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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 confer

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 1312 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.

A 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 com

ence.

mercial 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. CRUIKSHANK. Yes.

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. 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 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

like this by choosing up sides in generalities, in my judgment can only hurt in reaching the proper solution.

One thing I want to say is this, Mr. Cruikshank: I was sorry I did not get to listen fully to your statement. I have read most of it. I do want to compliment you on it. It contains, as your other statements have contained, a lot of very good information, fairly presented. I have noted over a period of years your testimony here has been of that sort, which is commendable and is contrary to the other line of presentation that I have been raising some objection to.

One thing I would appreciate. I presume your organization has evaluated the report of the Health, Education, and Welfare of April 3, 1959, on hospital insurance for OASI beneficiaries, and I believe in your statement you refer to the fact that in your judgment a lot of good information is there. I think it would be of value if your organization would prepare for this committee, unless you have already prepared it, an appraisal of this whole report that bears on this subject that you are interested in, because there are probably areas where you disagree and there may be some points that you may think there is incomplete information on or there might be further information.

In my judgment this is a good starting point, at any rate, and any criticism of this report, negative and constructive, I think would be very helpful to this committee.

Nr. CRUIKSHANK. We thought it was a very useful report; a very good, workmanlike job of collecting the facts.

(The information referred to follows:)

2. STATEMENT BY AFL-CIO PRESIDENT MEANY ON THE REPORT OF THE DEPARTMENT

OF HEALTH, EDUCATION, AND WELFARE, April 13, 1959 We are delighted that the report of the Secretary of Health, Education, and Welfare on health benefits has been completed. The report was called for by the House Ways anů Means Committee last summer when the Congress passed the Social Security Amendments of 1958 without including Congressman Forand's proposal to meet hospital and other health needs of social security beneficiaries.

Secretary Flemming is to be congratulated on the thoroughness and objectivity of this report. It cuts through the fog of poisonous misinformation with which opponents have attempted to choke the Forand bill (H.R. 4700). Overwhelming statistical evidence now supports what our members have known right alongthat retired workers have incomes too low to meet the rising costs of medical

care.

The careful analysis presented in chapter 5 shows that hospital and nursing benefits for old-age and survivors insurance beneficiaries are entirely practical. Not a word there suggests that the Department could not successfully administer such a program.

Congress should at once move toward enactment of the Forand bill. The Ways and Means Committee should hold hearings at the earliest possible date.

Our members want high quality medical services, both before and after retirement, and are willing to pay for them on a budgeted, prepayment basis during their years of employment.

High-powered advertising campaigns by private insurance companies are not going to give aged couples the $200 or more a year charged for very limited protection. Three-fifths of all people 65 and over had money incomes of less than $1,000 a year in both 1956 and 1937, as the DHEW report states.

Our members resent being told by spokesmen for organized medicine that those not covered by private insurance can, in case of need, turn to welfare agencies. Public assistance and other forms of welfare are based on the means test and are commonly not available before savings are nearly exhausted. Accompanying requirements too often affront the dignity of men and women who, through hard work and thrift, have built a modest home in which to enjoy their later years.

Congress should help preserve such homes through making health benefits available under our social security system.

A Federal program can be shaped to encourage desirable goals in health care: the preservation of good health ; high quality care in hospitals and less expensive nursing institutions, and a speedy return of the aged to their own homes and an active, constructive life.

The great majority of Americans would be protected regardless of where they work or whether they are able to continue doing so. Their contributions would help pay the costs, and benefits would be received as a matter of right. Administrative expenses would be smaller and workers would thus get the largest return for each dollar contributed. The annual cost for some time to come is estimated at only half the amount the AMA has been using ($1 billion instead of 2).

Mr. CURTIS. If you would care to, I would myself like to see a further critique of the report. Just one substantive thing, because we do not have much time here and I just regret that these are such short hearings that of course we cannot really get into the subject.

One thing that has troubled me in your presentation and in many presentations is the failure to separate two problems. There is the problem of the indigent which runs through all of these welfare programs.

I do not care whether it is housing, or whether it is food, or whatever. Its real basis is indigency and to me indigency should be treated as a complete problem.

I find too often in various programs, including this suggestion, that indigency is used as a vehicle to carry on a program that goes way beyond trying to handle the problem of indígency. I think particularly in this area essentially the people that your organization represents are not indigent. Is that not true?

Mr. CRUIKSHANK. Generally that is true; yes, sir. Sometimes they become indigent.

Mr. CURTIS. Sometimes they become indigent. Of course, indigency is a concern of all of us. However, as I view this problem, there are two things that we are treating with. One is the fact that we have in our society inadequate techniques, and inadequate facilities, and inadequate skills to provide for the bulk of our population who are not indigent and that is where we get into this area of trying to find out what kind of insurance programs and what kind of other techniques might take care of this job. I wish we could separate it from that angle, to see first whether or not we cannot adequately handle the basic problem in our society, which is not the indigent.

When we have set up a program or see a program is operating in that area, we should concurrently, because indigency is a serious problem, and at the same time, if you please, look at the problem of indigency, whether it is a matter of health, or whether it is a matter of housing, or whatever it is, and treat with that from this angle and not confuse the two, because I do not believe that the two can be handled in the same fashion.

That is an observation I would make in regard to the points that you have developed because much of your argument strikes me as being based upon the problem of the indigent rather than on the problems of those who can afford to pay.

One thing that is not mentioned in here, for example, is the fact that the bulk of our population now iş building up great equity as they go through life, the fact that today 1 out of 3 workers own their homes, when formerly, 50 years ago, only 1 out of 5 did, and that is a continually improving situation.

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