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for our people. Now we are trying to find a way to keep well and happy those people that the medical profession has kept alive.
Dean Brown. And with the recognition that there are certain or. ganic diseases like cancer, heart disease, and others which are incurred by the fact that we get older and often require much more time in care and much more costly care.
I must say, most of all, the anxiety of the old people of this country, after they have performed effectively in helping this country grow great, that anxiety is something I feel we must avoid.
Mr. FORAND. Thank you very much.
Mr. Mason. Dean Brown, as a fellow teacher, although one who has retired for the last 20-odd years, I find in following your paper here that you have answered the first five questions with an emphatic yes, but your sixth question: Is the Government ready to take another step? You did not answer that with an emphatic yes. You just said
it ought to be. Dean Brown. I did not want to presume, sir. I have a very high regard for the position of this committee in that respect.
Mr. Mason. We have had testimony from the Government itself saying we are not ready to take on this job. Now what are we going to do about that?
Dean Brown. Mr. Congressman, I must say that I was surprised to read the testimony of Monday, because I have worked long with various people in high places in Government, but I must respect their right to make a political decision.
Mr. Mason. It is a political decision?
Dean Brown. I think everyone in the Government has to recognize political considerations.
Mr. Mason. Dr. Brown, I had the privilege of addressing an educational group in Illinois about a year or so ago on their 75th birthday, their diamond jubilee, as they called it, and when I did of course I did some work and had the Congressional Library do some research. And I discovered that 75 years ago the average life expectancy in America was 58 years and today, or at that time, it was 70 years. Now of course you have made the point that we have to take care of those old fellows, and I am in that class, myself, because I am past the diamond jubilee.
I am just beginning to wonder now, if the Government is not ready to take this over, why we should force it on them until they get ready. Our job is to sell it to them and have them get ready to take it over, is it not?
Dean Brown. Sir, as I said, I have great respect for the position of this committee since I believe that all social security legislation is initiated here. I am looking to you, sir, as a part of the Government.
Mr. Mason. You want me to initiate or help initiate this program? Dean Brown. I do, sir, most respectfully.
Mr. Mason. Well, my feelings are just in the other direction. I had to go to work when I was 14 and I could make my own way. I guess if I had to have doctors' care and hospital care I could take care of it.
Dean BROWN. I don't think all of us are as fortunate as that.
Mr. ALGER. Dean Brown, since we wear the same school tie, I guess I have a little closer relation in one sense. It strikes me as I listened to you I had a difference with my old prof. I mention the fact that Princeton has produced a lot of interesting folk, like Mennen Williams and Adlai Stevenson. So I don't suppose it follows because we enjoy the same university that we necessarily have to agree. I have read your statement as carefully as I could. I have been interested in the give and take here in the discussion. I was interested in the remark you just made in answer to the gentleman from Illinois.
You mentioned the fact you recognized it was a political decision after all and you thoughtfully reserved judgment because this decision was up to the Government. Let me ask you this question: Do you believe that medical decisions, or business decisions of this type, are best decided by private interests or by politicians?
Dean Brown. I believe the medical profession has exactly the same problem as the academic profession has. We believe in academic freedom. But at the same time we believe there must be means of financing education in order to have academic freedom. I feel that the medical procession faces that same issue and, I may say to many of my best friends who are doctors, they face the problem of diassociating, intellectually, professional freedom from the particular device of private financing. And that is the confusion we will need to clear up and has been cleared up in many particulars.
Mr. ALGER. I appreciate what you have said. It does not escape you under any circumstances that we pass laws here for political reasons?
Dean Brown. I think the only reason you should pass a law, which is sound policy, is in reflection of the will of the people.
Mr. ALGER. I did not say sound policy. I always note that before we adjourn every 2 years on election year we increase social security. This is not just a coincidence. But that is what happens in politics. I merely wanted to be sure you understood when we shift this thing for the first time in this way from the private field to the Federal field it will immediately then become political.
Dean BROWN. Congressman Alger, I think the Congress crossed this line when it added medical services to old-age assistance. There is nowhere near the sharp line here that is often suggested. When, under the old-age assistance program, the Federal Government decided that the medical care of the aged was of interest to the people of the United States through the Federal Government, that was a definite decision.
To my mind, there is just as much reason for shifting from assistance to old-age insurance in respect to hospital care, which is peculiarly heavy and difficult to finance for the aged, as it was to introduce old-age insurance as a means of relieving old-age assistance.
Mr. Cohen made a splendid presentation of that.
Dean Brown. The basic philosophy of those, I feel, who have worked most on this type of legislation is that, in the case of the aged, it is far better to handle the problem by contributory old-age insurance than by old-age assistance, which is relief, in the broad sense, Government charity. As Mr. Cohen testified, unless we are
able to improve the insurance mechanism by providing hospital care, old-age assistance will become a heavier and heavier proportion of the means of taking care of the older person and his family.
Mr. ALGER. You call this contributory. This program is not contributory.
Dean Brown. It is under the old-age insurance. Mr. ALGER. I beg your pardon. This program will immediately place free of charge 13 million people without having contributed anything to the program.
Dean Brown. I think you are making a fine distinction which I cannot understand, because I am talking about the contributory oldage insurance system whereby the employee, the employer, or in the case of the self-employed, alone, contributes overall to the total cost of the provision of whatever benefit is forthcoming.
Mr. ÅLGER. I merely call to your attention that if somebody did not understand this system they might accept your contributory remark as covering this program. Everybody who is covered under OASDI who is over 65 will not have contributed a penny to the program but will immediately be subsidized by the Federal Government.
Dean Brown. That is a basic principle in social insurance and it has been respected repeatedly when the benefits under QASDI have been increased. That is, instead of going back and asking a person to begin contributions again when you change the benefit structure, you change it immediately for those eligible, counting on the contributory help of the younger to help the older. That is the basic principle of the old-age insurance scheme.
Mr. ALGER. That may be the reason that some of us find a little bit of trouble.
Dean Brown. May I make an analogy, sir, which may help to clarify? I have advised a good many employers on their retirement schemes. I know of practically no employer who says, when starting a plan, that a person 45, 50, or 60 when he retires, will get no advantage of earlier service. That is what you might call an accrued liability which comes into every private benefit plan which an employee is offered.
This is, in a sense, what you might call an accrued liability, in improving the plan, but it is improving it for the benefit of all.
Mr. ALGER. How would you define social insurance?
Dean Brown. Social insurance is that insurance established by Government whereby the coverage is not voluntary but is by law and where the funds are administered by the Government on behalf of the people. There is an element of contract between the citizen and the Government, and that contract is distinguished from the condition of being merely a citizen. It is that he has contributed to a scheme, therefore, over time, he will be the beneficiary of that program.
Mr. ALGER. Then what happens to the folks who are not under the social security program now and who are over 65?
Dean Brown. I would say that old-age assistance has always been considered the device to help people who through their working life did not work enough under coverage to be a beneficiary under the system. Now the great advantage is that, over time, a greater and greater proportion of the citizens have shifted from reliance on assistance to reliance on insurance benefits.
Mr. ALGER. Does there seem to you to be any inequity over the fact that many, many people, maybe millions, will be compelled to pay into this and don't want it?
Dean Brown. I think, sir, compulsion, as has been discussed before, is always a relative thing. If the voters of the United States vote to pay à certain income tax, I feel compelled as a citizen to go along. In fact, I will get into trouble if I don't. Now there is a whole range of those commonly accepted compulsions of being a citizen of a country which is in the long run concerned with one's welfare.
May I repeat, as other witnesses have, this is not merely government. Large employers today, unions today, have elements of compulsion. Why? For the benefit of particiating in those organizations, either as employees or as members.
Mr. ALGER. I appreciate that thought. What you have just said to me is a very interesting one from the standpoint of majority and minority. Here we have a constitutional system to protect the minority and yet you have made a statement as clearly as I have ever heard it said that the majority can steamroller the minority.
Dean Brown. I disagree wholeheartedly, and you know I do. We have a Constitution of the United States. We have a Supreme Court in a neighboring building which, if the Congress overrides certain rights of the individual, will intervene. The Supreme Court of the United States has had full opportunity to intervene in the case of social insurance legislation. I assisted in preparing the brief defending the act.
Mr. Alger. I shall not belabor this, and I certainly have enjoyed this. Maybe it is a good thing I got out of Princeton when I did.
On page 4 you point out that administering a large-scale industrial, financial, and service operation seems to be a special genius of the American people. I would like to point out to you that my observation has been that this is true in private industry. It is not true in government, Federal Government.
Dean BROWN. We differ there, sir.
Mr. Mason. I want to make one remark on the Supreme Court business. I am hipped on that. The Congress has had to veto at least eight times in the last 15 years the decisions of the Supreme Court that were based on a misinterpretation of the law.
The CHAIRMAN. Dean Brown, again we thank you, sir, for coming to the committee.
Dean Brown. Thank you very much, sir.
Please identify yourself by giving us your full name, address, and capacity in which you appear.
STATEMENT OF DR. ABE RUBIN, SECRETARY AND EDITOR OF THE
AMERICAN PODIATRY ASSOCIATION
Dr. RUBIN. Mr. Chairman and members of the House Ways and Means Committee, I am Dr. Abe Rubin, secretary and editor of the American Podiatry Association, known from 1912 to January 1958 as the National Association of Chiropodists.
The CHAIRMAN. Dr. Rubin, you will be recognized for 5 minutes. If you omit any parts of your statement, your entire statement, plus material appended to it that you desire to be included in the record, will be included in the record.
Dr. RUBIN. I so desire.
Dr. RUBIN. In the interests of many of our patients who would be eligible for benefits under the proposed legislation, and members of our profession, and as an interested lay person, I should like to present comment to assist you in the consideration of the legislation being proposed to provide health insurance benefits for persons eligible for old-age and survivors' insurance, as per H.R. 4700.
We, in our association, are not sociologists, economists, or health insurance specialists, nor do we have such specialists on our staff, and we are, therefore, not prepared to discuss the merit, or lack of, in solutions to the problem of providing for the health care of the aged.
However, I should like to bring to your attention a personal observation.
Earlier this year, in April, I had the privilege and opportunity of testifying before a Senate committee regarding legislation being proposed to provide for Government contribution to personal health service benefits for Federal employees and their dependents. While attending these hearings, I heard representatives of private health insurance companies, physician-sponsored health insurance corporations, and labor health service people tell how considerable progress is being made in providing for health insurance coverage for retired persons.
H.R. 4700, unless modified, it seems to me, would prevent the desirable growth of such programs.
Consideration should, therefore, be given to some mechanism whereby old-age and survivors insurance eligibles could elect to retain insurance coverage obtained before retirement.
Perhaps instead of providing for direct payment of utiilzed health services, disbursement from the proposed old-age and survivors' insurance trust fund could be made to eligibles so that they could continue their own health insurance, or purchase health insurance through established channels, or through a special channel similar to that being proposed under H.R. 4700.
Health insurance premiums paid during working years help to provide reserve funds for the later years of the worker when he is retired.
Encouraging the established health insurance channels to provide service during retired years will keep down what will otherwise be increasingly greater costs of providing health services or health insurance service for our aged people.
The other comment I wish to make concerns "free choice for the patient."
Because of the shortage of time, I would like to refer you to information I submitted on this to the hearings on social security legislation, and especially H.R. 9467, last year, as reported on pages 729736, hearings before the Committee on Ways and Means, House of Representatives, 85th Congress, 2d session, on all titles of the Social Security Act, June 16, 17, 18, 19, 20, 23, 24, 25, 26, 27, and 30, 1958.