initiative coupled with social responsibility has made this achievement possible.

We might say that our newest voluntary prepaid medical plan for the ages is not perfect any more than were our initial efforts with the Blue Shield program in general; nor is it now perfect. However, we are making a start and we are headed in the right direction. Changes in a voluntary plan can be made as experience indicates and these changes can be made to conform to various local needs.

The problems of the aged are manifold and sensitive. Physicians are in the unique position to evaluate these problems for when we see these elderly people as patients they usually tell us about their problems, medical and otherwise, and there is a lot more to all this than the passing of a law.

We, therefore, respectfully suggest that the Congress in its wisdom might continue to study this problem and continue to urge experimentation and expansion of voluntary health insurance in this field. Gentlemen, both personally and in behalf of the California Medical Association, I wish to thank you for the opportunity to appear before this important committee.

Mr. FORAND (presiding). Dr. Reynolds, we thank you for your appearance and the contribution you have made.

Are there any questions? Mr. Utt.

Mr. UTT. I assume that Dr. Reynolds would like to have the statement in full in the record.

Mr. FORAND. The chairman has already granted that permission. Mr. UTT. Including his other statement.

I do have a question I would like to ask the doctor.

Dr. Reynolds, it has been stated that a great many physicians are in favor of this type of legislation but are afraid to make their position known.

What has been your experience in that respect?

Dr. REYNOLDS. Congressman, to that I can only say that as president-elect of the medical association last year and as being about half way through my term of office as president this year, I have gone around to this 17,000 member army of generals from one county to the other and they seem not to hesitate to say whatever is on their mind, whether it happens to be critical of what I am doing or what I think or not. However, I must say that during all of that time I have not heard from one who feels that the social insurance plan would be better than an extension and an expansion of the voluntary program plan to cover this very definite known problem in medical

care.

Mr. UTT. It is your opinion that you do not have a captive membership?

Dr. REYNOLDS. Certainly I can say that I do not see anything captive about them. They are just exactly the opposite. They go off on wild tangents in spite of anything.

Mr. UTT. The record shows that you have been a practicing physician in California for some 30 years. I was wondering if, in your experience over those many years, you find that it is more difficult or less difficult for the indigent people or the aged people to obtain medical care services than it was when you began to practice in California.

Dr. REYNOLDS. I can confidently say that it is much easier now. The advent of insurance into the field has made it infinitely easier now to take care of thorny problems of medical care. It is far from perfect, acknowledgeably, but it is much better than when I was a young physician some 30 years ago.

Mr. UTT. In your own experience have you given a great deal of free medical aid? I happen to be an attorney. I know a lot of my business used to be taking care of people who did not have money to pay an attorney. I wondered if that was true of the medical profession, true as far as you are concerned personally?

Dr. REYNOLDS. I think that is true; yes, sir. I think it is true of the majority of physicians.

Mr. UTT. Are you opposed to or in favor of social security?

Dr. REYNOLDS. Social security, per se, I am certainly not opposed to. I think it has been an excellent piece of social progress in the country. I have no objection to it, as such.

Mr. UTT. Thank you very much, Doctor.

Mr. BETTS. Mr. Chairman.

Mr. FORAND. Mr. Betts.

Mr. BETTS. Do you know of any other States that have this plan? Dr. REYNOLDS. Congressman, I cannot say specifically. There are some that are quite similar but not identical. It is so much in the formative period now that it has not crystallized out everywhere.

Yes; I am quite aware that there are some experiments, probings, and formings of arrangements in other States.

Mr. BETTS. Do you think it is gaining in popularity?

Dr. REYNOLDS. Oh, undoubtedly it is. Perhaps it is partly due to Congressman Forand's needling, but it is certainly increasing in activity and I would say popularity.

Mr. BETTS. That is all.

Mr. FORAND. Are there any further questions? Mr. Alger.

Mr. ALGER. Dr. Reynolds, I am impressed here by both a positive and a negative thought which you expressed on page 3. First of all, the voluntary programs in California which you spoke of are available to everyone over 65 and not just those who are qualified under the social security program as this bill will be; secondly, that you made this statement:

that Government should not provide compulsory health insurance for those over 65 until and unless it has been proved that voluntary insurance cannot do the job.

I appreciate your saying that because, to my knowledge, no proof has been submitted to this committee that medical care has not been provided.

Thirdly, you point out that enactment of compulsory insurance at this time will destroy many programs in effect. I would like you to comment on that thought.

If we adopt compulsory programs in what way will it destroy programs now in effect?

Dr. REYNOLDS. Well, sir; it would remove the incentive of people to carry private voluntary personal insurance against the costs of illness because it would be, in essence, double coverage which they could not use in double strength. They would be paying through a compulsory tax mechanism and at the same time, in this case, they

would be paying individually for it and it would be improbable that people would want to do it and I should suspect that that type of effort would gradually diminish.

Mr. ALGER. Then on the other hand, as the voluntary programs are squeezed out for lack of incentive, there would be a greater reliance placed on the Federal Government.

Dr. REYNOLDS. That is true.

Mr. ALGER. So that this complsory insurance has built in its own seeds for growth.

Dr. REYNOLDS. I believe that that is true, Congressman.

Mr. ALGER. Thank you.

Mr. FORAND. If there are no further questions, we thank you very much, Doctor, for your contribution.

Dr. REYNOLDS. Thank you, gentlemen.

(The following was submitted for the record:)

[From the Herald Express, July 13, 1959]|

There are two influences which cause crime-heredity and environment. There are two influences which determine characterheredity and environment.-WILLIAM RANDOLPH HEARST.

THE FORAND MEDICAL BILL

With committee hearings starting in Washington on the Forand bill introduced into Congress by Representative A. J. Forand of Rhode Island, the Nation faces what may prove to be its most dangerous experiment in socialized medicine. While this bill in itself does not provide a plan as radical as the British plan which has been so strongly criticized, its passage undoubtedly would lay the groundwork for later expansion to such a plan.

The Forand bill proposes to amend the Social Security Act to provide for the Federal purchase of certain health care services for social security beneficiaries, but for these beneficiaries only.

Under the Forand bill, approximately 16 million persons eligible for social security benefits, most of them over 65, would be eligible for hospital, surgical, and nursing home treatment through a Government administered plan. The Federal Government would contract with hospitals, nursing homes, physicians, and dentists for the services.

Dr. E. Vincent Askey of Los Angeles, recently elected president of the American Medical Association, has declared that the AMA will continue its vigorous fight against "socialized medicine."

The AMA has estimated that the cost of administration under the Forand bill for the first 2 years would total close to $2 billion.

While some of this cost might fall upon the shoulders of the general taxpayers, the chances are that everyone who pays social security taxes will be shouldering the principal burden.

Social security taxes are expected to reach 9 percent of payrolls-up to the amount of $4,800-in the years just ahead, and the Forand bill would send them spiraling still higher. What it would do to the checks of those already on social security is a moot question.

Except in rare instances or in the case of necessity for certain emergency surgery, the elderly and aged patients would not be able to choose their own physicians, hospitals or nursing homes.

It would all be under bureaucratic control from Washington, in many instances administered by officials who are nonmedical people.

There is danger that hospitals under contract to the Federal Government would be overloaded by persons who did not actually require care while thousands of others desperately needing help would not be able to get into the overcrowded facilities.