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Nothing in the bill shall be construed to give the Secretary or administering agencies authority over the internal management of participating institutions or over the practice of medicine or the manner in which medical services are provided.


Persons eligible for permanent and disability benefits are not included. The proposal does not apply to costs incurred in Federal hospitals, or in tuberculosis or mental institutions, or in other countries. It does not cover all types of nursing homes or apply to institutions that provide primarily domiciliary care. It does not apply to workmen's compensation cases unless arrangements are made to reimburse the insurance system. It does not include elective surgery, or nonsurgical medical services except those customarily furnished by hospitals as an essential part of hospital care for bed patients.

7. FINANCING The bill would increase contribution rates of employers and employees by 14 percent each and of the self-employed by 38 percent.


The benefits would start 12 months after enactment. This would give time for adapting private insurance arrangements so that they supplement rather than duplicate the new benefits.

The CHAIRMAN. We thank you, Mr. Cruikshank, for bringing to us the views of the AFL-CIO with respect to the problems to which H.R. 4700 is directed, and also your discussion of the provisions of the bill.

Mr. Forand. Mr. FORAND. Mr. Chairman, I ask unanimous consent that that alert letter be made part of the record.

The CHAIRMAN. Do you want to make that a part of the record ? Mr. CRUIKSHAK. Yes, sir; if you wish.

The CHAIRMAN. Without objection, that letter will be included at the point at which you referred to it.

Mr. FORAND. I do not have any questions, Mr. Chairman.

I do want to commend Mr. Cruikshank and his assistants for the fine statement prepared for this committee. It contains a lot of information that I am sure will prove of great interest.

That is all.
The CHAIRMAN. Mr. Simpson.

Mr. SIMPSON. Mr. Cruikshank, does the AFL-CIO presently favor national compulsory health insurance ?

Mr. CRUIKSHANK. Mr. Chairman, it does.

Mr. SIMPson. Do I understand that the AFL-CIO is complaining about lobbying on the part of the doctors?

Mr. CRUIKSHÅNK. No, sir; we are not. The doctors have a perfect right to lobby. They have a perfect right, and we would be the last to stop them from doing it even if we could.

Mr. Simpson. You just complained about the president of the AMA having written to other doctors and referred them to a publication wherein they might find the basis for objecting to this proposed legislation. Do you object to that?

Mr. CRUIKSHANK. No, sir.
Mr. SIMPSON. Why did you put it in the record ?
Mr. CRUIKSHANK. No; I don't object.
Mr. SIMPSON. Why did you put it in the record ?

Mr. CRUIKSHANK. I am glad you asked the question, because if my tone implied I objected to it, I want to make it clear that I am not.

Mr. SIMPSON. You approved of it then?

Mr. CRUIKSHANK. I approve of the American Medical Association approaching their Representatives in Congress the same as any other group of citizens and I would defend their right to do so.

Mr. SIMPSON. You did not put it in in any critical sense ?

Mr. CRUIKSHANK. I did put it in in this critical sense. I put it in for this reason, Congressman Simpson: I put it in to indicate to the members of this committee and to your colleagues that if they are getting a flood of mail, they will properly be able to appraise it, knowing that it was inspired from headquarters in this way, and I also pointed out that this was put in just as an operation of the organization, not asking their members to think it through.

These doctors are all university and postgraduate people. They represent a level of education way above the level of our people.

Mr. SIMPSON. You mean they should actually know what the law would do to them?

Mr. CRUIKSHANK. It would seem to me that they would have a better chance of doing it rather than be told what to say and then say we will send you the reasons for saying it later.

That is what I was pointing out.

Then I would like to also point this out, Congressman, when you are evaluating your mail. Our members don't have secretaries so that we can say, “Send the Congressman a letter along this line and I will sign it.” Our members have to sit and chew their pencils and write out letters to their Congressmen.

Mr. SIMPSON. You are critical because they are what. Too intelligent, or what?

Mr. CRUIKSHANK. No; I am not critical of what they are saying at all. I am only pointing out as a means of evaluating the mail that comes in that it is inspired from headquarters and that it was given out in just this way. I am sure the members of the committee will be able to evaluate it better knowing how this letter came.

Mr. SIMPSON. Will you agree with me that your organization inspires letters and postcards to the Congressman?

Mr. CRUIKSHANK. We encourage our members to write their Congressman.

Mr. SIMPSON. I am very happy you do.

You do not object to anyone, I am sure, writing to his Congressman, do you, including the doctors?

Úr. CRUIKSHANK. No, sir; I don't object to that, but I don't believe that we have sent out letters to our people telling them to oppose this bill and the reasons will follow later.

Mr. SIMPSON. I am glad that you did put it in the record, because I am glad the doctors are warned that there is legislation which in their judgment threatens them in the practice of their profession and if the legislation is unwise and becomes law, it might cause injury or disaster to the citizenry of the country. Consequently, I think they do perform a service when they make the wishes of the professional people known to Congress.

Surely you do not disagree with that,



Mr. CRUIKSHANK. We would be happier, Congressman, if the AMA, realizing that its constituency were all university and postgraduate members, would send both sides of the issue to the doctors and let them decide.

Mr. SIMPSON. Do you send both sides when you write to people?

Mr. CRUIKSHANK. We don't have to. The daily press gives them the other side two or three times a day.

Mr. SIMPSON. Thank you very much.
The CHAIRMAN. Are there any further questions?
Mr. FORAND. Mr. Chairman, I would like to clear one point.

Mr. Simpson seems to think that Mr. Cruikshank put that letter in the record. That letter was put in the record at my request.

Mr. SIMPSON. Of course, Mr. Chairman, I would not ever question the word of my colleague.

The CHAIRMAN. Mr. Machrowicz will inquire.

Mr. MACHROWIcz. Mr. Cruikshank, I also want to compliment you on a very fine statement, and I want to tell you that I do not know how effective the AMA campaign has been, but I have here a file of 71 letters from doctors in my area, 63 opposing the AMA stand on social security, and 8 favoring it, so whatever the campaign is, it is not very effective in my area at least, I might say.

I wonder whether you were here yesterday, Mr. Cruikshank.
Mr. CRUIKSHANK. I was not; no, sir.

Mr. MacHROWICZ. Yesterday a spokesman for the American Nursing Home Association referred to a recent national conference of the joint council to improve health care for the aged.

I would like to know whether you or some member of the AFLCIO or spokesman for your organization participated in that conference. Mr. CRUIKSHANK. No, we didn't, Congressman.

When this organization was first formed there was some public denial to our charge that it was organized to oppose the Forand bill and we took that at face value and we wrote the executive secretary of the organization and said that we would be glad, as a representative of 131, million working people who are confronted with this problem of medical care for the older people, to sit with them as a representative of the recipients of medical care, noting that they were all the dispensers of medical care in one form or another, that we would be glad to sit with them and consult with them.

Å month or two went by and they finally wrote us and said they didn't think it was appropriate to have us sit in their councils and they didn't allow us to join.

Then when they had the conference 2 or 3 weeks ago here in the Statler, we saw the program and they invited us to attend and participate, as they said, and we wrote back and said:

What do you mean, participate? If you are studying the problems of the aged we would like to have a chance to present our view.

Then they wrote back and said:
Well, by participate we mean that you can come as an observer.

Frankly, I thought that representing 1312 million people, it was not beneath my dignity but beneath the dignity of my organization to go as an observer and simply be told by the people who have a commercial interest in this what is good for us without our having had the chance to really participate in deliberations.

That is the reason, Congressman, that we are not members and are not participating in that council.

Mr. MACHROWICZ. Then this so-called National Conference of the Joint Council To Improve Health Care of the Aged did not even permit your organization to express its views at that conference? Mr. CRUIKSHANK. That is correct.

They did say, Congressman, that we could perhaps seek the floor and state our views from the floor, but we did not think that that constituted actual consultation.

Mr. MacHROWICZ. In your paper I believe you stated that one of the basic shortcomings of the so-called commercial insurance on this subject matter is that the older people have to pay for it after retirement and no provision is made for it; whereas, under the Forand bill, they would not have to make any payments after retirement; is that correct?


Mr. MacHROWICZ. As you understand it, would the proposal which Secretary Flemming made, except that he said the staff would study it, do anything for people who have already retired, or would it be concerned only with the people who still have sufficient years of work ahead within which they could make contributions?

Mr. CRUIKSHANK. As I understand his proposal, Congressman, it couldn't possibly do anything for the 15 million people now over age 65.

As a matter of fact, I don't see how it can do very much for those under. It is a pretty foggy kind of proposal, as I understand it. Maybe I haven't analyzed it sufficiently yet, but, as I understand, he is going about seeing how people could under some kind of voluntary arrangement get a paid-up health insurance policy at age 65.

This is just more of the same. It has the same inherent weaknesses that non-Government insurance has at present, and if the present programs aren't working, and they aren't, this wouldn't work.

Mr. MACHROWICZ. Therefore, in your opinion at least, it wouldn't do us much good to wait for this report because it is not going to meet the basic problem that we are faced with; is that correct?

Mr. CRUIKSHANK. It won't do any good to wait for the report, and older people are in need of this program and in need of this help right now.

Mr. MACHROWICZ. That is all, Mr. Chairman.
The CHAIRMAN. Are there any further questions?
Mr. Curtis will inquire.

Mr. Curtis. Mr. Chairman, I am sorry that some of this discussion got off onto the question of who is lobbying for whom and lobbying techniques. I must confess I think it is a very healthy area to explore. I think lobbying techniques are very important, but the issues before this committee are not who says certain things; it is whether what they say has merit and whether the arguments have weight, and I think Mr. Cruikshank will agree with that observation.

Mr. CRUIKSHANK. I would also agree, Mr. Congressman, that it does not matter in terms of mail how many say it.

Mr. CURTIS. I could not agree with you more. It is what is said and the arguments and the facts, and I would hate to try to be the judge

on the lobbying techniques employed by your organization in relation to those employed by AMA or any other group.

I do think that it is a subject, though, that the public would be very much interested in and I think that it should be examined sometime, but not by this committee at this time.

On this council of health organizations, I thought that was composed of professionals in the field.

Is that not true?
Mr. CRUIKSHANK. They represent some of the organizations.

Mr. CURTIS. So there could be another reason why the CIO-AFL would not be a part of that other than somebody trying to do something arbitrary. It may be that they wanted to confine it to professionals.

I do not know; I just throw that observation out for your comment.

Mr. CRUISHANK. It is significant that they did not include the nurses.

Mr. CURTIS. I thought they did include the nurses.
Mr. CRUIKSHANK. No; they included nursing homes, but not nurses.

Mr. CURTIS. Do you think it is significant? Do you think that was deliberate?

Mr. CRUIKSHANK. I say it in view of the fact that the American Nurses Association has endorsed the Forand bill. It is at least something of a coincidence.

Mr. Curtis. Was not the American Hospital Association part of the council ?

Mr. CRUIKSHANK. Yes; it was.

Mr. CURTIS. I just do not understand that sort of reasoning, to be honest with you.

Maybe there is a motive, but I prefer to think that there are other reasons for these things. As far as I am concerned, I would rather devote my efforts to try and figure out what is the way to go ahead in this area.

Mr. CRUIKSHANK. That is exactly what we wanted to do. We wanted to sit with these groups. “HỈere we are, the consumers. You are the purveyors. Let's sit down together and work something out," and they said, "No, we don't want to hear from you people.

Mr. Curtis. I am saying to you, sir, why not take that on the basis of a proper motive instead of impugning it as improper motive?

It may be that their purpose was to get the groups of professionals together. I think your criticism as to why the nurses were not included is an apt one, but I do not mean that they were not included for some ulterior or mean motive. I prefer to find out what the reason is.

These arguments get to be on the one side that it is socialism and on the other side that the people opposed are not interested in human welfare. Mr. CRUIKSHANK. I didn't say that.

. Mr. CURTIS. Well, I have heard the argument used many times, and it has been used and it gets down to that.

Frankly, I do not care one way or another on either argument. I do think it is proper to examine into such a thing as socialism. I certainly do think that there is such a thing as callousness and I think it is proper to examine into it, but to try to solve an important matter

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