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assistance recipients and 54 percent medically indigent. Some 26 percent were age 65 and over. In only 10 percent of the admissions was there participation in payment to the hospital by family, charitable organizations, or insurance.

As the 1959 Florida Legislature found itself hard pressed for funds, the State appropriation for hospital care of public assistance recipients was made to the State board of health with instructions to supplement it with Federal matching funds.

Although we are of the opinion that indigent care programs should be administered and financed as close to home as possible, the doctors of Florida have cooperated in advising the State board of health and State welfare department on a contract by which hospital care can be provided welfare recipients by using State and Federal funds in the same program of hospital care for the medically indigent using State and county funds as previously described.

However, the arrangements have not been easy due to the rigidity in Federal regulations, as interpreted by the State welfare board, concerning the use of Federal matching funds. One might almost conclude that the law and regulations were so written as to require medical care to be completely administered by welfare agencies and to exclude the medically oriented agencies and medical doctors from participation in the planning or administration of the health programs. The proposed legislation under consideration would vastly broaden health care under the department of welfare and another broad health program has been proposed to the Congress in an expansion of rehabilitation activities under the department of education.

Continuing their study on the problems of medical care, the second Citizens Medical Committee on Health appointed by the Governor recently made the following pertinent recommendations:

1. For the extension of the benefits of health insurance: Through every practicable channel encourage the development and promote the use of voluntary low-cost health insurance which will extend benefits to the aged and cover long-term illnesses.

2. For reduction in the costs of hospital care in long-stay illnesses: The encouragement of the construction and operation of "limited service hospitals” in close proximity to major general hospitals to promote early transfer of patients from general hospitals and to provide efficient long-term care of chronic diseases.

3. For more adequate nursing home care: Legislative authorization for the welfare board to implement a program to pay the cost of nursing home care for public assistance recipients, this to be provided by county, State, and Federal matching funds; also encouragement of the active participation of religious groups in developing and maintaining nursing home facilities.

4. For accessible and economical medical care for the aged and those with chronic illness; The expansion of present outpatient clinics and the organization of additional clinics to meet the medical needs of the indigent aged and the chronically ill, with such services coordinated with and fully utilized in expanding and strengthening the intern and resident medical training program.

5. For home care of the aged and the chronically ill: Within the realm of existing health agencies expand and modify community

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nursing programs so the services of visiting nurses will be widely available and existing welfare agencies to sponsor foster home care, and homemaker and friendly visitor services.

6. For the provision of medical services to recipients of public welfare: The assignment of responsibility for medical and health matters to the medically directed health agency with the evolution of appropriate interagency administrative relationships.

7. For increased State and local responsibility for medical care of the indigent program: Use every possible influence to obtain a release to the States of tax sources now utilized by the Federal Government for the support of health services with planning and administrative responsibility centered as close as practicable to those served.

In accordance with these recommendations the Florida Legislature this year amended the hospital service for the indigent law to include outpatient medical care and development of ancillary medical and nursing outpatient services and implementation is proceeding as rapidly as available funds permit.

The Florida Medical Association has created the Florida Medical Foundation for the purpose of providing medical services for care of the indigent, postgraduate medical education, and research. This organization can work closely with the State board of health and State welfare department in providing and coordinating these medical services.

The fabulous advances made in the field of hospital and medical insurance in recent years attest the responsibility the people of this country feel to individually provide medical care for themselves. In 1958, a survey revealed that 63 percent of the population have health insurance, but only 35 percent of those aged 65 and over were insured. Led by Blue Shield and Blue Cross, insurance companies in Florida are improving their insurance coverage and are offering medical and hospital insurance on an individual basis to the aged. This is the American way.

In Florida, no one who needs it goes without hospital care. Voluntary health insurance is being rapidly expanded and is the answer for the majority. Health needs of the indigent are provided for by medically directed statewide programs.

Only the practicing medical doctor can prevent the abuses necessary to insure the economical and efficient operation of these medical insurance and indigent care programs. The initiative of the medical profession must be encouraged to assume the responsibility of these efforts, but it would be thwarted by Government programs such as the proposed legislation.

Florida is well on the way to finding answers to the economic problems of modern medical care through novel applications of traditional principles of individual responsibility in a cooperative manner.

We do not need additional Federal legislation to solve these problems but we do need a relaxation of the rigid regulations directing health activities under Federal welfare control and we do need release of certain Federal taxes collected in our State so that these funds might be applied to solving our particular health problems in our way.

(The remainder of the statement follows:)

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TRADITIONAL PRINCIPLES Medical care has been a matter of individual responsibility of both the patient who seeks the care and the doctor who administers it. This historical principle of medical economy as practiced in our country has produced the highest quality of medical care more generally available than in any other nation in the world today or in history.

Those governments who, in recent years, assumed the obligation to provide medical care for its citizens have, as a result, diminished the quality, increased the cost, and thwarted medical progress in comparison to the achievements of medical care in the United States provided under the principle of bilateral individual responsibility.

Traditionally, the individual physician has assumed the obligation to provide medical care to those who request his services regardless of their ability to pay. Fulfillment of this responsibility depends upon the physician's abilities and limitations of the environment. As the need for hospital facilities to provide good modern medical care for serious illness has increased, it has become more difficult for the individual physician, especially in the urban environment, to provide medical care for those unable to pay the costs of the facilities, medications and services required. Local and State governments in a variety of manners have assumed some of these costs for the indigent sick. More recent by amendments to the social security law, the Federal Government has sought to standardize medical care for the indigent as a function of the department of welfare and assume the bilateral responsibility of medical care for these citizens through the medium of Federal-State matched payments to "vendors" of medical services to public assistance recipients.

The proposed legislation under consideration, H.R. 4700, would assume for the Federal Government the responsibility of providing medical services for a segment of the population without the requirement of indigence. With only a change in age limits the entire population would be relieved of this vital individual responsibility and the services of the medical profession would be a part of the Government welfare program.

Thus a program of Government medical care would be achieved with little promise of providing a better quality or less costly medical care for the people of this country. Admittedly, the bookkeeping would be streamlined, but at what. cost in individual liberty inevitably lost when responsibility is surrendered. Can a government founded on the sovereignty of the people afford so great a loss of individual responsibility which is the foundation of sovereignty?

Laws and regulations must not be created that will thwart exercise of the fundamental American medical economic principle of bilateral responsibility for medical care in solving today's health problems as they have so successfully achieved major medical advances in the past.

The commerce and institutions developed in the solution of today's health problems by voluntary health insurance and medically directed indigent care programs would strengthen the economy and our most vital national resource, the initiative of individual responsibility. Government financed welfare directed free medical care programs will tax our economy and weaken the sovereign power of the people.

The CHAIRMAN. Dr. Hampton, we thank you, sir, for bringing to us the views of the Florida Medical Association on this legislation. You have presented your case in a very fine manner. You have made a good witness.

Dr. HAMPTON. Thank you, sir.
The CHAIRMAN. Mr. Mason?

Mr. Mason. All I want to say, Dr. Hampton, is this: You are the second physician today who has been telling us what your tSate is doing toward the solution of this problem, and that is the American way. Mr. HERLONG. Will the gentleman yield at that point? The CHAIRMAN. Mr. Herlong.

Mr. HERLONG. I would like to stress a statement that the doctor made that no one in Florida is denied hospital care that needs it.

The CHAIRMAN. Thank you again, Doctor.
Dr. HAMPTON. Thank you.

I would like to say, if I may, that I was impressed by Mr. Alger's comments this morning about catastrophic or major medical insurance. I believe that is the answer as he pointed out this morning,

This thing of preventing the abuses to any type of insurance policy whether it is voluntary, whether it is commercial, or whether it is Government, is the key because, if the patient stays in the hospital one more day on an average, that is where the costs go up and the doctors are practically the only people who can prevent those abuses and they must be encouraged to assume that responsibility

rather than letting that initiative and responsibility atrophy by Government paternal assumption. The CHAIRMAN. Thank you, sir. Dr. HAMPTON. Thank you, sir. Mr. ALGER. Mr. Chairman. The CHAIRMAN. Mr. Alger.

We have a rule around here that when you refer to a member, he is expected to pick up at that point and say something in his own defense, so we will have to recognize Mr. Alger.

Mr. ÁLGER. Mr. Chairman, I do not think we always wait to be recognized in that circumstance.

Dr. Hampton, you make the point, if I get it, that there are two groups of individuals that do need help and you are not contesting that, first, people on the welfare rolls who cannot take care of themselves; secondly, the medical indigent, and Florida law, as brought out under questions by the gentleman from Florida, is moving to help these two groups of people who have the difficulty and you are doing this without asking an overall, all-inclusive Federal program.

Dr. HAMPTON. That is true, sir.

Mr. ALGER. You made another statement on page 5 that I want to compliment you on because you pointed out that the medical care quality we have in this Nation is greater than in any other nation in the world today. This has occurred, if you please, without the type of compulsory Federal legislation now being asked for.

Secondly, you make another statement here which supports what the gentleman from Florida said earlier, quoting from page 5:

Traditionally, the individual physician has assumed the obligation to provide medical care to those who request his services regardless of their ability to pay.

Over and over we are hearing from the doctors, unless they are falsifying before this committee, that people who need the medical care are getting it, and those who are proponents of this bill and who think we also ought to have compulsory legislation are not proving their case that the people are not getting medical care.

I hope that you will follow these hearings because I asked Mr. Cruikshank this morning if he would submit a list of the record of cases where people are being turned away and, if there is any legitimate statement which he makes in that regard, I hope that you folks will be prepared in turn to answer Mr. Cruikshank.

Dr. HAMPTON. Thank you, sir. We invited the inspection.

Mr. ALGER. I did ask that the record be left open and that was granted.

If the AMA would add further light to this, I would appreciate it.
The CHAIRMAN. That permission has already been granted.
Thank you again, sir.
Our next witness is Dr. Irving.

Dr. Irving, the Chair observes our colleague from Iowa, the Honorable Ben Jensen, who is present.

Mr. Jensen, would you like to introduce these gentlemen ?

STATEMENT OF REPRESENTATIVE BEN F. JENSEN, OF IOWA

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Mr. JENSEN. I would be pleased and honored to do that, Mr. Chairman.

Mr. Chairman and members of the committee, I would like to introduce two very eminent doctors of Iowa. I have learned to respect the doctors of Iowa and the doctors of America. These doctors are very modest people. They cover their light under a bushel.

The doctors of Des Moines, Iowa, I have learned, do many operations and serve a lot of old people for exactly nothing. It warms my heart to know such people.

We are proud of these doctors of ours in the State of Iowa and I am sure they are a fair example of the doctors of this Nation.

First, I want to introduce Dr. Irving, who is chairman of the Legislative Committee for the Medical Society of Iowa, and next Dr. Wichern, who is the cochairman of the Legislative Committee of the Iowa State Medical Society.

Dr. Irving will speak first, Mr. Chairman.

The CHAIRMAN. Dr. Irving, you live in Des Moines, do you? STATEMENT OF DR. NOBLE W. IRVING, CHAIRMAN, IOWA STATE

MEDICAL SOCIETY'S COMMITTEE ON LEGISLATION; ACCOM-
PANIED BY DR. HOMER E. WICHERN, COCHAIRMAN
Dr. IRVING. Yes, sir.
The CHAIRMAN. Dr. Wichern, you live in Des Moines ?
Dr. WICHERN. Yes, sir.

The CHAIRMAN. You are going to make the statement, are you Dr. Irving?

Dr. IRVING. Yes. The CHAIRMAN. I notice we have you limited to 5 minutes. You are recognized for 5 minutes. Dr. IRVING. Thank you, sir, and members of the committee. Honorable chairman and members of the committee, I am Dr. Noble W. Irving, of Des Moines, Iowa, where I am engaged in the private practice of medicine. I am chairman of the Iowa State Medical Society's Committee on Legislation, in which capacity I am appearing. Accompanying me is Dr. Homer E. Wichern, also of Des Moines, and in private practice. He is cochairman of our committee.

I wish to thank your committee for the opportunity and privilege of appearing before it on behalf of the Iowa State Medical Society and in behalf of the 2,500 Iowa doctors of medicine to discuss H.R. 4700, introduced by Hon. Aime J. Forand, of Rhode Island.

Iowa physicians have reached a degree of unanimity seldom attained in: First, proposing and carrying out a positive plan of action

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