I suppose some witnesses will say to your committee, "Let's wait and seemaybe the Federal Government won't have to do anything."

That is what the doctors and the insurance companies said every time I made recommendations for this purpose, or Federal aid to medical education and research, or expansion of public health services for mothers and children, or stepped-up construction of hospitals and other medical institutions.

I usually found that those who are loudest in protesting against the Government's doing something for the health of the people are those who do not need help themselves.

The statistics on rejections for military service during World War II shocked me into proposing a broad national health program. When this was killed, I proposed other measures that I hoped would be acceptable. Some, but far too few, have been adopted.

In 1951, I established the President's Commission on the Health Needs of the Nation, a nonpolitical group charged with investigating all aspects of the national health situation and making recommendations based on facts. The Commission's report contained extensive data on shortages of personnel and facilities. It recommended specific measures to meet the shocking deficiencies which it had documented. One was that the Federal and State Governments pay voluntary health insurance premiums for persons who cannot afford them. This report was published in 1952, as my term as President was ending. The Eisenhower administration has disregarded the Commission's findings. It has not favored Federal grants to aid medical education. Its appropriation requests for hospital construction repeatedly have been below the levels authorized by the Hill-Burton Act. Congress has had to take the initiative in supplying adequate funds for medical research.

Now the Department of Health, Education, and Welfare has, at your request, made a study of "Hospitalization Insurance for OASDI Beneficiaries." I am informed that this report contains much evidence on the low incomes and the heavy medical costs of the aged and that the report in no way implies that such Federal health benefits could not be administered successfully. Yet, in spite of its own findings, the administration has failed to recommend Federal benefits to help widows, orphans, and the aged get proper health care.

I hope that your committee will provide the initiative and the leadership which are now so badly needed in this field, and that you will move ahead promptly with this significant advance in the long struggle to secure better health care for the American people.

Sincerely yours,

HARRY S. TRUMAN.

The CHAIRMAN. Our first witness this morning is our colleague from Michigan, the Honorable John D. Dingell. Mr. Dingell. Our next witness is our colleague from New York, the Honorable Seymour Halpern. Mr. Halpern.

Our next witness is our colleague from New York, the Honorable Thaddeus J. Dulski. Mr. Dulski.

Without objection, statements of our colleagues whose names I called will be placed in the record.

Our next witness is Dr. R. B. Robins. Dr. Robins, will you please come to the witness table? If my colleagues on the committee will permit me to take just a moment, since Dr. Robins is from my own State and one of our very outstanding citizens, I would like to present him to the committee.

Dr. R. B. Robins, known to all of us in Arkansas as Bob, has been a personal friend of mine for a number of years. Our acquaintance arose through his activities not only in the field of medicine, but his civic and political activities, and I want my colleagues to note that for a period of some 8 years, from 1944 to 1952, he was the Democratic national committeeman for our State and one of the very finest representatives we have had on the Democratic National Committee.

He served during that 8 years as the only doctor on the Committee. I don't know whether he exercised a great deal of influence

with the Committee about medical affairs, but he certainly has outstanding qualifications and a nationwide reputation in the profession. I am sure he commanded their respect as to any advice they may have sought from him. He is a graduate of one of our very famous schools, I would like our two Illinois members, Mr. O'Brien and Mr. Mason, to know, the University of Chicago having received his master's degree and medical degreee from the institution. He is a former president of the Arkansas State Medical Society.

In 1950 he was vice president of the American Medical Association. He is one of the founders and the fifth national president of the American Academy of General Practice, the group that he is representing this morning. This is the second largest medical organization in America, I understand, with something over 25,000 family doctor members.

Dr. Robins, we appreciate very much having you with the committee today to give us the benefit of the thinking of the American Academy of General Practice. We appreciate your being here and I personally will take great interest in hearing your views and the views of your organization.

Mr. MASON. Mr. Chairman, after the introduction, even a Republican will listen to this doctor with great interest.

Mr. FORAND. Mr. Chairman, apparently the doctor has some connection with both Mr. Mason and yourself. I haven't heard anything about Rhode Island, but on the basis of the statements already made, I, too, say welcome, Doctor.

Mr. MACHROWICZ. In view of the very fine introduction by the chairman, I also join in welcoming Dr. Robins.

The CHAIRMAN. You should feel at home. You are recognized for 15 minutes, Dr. Robins.

STATEMENT OF R. R. ROBINS, M.D., ON BEHALF OF THE AMERICAN ACADEMY OF GENERAL PRACTICE, CAMDEN, ARK.

Dr. ROBINS. Thank you very much, Mr. Chairman, for your kind remarks and to the other Congressmen I extend my thanks, too.

Mr. Chairman and members of the committee, as Congressman Mills has said, I am Dr. R. B. Robins, of Camden, Ark. I am testifying here today for the American Academy of General Practice, an association that represents more than 25,000 family doctors. The academy, which I helped found in 1947, is the Nation's second largest medical organization. As a doctor of medicine, I have had for many years a deep interest in governmental matters that relate to the health of my patients.

H.R. 4700 would affect the health of my patients and, in my opinion, not for the better.

Accordingly, when the American Academy of General Practice asked me to testify at these hearings, I prepared myself to meet with this committee and talk about the effect of this proposed legislation on the general practitioner and the patients he treats.

But the day before yesterday I changed my mind. I would like, with your permission, to file the original testimony that I prepared, if you will permit me to.

The CHAIRMAN. Without objection, your entire statement will appear in the record.

(The formal statement of Dr. Robins follows:)

STATEMENT OF THE AMERICAN ACADEMY OF GENERAL PRACTICE, RE H.R. 4700, 86TH CONGRESS, HEALTH BENEFITS FOR AGED UNDER SOCIAL SECURITY, BEFORE COMMITTEE ON WAYS AND MEANS, HOUSE OF REPRESENTATIVES, BY R. B. ROBINS, M.D., JULY 17, 1959

Mr. Chairman, I am testifying today for the American Academy of General Practice, an association that represents more than 25,000 family doctors. The academy, which I helped found in 1947, is the Nation's second largest medical organization. I am also a member of the American Medical Association board of trustees and a private citizen vitally interested in the political affairs of our country. For 8 years, I was Democratic national committeeman for the State of Arkansas. As a doctor of medicine, I am especially interested in political affairs that relate to the health of my patients.

We are here today to talk about compulsory health insurance. This is not a new topic, especially to a doctor who practiced during the Wagner-MurrayDingell days. These three gentlemen tried to sell their own variety of compulsory health insurance in one package. As you well remember, only a few of the so-called liberals wanted any part of the program.

Since then, the same experts on social and medical-economic reform have used a new approach. Every year, with most of the emphasis on election years, they amended the Social Security Act and tried to attain the same objective piecemeal under what might be described as a social welfare installment plan.

If I remember correctly, the Forand bill was introduced in August 1957almost 2 years ago. Ever since, different experts have tried to hang a price tag on this program.

Gentlemen, I'm a doctor-not an economist. I'm always ready to discuss fees with a patient but there are times when I admit that I can't come up with an answer. If a patient comes into my office and says, "Doc, I got a bellyache. How much will you charge to cure me?"-I can't answer him. He may need a good laxative or he may need a subtotal gastrectomy. The point is, I don't know and I may not know even after I've examined him.

I submit that no one knows how much the Forand bill would cost the taxpayers. I would personally say "plenty" and that's probably as close as any of the other estimates.

In Britain, the "experts" (and I have that word in quotes) predicted that compulsory health insurance would cost £130 million per year. This, as I understand it, was considered to be the maximum amount. In 1957, this program cost the British taxpayer almost £700 million or more than five times as much as the estimated maximum.

Saskatchewan also has a compulsory health insurance program and I feel sure that the Provincial government made a conscientious effort to determine the number of dollars required. What happened? At the end of 1 year, 12 short months, the government discovered that its figure was 50 percent too low. How can Congress have any confidence in estimates that have been historically inaccurate? How many patients will welcome hospitalization if they mistakenly think that Uncle Sam is going to pay the bill? In Saskatchewan, the average person over age 65 spends 7 days a year in a hospital. In this country, the same person is in the hospital 22 days per year. In Saskatchewan, people go to the hospital more often and they stay there twice as long. They either think it's free or else they think they've already paid for it and they might as well use it. I daresay there isn't a doctor in active practice who hasn't witnessed both of these reactions. How much of this would there be in this country? Who can tell? I can't-and I don't think anyone can.

In the last 20 years, this country has adopted a new social welfare philosophy. This consists of first recognizing that certain groups need help and no one will dispute this contention. Then, as a second step, we legislate special programs for people who really need help. When this is done wisely and after careful consideration of all factors involved, such legislation is little more than a logical extension of the Christian attitude.

But then, and here is where our objectives and logic follow different paths, we extend the benefits to everyone. The question of need never arises. How many patients, worth $15,000 or more, are currently lounging in VA hospitals with the blessings and best wishes of the Government? In 1956, the General Accounting Office checked 25,000 VA records and found 423 patients in this category. And even though the mechanism to prosecute for perjury now exists I have never known it to be set in motion.

I will always support and endorse voluntary health insurance plans tailored to meet the special needs of our senior citizens. But I will just as vigorously oppose making them wards of the State. The man who has been retired and the woman whose children are married and on their own have special emotional problems. I see these people every day and I'm familiar with these problems. They feel that they've been turned out to pasture, that their usefulness is ended, and that they must simply wait to die. If you make them exist on Federal handouts, you'll lower their morale to a point below ground level.

Some of these people need help and seem to accept it graciously. But there are others, many others, who want to feel that they can still take care of themselves. If you harass them with higher and higher taxes during their most productive years, you deprive them of the right, and I believe it is a right, to be free and independent and to hold their heads as high as they want. At least give them a choice. Don't destroy their initiative in the name of welfare and compulsory health insurance.

Representative Forand's bill supposedly would offer benefits to eligible social security claimants over age 65. I've heard a few of my colleagues ask if this age limit couldn't be lowered. Gentlemen, I've watched the social security program since its inception in 1935 and I don't think there's a person in this room who doesn't know, beyond any shadow of reasonable doubt, that the age limit would be lowered, progressively, relentlessly, and rapidly. Finally, perhaps in less than 10 years, the age restriction would be totally eliminated and we'll have pure socialized medicine. I know that those two words have been kicked around for years but as an eventuality, socialized medicine is no joking matter. Would any member of this committee willingly send his wife or child to a doctor who is forced to see 60 patients a day? Would you expect them to get individual care and attention? That's socialized medicine and I want no part of any program that is a blatant and obvious step in that direction.

You don't have to be a doctor to know that this country today has standards of health unmatched by any other nation. I think that personal freedom, enjoyed by both the doctor and his patient, has made a continuing and invaluable contribution to this happy state of affairs.

But there are men in this room who now want to tell my patients: "Give us your tax dollars and let the Government buy your medical care. We can spend your money for you. We don't think you're capable of taking care of yourself." I don't care how you dress it up or how many fancy words you use, it adds up to pure compulsion with the complete and total elimination of individual freedom.

My patients, and those of every other doctor, aren't animals-they're people. They've solved many personal problems and solved them without an outside agency stepping in and coming up with an over-the-counter answer.

I'm always amused, in a tragic sort of way, by different attitudes toward health care problems. Too many people seem to think that the doctor is nothing more than a mechanical clinician. He can suture an incision, treat a diabetic, or help prevent polio, but this seems to be as far as he should go. The planning of health care programs is arbitrarily turned over to social welfare experts who know practically nothing about the patient's physical and emotional needs. Gentlemen, it doesn't make sense.

A minute ago I mentioned that many elderly patients feel that they no longer have any reason to exist. I see this every day and, gentlemen, it's a pathetic reaction. For the greater part of their lives, these people have felt that they were making real contributions to society. They've worked hard and raised families, paid for their own homes and seen their children mature and go out on their own.

Then suddenly, and it seems to happen very suddenly, they're 65 years old. Their employer calls them in and mentions that the company enforces compulsory retirement at age 65. Many of these people are still mentally alert and in excellent physical condition. They don't need to retire and, to put it bluntly, they don't want to quit.

Then, just to make matters worse, the employer tries to tell them how lucky they are. He points to social security benefits and talks about having plenty of time to fish and work in the garden. This kind of life may sound good to the man who's only 45 and still has 20 years to go but the man who's 65 is acutely conscious of the real reason. He knows that he's being told, nicely or otherwise, that he's just too darn old. Whether he is or not makes very little difference. Someone has told him that it's the end of the line.

I mention this reaction simply to point out that my patients, and I must speak for them, have an underlying urge to be free and independent. They may wel come retirement income benefits because they feel that they've saved this money over a period of years but compulsory health insurance is a horse of another color. You can't edit the word "free" out of the public's reaction. Many people in England, despite fantastic health insurance taxes, still talk about "free" medical care.

This is what I want to avoid. As a doctor, I think it's important to tailor programs that give the individual a feeling that it's his program, molded to his individual needs. Let him buy it in the open market, don't force it down his throat.

A month or so ago, I read about a bill that would let taxpayers deduct health insurance premiums. This makes a great deal of sense. I'm not going to testify on a bill that we aren't considering here today but I do applaud the spirit of such legislation.

Rather than say to my patients, "Here's a cut-and-dried health insurance plan that you have to buy whether you like it or not," why not encourage these people to care for their own individual needs? The health insurance industry has already come up with plans that provide good coverage at very modest costs. The elderly patient who participates in one of these plans knows that he's paying his own way. This is an important consideration but it's often overlooked when we get all wrapped up in dollars-and-cents considerations. Let's think in terms of people and not in terms of plans. The moment a doctor sees his patient as a case history and not as a person, he should bury himself in a laboratory and work with mice, not men. Some of this philosophy must permeate these delibera. tions today.

Thank you very much.

Dr. ROBINS. As I go through the script here I am going to eliminate some sentences and paragraphs because I want to respect the time limit which you have extended me.

I was listening to this committee's hearings when Representative Forand brought up the subject of British medicine.

In the Congressman's view-at least, as I understood him-compulsory national health insurance in that country was, by and large,

a success.

It was at that point that I decided to take another approach in my testimony before this committee, for I had just got back from Great Britain earlier this week.

Ever since 1948, when the national insurance scheme and the national health service were inaugurated in Great Britain, I have been interested in the effects they would have on that nation's health care. I have, like many other American doctors, read a good deal about it. And for many years, I had wanted to see the program in action at firsthand. I had wanted to compare it with the quality of health care received by the people of the United States; I had wanted to talk personally with family doctors in Great Britain so that I could obtain an unadorned, undiluted account of how they view medical challenges and problems in their country today. It seemed to me that a look at the British experience, from the standpoint of an American doctor, would give me a yardstick with which to measure the general practitioner's situation in the United States as compared with that of his British colleague.

For compulsory national health insurance here, even on a limited scale, could be the precursor of compulsory national health insurance across the board. And on that subject, the British doctor has, whether he likes it or not-become an expert.

Last week, therefore, I went to the experts. And I got expert opinions during a busy and interesting week devoted largely to private, no-holds-barred discussions with men and women who can speak