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Mr. FORAND. I believe that the people have a right to say what they want to say even though I may not agree with what they say.

Now, I know that other means have been used to intimidate not just doctors, but also Members of Congress. In fact, you are perhaps conversant with the questionnaire that emanated from the AMA just before the election campaign last year.

Now, I am going to read the 15 questions that were in this questionnaire which went out to leading physicians in every congressional district in the country. I am going to leave to you and to others an opportunity to think for themselves whether this was intimidation or an attempt to intimidate or not.

Mr. CURTIS. Mr. Chairman, a point of order. Is the committee going into the subject of lobbying tactics or the issue of the health of the aged?

If you are going into lobbying tactics, that is one thing. If you are going into something else, which I thought we were, let us confine ourselves to that.

Mr. FORAND. This is not lobbying. It is electioneering.
Mr. CURTIS. Whatever you call it.

The CHAIRMAN. The gentleman has made a point of order. Of course, we will stay within the rules in asking questions and the Chair feels that Mr. Forand has the right to interrogate the witness, just as is true of any other member of the committee, with respect to any matter that might come within the overall and general study that the committee is making of this problem.

Mr. Forand.

Mr. FORAND. This questionnaire reads as follows:

1. Who is the person or persons in each ward or county in the congressional district who is most influential with the Congress?

List the names, addresses, and business or profession of each.

2. Who is the physician who knows and can work with each of the above? 3. Who are the four or five men in the Congressman's district who really influence him? List their names, addresses, and business or profession.

4. Who are the principal contributors to his campaign?

5. What contacts does the medical profession have with officers or leaders of such organizations as the Blue Cross-Blue Shield, dentists, hospital boards, or directors, chambers of commerce, farm bureau and grange? Who are the doctors who can talk to these leaders?

6. Who is the Congressman's personal physician at home and in Washington? 7. What contacts does the medical profession have or who knows the Congressman's top secretariat on his Washington staff?

8. What are the Congressman's hobbies, his favorite charities, boards or organizations, church?

9. What papers in the district supported him in his last campaign? What is their present attitude toward him.

10. What contact does the medical profession have with any or all of these newspapers, either directly with the editors or through other influential citizens or advertisers?

11. How big a factor is labor in the district?

12. Do any of the labor organizations deviate from the national labor organizations and for what reason.

13. How big a factor are old folks in his district?

14. What contact has organized medicine or individual physicians with the Congressman?

15. What is his general attitude?

Are you familiar with this questionnaire?

Dr. LARSON. Yes, I have seen it.

Mr. FORAND. What was the purpose of it?

Dr. LARSON. The purpose was to find out the feeling of the Congressmen and to be able to give to him in the most effective way the position of the American Medical Association through his own physician, through the local organizations of physicians.

I see nothing wrong in that. There was no intention to intimidate. I think every Congressman, unless I am badly mistaken, is very glad to know what his constituents think about legislation, whether physicians, farmers, or businessmen, or laborers or who they are. Mr. FORAND. How about the question regarding campaign contributions?

Dr. LARSON. Campaign contributions?

Mr. FORAND. Yes.

Dr. LARSON. That is entirely a personal affair, a personal affair so far as the physician is concerned. Nobody is going to tell me who I am going to contribute money to.

Mr. FORAND. Well, it is very interesting to read that list. If there is not an indirect inference contained in there, I am misreading it. Now, I have a lot of respect for doctors. I have some of my own relatives who are doctors and who are just as bitterly opposed to this bill as you and your organization are.

That does not disturb me in the least because I am still working for one purpose and that is a solution of the big problem.

Dr. LARSON. We are, also, Mr. Forand, and I think, as I said a year ago, I believe I used the word "catalyst," that you could consider yourself a catalyst in this whole problem of care of the aged. You are the one who dramatized this problem before the American public through this bill and I congratulate you on that. I thank you for your expression of sincerity on my part.

I want to assure you that I consider that you are sincere, also.

Mr. FORAND. I want you to understand, Doctor, that when I say you, I do not mean anything personal. I am referring to you as a representative of your organization.

Dr. LARSON. Thank you.

Mr. FORAND. On page 8, I do not recall whether it was you or Dr. Swartz, who made a statement relative to the estimate of cost of $2 billion as the cost of this program.

Secretary Flemming told this committee in his report, and also before the committee here, that the cost would be approximately a billion dollars for the first year.

Dr. LARSON. This is $1 billion, something like that, was his estimate. But this figure of $2 billion is based primarily on the estimate of the health insurance association.

Now, I am not qualified to go into those statistics and I understand that Mr. Faulkner is supposed to testify sometime this week and I would imagine that he will go into that subject rather carefully.

Mr. FORAND. Thank you.

Now, do you agree with the American Hospital Association that it is conceivable that the use of the social security mechanism might eventually be necessary in the handling of this problem?

Dr. LARSON. No, we don't. The position, as I understand it, of the American Hospital Association, is that they are opposed to the Forand bill, they recognize it may be necessary to have some form of Federal intervention if you want to call it that.

Now we are convinced in our own minds that given time this probably can be solved on a voluntary basis.

We agree it is going to take time, but we think the progress to date has been good and that we can solve this on a voluntary basis. Mr. FORAND. But you have no idea how long that will take? Dr. LARSON. No, sir. I don't think anyone has.

Mr. FORAND. Because we have already spent years studying. We have the statistics, and talks about it, but we have yet to reach a successful point.

Dr. LARSON. I realize that.

Mr. FORAND. Is your object of a voluntary basis, prepayment plan through the use of nonprofit organizations, something like Secretary Flemming suggested the other day?

Dr. LARSON. I heard that he had suggested that. I was not here.

I think that is a very interesting subject. We would certainly want to study that very carefully. I could not give you any opinion offhand on it.

Mr. FORAND. I wish you would let the committee know if you reach a conclusion on that.

Dr. LARSON. We will do so.

Mr. FORAND. Does your organization consider this H.R. 4700 to be unethical insofar as your profession is concerned?

Dr. LARSON. Unethical?

Mr. FORAND. Yes.

Dr. LARSON. No.

Mr. FORAND. I gather from your statement you consider nurses an indispensable element in the health posture of our Nation. Can you tell me why the American Nurses Association was not invited to participate in the joint council for the health care of the aged?

Dr. LARSON. Well, the four organizations that formed the joint council were considered to be the major purveyors of the service. Now, someone had to start it. Since the organization has started there has been considerable discussion as to the advisability of admitting other organizations such as the American Nurses Association, the AFL-CIO, and other organizations that have expressed an interest. I think the board of directors, of which our organization only has 3 out of the 12 on the joint council, is giving very serious consideration to that.

Mr. FORAND. Now, I understand from the activities of this so-called joint council that that is a front for the AMA to kill H.R. 4700.

Dr. LARSON. I do not believe that is true, Mr. Forand. I think that this is a sincere endeavor on the part of the four organizations to study this problem, find out the extent of the problem, to assess what we already have and to see whether or not something cannot be done on a voluntary basis to solve the problems of the aged.

Mr. FORAND. It seems peculiar because I understand that the American Nursing Association is favoring this bill, the labor groups are favoring this bill, and neither one of them was permitted to participate as active participants in the joint council's activities.

Dr. LARSON. It seems to me, if you are referring to labor, they are the recipients of that service. This organization, so far at least, is composed of the purveyors of service.

Mr. FORAND. You do not think the participants are in a position to contribute something to these deliberations?

Dr. LARSON. Yes, indeed, and I think in time the joint council is going to give very serious consideration to taking in many other groups to solve this problem.

Mr. FORAND. I hope that thought becomes a reality because, as I have said before, and I think I said that to you last year, I am anxious for all interested groups to work together on this program. I do not believe that it should be limited to a little group here, a little group there, because that is what we have been doing for years and we have accomplished very little as a result of that.

If we could get all groups together to exchange ideas and then taking the best point of each suggestion that is made we may reach the solution that we are after.

Dr. LARSON. I agree with that.

Mr. FORAND. Now, Doctor, I suppose you recognize this little pamphlet?

Dr. LARSON. Yes.

Mr. FORAND. The facts about the Forand bill, 15 questions you want answered. I have read this over several times now. This is put out by AMA. I find that there is some truth, some untruth, some half truths contained in it.

I would like to know who wrote this, if you are free to tell me— that is not the same pamphlet you have in your hand, not quite the same pamphlet.

Mr. STETLER. The one you have, Congressman, is the one that was put out last year. This one that Dr. Larson has is substantially the same, but it was prepared by the staff of the American Medical Association based on the policies and pronouncements of our house of delegates.

Mr. FORAND. You mean the public relations staff?

Mr. STETLER. Part of the staff; yes, sir.

Mr. FORAND. I understand the association has been expending considerable money on the public relations activities and has hired a California firm to lead it, and taking some of our high type reporters on the Hill to work on it.

Of course, I don't blame you for that. You are entitled to do anything you see fit and proper.

But I was interested in trying to find out who it was that prepared this pamphlet because there is misinterpretation in several instances, the same as is contained in this other publication here issued by the Association of American Physicians and Surgeons.

Of course, I have a pile of material issued by the association, including "The Pill That Could Change America," which deals with the so-called British socialized medical system.

I am wondering if whoever wrote this would not have also been doing the right thing if he had also referred to the other side of the picture, rather than all of the bad side of the English system.

Now I am one of those who admits that when the Britsh plan was inaugurated it was full of flaws and they had a lot of trouble. They have it perfected pretty well now to the point where I understand even the most conservative in England would not want to abolish their sys

tem of medicine any more than we would want to abolish social security in this country.

If reference is made to some of the things stated in this book, "The Doctor Business," written by Richard Carter or the article in Harper's magazine, May 1959 issue, that was written by John Cook on "Socialized Medicine Is 10 Years Old, What We Can Learn From England's Experience," I think we might have had perhaps a little different picture.

Now, Lord Moore, personal physician to Sir Winston Churchill for many years, and one of the older statesmen of British medicine wrote this:

If consultants were asked whether they desired to go back to the old days, I believe the overwhelming majority would prefer the condition of today.

That is part of this article in Harper's magazine for May.

I suggest if you have not read it, that you do so and compare it with the statements made in the pamphlet "The Pill That Could Change America."

I could go on indefinitely, but I have taken up enough time. I give way to some of the others right now.

I thank you, Dr. Larson.

Dr. LARSON. Thank you, sir.

Mr. FORAND. Mr. Chairman, I would like to have inserted at this point in the record a number of letters received by me in support of H.R. 4700.

(The correspondence received follows:)

THORN WOOD, N.Y., April 11, 1959.

DEAR REPRESENTATIVE FORAND: I wish to say that the American Medical Association does not represent the opinion of all physicians regarding your medical care bill. Such coverage as you sponsor is absolutely essential and we are so advising our patients.

Sincerely,

G. MARGERY ALLEN, M.D.

BEVERLY HILLS, CALIF., July 5, 1959.

DEAR CONGRESSMAN FORAND: I'm enclosing for your delight a neat piece of literature. Perhaps you have seen it.

(1) At the psychiatric convention recently, a well-known British psychiatrist reported that England is doing an excellent job in the field of mental hygiene. (2) A physician from the University of Colorado, who has just returned from England, thinks that the English people enjoy good medical service and are pleased with their medical system.

If you like to see these sources, I'll be glad to send them to you.
Best wishes.

Cordially yours,

LEON PRITCHER, M.D.

CALIFORNIA MEDICAL ASSOCIATION,
San Francisco, July 1, 1959.

EMERGENCY LEGISLATIVE BULLETIN-FORAND BILL

H.R. 4700, the Forand bill-another socialized medicine scheme-will be heard July 13 before the House Ways and Means Committee in Washington. Provides hospital, nursing home, and surgical services to eligible social security recipients. Financed by a large increase in social security taxes.

If we are to avoid this socialization, you must (a) communicate with the California members of the House Ways and Means Committee and its chairman and your Congressman (listed below); (b) urge other interested groups: e.g., dentists, pharmacists, nurses, technicians, assistants, businessmen, etc., to like

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