commercial companies represent a markup of about 50 percent. Have you any comments on that? Mr. DAVIS. Yes; I do, and I do not want to, of course, criticize the insurance industry, because I think they have done some very, very constructive work in this field though they have been developing slowly. Unfortunately, in the insurance industry, as in any other industry or in any other group of people, including the AMA or even labor, you have certain companies which do a better job than other companies. There are certain plans that have come out recently from some of the smaller companies, and also from some of the largest companies, which I know, based upon the actuarial experience that we have developed over the last 5 years with retired people, are not going to pay out, in my opinion, more than 50 cents on the premium dollar, and this is a very easy thing to analyze, Congressman Forand. All you have to do is take the HEW statements of cost per dollar and allocate it toward the benefit structure that these plans carry. For instance, there is one plan being offered for $8.50 a month. There is no question that if operated on the basis of our trusteeship, this same benefit program could be offered for $4.25 a month. Mr. FORAND. Thank you very much. Mr. DAVIS. There are other companies, however, which are giving a higher percentage ratio of benefits than this particular plan. However, we feel that the trusteeship is the best answer to the problem. The CHAIRMAN. Are there any further questions? Mr. ALGER. May I ask just this? The CHAIRMAN. Mr. Alger. Mr. ALGER. I was hoping someone else would ask this question: What relationship, if any, would there be between the setting up of the trusteeship and the Government jurisdiction? In other words, would the trusteeship be entirely apart from Government? Would we keep an eye on it? Mr. DAVIS. We have tried very, very hard in our proposal, in order to avoid the possible criticism of the groups that we think should form this trusteeship to keep Government out of the trusteeship. What has happened, Mr. Alger, is that the person has lost the paying agent. This becomes the most important loss to the individual. When he was working and employed, there was a simple mechanism for him to pay his insurance-a payroll deduction. It was taken out of his pay and he never even realized he was paying it. Suddenly, upon retirement, he no longer has a paying agent. Therefore, all the plans in existence up to now require an affirmative action each month, a direct payment, a check sent in, as is represented by the fact that we receive in our office 100,000 checks monthly. Mr. ALGER. I know you know much more about this. We ought to have, as you suggested, the subcommittee go into this, but I do not want to take a lot of time. Can you just tell me the relationship? Mr. DAVIS. The relationship would only be that we would ask your committee to authorize the Social Security Administration to make a payroll deduction from the social security annuitant's check, if authorized by the annuitant to do so, and that we would reimburse in full the Social Security Administration for the clerical work that they do. Mr. ALGER. Who would form the trusteeship? Mr. DAVIS. The trusteeship should be organized, as we say in our report, by the five groups who are represented at these hearings. Mr. ALGER. Don't you want legislation? Mr. DAVIS. The only legislation that we require is the authorization for the Social Security Administration to make a deduction from the pension check. It has no authorization to do that under the current law. If that authorization were given, then the wheels could be set in motion. We have already met with the American Medical Association, with organized labor, with the National Association of Manufacturers, with the insurance industry, and though none of them will agree that they will accept our proposal carte blanche, they have all agreed that there is good merit in the program and that, if invited to a meeting to discuss this proposal further around the table in order to solve the problem, they would do so. Mr. ALGER. I think you have some interesting ideas. The CHAIRMAN. Are there any other questions? Thank you again for bringing to us these suggestions. Mr. Machrowicz ? Mr. MACHROWICZ. On behalf of Congressman O'Brien who could not be here this afternoon, I would like to welcome Dr. Piszczek and also state that, although I had not met him until the other day, on the basis of the glowing terms in which our mutual friends have described his high professional stature, I am sure that he will have very much to contribute to our hearing today. STATEMENT OF EDWARD A. PISZCZEK, M.D., CHICAGO, ILL., ON BEHALF OF THE ILLINOIS STATE MEDICAL SOCIETY Dr. PISZCZEK. Thank you. Mr. MASON. Now, Mr. Chairman, I want to add my 2 cents' worth. The CHAIRMAN. Mr. Mason. Mr. MASON. The distinguished and eminent phyicision that is before us, and his companion over there, are both from my home community. Dr. Piszczek has gone to Chicago to practice, but he originally came from my home community. They are very eminent physicians, and I particularly ask, as a favor to me, that the author of this bill will handle the testimony and his questions in a kindly, sympathetic manner. Mr. FORAND. I assure you I will do that. Mr. KEOGH. Mr. Chairman, I would like the record to note that we have in the audience another Illinois doctor from Chicago who in addition to all his other qualifications is the personal physician of our distinguished colleague, Mr. O'Brien: Dr. Sullivan. The CHAIRMAN. We are pleased to have Dr. Sullivan. Dr. PISZCZEK. I am Dr. Edward A. Piszczek, of Chicago, councilor of the State and the Chicago Medical Societies, and specialist in pre ventative medicine and public health, and for 26 years a servant of the people of Cook County. The CHAIRMAN. Doctor, you are recognized for 5 minutes. Dr. PISZCZEK. Mr. Chairman and members of the committee, on behalf of the Illinois State Medical Society, the membership of which consists of more than 10,000 licensed doctors of medicine residing in the State of Illinois, I urge your committee to disapprove H.R. 4700. Physicians generally, as well as the numerous medical organizations which they have established, are by no means unmindful of the many problems which are confronting our aging population, nor of the health needs of America's senior citizens, present and future. We cannot agree, however, that the social security approach proposed by H.R. 4700 is a wise or effective one. The accumulation and spending of enormous amounts of tax moneys is no proper substitute for thorough study and planning at the State, local, and community levels. Even if the need for Federal intervention on a vast scale could be demonstrated, and we earnestly submit that it cannot, H.R. 4700 would fail to benefit many who are in the greatest need of assistance, and would at the same time destroy much of the amazing progress which has been made in the field of voluntary prepayment medical, surgical, and hospital insurance. Your committee already has detailed data covering these areas of activity prepared by the American Medical Association, the Health Insurance Association of America, Blue Cross-Blue Shield, and by other organizations and individuals. In Illinois, numerous forces have been at work for some time to assist our older citizens in obtaining the health services they require. The Illinois State Medical Society maintains an active committee on aging, and the society's house of delegates has supported the committee's excellent work enthusiastically. The society has cooperated with the National Joint Council to Improve the Health Care of the Aged which held a national conference here in Washington last month; it has informed the Hon. William G. Stratton, Governor of Illinois, of its wish to help plan and participate in State conferences on aging in preparation for the White House Conference on Aging to be held in January of 1961; and it has encouraged the appointment of committees on aging by county medical societies throughout the State. At its annual meeting in May of this year, the society's house of delegates adopted a resolution urging all members of the society to serve needy aged persons at reduced fees, and asked our hospitals to find ways of granting them similar consideration. In addition, the society is placing ever-increasing emphasis on the problems of aging in its publications, its educational and scientific meetings and in its contact with other lay and professional organizations. In Illinois, as in other States, many religious groups are stepping up their activities in this field. A large Presbyterian retirement vil lage will soon be started in Evanston, Ill., just north of Chicago. A similar home will be erected under Catholic auspices in nearby Glenview. Many other institutions of this type are planned throughout the State. Chicago and Cook County will soon be served by a home care program to be operated in cooperation with Cook County Hospital. I might add that that program started this Monday. Through these means patients who need medical attention but do not require hospitalization will be cared for in their homes, and a very high percentage of these will be in the over 65 age group. At Oak Forest, Ill., some 200 tuberculosis patients were recently transferred to other institutions, and another 250 will soon follow. This will provide room for more than 400 elderly people in Cook County's largest home for the aged, which up to now has been partly used for TB, but because of the earlier recognition of TB, the more effective treatment, the hospital stay has been reduced from more than a year down to about 7 months, on the average. Just last month the Illinois Legislature acted to continue a State commission on the aging and aged which is studying all aspects of the problem at the State level. Proposals for the creation of a new post of special assistant to the Governor for problems of the aging seem destined for early adoption. And Illinois is currently spending tens of millions of tax dollars annually for the health care of its medically indigent, many of whom are in the advanced age group. In this connection, the Illinois State Medical Society has always cooperated closely with the Illinois Public Aid Commission and with county welfare departments in their public assistance programs. Time does not permit any further recital of the continuing efforts of both public and private agencies to assure our senior citizens that their needs will be met. The physicians who comprise the membership of the Illinois State Medical Society simply cannot be persuaded that national compulsory health insurance is desirable for any segment of our population whether over or under the age of 65. And to pretend that H.R. 4700 is not a program of compulsory health insurance which would lead logically to the nationalization of all of our health services is simply a refusal to face the facts. Respectfully submitted on behalf of the Illinois State Medical Society. The CHAIRMAN. Doctor, we thank you, sir, for bringing to us the views of the Illinois State Medical Society. We appreciate your coming to the committee. Are there any questions? Thank you, sir. Mr. MASON. Mr. Chairman, my community produces some great men. The CHAIRMAN. Doctor Rouse, will you please come to the witness table. Mr. Alger? Mr. ALGER. Thank you, Mr. Chairman. It is my very real privilege and pleasure, and I appreciate your recognizing me, to introduce Doctor Rouse. Doctor Rouse, I might warn you right now that this introduction will not help too much. I am in a little disfavor for questioning a little longer this morning than maybe I should have, according to some of my colleagues, but just the same, I would like to present you in the best way that I can. I do not think I can do justice to it. I would like to say to my colleagues that the doctor is a native Texas. He is a private practitioner of medicine in Texas in gastroenterology, gastrointestinal diseases. Doctor Rouse is more than that, however. He is an author of many leading papers for leading medical journals. He is a lecturer and professor at the Southwestern Medical Institution. He is a statesman of stature in our community because of the part that he has played in community affairs, both in Texas and in the southwest in his business and civic affairs. He is past president of the Texas Medical Association of 8,000 members, current president of the Southwestern Medical Association of 14,000 members, was the Texas chairman of the delegation to the House of Delegates of the AMA, and recently was elected vice speaker of the AMA. I am certainly proud that he comes from our community, and I think he will be a good spokesman. I might say he is also a member of that committee that has to do with the insurance and prepayment plan. Doctor Rouse. The CHAIRMAN. Doctor, after such a fine recommendation, it is a shame to limit a man to 5 minutes, but we will recognize you for 5 minutes. Mr. MASON. My colleague has shamed me in my introduction of my distinguished friend. The CHAIRMAN. Thank you, Mr. Alger. Mr. ALGER. Thank you. STATEMENT OF MILFORD 0. ROUSE, M.D., DALLAS, TEX., ON BEHALF OF THE TEXAS MEDICAL ASSOCIATION Dr. ROUSE. Mr. Chairman, and members of the committee, I am most grateful for the kind words of my good friend, your honored colleague. I have come to discuss with you, on behalf of the 8,000 members of the Texas Medical Association and of our fellow citizens, the matter of H.R. 4700. In the interest of your time, I shall probably abstract my prepared statement, and if I can make it even a little more spicy, perhaps that will add to it too. In Texas are men who think for themselves whether they smoke or not, and they speak for themselves without any outside stimulation or repression from the upper echelons, I can assure you. Mr. MASON. We know that. Dr. ROUSE. We feel keenly the responsibility of maintaining the best health for the 9 million people in our State, not just those above 65. In a State that is steeped with the traditions of individual liberty and initiative, we feel, however, that the voluntary private approach in the matter of medical care for the aged should continue to be utilized to provide hospital and surgical benefits for our senior citizens. The prepared statement covers the main reasons that have led our policymaking body to repeatedly take a stand against any kind of legislation such as we are discussing today. I mention that I also have the privilege of representing the overwholming majority of fellow Texans, whether they are doctors or not, and yesterday there appeared as the leading editorial in the Dallas Morning News, which is the most widely read paper in the Southwest, an editorial entitled, "Blueprint for Socialism," which I have just asked the chairman to distribute to |