you, and, frankly, this summarizes very nicely what I think is really the greatest concern of us physicians about this type of legislation.

I would like to quote a few things in lieu of the things that are mentioned there. If it might be possible to put the entire editorial in, it would be fine. This reads:

The blueprint for American socialism is now on display in Washington in the way of H.R. 4700.

Then, after describing the bill—

but the staggering cost is not the worst feature of it. This is the entering wedge for socialism on all fronts. If this bill passes, it will be aimed in the future to apply to all persons on social security rolls at all ages.

Once the medical profession is socialized, then journalism, law, engineering, and every other profession and business will be attacked.

Washington has no more business providing free medical care to people over 65 than it does to provide them shoes, bread, or automobiles.

As was mentioned by your colleague, Mr. Alger, "Existence of a problem in this country like medical care does not justify Government controls to solve it." Then after mentioning the British experience, the conclusion is this:

Either this country stops the steady push toward socialistic services or it goes headlong into them.

This is the issue with H.R. 4700, in the opinion of this editor, who is widely read in our section.

I would like in the remaining time to just report what in Texas we have done about it, which reminds me of the beautiful southern lady who owned a mansion across the road from which was a honkytonk, to her continued unhappiness.

One night she called her servant, Mandy, and said, "Mandy, you are a good Christian. This den of iniquity is bound to offend you like it does me, so let's pray that the Lord will remove it."

They prayed and went their own way and the next morning when Mandy came in the lady said, "Mandy, a wonderful thing. Last night we prayed. I prayed for months and nothing happened, but I got up this morning and the thing had burned to the ground." Mandy said, "Yes; you prayed and went to sleep. I prayed and looked for the matches."

And so in Texas now we have looked for the matches, and we have tried to overcome this problem just as others in other States are doing and I would like to report that the Texas Medical Association is fully engaged in the multiphased program designed to alleviate many existing problems related to medical and social services for the aged.

Last year our committee on voluntary health insurance made a very comprehensive study. They reported for one thing that there were no bona fide instances of anyone suffering from lack of proper medical care in our good State. They did feel there was a need for providing some special form of prepayment insurance for the 675,000 Texans over 65, and our House of Delegates asked the Blue Cross to make a special survey, upon which several thousand dollars are now being spent.

We have already authorized Blue Cross then to proceed with the policy. The director of Blue Cross assures me this week that it will be ready October 1. Several other positive programs are briefly mentioned.

The association's committee on voluntary health insurance has embarked upon a comprehensive plan designed to control the costs of medical care, and to keep the availability of good medical care within the reach of as many individuals as possible.

Our committee on aging has been very active, and presently is completing an intensive educational and informational program among the profession. With the cooperation of the American Medical Association we had a very successful regional conference on aging, in Dallas,

We have another one in the planning stage now. In addition to the independent activities, the Texas Medical Association is cooperating with many other State groups which hold the primary responsibility for health services, for example, last spring our State association joined with the Texas Hospital Association, its Dental Association, and the Texas Association of Nursing Home Operators to form the Texas Joint Council to improve the health care of the aged.

This council is exploring the entire spectrum of problems relating to aged, and the aging process.

During the last 18 months we have been working closely with private insurance carriers and Blue Cross-Blue Shield, to encourage a million more Texans to procure voluntary health insurance.

Mr. FORAND (presiding). Doctor, are you almost finished with your statement? You have gone over your time. We will give you a brief

extension.

Dr. ROUSE. In conclusion, we believe that the legislation is not needed, and we are hoping that you will reject the proposed legislation and thereby enforce the philosophy of free enterprise which has given our United States the highest quality of medical care in the world.

Thank you.

Mr. FORAND. Doctor, first, let me thank you for coming to the committee and giving us this fine report. I enjoyed your story about the prayers.

I advise you now that you had better continue praying and working, because I do not intend to give up the fight. We have to have a solution to this problem and, if you people can come up with a better plan than mine, I will embrace it. But you have to convince me that it is better than this.

Dr. ROUSE. That is a fine spirit. gressman; yes, sir.

Mr. FORAND. Thank you so much.
Are there any questions?

We will continue to work, Con

Mr. MASON. Mr. Chairman, I just want to make this statement. Doctor, you will agree that this fine gentleman of ours, who is the author of this bill, has done a great job in stimulating and initiating things that were too long ignored and neglected. You will agree to that, won't you?

Dr. ROUSE. We appreciate his effort in putting all of us at work and thinking; yes, sir.

Mr. MASON. Why, of course.

Mr. FORAND. Are there any further questions?

If there are no further questions, we thank you, Doctor.

Dr. ROUSE. Thank you for the privilege.

(Dr. Rouse's statement follows:)

STATEMENT BY MILFORD O. ROUSE, M.D., OF THE TEXAS MEDICAL ASSOCIATION

Mr. Chairman and members of the committee, I am Dr. Milford O. Rouse of Dallas, Tex. I am appearing here as a representative of the Texas Medical Association. I appreciate very much the opportunity to appear before you, and to discuss with you the views of the medical profession in our State concerning the provisions of H.R. 4700.

The medical profession of Texas is acutely aware of its great responsibility to make available the best medical care possible for the aged as well as for the State's entire population of more than 9 million. We are particularly cognizant of the existence of certain medical care problems among our senior citizens. We fully concur that efforts to resolve existing problems should be continued and increased.

Nevertheless, we do not agree with advocates of H.R. 4700 as to the nature and extent of existing problems, nor as to the means of resolving them. In a State steeped in the traditions of individual liberty and initiative, we feel that the voluntary private approach should continue to be utilized to provide hospital and surgical benefits for older persons. Permit me to summarize the basis of our opposition to this legislation, and to report the positive approach which is being pursued vigorously in our State.

The policymaking body of our 8,000-member association repeatedly has expressed its opposition to H.R. 4700 and similar legislation. The basis of our position is as follows:

First, and foremost, we feel that hospital and surgical services for the aged can and should be handled in keeping with the American traditions of free enterprise. Blue Cross-Blue Shield of Texas and the private insurance companies have demonstrated their ability to meet the extensive insurance needs of the growing population of our State.

Second, we oppose Federal intervention in medicine because it is detrimental to the doctor-patient relationship and to good medical care. We believe that each illness is a personal problem which is of primary concern to the patient and to the doctor and not to an expensive third party like the Government. We oppose Federal intervention because we believe that the patient should have unrestricted free choice in selecting a doctor. We also believe that the doctor owes his unqualified responsibility directly to the patient and not to a Federal agency which might use the individual's tax contributions in order to pay for his medical bills.

Third, H.R. 4700 actually is national compulsory health insurance. It embraces the principle of Government regulation of professional fees, wages, prices, and services.

Fourth, we do not feel it will solve the primary problem of financing medical care for the aged. In our State, for example, only 421⁄2 percent of the aged are covered by social security benefits.

And, fifth, this legislation will result in higher taxes, and less take-home pay for all covered by social security. It also will impose another tax burden on the employer. It could result in the fiscal wrecking of the entire social security system.

Permit me to report that the Texas Medical Association is fully engaged in a multiphased program which is designed to alleviate many existing problems related to medical and surgical services for the aged. Following preliminary investigation, the association's committee on voluntary health insurance reported that a need does exist for a tailormade insurance plan for the 675,000 Texans who are 65 years of age or older. The committee has asked Blue Cross-Blue Shield of Texas to undertake a factfinding survey related to all aspects of medical care for the aged. We believe that at the completion of this study that we will have far more accurate information than presently is available. With these facts on hand, our committee will formulate a realistic plan of coverage for the aged-a plan designed to fulfill those needs which are brought out in the survey. The Texas House of Delegates has authorized Blue Cross-Blue Shield to initiate the plan, and I am pleased to report that it will be introduced in October.

Several other positive programs are worthy of brief mention. The association's committee on voluntary health insurance has embarked upon a comprehensive plan designed to control the costs of medical care, and to keep the availability of good medical care within the reach of as many individuals as possible. The Texas Medical Association's committee on aging has been very active. It

presently is completing an intensive educational and informational program among the profession. The committee, in cooperation with the American Medical Association, conducted a very successful regional conference on aging in Dallas. Another State conference is in the planning stage, and likely will be presented at the Texas Medical Association's annual meeting next April.

In addition to its independent activities, the Texas Medical Association is cooperating with many other State organizations which hold the primary responsibility for health services. This past April our State association joined with the Texas Hospital Association, the Texas Dental Association, and the Texas Association of Nursing Home Operators to form the Texas Joint Council To Improve the Health Care of the Aged. This council is exploring the entire spectrum of problems relating to the aged and the aging process. During the past 18 months, the association has been working closely with private insurance carriers and Blue Cross-Blue Shield to encourage a million more Texans to procure voluntary health insurance.

In summary, we in Texas believe that this legislation is unwise and not needed. We believe that private, individual care is greatly superior, and far less expensive, than Government medicine. We hope that you will reject the proposed legislation which is before you. In this way you will be endorsing the philosophy of free enterprise which has given the United States the highest quality of medical care in the world today.

Thank you very much.

Mr. FORAND. The next witness is Dr. Azzari.

Dr. Azzari, Mr. Keogh, who was here, but had to leave, was intending to give you one of those flowery introductions.

Dr. AZZARI. Thank you just the same, Mr. Chairman.

Mr. FORAND. He advised us of your great experience, background, and qualifications and impressed us so that we are eager to listen to what you have to say.

Dr. AZZARI. Thank you, Mr. Chairman.

Mr. FORAND. For the purpose of the record, will you give your name, your address, and capacity in which you appear.

Dr. AZZARI. May I ask your chairman's permission to have Mr. Farrell sit to my right. He is the director of the bureau of medical care insurance.

Mr. FORAND. We will be glad to have him.

You are recognized for 5 minutes.

STATEMENT OF DR. RENATO J. AZZARI, MEMBER, BOARD OF TRUSTEES, AND PAST PRESIDENT, MEDICAL SOCIETY OF THE STATE OF NEW YORK

Dr. AZZARI. Mr. Chairman, and members of the committee, my name is Dr. Renato J. Azzari, the Borough of the Bronx, New York City.

As a member of the board of trustees and past president of the Medical Society of the State of New York, I am here today to voice the vigorous and unalterable opposition of our organization, the third largest group of its kind in the world with 24,903 physician-members, to the enactment of H.R. 4700. I do so in keeping with the actions taken by our house of delegates and council.

No complete and conclusive evidence has been presented to prove the need for such legislation in New York State. On the contrary, there is ample evidence that there is no need for such a law in the Empire State.

The numerous programs now being conducted efficiently and effectively in New York State by voluntary State, county, and local group, make H.R. 4700 unnecessary. According to reliable information, there are 14,780,000 persons, 88 percent of the people of the State, now covered by some form of hospital insurance. Thirteen million, two hundred thousand persons, 80 percent of the population, are covered by regular medical care and/or surgical insurance. It is recognized that the coverage in all instances is not complete. Much progress has been made in recent years in extending the benefits of voluntary plans to those participating in them. It can be expected that greater advancements will take place in the future.

Exclusive of Federal aid, it is reliably estimated that New York spends almost $6 million a month ($72 million a year) on a caseload of 87,000 old-age assistance cases. This financial assistance includes other factors besides medical care.

In New York, any person who requires medical care but cannot pay for it receives that care. This program in terms of medical standards, administrative efficiency, and results has been classified as one of the best in the country. Reliable sources show that approximately $100 million a year is spent to provide medical care for the medically indigent.

There can be only one interpretation of the proposed law-it is the compulsory socialization of medical care. The law would destroy the doctor-patient relationship and result in extensive compulsory taxation. Inevitably, pressures will arise to extend such law to the rest of the population. Such a law would undermine voluntary health insurance; gradually replace it. Few people would carry both Government and private plans in New York State.

H.R. 4700 would destroy personal and family responsibility in regard to medical matters. It would stifle the initiative of individuals and families to care for themselves and their aging relatives, a virtue unfortunately already on the wane in many families. This responsibility rests primarily with the individual and his family and is a fundamental principle upon which our Nation was founded.

The State society recognizes that problems exist among our senior citizens. We have taken steps to meet these problems.

Implementing and encouraging further expansion of the voluntary plans, in May 1959 the house of delegates strongly urged both Blue Cross and Blue Shield plans to develop programs for people over 65. The New York plans have responded to this request and steps already have been taken to provide more adequate medical and hospital care for the aged at a price they can afford.

Early this year, the Western New York Medical Plan, Inc. (Blue Shield plan, Buffalo), offered to everyone in the over-65 group a contract providing medical and/or surgical service benefits at no additional cost and with no reduction in benefits. A total of 2,368 persons, ranging from 65 to 97 years of age, signed the contracts. This type of pilot study is being actively encouraged and will be further implemented in the future.

The board of directors of United Medical Services, Inc. (Blue Shield plan, Metropolitan New York), which covers some 5 million persons in 17 downstate counties, including New York City, has approved a