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marily. The demand in this area could swamp the existing pathologic facilities with unnecessary requests.

2. The bill would lead to Federal control but control must be local and by physicians in the area, if medical care is to be the best available.

3. Experience with all socialized schemes of medical care, noteworthily the English, which I know firsthand, has always cost far in excess of estimates. In this particular area the costs have increased seven times during the period of its operations.

4. The bill would destroy the excellent voluntary programs fostered by Blue Cross, Blue Shield, and the private insurance companies which are rapidly mobilizing effective means for care of the aged. These plans are doing this task in an orderly, well-integrated manner. Necessary actuarial experience is being gained which in a relatively short period of time will enable everyone to obtain the care they need at a reasonable price under the free enterprise system which has up to this time given us the excellent medical care we enjoy.

Finally, Mr. Chairman, I would like to point out two examples of the effect of governmental influence on medical care which tend to highlight the statement we have made. The first is the problems associated with Medicare. Congress wrote a free ticket at the initiation of the act of medicine but when the costs were found to be considerably higher than initially estimated, Congress cut back the budget. This disrupted the excellent medical planning and caused much confusion between patients and their private physicians. This we do not want to see now in this particular area.

The second is an example in our own field of pathology. The College of American Pathologists has distributed literature throughout this country on the early diagnosis of cancer of the uterus by the examination of cells from the vagina. This has been proven to diagnose cancer of the uterus at an early treatable period. Pathologists in this country have been anxious to utilize these tests. However, when we attempted to distribute this information to pathologists in Canada, where socialized medicine exists, we were told by the pathologists there that they did not want these pamphlets distributed because it would make too much work for them. We have had similar experience in South American countries. And in that area the interest is directly related to whether or not the physicians are under a free system. This proposed legislation can only stifle the initiative of physicians in a similar fashion.

In summary, we are opposed to H.R. 4700 because :
1. It does not provide the care needed by the aged.
2. It is a socializing concept of medical care.
3. It would be excessively expensive.

4. It is disruptive of good medical plans which are now being developed to care for the aged.

5. It provides for Federal control where local medical control is superior.

Mr. Chairman, I thank you for the opportunity of appearing before this committee to make this presentation. It will be happy to answer any questions.

Mr. FORAND. Doctor, I believe that pathologists such as you represent are in many cases employed by hospitals which are receiving Federal money through such programs as maternal and child welfare, public assistance, veterans programs, and the Defense Department programs, is that correct?

Dr. HUNTER. Well, pathologists are in most instances, Mr. Chairman, under contracts in hospitals. They are not employees of the hospitals.

Mr. FORAND. That does not say that the money that is used to pay your fees does not come from the Federal Government.

Dr. HUNTER. Some fees are paid from Federal sources.

Mr. FORAND. I have already indicated that I would like the cooperation of all groups interested in this problem of the aged. I would like your advice on proposals for the remuneration of pathologists and other specialists in the manner that would be recommended as equitable. Would your organization give to me or to the committee assistance in regard to making provisions on remunerations that you would like to have included in such a bill?

Dr. HUNTER. Well, sir, number one, we will be happy to cooperate in any way we can. However, as I want it clearly understood, we are definitely opposed to the bill and, although we are happy to cooperate in any way we can to help improve the care of the patient, we are not in favor of this bill as it was written.

Mr. FORAND. You are opposed to the bill. What do you have as an alternative program?

Dr. HUNTER. Well, our alternative program is, I think, rather clear cut in the statement made. What we believe is that the present system, the voluntary insurance system which now exists is a good system. This is a system which is now working and working well in the areas in which it has gone.

In the aged, we have problems which are not yet answered because we have not had enough experience. All we need is sufficient time for these things to be developed, but you cannot develop them overnight and these things, I think, will answer the problem in a relatively reasonable period of time.

Mr. FORAND. Again that question of time. We have been studying this question for years and years and years. We get no action but we get a lot of talk and a lot of requests for time.

Dr. HUNTER. Mr. Chairman, I beg your pardon for interrupting. Mr. FORAND. Go ahead.

Dr. HUNTER. Would you not agree that the experience that we have had shows an increase and improvement in the care of the people of our country by the voluntary program?

Mr. FORAND. For about 2 years now there has been some real action and it was about 2 years ago that I introduced my bill that set off the keg of dynamite under the seat of these people.

Dr. HUNTER. My congratulations to you.

Mr. Forand. I think I will have to get another keg of dynamite to blow this thing wide enough so that we might get a solution.

Dr. HUNTER. When we see that something like 120 million people in this country are covered by insurance and it is expanding at a rapid growth rate, we have every indication that we are going to be able to do the job in a very short period of time.

Mr. FORAND. Of course, "short” is very indefinite.

Dr. HUNTER. Well, I would say as things go from the present time, we will be doubled in 5 years and probably covered up to about 80 percent in 10 years.

I think, from my way of looking at it, that is a very reasonable period of time.

Mr. FORAND. I am going to tell you for the benefit of you and all others concerned that I am going to keep fuel on that fire. I want a solution to that problem.

Dr. HUNTER. More power to you, sir. I am in favor of a solution, too.

Mr. FORAND. Mr. King.

Mr. King. Dr. Hunter, I was not following your written statement. I wish you would elaborate a bit in connection with your reference to the submission to Canada of some findings that they were too busy to look at or deal with. Would you elaborate there?

Dr. HUNTER. I was referring to the Papanicolau procedure with which you may be acquainted. We had published a large number of pamphlets indicating how the procedure should be carried out and the details of just how it should be done. This is a proven procedure at the present time. It has been proven to be able to diagnose the presence of the early stages of a malígnancy in the uterus and thereby the patient can be treated before the disease has gotten a head start.

This literature was distributed throughout the country and at the present time it is widely used and I think well used. We have some colleagues in Canada who are members of our association. We distributed it to them, and wrongly or rightly—I do not understand completely their ideas on this—they felt that if they distributed this, this would increase their work excessively for them and they are not particularly interested in it.

This we believed to be the result of the fact that most of these men are federally controlled by the Canadian Medical Service, and, although they are interested in taking care of patients, they are not interested in the same degree that their American colleagues are in the sense that they are anxious to forge ahead and make improvements in medical care.

This we believe is a byproduct of Federal medical care. Mr. KING. I dislike to believe, Doctor, that anything as important as this can be handled in such a way regardless of what form medicine would take in any country.

Do you not believe that conscientious doctors there, regardless of what impediment they might be suffering under, would cry out against their workload and say that an important finding like this would be made available to them and they are too busy to handle it? Is it true that it is your feeling that because of Government interfering with medicine in Canada they are not able to have disseminated valuable information such as you describe?

Dr. HUNTER. This information, Mr. King, is available to the doctors there perfectly freely but this is more a matter of publicity and the spread of the publicity has been an effective means of improving the control of cancer of the uterus in this country.

I believe that with the facilities that the Canadian doctors have that it is their belief that they will not be given the facilities, the per

sonnel. This requires many, many technologists and much equipment to carry out. I believe that they do not believe that they will be given the necessary facilities to have this carried out the way they would like to have it done.

Mr. King. I see. Thank you, Doctor.
Mr. BETTS. Are you a member of the AMA?
Dr. HUNTER. Yes, sir; I am.
Mr. Berts. What do you say about the freedom of expression?

Dr. HUNTER. Well, I am a member of the house of delegates of the AMA and I assure you that the AMA is a forum where every one has a perfectly free right to express himself and if you are a member of the AMA, you can express yourself any way you want just like you can here.

Mr. BETTS. Without fear of reprisal?
Dr. HUNTER. Without fear of reprisal.
Mr. FORAND. Mr. Alger.

Mr. Alger. Dr. Hunter, the factor of timing is certainly an interesting one. There was an earlier statement here today that holding hearings focuses attention on this problem and maybe there is a salutary effect no matter what happens.

Dr. HUNTER. I think you are absolutely right.

Mr. Alger. From your knowledge, have you any idea of what the personnel requirements would be in the Federal Government to put this program into effect and how much time that might take?

Dr. HUNTER. Well, anything I would have to say in this regard would be a guess and I do not think it would be accurate except that, if you would say that a program like this would be similar to medicare, it took about a year to put medicare into effect and after it got into effect, it was a very jumbled up mess for about 8 months. Then when the budget was cut and disrupted the organization of the setup, at that time it was further distorted or upset, so that a matter of 2 years would be a minimum to get a thing like this into effect, and I think the growing pains associated would be very, very severe for another 2 years.

Mr. ALGER. I do not know whether the gentleman from Rhode Island has a time limit on you, but you had better hurry. If we were too quickly to go to a compulsory Federal plan, would it cause the breakoff of voluntary programs which are just getting started ?

Dr. HUNTER. I believe somebody made the point earlier that individuals would not be interested in taking up two insurance plans and this would kill it.

Mr. Alger. Would you go so far as to say that, if compulsory insurance came in, it would kill off the development of new voluntary efforts ?

Dr. HUNTER. It would kill off voluntary efforts to improve the care of the aged and this would kill off the terrific amount of work that is already given by doctors on a quasi-free basis. They do the work and just do not send the bill for it in many cases where the person is indigent or their income is low.

Mr. ALGERS. This seems like a real concern for us to certainly bear in mind, Doctor.

Thank you, Mr. Chairman.
Mr. Forand. If there are no further questions, we thank you, Doctor.

Dr. HUNTER. Thank you very much.

Mr. FORAND. The next witness on the calendar is Mr. Gordon E. Brewer.

The Chair is advised that Mr. Brewer has consented to change places with Mr. Adolph Held. Is that correct?

Mr. BREWER. That is correct.

Mr. FORAND. Our next witnesses are Mr. Held and the delegation of the Council of Golden Ring Clubs.

Mr. Held, for the purpose of the record, will you identify yourself and those with you?

Your council has been allotted 15 minutes.



Mr. HELD. I will not take that much time.

Mr. FORAND. Before you start your statement, Mr. Keogh has a statement.

Mr. Keogh. I wanted to be here when Mr. Held and his group were presented and I was momentarily called out.

I am sure, Mr. Chairman, you will recall that you had the pleasure of appearing before a meeting of this fine organization in New York as I have on occasions, and I am delighted to pay my respects to Mr. Held and to his associates for the great work they are doing in connection with the Golden Ring Clubs and, personally, I am delighted to see you all here in Washington.

Mr. FORAND. I may add right there that it was my pleasure last year or 2 years ago to speak before this group in Carnegie Hall where the place was packed to the rafters. There is real interest by this group in this proposal.

Mr. Mason. May I ask, Mr. Chairman, what are the qualifications for belonging to this Senior Golden Club? Is it just age?

Mr. HELD. It is age. Mr. Mason. What is the age limit? Mr. HELD. Sixty-five and over. Mr. Mason. Well, I have been eligible for nearly 15 years. Mr. HELD. We are very glad to meet you. You are very welcome. Mr. FORAND. You may proceed, Mr. Held. Mr. HELD. My name is Adolph Held. I am president of the Council of the Golden Ring Clubs of Senior Citizens. This is a voluntary position. Professionally, I am director of the health and welfare department of the International Ladies' Garment Workers' Union. I was formerly president of the Amalgamated Bank of New York.

I am accompanied to these hearings by Mr. Arthur Adams of the Big Six Pensioners Club, Typographical Union; Mr. Oscar Anderson of the Senior Citizens Community Center, St. Luke's Lutheran Church, Queens; Mr. Abraham Beder of the Washington Heights and Inwood Social Action Committee; Mr. Peter Gallegos, membership president, Sirovich Day Center (named after the late Representative William E. Sirovich); Mr. Louis Guss of the Golden Ring Club of Senior Citizens; Mrs. Fanny Kriegsfeld of the Golden Age Club, YM & YWHA; Mr. Zalman J. Lichtenstein, program director, Golden Ring Clubs; Mrs. Ann Mulrooney, president, Golden Age Drop-In Center, Pater

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