Mr. FORAND. Dr. Berger, I direct your attention to last sentence in the first paragraph on page 2 of your statement. It reads:

Does it not seem inconsistent that we should be fighting such communism in Geneva while introducing legislating supporting it in Washington?

Now, are you stating that this is Communist legislation, that I am a Communist or a Pinko? I resent this and I would like to have explanation of what you mean.

Dr. BERGER. I will be glad to, Congressman. Perhaps your definition of communism and mine may differ. However, as I see communism and this is a personal point of view, it is the introduction of the State into the affairs of the individual to such an extent that the individual becomes a rather lesser person than the State. The rights of the individual are lost. I would say that if Government were to interfere in the health care of these aged people whose care properly belongs to themselves where possible or to their relatives, then this is actually an example of not what we see in Russia but an example of pure communism.

I feel that this is probably a mistake, that we would by such a mechanism break up normal family obligations and responsibilities. I recognize, of course, sir, that there are individuals who have no family and I would contend that such individuals are being cared for locally, so that I do not see that this problem exists. Certainly in my own community there is no one at any age who suffers from lack of medical

care.

Mr. FORAND. So in your mind I am introducing communistic legislation?

Dr. BERGER. As I see communism; yes, sir, I am afraid I will have to come to that conclusion.

Mr. FORAND. Well, it is the first time I have heard of the term "communism” being that broad. If it suits your purpose, of course, this is a free country, you can use it but I frankly resent it.

Dr. BERGER. I am sorry, sir, there is nothing personal intended there.

Mr. FORAND. I gather from your testimony that you work for the New York City Department of Welfare and attempt to provide good quality care for elderly patients. As I understand it you and private physicians on the welfare panel who care for these patients are paid from public funds. Is that not correct?

Dr. BERGER. Yes, sir.

Mr. FORAND. Do you feel that this type of provision for the care of patients is socialized medicine?

Dr. BERGER. I feel that it is a proper activity of a community to care for its aged or for anybody else who is indigent.

Mr. FORAND. You have not answered my question. Is that socialized medicine?

Dr. BERGER. I would say that this is a small degree of socialized medicine, yes.

Mr. FORAND. And you are taking part in it?

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Dr. BERGER. Yes, sir; I am.

Mr. FORAND. Is it communism?

Dr. BERGER. No, sir; because these people still have a considerable degree of free choice which I think would probably be lost in the legislation that you are proposing.

Mr. FORAND. If the patients had contributed to a fund and the doctors and nursing homes were paid from this fund for care provided would you consider that to be socialized medicine?

Dr. BERGER. No, sir.

Mr. FORAND. What specific features of the Forand bill do you believe involves socialized medicine?

Dr. BERGER. I think particularly the fact that it probably could not be managed economically by the individual, himself. His taxes to cover it are at best only half of it since the other half is passed on to the rest of the population. I recognize here, sir, that I am not speaking in a role that I would prefer to be in, that of a practicing physician. Economics is certainly not my forte. But I will try to answer the question and not avoid it.

Mr. FORAND. But if the funds for this were coming from taxation generally, such as the public fund from which you are paid, for work in New York, it would be all right?

Dr. BERGER. No, sir, I did not say that. What I feel is this, that the individual should, if possible provide for his future. If he does this by paying some part of his income to social security that is perfectly all right. At best he contributes half of this and the Secretary of Health, Education, and Welfare indicated that even this half would not cover the entire costs of this expense. Therefore, all other individuals are being taxed to cover this particular expense which the individual should have borne, himself.

Mr. FORAND. Where did the money come from for the Welfare Department to pay for your services?

Dr. BERGER. It comes from the taxes that are raised by the city of New York.

Mr. FORAND. Is there any difference between that type of tax and the Federal Government's?

Dr. BERGER. I think there is because of the nature of administration of a large organization originating here in Washington to handle a matter in some distant part of the country. I think on a local basis there are better opportunities to do this job properly. I recognize and I agree with you these are public funds raised by the public. Mr. FORAND. Are you aware of the fact that the public money that the city of New York uses to pay for your services in part is Federal money?

Dr. BERGER. I am, sir.

Mr. FORAND. Then what is the difference?

Dr. BERGER. I personally would prefer frankly that there were no such source of revenue either city or Federal. Certainly I practiced medicine before either of these were available and old people in those days were cared for adequately. This is again one of the altruistic gestures of my profession. I think we would be perfectly willing to bear this burden alone without any tax setup.

Mr. FORAND. Then why don't you render your services free? Dr. BERGER. We did for many years until these things became available.

Mr. FORAND. I did not say in the past. Why don't you now?

Dr. BERGER. For the most part they are when one considers the nature of the funds. For example, as a consultant in internal medicine a private patient might very well pay $50 or $100 for my serv

ices. I render these to the city of New York for $5. I am a consultant to the Department of Health, Education, and Welfare, Public Health Service, and render the services there for nothing.

Mr. FORAND. If you are so much opposed to the payment of Federal or State funds for this purpose and you get so little, it is difficult to understand why you accept even that mite.

Dr. BERGER. Perhaps you are right, I should not.

Mr. FORAND. Now you imply that you would favor increasing social security benefits so that people can defray all of their expenses, medical and nonmedical. Would you care to give us an estimate as to why the necessary increase would be on the average more or less than $10 a month?

Dr. BERGER. I have no knowledge in this area at all. It is not that I favor this, sir, but I was trying to give you not a negative approach but some positive methods by which this problem could be met. One of the methods would be, of course, to provide these people with enough money so that they could meet all of their expenses.

Mr. FORAND. Where would that money come from?

Dr. BERGER. The money should come from the deductions from their own salaries during their working lifetime.

Mr. FORAND. The employee and the employer as the system operates today; is that correct?

Dr. BERGER. I would prefer that it be the employee, himself.

Mr. FORAND. Just the employee?

Dr. BERGER. Yes, sir.

Mr. FORAND. Thank you. That is all, Mr. Chairman.

The CHAIRMAN. Any further questions?

Mr. Machrowicz wishes to inquire.

Mr. MACHROWICZ. I presume that you think our social security system is socialistic in nature?

Dr. BERGER. Yes, sir.

Mr. MACHROWICZ. I assume you think it is legislation supporting communism?

Dr. BERGER. Communism has become such a charged word that it is a little difficult to talk about it.

Mr. MACHROWICZ. What is your definition of communism?

Dr. BERGER. I think I did give it previously, sir, when I said I felt it was a system of government whereby the individual becomes less important to the state, the rights of the individual become subjugated to those of the state.

Mr. MACHROWICZ. I would like to ask a question which might not seem relevant but I think it will be, to understand your thinking. You are familiar with the Keogh bill, H.R. 10?

Dr. BERGER. Yes, sir.

Mr. MACHROWICZ. Do you support the bill?

Dr. BERGER. Yes, sir.

Mr. MACHROWICZ. H.R. 10 gives a tax break for doctors to help them set up a retirement fund. Do you consider H.R. 10 communistic? Dr. BERGER. No, sir.

Mr. MACHROWICZ. You do not?

Dr. BERGER. I do not see how they can be considered in the same voice at all.

Mr. MACHROWICZ. It certainly gives them a tax break to set up retirement fund for them. Would it not be according to your definition communistic, also?

Dr. BERGER. No, sir; at the moment they are being discriminated against as are all self-employed individuals. This is merely bringing the situation exactly to the same position where yours is right now.

Mr. MACHROWICZ. You are not hesitant to accept a tax break to help you set up a retirement fund, are you?

Dr. BERGER. No, sir; not as long as the Members of the Congress of the United States will accept such a tax break.

Mr. MACHROWICZ. Nothing communistic in that?

Dr. BERGER. No, sir.

Mr. MACHROWICZ. I certainly appreciate your answers because they certainly give me an opportunity to give proper perspective to your testimony, Doctor.

Dr. BERGER. Thank you.

The CHAIRMAN. Any further questions.

Mr. CURTIS. I have a comment. I wish to express an appreciation to the doctor for the very frank manner in which he has testified in his attempt to use terms, as I understand it, with dictionary definitions rather than overtones of epithets. I am afraid there has been a great tendency in this country to avoid honest discussion by pretending or putting on the pose of being insulted. It has gotten to be that the word socialism cannot be used even though it is a perfectly respectable word, it has a definite meaning.

I think I got a great deal out of your discussion of why you felt this was socialistic and why you also felt that in certain aspects there were communistic elements in the thing. I may not agree with you but it certainly was a very fair and honest presentation and I want to thank you for this forthright testimony.

Dr. BERGER. Thank you, Congressman Curtis.

The CHAIRMAN. Any further questions. Mr. Alger?

Mr. ALGER. Dr. Berger, I want to joint the gentleman from Missouri in commending you for a forthright statement. I think it puts this bill in a better perspective. I just hope you stand firm in the things you believe in.

Dr. BERGER. Thank you.

Mr. METCALF. Since we are commenting on Dr. Berger's statement, I want to inform Dr. Berger I am a cosponsor of the Forand bill. I have carefully listened to your definition. I, too, have your testimony in proper perspective here today.

The CHAIRMAN. Thank you for bringing your views to the committee.

Dr. BERGER. Thank you, Mr. Chairman.

The CHAIRMAN. Our next witness is Dr. Dixon.

Please identify yourself in the record by giving us your full name and occupation.

Mr. FORAND. Before Dr. Dixon begins, may I say that Dr. Dixon comes to us with quite a background. He is commissioner of health in the city of Philadelphia. He is a member of the board of directors for the Hospital Council of Philadelphia, chairman of the area programs committee on medical care of the American Public Health Association, and is a diplomat of the American Board of Preservative

Medicine, member of Public Health Board of Preventive Medicine at the University of Pennsylvania and I understand after August 1 he is to be president of Antioch College.

STATEMENT OF DR. JAMES P. DIXON ON BEHALF OF HOSPITAL COUNCIL OF PHILADELPHIA

Dr. DIXON. Thank you, sir.

Mr. Chairman and members of the committee, I am Dr. James P. Dixon of Philadelphia, Pa. I am a director of the Hospital Council of Philadelphia and appear today on its behalf and specifically on behalf of its committee on government relations which, during the past 4 months, has been making an intensive study of the problem of financing hospital care of the needy in Pennsylvania.

The CHAIRMAN. Dr. Dixon, you will be recognized for 10 minutes. Dr. DIXON. Thank you, sir.

Th Hospital Council of Philadelphia includes in its membership 62 hospitals located in 8 counties of southern New Jersey and eastern Pennsylvania where they serve a metropolitan population of nearly 5 million people. Many of them have been considered among the finest in the Nation, and their services are used by patients from all parts of the Eastern United States. Yet today many of these hospitals are dangerously close to the brink of financial disaster.

UNREIMBURSED NEEDY CARE ENDANGERS ENTIRE HOSPITAL SYSTEM

During the fiscal year just ended, our 58 member hospitals located in Pennsylvania rendered over 1 million days of inpatient care to the needy at an average ward cost of $20 per patient day or a total cost of over $20 million. An entire third of this cost represented unpaid care rendered to persons on social security.

Toward this $20 million of free care, the city of Philadelphia contributed $10 million, the State of Pennsylvania granted $4.4 million, and the United Fund contributed an additional $1.3 million. Our hospitals were thus required to provide nearly $5 million in free care from their own resources. This deficit is up nearly half a million dollars from the previous year and is rising steadily.

Unrestricted endowments in most hospitals have long since been swallowed up by these deficits, and ward bed endowment no longer attracts private philanthropy.

We are caught in yet another squeeze between our traditional charity standards and our traditionally low wage standards. Philadelphia hospitals are currently undergoing a union organizing drive under the slogan that hospital employees should not be required to subsidize community hospitals through substandard wages. As this situation resolves itself, it will undoubtedly add to our financial crisis, since wages and salaries make up about 80 percent of hospital operating costs.

Unpaid care has become such a drain on the resources of our hospitals that the quality and the availability of hospital services are seriously threatened. Every possible resource is poured into free care; funds are lacking to modernize or replace outmoded buildings and equipment; services have been reduced substantially in several