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The CHAIRMAN. We will now hear from our colleague, the Honorable Frank Kowalski from the State of Connecticut. We are happy to welcome you, Mr. Kowalski.

Mr. KOWALSKI. Thank you, Mr. Chairman.



Mr. KOWALSKI. Mr. Chairman, may I express my appreciation to you and to your committee for giving me this opportunity to appear before you in support of H.R. 4700. I also want to commend our distinguished colleague, Congressman Aime J. Forand, for introduc

this progressive .
am no expert health insurance



essentially as a man who is concerned with the vital need for medical care and hospitalization for our elder citizens.

Some who oppose this legislation say it is socialistic for the Government to be concerned with health assistance for our citizens. If this is so, then I am a most grateful beneficiary of our socialistic system which, in my case, provides me as a retired Army officer with medical care at the expense of the Government. Believe me, gentlemen, it is a wonderful feeling to know that as I grow older this great democracy has provided for the day when I may need medical and hospital care.

Some will say, well you've earned this—you served in the Army 30 years. This is true and I hope I have earned these wonderful benefits. But who can really say which one of our citizens has made the greater contribution to his country—the professional man, the manager, the worker, or the serviceman. In any case, I am grateful that a previous Congress provided these progressive social benefits to me and to our military personnel and their families.

In the light of my own background, my own experience and my own benefits, I could do no less than to co-sponsor and support the Forand bill. If this legislation is incorporated into our social security program, then the workers of this Nation will in their later years enjoy a small part of the benefits that our military personnel and their families have enjoyed so much more completely for many years. And I might say that the Forand bill does not provide these benefits for nothing. The workers covered by social security will, of course, contribute from their pay envelopes to pay an essential part of the costs of their health insurance.

Nothing is so devastating to a person or family as a serious illness. The cost of medical care has become so expensive that only the wellto-do can afford a sickness. The President, deeply concerned about this cost has urged the medical profession to do something about the continuously climbing doctor's bills. This is fine, but records show that thousands of our citizens have put off badly needed operations because they simply cannot pay for the care.

Our older citizens living on fixed or declining incomes are the main victims of this economic squeeze on their health. It is reported that only 40 percent of the people over 65 years of age are covered by any health insurance programs. Thousands of our oldsters must depend on their children for care, or they are forced to seek medical assist

ance from charitable institutions, or just can't and so don't pay the doctor's bill.

We know that the incidence and severity of illness increases with age. A study conducted by the Department of Health, Education, and Welfare over a 12-month period in 1957-58 of two groups of 100 persons each showed that those 65 and over had 1,630 disability days, as against 697 for those under 65. The same study showed that people 65 and over required 178 days of hospitalization as against 76 for the younger group. The aged group had almost four times as many days of "restricted activity"-4,730 as against 1,743 for the younger group.

The committee is familiar with the provisions of this legislation, so I shall not belabor details. I would like to, however, emphasize the elements of this legislation which I favor.

I favor a program which will become a part of our social security system. Under this program, I would like to see all those retired under social security eligible for hospitalization which would be completely paid for up to a period of 60 days. This would include payment for a semiprivate room, board, drugs, and care together with payment for convalescent care up to another 60 days. It would also include the cost of dental and all other surgery.

In conclusion to this brief statement, I should like to say that if the medical scientists in our great American democracy have discovered wonder drugs and medical techniques which will prolong the lives of our citizens then, in my opinion, our Christian society and Government should provide the means for our elder citizens to enjoy the right and opportunity to live out this greater span which has been won for them.

Therefore, I urge this committee to give the Forand bill a favorable report so that Congress may have an opportunity to implement its progressive human program.

The CHAIRMAN. Thank you, Mr. Kowalski for coming to us and giving us your views on this

subject. Mr. KOWALSKI. Thank you, Mr. Chairman. The CHAIRMAN. Our next witness is Dr. Larson and Dr. Swartz. Mr. Simpson.

Mr. SIMPSON. Mr. Chairman, I note these gentlemen are accompanied by our colleague, Mr. Short.

Mr. Short, did you want to present one of your constituents?



Mr. Short. Yes, Mr. Chairman. If I could impose for just a moment or two, I am very happy and very proud to have this opportunity to present to this committee and to you, Mr. Chairman, one of North Dakota's most distinguished citizens.

I might add that all North Dakota citizens are distinguished, but this is one of the more distinguished ones. Dr. Larson is the past president of our State Medical Association. He is the present chairman of the board of trustees of the American Medical Association. He has just returned from the World Health Organization Conference in Geneva, Switzerland.

I assure you I do not know anyone in our State more qualified to testify on the legislation before you and certainly we in North Dakota are very proud to have Dr. Larson as one of our outstanding North Dakota citizens.

The CHAIRMAN. Mr. Short, we thank you, sir, for those remarks and your presentation of Dr. Larson.

Dr. Larson, you and Dr. Swartz may have seats if you desire. In the beginning will both of you please identify yourselves for the record, giving your full names and addresses and capacity in which you appear.



Dr. LARSON. Thank you, Mr. Chairman. I am Dr. Leonard Larson of Bismarck, N. Dak. I am appearing here today as chairman of the board of trustees of the American Medical Association.

With me is Dr. Frederick C. Swartz, of Lansing, Mich., who is chairman of the Medical Association Committee on the Aging, and also Mr. Joseph Stetler, who is head of the law division of the American Medical Association.

The CHAIRMAN. You gentlemen are recognized for 30 minutes. Do you want us to notify you at any point so you can divide the time.

Dr. LARSON. My presentation will take approximately 10 minutes.
The CHAIRMAN. All right, you are recognized.
Dr. LARSON. Thank you.

Mr. Chairman and members of the committee, Dr. Swartz will present the basic reasons for the position of the medical profession concerning H.R. 4700, 86th Congress.

Initially, however, I would like to report briefly to the committee concerning the sustained progress that is being made under the present system of health care in this country.

Slightly more than 1 years ago, I appeared before this committee and pledged the American Medical Association to a dedicated, continuing effort in the field of health care for the aged.

I am proud to be able to tell you that the American Medical Association is making good on that pledge.

I say this with humility, because the very real progress being made represents the cooperative effort of hundreds of thousands of our citizens—doctors, nurses, dentists, social workers, hospital staff members, insurance company personnel, community and religious leaders--all working voluntarily together to do the job.

It is also to the credit of these private citizens that they are proving their ability to do the job in their own communities, and to do it effectively and well.

A few specifics from their record of accomplishment are appended to our testimony and I would request that this be made a part of the record.

The CHAIRMAN. Without objection, it will be included in the record Dr. LARSON. Thank you.

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At this time it is enough to say that retirement villages, new nursing homes, chronic disease care centers, home care programs, recreational facilities and research projects have been established and that many many more are on the way.

The medical profession takes pride in the part it has played thus far, and accepts its continuing role of leadership and support in the years ahead with confidence. We believe that the ultimate solution to the problems that remain must be found in private and voluntary action at the community level, and in private health insurance.

Let me say a few words on the subject of voluntary health protection insurance, which has made revolutionary progress since World War II. Yet as rapidly as it has expanded in that period it seems to be gaining momentum still.

At the end of 1945, only 32 million people were covered by voluntary health insurance. But by the end of 1958, the number had soared to 123 million.

Putting it another way, fewer than one American out of three in 1945 had voluntary health insurance. Yet today, the figure is nearly three out of four.

This is important, because it indicates that prepayment plans and the health insurance industry by providing more and expanded health coverage for all age groups are anticipating and solving tomorrow's problems of financing the health care of the aged.

H.R. 4700 fails to take into account the ever-increasing number of persons who will be covered by private health policies when they reach age 65, and the increasing public awareness of the value of voluntary health insurance protection.

Last December, the American Medical Association house of delegates, aware of medicine's responsibility in this regard, adopted a proposal which applies specifically to those over 65 with modest resources or low family income. This proposal urged physicians to set their fees at a level which will encourage the continued development of insurance and prepayment plans at reduced premiums.

Our State and local medical associations have been moving promptly to make this policy effective.

I am happy to report that there are now 25 plans in 23 States offering Blue Shield programs for those over 65. Further, in 16 other States, our medical societies, in cooperation with the plans they sponsor, are working out programs of a similar nature.

The progress of Blue Cross and Blue Shield is only part of the story. An ever-increasing number of private insurance companies are now making initial coverage available to those over 65 on an individual basis and, at the same time, improving the type of health insurance coverage provided.

According to the Health Insurance Association of America, 60 percent of our senior citizens who need and want health insurance will have protection by next year. Further, that percentage will increase until three-quarters will be covered in 1965, and 90 percent in 1970.

Private insurance prepayment plans are rapidly doing the job.

But their gains would be nullified by passage of H.R. 4700, which would undermine and gradually replace voluntary health insurance if it were allowed to become law. Few people would be willing or able to carry both Government and private plans.

In addition to discussing the progress which has been made in developing financing mechanisms, it should also be remembered that the medical profession has, for many years, intimately concerned itself with the health care of the aged. I believe that the record of medical accomplishment attests to the fact that we have translated this concern into positive action. It should be understood in this connection that medical progress is linked irrevocably with the opportunity of medical researchers and practitioners to work with complete freedom.

Since the beginning of the 20th century, medicine has made revolutionary advances that have lengthened life and opened entirely new approaches to curing illnesses. Since 1900, better medical care has increased the life expectancy of the average American by 20.5 years.

This means that the medical profession itself has helped to swell the ranks of our aged population. We are proud of this, and are convinced that we can meet future challenges in the same way, with the same success and with the same benefits to mankind.

We believe, therefore, that any proposal that would undermine or destroy the voluntary progress we are now making should be defeated. We believe a Federal, compulsory health-care system can lead only to disillusionment and to inferior medical care for those millions of older citizens who deserve the opportunity of making their extra years rewarding.

With your permission, Mr. Chairman, I would like to call on Dr. Swartz to present additional views with respect to H.R. 4700.

We will then be happy to answer any questions that members of the committee may have.

(The attachments to Dr. Larson's statement follow :)

(Reprint July 13, 1959, Issue, AMA News)


From Maine to California, State Governors, city officials, religious leaders, social workers, and medical personnel are coming to grips with the problem of caring for the Nation's aged.

This was brought out clearly in a nationwide survey conducted by the AMA News to find out what was being done at the grassroots level.

The survey showed that even as a House committee prepared for hearing on the Forand bill-a proposal to expand social security to provide health care for the aged-bold, imaginative work was being done by thousands of groups to take care of the problem at a local level.

The study turned up problem areas, but at the same time concrete advances were noted in the ever increasing number of retirement villages, retirement cities, retirement hotels, and geriatric units being organized and built.


It showed far-reaching progress in health insurance coverage for the aged, and emphasized that religious groups and fraternal orders have stepped up their traditional crusade of caring for the aged.

And finally, it pointed up what Gov. George D. Clyde of Utah said when he recently appointed a State committee on aging:

"While we must take advantage of national leadership, basically the problem of the aged is one that must be met in the State, the community, and the family.

"It is imperative that we give older people an opportunity to do the things they can do, for society's sake and their own."

Governor Clyde, like many of the experts in this field, has recognized that the problem is too complex to be solved by a Federal handout.

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