Later:

You pay more, but you also get more.

Speaking of the hospital services under "technical equipment,” it

says:

There has been, however, significant increase in the proportion of hospitals offering a more specialized service.

Finally, then, under "length of stay" on page 35:

There has been a large increase in persons going into hospitals, but they stay a shorter period.

We are enjoying the highest level of care I guess of any nation of the world, and all of this without compulsory Federal insurance and in view of your comment about the rising cost of living, which we are all aware of, I wanted you to check this further.

Then I wanted to ask, later in the page, if I may, about the matter of medical incident, and we are certainly aware of this.

Maybe you heard the other doctors testify. We are troubled and we are trying to solve this in some way, but what disturbs me is your statement here, and I will directly quote you, because I am trying to understand your reasoning. You say this:

The aged should be spared the humiliation of charity and given the right to receive medical care with dignity.

What is this given the right by the Federal Government, and further, given by the Government from a compulsory taxing of all the people?

Mr. BREWER. We feel that our members who will have paid in advance for the cost of medical care which they will receive will then be entitled to such coverage.

I believe that your discussed this point this morning with Mr. Cruikshank.

Mr. ALGER. I got no better answer then, and I asked him the same thing. I do not mean to cast an aspersion against your statement

now.

Let me add this thought. When I asked Mr. Cruikshank, yes, he said, what you have said just now too; as he said, the members who have paid the cost. These members have paid no cost to receive this, Mr. Brewer. They will immediately get medical service without having paid anything and there will be millions of them, and we say virtuously here at the Federal level we are giving them the right.

I do not know what right we give when we immediately enforce compulsory taxation on all our people.

Mr. BREWER. Congressman, if you and I subscribe to an insurance plan today, we will receive as a matter of right benefits tomorrow if we become ill and need care, so that we may not have paid in advance either when any tpye of plan such as this is instituted. That is the very theory of the insurance, that it will become effective immediately. There has to be a starting date.

Mr. ALGER. However, look at the great difference between this OASI and insurance. We establish it clearly by saying at age 65 you qualify, and that means anybody now on OASI who is over 65 immediately has that right without paying in a cent.

When a man takes out a policy, he is taking out a risk factor. Mr. BREWER. He may become ill the next day.

Mr. ALGER. Yes, but this is entirely different from the outline just pointed out to you. He may have paid for months or years, but these people do not pay a penny, if you want to take the case of those who are now 65.

Mr. BREWER. But those who follow will be paying their own fair share.

Mr. ALGER. Wait a minute.

The ones who follow will be paying for those who are getting the free ride.

The thing that troubles me though is the statement you have said, even as Mr. Cruikshank said, this right that we are giving people. I do not understand what right you speak of.

If I may, and I want to tie into your later statement, here is what you said and I want to quote it:

Proper care of the aged has always been considered a social responsibility and there is no reason why the definition of "proper care" should not be broad enough to cover adequate medical care, which most aged are currently unable to afford.

If medical care is only one in this broad area of proper care, what premise are you establishing here that proper care of the aged has always been considered a social responsibility?

I do not understand you at all.

Mr. BREWER. Congressman, in this country we have subscribed to the right to life, liberty, and the pursuit of happiness under the Constitution.

Now, certainly there has been adequate testimony here before this committee today and yesterday, and I believe that you have expressed similar sentiments, that we do not throw our aged out in the street, that we do take care of them, and certainly that indicates a social responsibility or a social consciousness on our part.

Mr. ALGER. Who takes care of them, Mr. Brewer?

The Federal Government?

To take care of the aged has always been a social responsibility, and you immediately conclude that that is the Federal Government. Mr. BREWER. Not necessarily.

All the aid to the aged is not coming from the Federal Government. Mr. ALGER. I cannot explore this further, and I do not want to take too much time. I have to express my concern now because you are not coming through to me, and I am trying to understand as best I can.

Thank you very much, Mr. Chairman.

The CHAIRMAN. Are there any further questions of Mr. Brewer? Our next witness is Mr. Franzoni.

Will you give us your full name?

STATEMENT OF DR. WILLIAM S. APPLE, ASSISTANT SECRETARY, AMERICAN PHARMACEUTICAL ASSOCIATION

Dr. APPLE. Mr. Chairman, Mr. Franzoni is at court and I am appearing for him.

The CHAIRMAN. All right; please give us your name, address, and capacity in which you appear.

Dr. APPLE. My name is William S. Apple. I am incoming secretary and general manager of the American Pharmaceutical Association.

The CHAIRMAN. Dr. Apple, you are recognized for 5 minutes. If there is any part of your statement that you do not orally present to the committee, that part will also be included in the record. Dr. APPLE. Thank you, Mr. Chairman.

Mr. Chairman and members of the committee, the American Pharmaceutical Association, organized in 1852, is the oldest national association of individual pharmacists in the United States. It is completely representative of the pharmacists of this country, both vocationally and geographically.

Through its house of delegates, in which all State and National pharmaceutical associations are represented, it speaks for the prac ticing pharmacists of the United States. Included in this group are owners, managers, and other registered pharmacists who practice their profession in the community pharmacies and hospitals of our country, as well as those who are engaged in the practice of pharmacy as educators, industrialists, and researchers.

Two affiliates of our organization are the American College of Apothecaries, a group of prescription specialists serving the public directly, and the American Society of Hospital Pharmacists, a group of specialists engaged in hospital pharmacy service.

The members of our association meet more people from day to day in the course of their professional practice than do any other members of the allied health professions. They are, therefore, in very close touch with people in all walks of life and in all economic circumstances. Because of the nature of their service and contact with the public they are made aware continuously of the kind, quality, and extent of medical care available to our citizens at the community level.

The American Pharmaceutical Association holds the view that compulsory health insurance in any form would retard rather than advance fundamentally sound contributions to medical care. It is too unsuited to the American way of doing things to be relied upon in correcting the defects in medical care programs. Effective medical care plans must be consistent with the professional ideals and objectives of the health profession and in harmonious accord with those social and political concepts to which this country owes its progress and its greatness. This is not the time to encourage socialistic experiments either in medical care or in any other phases of our national life. This is not the time to centralize in Washington control over the health professions. Rather, every attempt, governmental and otherwise, should be directed at strengthening medical care within the limits of free enterprise. Once personal initiative is stifled or emasculated it can no longer be depended upon to give the American people those high standards of medical services to which they have long been accustomed. We are thoroughly aware of the necessity for the growing need of providing adequate health care for our senior citizens. The best of medical care is available to this segment of our population, just as it is available to our citizens as a whole. The real problem with which we are confronted is to provide this medical care in a manner which is best suited to this group under the free enterprise system. We recognize that they are not all in the same economic circumstances.

The same is true of the citizenry in all other age groups. Therefore, the principles involved in providing free enterprise medical care are not different even though the peculiar requirements of an aging population need special study and application of these principles. Ever since the beginnings of our Nation, the special problems of providing health services have been considered on an individual or community basis. In considering legislation such as is contemplated in H.R. 4700, we are confronted with the great question as to whether communities should surrender the solution of their intimate problems dealing with health and medical care to the Federal Government, or whether they should be met at the community level. Many of the problems entering into the care of the aged require specialized approaches, depending upon environmental and other local conditions. Such approaches cannot be made adequately by the Federal Government. They are fundamentally the responsibility of local community agencies, if they cannot be handled satisfactorily by the individual or the family.

Throughout the history of our country, the genius of private enterprise has been responsive to the ever-changing needs, wants, and demands of our population. It is our feeling that in the matter of health care of the aged, this national trait should be given every opportunity to accomplish the solution of problems such as this proposed legislation is intended to solve.

Although the full seriousness of the problem of medical care of the aged has been clearly recognized only recently, the response of private enterprise as reflected in the insurance industry has been remarkably effective.

Voluntary health insurance programs have now progressed beyond the experimental stage and are being improved continually. There are nearly 1,000 individual competing firms engaged in offering programs to meet the needs of voluntary health insurance, including special programs devised for our senior citizens.

It is important to recognize that while there are some 15 million persons over 65 years of age, about 25 percent, or about 4 million of them have no need for or interest in securing health insurance. Another 18 percent of the aged are recipients of public welfare programs and are receiving health care under the federally aided programs. There are an indeterminate number who are already included under Federal, local, public, or private programs, including those who receive care as permanently and totally disabled members of military establishments, veterans, seamen, et cetera. It is therefore estimated that of those who need and want health insurance in the group above 65 years of age, over 50 percent have it. It has been estimated that by 1960 about 60 percent of those who want and need such protection will have it. By 1965 this figure will rise to at least 75 percent and to more than 90 percent by 1975. These are considered conservative figures.

From all we have been able to gather in committee studies of the problem, it is necessary to keep in mind that the costs of the program proposed in H.R. 4700 have not been and really cannot be estimated with any degree of accuracy. Experiences and available information on the system of health care in England show excessive costs for compulsory health insurance and there is no reason to expect our experience to be more favorable.

Attention has already been directed to the pressures which will undoubtedly be exercised in due course to extend Federal protection to other aged groups once the system has been adopted for those who are over 65. The increased taxation necessary to develop the system will fall heaviest on our lower income group and add to their burdens. Unquestionably we face a problem which must be met and solved but there are convincing arguments, at least at this time, that indicate that the solution to this problem is not via the provisions outlined in H.R. 4700. The Joint Council To Improve the Health Care of the Aged, the White House Conference on Aging, and constructive action being taken by individual professional associations, local community public and private agencies, and a host of research workers are all striving to establish programs which, in essence, are designed to help take care of the many socioeconomic problems of this group. These efforts should be given every opportunity to produce productive results.

Thank you very much.

The CHAIRMAN. We thank you, Dr. Apple, for bringing to us the views of the American Pharmaceutical Association. We appreciate your doing so.

sir.

Are there any questions?

Thank you, sir.

Dr.APPLE. Thank you.

The CHAIRMAN. Our next witness is Mr. Phillip Coontz.

Mr. Coontz, would you identify yourself for the record, please

STATEMENT OF A. PHILLIP COONTZ, PRESIDENT, IOWA

PHARMACEUTICAL ASSOCIATION

Mr. COONTZ. Yes, sir. I am A. Phillip Coontz, president, Iowa Pharmaceutical Association, and a practicing pharmacist from Waterloo, Iowa.

The CHAIRMAN. Mr. Coontz, you are recognized for 3 minutes, sir. Mr. COONTZ. Thank you, sir.

My association is grateful for the privilege of appearing before this committee to present our picture on H.R. 4700 as seen through the eyes of the pharmacists, daily serving in the 835 licensed drugstores in the State of Iowa.

We are aware that pharmaceutical service is not directly involved in the proposed H.R. 4700, but is indirectly involved through drugs furnished to patients in the hospitals under this program.

We are, however, cognizant of the fact that such a program could be the initial step toward an eventual and inevitable socialization of our own profession. This is one primary reason for objecting to the passage of this bill.

The Iowa Pharmaceutical Association fully concurs with the statements which have been presented by our national professional society, the American Pharmaceutical Association. We stand in opposition to any trend which might

(1) Socialize the practice of medicine and the affiliated health fields;

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