instead of having a lot of so-called executive sessions, we could have panel discussions, bringing in the various groups, the medical group, the welfare group, the union groups, the chamber of commerce, and so forth, to sit around the table and talk these matters over, that we could arrive at a solution? Dr. ROBINS. I think that would be splendid. I think it would be a very good idea. Mr. FORAND. I hope that this suggestion might be taken seriously and that we can get somewhere. I could go to England by myself on my own. Anyone else could. However, that would not be official. That is the reason why I would like to see a subcommittee that would be a representative body of this Congress that would officially visit these countries and see what is going on and then file an official report on which we could base our final decision. Dr. ROBINS. Yes, sir. The only thing was or I read about in Mr. Cook's article is I am afraid Mr. Cook, being a layman, did not have the opportunity to really see people that could speak authoritatively from the medical side of this. He talked as a layman mostly. Mr. FORAND. That is absolutely true. You speak as a doctor. He speaks as a layman. Dr. ROBINS. That is right. Mr. FORAND. We ought to be arbiters and once we get these groups together it may not be that any individual would have the solution, but as a result of these discussions the good points that one would suggest and as the good points that another would suggest would all be put together and perhaps we would come up with that solution. Dr. ROBINS. Certainly. Mr. FORAND. Thank you very much. The CHAIRMAN. Any further questions? Mr. Mason? Mr. MASON. Dr. Robins, you have given us a picture of conditions in England from firsthand observations and experience. I am awfully glad to get that firsthand picture because it is much more convincing to me than just theoretical discussion. Doctor, I have just on question. This problem of taking care of the aged is quite a problem. It has been a problem that has been with us a long time. How would you express the progress that has already been made in the solution of that problem in the last 3 or 4 years compared to the 20 or 30 or 40 years behind that time? Have we not done tremendously to solve this problem during the last 3 or 4 years such as we never imagined 30 or 40 years ago? Dr. ROBINS. You are eminently correct, Mr. Mason. We have had tremendous progress. As you know, it takes time to work these problems out. You can't do it overnight suddenly by a piece of legislation. You certainly can't do that. I think if the American people are left alone in their voluntary way that they will ultimately come up with a very satisfactory solution to this problem, but it takes time. Mr. MASON. Judging from the progress that we have made in the last 3 or 4 years, I would say from where I sit that we will have the solution within a few years, much better than any solution that could come from Government supervision and Government interference. That is my opinion. Dr. ROBINS. I think you are correct. Certainly I do; yes, sir. The CHAIRMAN. Any further questions of Dr. Robins? Mr. Alger? Mr. ALGER. Dr. Robins, I think this is very interesting and I appreciate the fact that you changed your mind from whatever you intended to say before, in view of the fact that I am among those who are interested in the British experiment. The first day of the hearings Dr. Flemming of the Health, Education, and Welfare Department was here, and he was opposing the bill for various reasons and I asked him a number of questions for the record that we didn't have time to develop then. One of those questions was if he has made studies and if he would provide for the record for our information whatever can be learned from the British experience, and he said that they do know something about it and would provide that information. I have no way of knowing what that information might be, but I wanted you to know that the inquiry was made. I would appreciate it myself if you would look that over carefully when it is put in the record so that we can benefit from your further observations. In fact, Mr. Chairman, if it is not inappropriate, and I am asking for your information or your suggestion on this, if when Mr. Flemming submits that for the record would it be appropriate to give it to Dr. Robins for comment and leave the record open for his comments. I have no idea what Mr. Flemming will say. The CHAIRMAN. It usually isn't done. Mr. MASON. I would join in that, Mr. Chairman. The CHAIRMAN. If the gentleman from Texas would like to have comments from Dr. Robins on that material it probably can be made available to him before the record closes, and we would appreciate having Dr. Robins comment on it if you desire him to do so. Mr. ALGER. Mr. Chairman, I am only interested in information. I have no idea of Mr. Flemmings' comments. The CHAIRMAN. We will try to do that. Mr. ALGER. One or two other things. You pointed out the doctors are moving away from Britain. Is that because of the present British experiment or use of socialized medicine? Dr. ROBINS. That is how I sensed it, Mr. Alger; yes, sir. I further found that medical students coming out of school were wanting to emigrate. Mr. ALGER. At the top of page 8, you make this statement. You mentioned the system was felt to be demoralizing to both patients and doctors. Just what do you mean by "demoralizing"? Dr. ROBINS. I could talk for quite a little bit on that. I would like to bring up a personal example. On Sunday night, before I left for London on Monday, about dinner time in the evening I was called by a mother, and I could hear some commotion in the background. She asked me to come over to her home right away. I I went over and saw that the problem was with a young daughter, 16 or 17 years old, who had come home intoxicated. There was a family disruption between the father and the mother and the daughter. gave this young lady a shot of sparine. Of course she became sleepy very soon and went to bed. The father and mother asked me if I would linger a little while in their living room and talk to them of their problem with their daughter, so I did. I must have stayed there an hour and a half or two hours, letting this father and mother pour their hearts out to me about their problem with the daughter. They spoke about a psychiatrist. Finally, I asked them what church they belonged to and they told me Presbyterian. I said, "I believe you should take this problem first to your minister and discuss it with him and see if he can't be helpful." The doctor that I was telling that to in Great Britain smiled and he said, "Mercy, Doctor, we couldn't think about spending that much time with one of our patients." Mr. ALGER. That certainly is interesting, Dr. Robins. In fact your whole reaction in talking to those people is informative and it is something we cannot properly discuss here. Your statement is a rather curious and interesting commentary on both the inception of our Constitution and our way of life, that regardless of differences of viewpoint it is based on a religious belief, a moral code of conduct. Unfortunately, if ever we dare mention it we can be accused of playing politics with religion, and yet I know that many colleagues on both sides of the aisle here in Washington feel that a lot of these answers spring from moral responsibility based on a religious belief and yet are afraid to mention it because that would be construed as, as I say, having the Bible on their side politically. I think we go to the other extreme. To my knowledge this is the second time that this has been mentioned. The word "religion" has been mentioned one other time to my knowledge in these hearings. Anyway, the advice you gave that family and your own reaction I applaud. I certainly appreciate what you have said. It is easy to become discouraged here when you are on the losing end of a few things and yet you think the facts prove your whole point of view. I have a feeling that lots of folks on these issues on both sides feel that their facts are not being properly weighed. I sit here appalled at what you have just said about Britain. You said twice in your statement you are no authority and you can't report as an expert on the British system, but you brought up some information which is either to be thrown out the window or agreed to as far as I am concerned, else the facts will not stand that have been presented by the proponents of this bill, no matter how high their motivation. I want to close with this statement to you. I will feel much better if I can say it. Politicians up here many times think, unfortunately, being against some Federal program perhaps will be confused in the voters' minds with our being against that need. In other words, some men here in Washington would be afraid to oppose the Forand bill because politically they fear that the voters might confuse this opposition with that Congressmen being opposed to medical care for the sick. Do you follow my statement? Dr. ROBINS. Oh, yes. Mr. ALGER. When Mr. Reuther was here yesterday, with the adroit language and manners that he displayed in presenting his viewpoints, I recognize that somebody like myself could be placed in a very uncomfortable position, as when I oppose something. In this case I am not against helping the aged or the sick with medical care, but I think there are other ways to do it than with immediately presupposing a Federal solution. I appreciate your letting me make this speech, Mr. Chairman. Thank you, Dr. Robins, for your testimony. The CHAIRMAN. Mr. Machrowicz? Mr. MACHROWICZ. Doctor, I wasn't going to ask you a question, but this last discussion got me to thinking. I know that you are not a young man and I am not either. I am sure you remember the thirties very well, and I remember very well what the doctors were telling us in the thirties as to what would happen if we got a social security system in this country, what dire things would happen. Do you think those dire things did happen to us? I hear this argument about what would happen if we get this socialized medicine, as they call this, that this would be a terrible tragedy to the country. We were told that in the thirties when the social security system was adopted originally, weren't we? Dr. ROBINS. Yes, sir. Mr. MACHROWICZ. And no terrible tragedy occurred to this country? Dr. ROBINS. Mr. Congressman, but you notice the tendency at every session of Congress is to expand, expand, expand social security into other areas until finally it looks to me as though individual responsibility is going to be taken away from the individual in this country and he will be finally dependent upon his great Central Government to take care of him. Mr. MACHROWICZ. That is all. Dr. ROBINS. I think that is bad philosophy. The CHAIRMAN. Mr. King. Mr. KING. Dr. Robins, I am not going to ask a question because it is getting to be the habit around here to sermonize a little bit so I will succumb to that desire. Mr. Machrowicz sort of alerted me concerning this fear or apprehension that certain groups in our country throughout the last 25 years have expressed when certain legislative proposals are introduced. I think a great number of enactments took place during the thirties that the record will show very competent men declared flatly would ruin their business, if not the country, if they were enacted. I am thinking of something that had to do with the financial structure of the country, but another one strikes me very interestingly and it is more appropriate to this discussion, completely aside from the merits of Mr. Forand's bill. Several years ago a spokesman for the insurance industry was before the committee and he was an unusual witness for this reason. This was when there was reason to believe that the wage level would be increased for OASI purposes. He said: I am a little embarrassed today, gentlemenor words to that effect. During President Wilson's administration at the time it was proposed that our servicemen be insured we appeared and I will frankly admit we drew a very dreary picture in our testimony of what was going to happen to the great insurance industry of this country if the President would permit the insurance of our servicemen to be handled by the Government. He said: I am sorry to say that what we predicted didn't happen. Just the opposite happened. It stimulated people who not only had some faith in insurance, but it got to people that hardly knew what insurance was. We enjoyed, great, great expansions in our business following World War I. When the Social Security Act was proposed we again vigorously opposed the act and spelled out again the adverse, if not devastating, effect social security was going to have upon the insurance business. He said: It didn't happen. We have enjoyed greater expansion than we even dreamt would take place since. And he admitted that each time improvements in the act were made or the wage level was increased they again appeared and warned the committee that great injury was going to be suffered by the insurance industry. He said: In each case it has not happened. The opposite has happened, so you can understand that I feel awkward today telling you again that if you enact this amendment we are going to be suffering. I don't know whether that knowledge could fit well into the history of the medical profession opposing many of these things, as Mr. Machrowicz said. I don't think that we are correct in stating their apprehension with respect to many amendments that have been enacted in the past. However, that has nothing to do with this. The proposal of Mr. Forand's amendment is a little different, but are you willing to admit that you could be wrong? Dr. ROBINS. Oh, certainly; I can be wrong, surely. Congressman King, social security is a rather young program in our country-some 20-odd years old now. At each session of Congress there are amendments and attempted expansion of the social security program. How do you and I know that this will not continue to be done to such an extent that the social security program may meet its downfall in the next few years? Mr. KING. That is all. Mr. BETTS. Mr. Chairman. The CHAIRMAN. Mr. Betts. Mr. BETTS. Doctor, from your observations of the English system were you able to determine what the solution is with respect to incentive for young men to follow the medical profession, say, son following father, and become doctors? Dr. ROBINS. Very definitely, I found out and they have physicians to substantiate this. Doctor Grant over in Glasgow told me this. Mr. BETTS. Who told you? Dr. ROBINS. Dr. I. D. Grant, of Glasgow, who is president of the College of Family Doctors over there-College of General Practitioners. I had a visit with him the other day in London. He told me, and this is documented, that 10 years ago 40 percent of the medical students came from medical families and that today, 10 years later, only 10 percent-which, of course, indicates to me that the son of a doctor apparently does not desire to follow in his father's footsteps. He sees what the father is going through and he has no ambition to study medicine and follow his father. Mr. BETTS. That answers my question, Mr. Chairman. The CHAIRMAN. Are there any further questions? Dr. Robins, again we thank you, sir, for coming to the committee. We appreciate the opportunity of having you here. Dr. ROBINS. Thank you, sir. Mr. BETTS. Mr. Chairman. |