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So let us get the chips right down.
Mr. FORAND. Will you yield?
Mr. CURTIS. Yes.

Mr. FORAND. I will tell the gentleman that I am not going to reveal my sources of information any more than a newspaperman does. I am not going to jeopardize the future of these men who are trying to do an honest job.

Mr. CURTIS. That is what I define as smear tactics if you are not willing to specify what the accusations are, where it occurred, and who are making them.

I regard coercion against anyone, doctors or whoever it is, as something that is reprehensible.

If you do not have the proof of it, then I do not believe you should air it as a public charge.

Mr. FORAND. I have the proof, but I do not think I will give it to the gentleman.

Mr. CURTIS. I think the situation is now quite clear.

Second, on the point of the accusation made of intimidation of the Congress, those were the words of the gentleman from Rhode Island, I have heard nothing in there that would substantiate even an implication of intimidation of Congress.

I think that should be spelled out.

Thirdly, in regard to the pamphlet the gentleman from Rhode Island said contained misinformation, half information, I think in fairness he should specify where he thinks it is misinformation or where it is half information so that the American Medical Association will have an opportunity of presenting why they think that is contrary to their views and also in doing that it will help this committee to gain a better understanding of the issues that really are before us.

I hope the gentleman from Rhode Island will present a bill of details to the American Medical Association so that they will have an opportunity of answering why the do not believe this particular pamphlet contains misinformation or half information.

I do not know whether it does, or does not.
Mr. FORAND. All the gentleman has to do is read the bill itself.

Mr. CURTIS. I have read that. That is no answer, and the gentleman knows it.

If he thinks there is a sentence, or half sentence, which contains misinformation or half information, let him point that out and then let those whom he has accused of improper techniques reply.

I say misunderstandings might exist, although I also may say this. Many people I disagree with, but that does not mean that I think they have ulterior motives or they have deliberately tried to present false or half information.

Now, there is only one thing I am going to ask other than to compliment the witnesses for their papers and their presentations which I think was on the subject and contained valuable information.

I hope that the AMA, as well as other organizations who are testifying before us, will study the April 3, 1959, report of the Department of Health, Education, and Welfare, on the hospital insurance for OASDI beneficiaries and submit a critique from your standpoint of that report. I think it would be very beneficial to the committee.

In other words, where you think the report is accurate, where you think further information might be developed, or where you might differ from some of the facts or arguments presented.

That kind of critique on your part, as well as any other organizations testifying before this committee would be very helpful in giving us the information and the opportunity to evaluate some of these very serious problems involved in the care of aged.

Dr. LARSON. Mr. Curtis, may I comment on that?
Mr. CURTIS. Yes.

Dr. LARSON. This report of HEW is being given very careful study now by our Bureau of Medical Economic Research. I can assure you that a critique will be prepared and presented to this committee.

Mr. CURTIS. Thank you.

I trust that the interrogation that you received here will not intimidate the AMA from continuing to do the best they can to disseminate their views and testifying before the Congress.

Mr. FORAND. I can say, Doctor, there was no intent of intimidating the AMA or any other group, but it was an attempt to clear up certain points that had

been brought to my attention. Dr. LARSON. Yes, sir.

Mr. FORAND. I want you to take it in that manner and not interpret it as intimidation.

Dr. LARSON. We do.
Mr. FORAND. I want your help.
Dr. LARSON. Thank you.
Mr. FORAND. Are there any further questions?

Mr. ALGER. You have covered a lot of ground. I want to get at the truth of some of these things so that I will feel better, myself, about the problems confronting us.

I must lay a couple of premises because I am going to be on some very ticklish ground in the next few minutes in what I say.

I assume necessarily the facts and the truth are presented us by both sides. Out of that can come a solution, whatever that solution may

I also assume that everybody in this Congress and everybody testifying before us are men of good will, dedicated to trying to solve this. I think I have uncovered one exception to that, which I will touch on in a few minutes.

I did want to mention that I was a little appalled at the testimony of Mr. Cruikshank and others here, who have taken exception to doctors writing their Congressman, even suggestions from their own organizations that they write us, when I have had so many letters from good workingmen, people in my district, union members, who actually, if not mimeographed, have been given the exact language to use.

I see no fault with this. As a Congressman I see through it and I trust my constituents know that I do. I join the gentleman from Missouri in applauding your tactics in contacting Members of Congress.

I go further and say you have been very negligent over the years on other issues of Government.

Government by the people fails when folks like you do not take part in legislation which affects you socially.

I want to applaud the gentleman from Illinois.

may be.

I asked Mr. Flemming to give us the benefit of the British experiment so that we can benefit from it.

You have pointed out in both your statements that apparently our Nation has the best health and the best medical program in the world. Is that open to contest?


Mr. Alger. If that is so, we have gotten to that point without this compulsory type of program?

Dr. LARSON. Yes.

Mr. ALGER. On the other hand, I feel that the proponents of this bill have not made a case. I want to repeat to you what came before us at the time Mr. Cruikshank was testifying when he pointed out that this Federal program was needed.

I asked him, Will you document for us the cases, place, and people who have been denied care because they could not afford it?

We know there undoubtedly will be cases from among 175 million people. We know a number of doctors have told us that medical services are also dispensed free.

Mr. Cruikshank said he would present that for the record.
The chairman has agreed to leave the record open.
So if you choose to answer that documentation, you may do so.
I want to comment briefly on the report.

Senator Morse pointed out in his statement that the cost of living as a whole has risen 23 percent since the benchmark of 1947–49, but many of the medical costs have gone up 44 percent since that time.

I notice in the report where it mentions this, they have two benchmarks, they have the 1948–58 cost itemized here showing the medical expense to have risen higher in that period, but the next sentence points out over a lower period 1938–58, the price of medical care increased only slightly more than the average for all goods and services.

Then this report goes on to comment that far more service is being extended, the hospital stays are shorter, and the hospital service for the money is greatly increased. Longer life is the result.

I simply bring this out to point out that it is obvious to me that doctors may very well have not increased their charges, although their costs went up during war periods.

Does this strike you as a possibility and the difference between the benchmarks of just after World War II as compared to the 20-year period, 1938-58

Dr. LARSON. Yes, I think that is perfectly true.
Mr. ALGER. I simply wanted that on the record.

In the matter of compulsion, Dr. Swartz mentioned it and you mentioned it, too. Dr. Larson. There is no question about this being compulsory as to who pays for it; is that correct?

Dr. LARSON. That is right. Mr. ALGER. I want to ask you something else about the doctors. I bring up this line of questions because we do have a free society, I believe, and it would be entirely optional for doctors to join this program or not as they saw fit. Is that correct?

Dr. LARSON. Yes, sir.

Mr. ALGER. Let us say the doctors did not like the paperwork or believed it would not work, and supposing enough doctors would not join, would there not have to be compulsion on the doctors for this law to work?

Dr. LARSON. If a sufficient number refused to work, I suppose compulsion would be the only answer.

Mr. ALGER. You pointed out in your statement several times that Federal control would enter necessarily. Does it not also follow that the police power of the Government is also behind any legislative power of the Government?

Dr. LARSON. I think so.

Mr. ALGER. So ultimately doctors would have to be drafted in this, if enough doctors did not volunteer. Have you any idea in your analysis of this how many additional administration personnel would be needed?

Dr. LARSON. I have no idea.

Mr. ALGER. You mentioned the total medical cost of $15 billion private and $5 billion public, $20 billion. Then you made the statement that in time in the future necessarily you could not draw the line, the Federal Government would have to move into the whole field; is that correct?

Dr. LARSON. Yes.

Mr. ALGER. I believe Dr. Swartz said that. Is that not correct, Dr. Swartz

Dr. SWARTZ. That is right.

Mr. ALGER. In other words, do you see any reason for limiting this to age 65 once the program is in operation? How could we limit it to

age 65 ?

Dr. SWARTZ. This is the thing that troubles us.

Mr. ALGER. I want to ask you one other thing. I want to be very careful in what I say. I was a little bit concerned about one witness who appeared—I am thinking now of the Physicians Forum, because there is something I happen to know about this group. I have some additional documents since then. I want to ask you this. I am not trying to prejudice the case either way here, but I have information from the House Un-American Activities Committee that says that the Physicians Forum has contributed articles regularly to Communist newspaper organizations. The organizations are cited by the House Un-American Activities Committee.

Can you tell me anything about the Physicians Forum?

Dr. Larson. No sir; I am sorry, I know nothing about the Physicians Forum except that I understand that there are about a thousand members; that is all I know about it.

Mr. ALGER. Then I do not want to go any further in this. I want to merely protect myself on my remarks here. I have taken the sole responsibility. I will have additional information for anyone listening to me, including yourselves, on this matter if anyone should be disposed. I am getting it from the House Un-American Activities Committee.

Mr. FORAND. Any further questions? If not, we thank you, Dr. Larson and Dr. Swartz and Mr. Stetler for coming to the committee. I think we have gotten a great deal out of the discussion.

Dr. LARSON. May I thank you, Mr. Forand? It is a privilege.

Mr. FORAND. I am sure we can count on your organization for further work along this line and together I hope we can reach a solution.

Mr. BETTS. Mr. Chairman, I have a letter from the Ohio State Medical Association which requests that it be brought to the attention of

the committee. I am wondering if we can have unanimous consent to insert it in the record after this testimony.

Mr. FORAND. Without objection, it may be done. (The letter referred to follows:)


Columbus, Ohio, July 6, 1959. Hon. JACKSON E. BETTS, Ways and Means Committee, U.S. House of Representatives, Washington, D.C.

DEAR CONGRESSMAN BETTS: I believe you may be interested in having the official opinion of the Ohio State Medical Association with regard to H.R. 4700 (Mr. Forand), which, I understand, will be heard by the Ways and Means Committee in the near future.

The Ohio State Medical Association is opposed to the enactment of H.R. 4700 for the following reasons:

1. This proposal is another attempt to substitute government responsibility for individual responsibility.

2. The harassed American taxpayer is looking for tax reductions, not tax increases; pay increases, not more payroll deductions.

3. The proposed system of compulsory health insurance would be another step in the socialization of medicine, and could lead to the complete governmental control of the practice of medicine by extension of its provisions to all age groups.

4. The Forand bill does not guarantee free choice of physician and hospital. It stipulates that beneficiaries would be restricted in their treatment to those individuals or institutions willing to enter into contracts with the Government under its terms and conditions.

5. It would be unwise to provide additional benefits of unpredictable cost to the present overtaxed social security system.

6. The establishment of a system of governmental social security hospital and surgical benefits would jeopardize the future of voluntary insurance programs which have made such progress in recent years.

Speaking generally, the Ohio State Medical Association believes is time for the Federal Government to call a halt to the enactment of legislation to control the lives of its citizens through a paternalistic approach to the solution of problems which can be resolved through private initiative, aided, if necessary, by local public agencies.

It will be appreciated if you will bring this statement to the attention of your committee and, if possible, have it included in the printed record of the committee hearings on H.R. 4700. Sincerely yours,

FRANK H. MAYFIELD, M.D., President. Mr. FORAND. The next witness is Mr. Wilbur Cohen. Mr. Cohen, will you come forward, please?

While we have known you well and favorably for many years and I am happy to see you again, for the purpose of the record, will you identify yourself by giving your name, address, and capacity in which you appear?



Mr. COHEN. Thank you, Mr. Chairman.

My name is Wilbur J. Cohen. I am a member of the Welfare Policy Committee of the American Public Welfare Association and I am representing that organization here today.

I am professor of public welfare administration at the University of Michigan, where I am engaged in teaching and research on social security and where for some 4 years in my seminars there we have been studying the Forand bill at some length. Later in the course

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