would lose under a nationalized health scheme. All patients would lose under any system of compulsory nationalized medicine: (1) His doctor's best judgment. (2) The confidential relationship with his doctor. (3) Dignified, personal medical care. (4) Free choice of doctors. (5) Time and money. (6) Another major struggle to keep liberty in America. THE DOCTORS BEST JUDGMENT Now under our private medical system a doctor is free to do his very best for his patients. Government run medicine would tell him whether to treat individuals, how, why, when, at what cost, and with which government prescribed drugs. THE CONFIDENTIAL RELATIONSHIP Although tax returns are supposed to be confidential, they are not. Likewise, secret medical records would become an open book under government systems readily available to the prying eyes of government clerks. FREE CHOICE In private medicine, patients can choose any doctor willing to provide conscientious personal medical care. Compulsory government medicine would limit and impair that freedom. TIME AND MONEY Now patients pay their doctors once for services rendered. Under government medicine, patients pay twice. Once in taxes, inflation and red tape, whether or not they use any medical service and secondly, if they decline the regimentation then for the doctor of their choice. DIGNIFIED PERSONAL CARE Under private medicine, patients and doctors are treated and dealt with promptly with dignity and mutual respect. The doctor is fully responsible to each individual patient. Governmentally rationed medicine would make patients a mere number and an annoyance to the clerks and doctors who would have little legal, ethical or moral responsibility to the patients. THE STRUGGLE TO MAINTAIN LIBERTY IN AMERICA If nationalized medical care is decreed, all Americans will have lost a cherished and valued liberty that has been guaranteed by our Constitution. A large block of private savings would be diverted from private channels which now help lubricate the dispersed decision making of the private capitalistic system and into the monopoly control of government clerks. It was Lenin who said, "State (central government) monopoly capitalism is the fullest material preparation for socialism, it is its threshold, it is that rung on the historical ladder between which and the rung called socialism there are no intervening rungs." (Lenin-Selected Works-International Publishers, New York, 1943, Vol. II, P. 367.) (A discussion of state capitalism as a stage through which Russia must pass to advance economically.) The expert testimony of Mr. Powell, Dr. Quinlan and Mrs. Peterson is the kind that H.E.W. and the federal government never seeks, since it would not help build the gargantuan empire centralized in Washington. When Mr. Powell was asked whether he thought the omnipotent wisdom and apparently unlimited resources of the U.S. federal government would enable it to initiate a nationalized scheme which would avoid the errors of nationalized schemes in other countries, he replied "When health care is offered free of charge at the point of consumption or at less than market price at the point of consumption, then the demand for practical purposes is literally unlimited. Consequently, no addition of resources will bridge the gap between infinite demand at zero price and limited resources. The conflict is inherent in the system and no one can make it work satisfactorily." Mr. Powell fervently said "surely this is an American doctrine-that you always get most and do best by giving people the most freedom to demand what they want and to supply that for which there is a demand. That's what America taught the world-why are you running away from it now?" See further quotations from Mr. Powell's book "A New Look at Medicine and Politics" Appendix 1. LEGALLY UNSOUND Neither the founders of the U.S. Constitution, nor its amendors, intended for the Federal Government to interfere in private contracts for medical care by subsidizing citizens capable of paying their own way. Appendix 3 reviews constitutional provisions and clearly proves the legislation before you is without a sound legal basis. SUMMARY The Bills before you to subsidize and control medical care in whole or in part for everyone are morally, economically and legally unsound. They violate the principles upon which the success of America is based. They usurp power; are inflationary; would lower the quality of medical care available; restrict the opportunity to obtain medical services; increase costs of medical care; increase dictation to and control of everyone by the central government; ignore the experiences in socialized countries and gravely threaten individual freedom for us all. They should be immediately abandoned. It is respectfully suggested that the Committee shou'd substitute in place of these Bills an investigation of how the Congress can keep the federal bureaucracy from destroying individual freedom in America. Mr. ULLMAN. Would you like your various appendix matter included also in the record? Dr. DORRITY. Please, yes, sir. Mr. ULLMAN. Without objection then the appendix material will be included in the record. (The appendix matter referred to follows:) APPENDIX I "A NEW LOOK AT MEDICINE AND POLITICS" (By The Right Honorable J. Enoch Powell, British Minister of Health- The following are excerpts from Mr. Powell's Book-Published by: INTRODUCTION Since medicine has become inextricably involved with politics, and the organization of medical services sometimes seems to have assumed more importance than the quality of those services, a new look at medicine and politics is badly needed. Few people can be better equipped to supply this new look than an exminister of health. We may sometimes regret the days when th doctor, G.P. or specialist, was the independent practitioner of a highly skilled art, answerable to no one but his own conscience and the corporate conscience of his colleagues for the standard of the care he gives his patients, and asking-and very often waiving-a direct monetary return for his services. Now, since the National Health Service, the hospital doctor is a State employee and the general practitioner is a contractor to the State. Such a change in the setting of medicine is fraught with profound consequences, which are still only gradually being explored and understood. These consequences are widely misunderstood, by profession and public alike, as being accidental or transitory or easily remedied, due perhaps to the weakness of a particular Minister or the faults of a particular government. Mr. Powell shows that this is not so. The strains and stresses, the inadequacies and dissatisfactions, which the professsion and the public experience, are implicit, he argues, in the nature of a free, comprehensive national health service itself. (From the introduction to Medicine and Politics.) "From the point of view of its recipients, Exchecquer money is for all practical purposes unlimited. The consequences elsewhere of an increase in a particular expenditure are infinitely remote and unascertainable, and no sense of responsibility for justifying even the present level of expenditure is felt by those concerned." p. 15 "In one case people feel 'involved' and therefore, responsible, in the other they do not." p. 18 "The necessity which is proverbially the mother of invention is least fecund when she is presented in the guise of his majesty's treasury." p. 20 "Financing of a service by the public and especially Exchecquer money converts every limit upon demand into an arbitrary and perverse or even malevolent decision imposed by conscious authority." p. 20 "In a publicly financed service, remuneration of the employee is seen as an arbitrary evaluation placed upon people and their work by a political authority." p. 21 "But the moment the employer or the paymaster is the Exchecquer, it is assumed that he has the power to pay more at will, and so what is actually paid or offered, is treated as a deliberate evaluation of the employee by the employer, and resented accordingly." p. 21 "You do not hear artists, or clergymen, or monks, or missionaries, or actors, or novelists complaining that their sense of vocation is being exploited. Nor did the doctors or the nurses or the dentists do so before the Exchecquer became paymaster." p. 23 "With the medical profession, . . . the supply can adjust itself to change in demand only after a more or less substantial interval of time." p. 24 SUPPLY AND DEMAND "Medical care under the National Health Service is rendered free to the consumer at the point of consumption-" p. 26 "Consequently supply and demand are not kept in balance by price. Since, therefore, resources are limited, both theoretically and in practice at any given time, or the demand is unlimited, supply has to be rationed by means other than price. The forms of rationing adopted deliberately or by default, and usually unrecognized certainly unproclaimed as such, are among the major irritant ingredients in Medicine and Politics." p. 26 "Common thought and parlance trend to conceal or deny the fact that demand for all practical purposes is unlimited. The vulgar assumption is that there is a definable amount of medical care 'needed', and that if that 'need' was met, no more would be demanded. This is absurd. Every advance in medical science creates new needs that did not exist until the means of meeting them came into existence, or at least into the realm of the possible. For every heart-lung machine or artificial kidney in operation there must be many times that number of cases to which the treatment would be applicable. Every time a discovery is made in, for example, the techniques of grafting, the horizon of 'need' for medical care is suddenly enlarged." p. 26 "There is a characteristic of medical care that makes its public provision exceptionally problematic. The demand for it is not only potentially unlimited; it is also by nature not capable of being limited in a precise and intelligible way." p. 28 "The National Health Service, then, must and does apply covert rationing devices in order to limit demand to the actual amount of the supply." p. 29 "In fact, the Minister does exercise substantial control over the volume of service provided, but he does so indirectly through his power to fix what remuneration the executive councils shall offer to the practitioners in contract with them. If this remuneration were such as to attract into contract with the councils rapidly increasing numbers of practitioners, then indeed the volume of service rendered and consequently the expenditure would go through the roof'. p. 30 "Indeed, in the last three years the number of general medical practitioners in the service has actually begun to fall at a rapidly accelerating pace." p. 30 "... the volume of private practice . . . is so trivial that many decline to accept private patients at all, on the ground that the accounting, billing and other separate arrangements would cost more than they were worth." p. 34 "It is a common error to suppose that a cash relationship is inconsistent with mutual respect between professional and client, or is synonymous with selfishness or irresponsibility. A glance at any of the non-nationalized professions proves the contrary. The question is rather whether a tolerable and satisfactory relationship between general practitioner and patient can exist when there is no cash nexus." p. 35 "... good and bad service (in similar circumstances) are remunerated at one and the same price. A capitation fee can no more distinguish between good and bad service than a fee per item of service, which governments have consistently rejected." p. 37 "Thus, outside as well as inside the hospitals the figure on the supply side of the equation is fixed at any particular time by those complex forces that determine that state's decisions on expenditure. With this figure demand has to be brought into balance. Virtually unlimited as it is by nature, and unrationed by price, it has nevertheless to be squeezed down somehow so as to equal the supply. In brutal simplicity, it has to be rationed; and to understand the method of rationing is also essential for understanding Medicine and Politics. The task is not made easier by the political convention that the existence of any rationing at all must be strenuously denied. The public are encouraged to believe that rationing in medical care was banished-being applied to medical care is immoral and repugnant. Consequently when they, and the medical profession too, come face to face in practice with the various forms of rationing to which the National Health Service must resort, the usual result is bewilderment, frustration and irritation. "The worst kind of rationing is that which is unacknowledged; for it is the essence of a good rationing system to be intelligible and consciously accepted. This is not possible where its very existence has to be repudiated." p. 37 & 38 "So it is always arranged that there shall be plenty of people waiting when the great man arrives, so that there is no danger of the expensive mill even momentarily lacking grist." p. 38 "There has to be some differential rationing for different qualities of an article, and if not price, then, for example, time: better surgeon, longer wait, and vice versa." p. 39 "Generally, the waiting list can be viewed as a kind of iceberg: the significant part is that below the surface-the patients who are not on the list at all, either |