What would she have done without help from someone who wouldn't take "no" for an answer? If treatment had been urgently needed in point of time, what would have happened to Mrs. S. while the wheels of a "charity case" ground slowly on?

Mrs. H.

Mrs. H., a widow, aged 70, lives alone in her own small frame house. Her husband died in 1947 but had not during his working years been covered by social security. After his death, Mrs. H. got a job in a covered employment and managed to establish benefits for herself.

Today, at age 70, Mrs. H. is retired on a social security income of $63 a month. She has no savings of any kind. She is badly crippled with arthritis-can merely hobble around. And she has cataracts on both eyes.

Mrs. H. badly needs medical treatment, hospitalization, possibly surgery, and medication, but how would she pay for it? She can seek old-age assistance and charity medical care, but to do so means a loss of self-respect, a threat to her home ownership and to her sense of pride and independence. The Forand bill would certainly be a source of financial support for medical care and of reassurance and peace of mind to Mrs. H.

Mrs. R.

Mrs. R. is 83 years old. She has a social security income of $51 per month. A student from nearby University of Detroit is currently paying her $8 a week for a room with kitchen privileges, while classes are in session. This helps her finances and relieves the lonesomeness of her small frame home. She has Blue Cross paid for by her son who has his own obligations.

Mrs. R. gets by in part because she is a once-a-month recipient of surplus foods. She is unable to pick up the food herself, so on the appointed day I take her permit card and a paper bag and perform the errand for her. On the April delivery day I handed her 1 pound of butter, 1 pound of rice, and 5 pounds of cornmeal as I wished her a happy 83d birthday.

Mrs. R. does not seek regular medical care because she can't afford it. If she became ill, Blue Cross would help, but her policy is so limited in benefits that she would have to depend on others for financial help.

These are a few specific examples which serve to underline why we urge your support of the Forand bill. To be sure it will not solve all the problems of all the older people for all time, but it is an important, a vital step in the direction of helping our senior citizens to enjoy their earned leisure and to maintain a sense of dignity and self-respect in the community.

The CHAIRMAN. Dr. Bee.

Doctor, will you please identify yourself by giving us your full name and address and capacity in which you appear?

STATEMENT OF DANIEL H. BEE, M.D., CHAIRMAN, BOARD OF TRUSTEES, THE MEDICAL SOCIETY OF THE STATE OF PENNSYLVANIA

Dr. BEE. Congressman Mills and members of the committee, I am Dr. Daniel H. Bee, a general practioner of Indiana, Pa. I am chairman of the board of trustees of the Medical Society of the State of Pennsylvania and a current member of the house of delegates of the AMA.

The CHAIRMAN. Dr. Bee, without objection your entire statement will appear in the record. You are recognized for 5 minutes. You may proceed as you desire.

Mr. MASON. Mr. Chairman, before Dr. Bee presents his statement, our colleague Mr. Simpson is unavoidably absent. He told me that if he were here he would be honored to not only present Dr. Bee but to recommend him, and he said this, that he was sure Dr. Bee's testimony would be of value to this committee. So I am expressing those sentiments for our colleague Mr. Simpson.

The CHAIRMAN. Thank you, Mr. Mason.

You are recognized, sir, for 5 minutes.

Dr. BEE. Gentlemen, the Medical Society of the State of Pennsylvania feels that H.R. 4700, which we are discussing today, is a bad piece of legislation and should not receive favorable consideration by your committee.

We feel that the solution to the problem of medical care for the aging is not simply a matter of having the Federal Government pay medical and hospital expenses. The problems of the aged and aging fall into at least five major groupings:

1. Economics.

2. Hearth.

3. Housing.

4. Relationship with the community.
5. Meaningful activity.

This group of people is concerned with enough money to live on, the struggle to stay well in late years, a suitable place to live, and something to do in the way of meaningful activity during these later

years.

Before any precipitous action is taken, such as H.R. 4700 provides, we believe that studies going on nationally and in Pennsylvania should be completed and evaluated to ascertain where emphasis should be placed.

If action is required, we believe that this action can best be handled at the State and local levels by an expansion of existing facilities or creation of new facilities.

We are greatly concerned over the effect that this bill would have on voluntary health insurance.

We are also worried about the effect that this legislation will have on the citizen's willingness to provide for himself and his family.

Our written statement is divided into two portions, (1) that of opposing the bill, and (2) offering alternatives. I would respectfully call the committee's attention to the alternatives, which we believe should be taken as soon as the depth of the problem is determined.

Again may I reiterate that before any action is taken the studies. currently underway should be allowed to continue in order that we may ascertain the best way of handling the situation with the least cost and waste to the taxpayers.

As to the concrete programs which organized medicine is taking in Pennsylvania, I should like to submit the following:

We have evolved a system where, to the best of our knowledge, no aged or indigent person has gone without medical care providing he seeks this care from his physician. These measures are handled by the individual physicians in their offices and the free-care facilities of our hospitals.

The society has given formal approval and cooperation to the medical-care program of the department of public welfare. Most Pennsylvania physicians cooperate in this plan.

Our commission on geriatrics is at the present time working on a preretirement insurance plan of having workers prepare for their health-care needs for their later years by accumulating something in their productive years.

Our Commission on Nutrition and Cardiovascular Diseases are providing counseling services to nursing homes, nurses groups, phycians, et cetera, on heart, circulatory, and nutrition problems on which advice is sought. This has been considered in many counties as a great help.

At the present time we are studying together with Pennsylvania Blue Shield a low premium plan for the care of older people on limited incomes. I might also add that there have been no rate increases in our subscriber rate for 15 years.

The Medical Society of the State of Pennsylvania has been interested in the system of adjusted fees for the older underincome citizens that was suggested by the American Medical Association. We have not had the opportunity to submit this proposal to our policymaking body which has not met since the suggestion was made. It will, however, discuss this at its October 1959 meeting.

For these reasons and for those submitted in the written statement, the Medical Society of the State of Pennsylvania wishes to be placed on record as strongly opposing H.R. 4700.

Thank you very much, Mr. Chairman.

The CHAIRMAN. Dr. Bee, we thank you, sir, for bringing to us the views of the medical society.

Dr. BEE. Thank you.

(The prepared statement of Dr. Bee follows:)

STATEMENT BY DANIEL H. BEE, M.D., OF THE MEDICAL SOCIETY OF THE STATE OF

PENNSYLVANIA

I would like to take this opportunity to state the position of the Medical Society of the State of Pennsylvania on H.R. 4700, and all similar amendments to the Social Security Act which would increase the tax rate and initiate medical care coverage for a segment of the aging population.

H.R. 4700, introduced by the Honorable Aime J. Forand, makes, in our opinion, several undesirable changes in the present Social Security Act. According to our understanding it would (1) initiate hospital, nursing care, and surgical payments for persons eligible for retirement or survivorship benefits under OASI; and (2) increase the earnings formula under which persons would be taxed.

The initiation of hospital and nursing home care, including nursing and surgical payments, would, in our opinion, create a considerable degree of confusion. The author estimates that, under this proposal, 12 or 13 million persons could receive medical and hospital services under the plan in the first year. This would certainly create a rather serious situation in hospitals and nursing homes that are already full or are operating at almost complete capacity.

The Medical Society of the State of Pennsylvania, in conjunction with other interested parties, including the State government, is presently undertaking an investigation of this problem in Pennsylvania. This will include the effective utilization of hospitals. The study will concern itself with bed capacities by the type of patients, i.e., diagnostic, medical, surgical, etc. It will also include cost by beds and cost of drugs, diagnostic services, etc. In the light of recent Blue Cross rate increases in our State and the trend of increasing hospital costs, such a survey is definitely needed and timely and should precede any legislative innovations in the care of a large group of people.

Recently the American Hospital Association, the American Dental Association, the American Nursing Home Association, and the American Medical Association have formed a Joint Council To Improve the Health Care of the Aged for the purpose of studying care of the aged. The Medical Society of the State of Pennsylvania is interested in a similar State council to study the problems locally. Besides hospital and nursing home care, the council will undertake a positive program of increasing the opportunities for older people to obtain voluntary health insurance coverage and expanded health care facilities. It

will also endeavor to develop more community health services for this group. Here again, this study should precede any precipitous legislative action. At the present time the State government is also studying this problem and is making definite headway. The bureau of services to the aging in the department of public welfare and its advisory committee are beginning already to get into the area of care of the aging.

I mention these facts to the committee so that they will all understand that organized medicine and other interested groups have and will continue to work with these problems in Pennsylvania until they are solved in our State.

We believe that H.R. 4700 would violate the basic concepts of the original social security program. Since its beginning, social security has provided indemnity benefits which most people have used as a base in planning their retirement needs. The interjection of a service or medical care benefit (which the Forand bill does for the first time) would alter the basic program.

Our society is further concerned over the threat to existing voluntary health insurance programs. The establishment of a compulsory Federal system of providing hospital and surgical services would result in the cancellation of a large number of presently existing policies, thereby seriously injuring the insurance industry. The aged would have no incentive to continue to provide private health insurance coverage for themselves even though many have the financial ability and present willingness to acquire medical care without Government interference.

Rather than take action as mandated by H.R. 4700, which suggests solving only a portion of the problem, we strongly recommend the following:

(1) Greater contributions by the Federal Government in the existing State medical care phases of public assistance programs for the aged indigent.

(2) Expansion of the Hill-Burton program to provide existing community facilities with additional equipment, beds, etc.

(3) Coordination of services and objectives by State agencies, working on these problems.

(4) Creation of new local facilities or services if and when a qualified survey of needs, goals, and resources so indicate.

(5) Creation of counseling centers for the aging, these centers to be used both for individuals and their families.

(6) Increased use of outpatient or ambulatory patient facilities in existing local hospitals.

(7) Rehabilitation teams, working out of hospitals for planned long-term and rehabilitation care. Such a team would also review all of the possibilities of home care, homemaker service, sheltered workshop, etc.

(8) Centralized information services or centralized provision for comprehensive services to aged and/or chronically ill or disabled as they currently exist in Chicago and Cleveland.

(9) The creation of State coordinating committees on chronic illnesses and problems of the aged, composed of representatives from the interested departments and qualified voluntary organizations.

(10) Education of employers, union officials, employees, parents, children, and professionals in the meaning of long-term illness and chronologic retirement. (11) Workshops and education courses be established for nursing home operators, homemakers, or practical nurses for the aged, and operators of foster homes.

(12) Increased use of State tuberculosis sanitoriums for selected types of other chronic diseases.

(13) Screening clinics for the purpose of ascertaining the eligibility of candidates for nursing homes or county institution district facilities.

(14) Public housing modified to suit the handicapped and/or elderly, educating architects in this regard for public or private housing.

(15) Urging that all of these programs achieve individual self-help and health care rather than greater institutionalization and dependency.

We respectfully request that all of the above avenues be investigated thoroughly before action, as suggested by the Forand bill, H.R. 4700, is passed. We, therefore, respectfully request that your committee not take favorable action on H.R. 4700.

The CHAIRMAN. Our next witness is Dr. Johnson.

Mr. FRAZIER. I would like to introduce the next witness, Dr. Joseph W. Johnson, Jr., of Chattanooga. Dr. Johnson is one of our eminent

physicians. He is speaker of the house of delegates for the Tennessee Medical Association, also a member of its board of trustees. He is and has been for the past 12 years a member of the prepared insurance committee. Dr. Johnson is well qualified to discuss the important problems the committee is now considering for he not only has a wide private practice but has had experience for many years in insurance matters as medical director of the Interstate Life Insurance Co., one of our largest insurance companies in Tennessee.

Dr. Johnson has contributed greatly to the fine progress which has been made by the medical profession in Tennessee in their efforts to take care of the aged and indigent.

In addition to that, I might say that he is the son, also, of a very prominent doctor and his grandfather was a Member of Congress from the Third District, the district that I now have the honor of serving. But I must add this, for the benefit of my colleagues, and maybe this should be eliminated, that he was on the other side of the fence. Of course, he served before I had any aspiration to enter the Congress and even before I was born.

The CHAIRMAN. Dr. Johnson, while you are here I wish you would take occasion to advise our colleague from Tennessee as a doctor so that he will ease up a little bit. We think he is working too hard. Maybe we are a little responsible for that.

Dr. JOHNSON. I have had the privilege of waiting on some members of his family in the South, but I have never been so bold as to advise Mr. Frazier.

The CHAIRMAN. You are recognized.

STATEMENT OF JOSEPH W. JOHNSON, M.D., SPEAKER OF THE HOUSE OF DELEGATES OF THE TENNESSEE STATE MEDICAL ASSOCIATION, ACCOMPANIED BY JACK DRAKE, PUBLIC SERVICE DIRECTOR AND SECRETARY OF THE COMMITTEE ON THE AGED Dr. JOHNSON. I would like to make this brief statement. I have with me Mr. Drake, who is our public service director from Tennessee and secretary of our State committee on aged.

Those of us who practice medicine in Tennessee realize the medical needs of the aged must be met effectively for we deal with them daily, directly, voluntarily, and with a responsibility given to us by our State legislature. I think we in medicine must never forget that legislatures give us the privilege of practicing medicine. We appreciate, therefore, the concern of this committee and the Congress for the medical needs of the aged. Nonetheless we oppose H.R. 4700 as unwieldy, uneconomical, untimely, and unlikely to accomplish what it proposes to do.

We consider H.R. 4700 unwieldy since it lacks appropriate definition, providing medical, hospital, and nursing home care for a group of the aged defined only in terms of age and additional tax contributions to ŎASDI.

Medical need requires definition and should be flexible, knowledgeable, and contemporary.

In Tennessee, the medical profession, concerned with provision of medical care for the medically indigent, including the aged, sponsored in the Tennessee General Assembly of 1953 a bill for the hos