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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.

It is natural that we should want to do all we can to make the declining years and health of our senior citizens brighter and more comfortable.

But we should beware in analyzing the Forand bill of any "pie-in-the-sky" political schemes that would not only threaten the national economy but at the same time would fail to do the job.

It should be the sincere hope of all those interested that in the hearings in Washington, all of the advantages and disadvantages of the Forand bill will be exposed to public and legislative scrutiny.

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The fact is that close to 43 percent of our citizens over 65 years of age already are covered by health insurance, much of this during the last few years.

Also, the Health Insurance Association of America expects this trend to grow until 75 percent of the older people who need such protection can be covered by voluntary health insurance by 1965, and 90 percent by 1970.

If Federal aid is to be provided, it would seem that the better channels for distribution of such aid might be through the existing plans.

Mr. FORAND. The next witness is Dr. Braun.

Would you come forward, please, sir?

Doctor, I understand that you are substituting for Dr. Butler and Dr. Lavietes.

STATEMENT OF DR. EDMUND BRAUN, MEMBER, BOARD OF DIRECTORS, PHYSICIANS FORUM, NEW YORK, N.Y.

Dr. BRAUN. I regret exceedingly that Dr. Butler who, for over 30 years, has been interested in the improvement of medical care as a practioner, as a teacher, and interested in the social aspects of medical care was unable to come today because his plane was grounded in New England. I will take his place.

I am former chairman of the Physicians Forum, a national organization of physicians, and a member of the board of directors, and a member of the executive committee of the board of directors.

I am in private practice in New York.

Mr. FORAND. At this point, I would like to read for the record a telegram I received this morning from Dr. Butler. It says:

Regret that cancellation of airplanes from Marthas Vineyard this afternoon and evening because of fog prevents my being present at hearings 10 a.m. Tuesday as planned. Hence, I wish in this telegram to record endorsement of the Forand bill, H.R. 4700. Written statement has already been sent to the committee together with the policy statement of the board of directors of the Physicians Forum. We again, as specifically mentioned in our statement last year, feel some revision of the bill is needed to protect the quality of the medical services to be received by OASDI beneficiaries. The low standard of current welfare medical and nursing home care must be avoided. Fragmentation of services must be replaced by comprehensive medical services and standards must be defined for nursing homes if the proposed extension of benefits under the bill is to provide the desired quality of medical services. I would be very glad to discuss this aspect of the bill with members of your committee at any time. The form letter from Dr. Orr, president of the AMA, entitled "Legislative Alert," and dated July 7, that urges doctors to contact their Congressmen immediately to ask them to register opposition to the Forand bill, indicates the usual reactionary attitude of AMA officials. I trust you know that such official opinion often is not that of the majority of physicians. For example, such official opinion is still opposed to including physicians under social security though the majority of physicians are now on record as favoring inclusion.

I have been unable to notify Dr. Braun, whom I was joining at your hearing in representing the physicians for us. Would you kindly tell him of this telegram and my inability to be present.

It is signed, "Dr. Allan M. Butler, President-Elect, Physicians Forum, Chief of the Children's Medical Service, Massachusetts General Hospital, and Professor of Pediatrics, Harvard University."

Dr. BRAUN. I would like to introduce the statement of our position in favor of the Forand bill into the record and then, in addition, I would like to make some comments of my own which have relevance to certain aspects of the problem of the Forand bill.

Mr. FORAND. Doctor, without objection, that will be included, and you are recognized for 10 minutes.

(The statement referred to follows:)

TESTIMONY OF THE PHYSICIANS FORUM ON H.R. 4700 PRESENTED BY DR. ALLAN M. BUTLER, PROFESSOR OF PEDIATRICS, HARVARD MEDICAL SCHOOL AND CHAIRMANELECT OF THE PHYSICIANS FORUM, INC.

I speak for the Physicians Forum, a national organization of physicians in existence for more than 20 years. Our members, who number over 1,000 and are mainly private practitioners, also belong to their county medical societies or other recognized professional associations.

The Physicians Forum appreciates this opportunity to present our views in favor of adding medical care benefits to the Federal social security system, a plan we have advocated for many years. The official position of the Forum on H.R. 4700 is contained in a policy statement which follows my introductory remarks.

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