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And I believe that you, as a committee, would not want to be responsible for a bill which will excel in pioneering in so many areas, but which might fall short in supplying the very essence of the success or failure of this whole program.

High standards must be included from the start relating to hospitals and, especially, nursing homes. If professional services are to be provided, I would strongly suggest that very rigid criteria of qualifications be established.

As we have learned from the painful experience of the Veterans Administration, standards can be raised only with herculean efforts.

The decision of designating the agency to be responsible for the administration of this program might well be delegated to the Governors of the various States, because the strength of State departments differ.

However, if this program is to be thought of as one of public assistance programs—which would be lamentable-it should be administered by the public welfare department, but if it is to be a plan which has to do with the health of individuals, then I feel most certainly the administration of this program should be the responsibility of the department of health, a department primarily concerned with dealing with doctors, and experienced in carrying on medical care programs.

The last suggestion I have to make is that certain sums of money be set aside to support and document the experience of programs demonstrating various methods of providing comprehensive care for older people. Valuable experience is already being accumulated along these lines by many of our member associations, in urban areas, that is, the Group Health Federation of Washington, D.C.; the Health Insurance Plan of Greater New York; the Group Health Cooperative of Puget Sound, and in rural areas by the cooperative in Elk City, Okla., Two Harbors, Mich., and the Rip Van Winkle Clinic in upstate New York.

A study of the high quality of services, and the amazing economies being provided in these medical plans may hasten the day when H.R. 4700 can afford the ideal in health benefits, that is, truly comprehensive medical care.

In conclusion, I would again like to thank you on behalf of the Group Health Assoociation of America for this opportunity of appearing before your committee, and to say that because of the obvious need for legislation such as H.R. 4700, and because it embodies so many of the principles for which our association stands, we sincerely hope that this committee will find it possible to effect passage of this bill without further delay.

The CHAIRMAN. Doctor, we appreciate your bringing to us today the views of the Group Health Association of America.

Are there any questions of Dr. Esselstyn?

Mr. FORAND. Mr. Chairman, Doctor, first of all, let me compliment you on your paper and thank you for bringing in some suggestions, something I have asked for, but received very little of.

Now, I would like to have your comment on the great concern that seems to have been expressed during these hearings on the physician-patient relationship.

Would you care to comment on that?

Dr. ESSELSTYN. I think a great deal has been said about the effect of this program on the physician-patient relationship. A great deal has been said about the effect of group practice on the physicianpatient relationship.

I think the method of remuneration of doctors, the way they are organized, has very little to do with the doctor-patient relationship.

If the driving force of a doctor is in interest of people, it is not going to be affected by the method of payment of the organization under which the care is provided.

Mr. FORAND. Do you agree with me that in this great opposition that has been voiced by the members of the medical profession represented by the American Medical Association, for instance, is because they fail to see the point, they fail to see the difference between a proposal to finance a program and the control of medicine as they seem to interpret my bill to be?

Dr. ESSELSTYN. I feel very strongly that this bill would not control medical practice. It would make medical practice as the doctor wants to practice it more available.

Mr. FORAND. Thank you very much.
The CHAIRMAN. Are there any further questions?
Mr. King.

Mr. King. Doctor, it has been suggested that if older people are entitled to hospital benefits through the social security system there would be a great deal of abuse of such benefits and unnecessary utilization of hospitals.

Will you comment on that, on the basis of your experience ?

Dr. ÉSSELSTYN. I think the catch in that question is the word "unnecessary.

It seems to me that there are a great many unmet needs right now in this age group. I am sure that if a program like this were to be implemented there would be a backlog of unmet needs which would make at the start a certain amount of hospitalization necessary, which would represent not the current, but the backlog of needs.

I think after this was taken care of there would be no further great surge in this direction, especially if diagnostic services were made available outside of the hospital.

Mr. King. You do not believe that the average patient will acknowledge that there are persons who will seek attention for frivolous reasons?

Dr. ESSELSTYN. I think there is a great deal of evidence to show that this will not happen. The group health insurance plan of New York has some statistics. Among them is the fact that with the unlimited use of medical care the average use is only 5.2 physician services per year.

So that when there are ways and means developed so that medical care which is unlimited is available it is interesting to see that this is not abused, that this is something which strikes an average and which can be foretold on an actuarial basis.

Mr. KING. You feel, then, that the type of patient which would insist upon going to a hospital, even over his or her own doctor's advice, would be at a minimum ?

Dr. ESSELSTYN. Very definitely. I think it would be an insignificant minimum.

Mr. King. As I understand from the discussions yesterday, one does not enter a hospital until a doctor approves.

Dr. ESSELSTYN. That is right.
Mr. King. That is all, Doctor, thank you.
The CHAIRMAN. Mr. Alger will inquire.
Mr. ALGER. Doctor, I have two questions:

On page 3 at the top of the page you mention the profit motive as being an honorable one. You recognize also that treatment of the sick should not be measured in dollars.

I think I get your viewpoint thoroughly. It makes me uneasy and I am expressing a feeling, hoping that you will ease my mind.

Sometimes we pass legislation here that in some ways tries to change human nature. The doctor is only a human being. The profit motive in our country is an incentive feature. When we take away from them incentive, no matter how great the humanitarian in each of us, when we take away any of the incentive, the incentive of profit, ultimately human beings will not do as much as they can do.

Now, I did not write these rules. I just observe them in human beings, including myself. This makes me uneasy.

Do you not feel profit motive as an incentive has a place in the scheme of medicine?

Dr. ESSELSTYN. No; I don't, very definitely. I feel that the present method of remuneration of doctors is very unfortunate and is very rapidly being changed as you, I am sure, realize, because today over 35 percent of the doctors in the country receive at least part or all of their remuneration on some method other than a fee for service or piecework kind of basis.

I feel that the person who is in medicine today is in there because he is a dedicated person just as the professor in college teaches, not on an incentive basis, but on the fact that this is the way he wants to spend his life.

I feel it is the way the doctors should practice and will practice and are getting to practice more and more every day.

I think the incentive motive is a very small one and should be removed.

Mr. ALGER. I certainly appreciate your viewpoint and bringing the subject up.

I have one other question.

On page 5 you quoted Dr. Blasingame. I am not acquainted with the statement he made, and I hardly know Dr. Blasingame, but I listened very carefully so far as I could, I reread most of the testimony. So I feel I am fairly close to what some of the doctors are trying to say and some of the proponents. You quote here, quoting Dr. Blasingame:

6* * * is to stop any further Government intrusion in the field of medicine, no matter how worthy the

If Ì may paraphrase what I feel to be the American Medical Association's feeling as they have expressed it here, it is that through Government legislation and compulsion the medical service will be poorer, the quality of medical service will actually be less, and when they say, “no matter how worthy the cause," I think the point there is, if I get the point, that here again we are confusing a need in our

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minds with the fact that immediately, since there is a need to improve medical care, whatever the need, there must be a Federal solution.

I believe that the doctors have made it plain to us here that whatever solutions there may be and working with Mr. Forand and under his stimulation to find the answer, it is not necessarily in the realm of Federal compulsion or Federal legislation.

Does that seem a fair interpretation of what Dr. Blasingame might have meant ?

Dr. ESSELSTYN. No. Actually, the context in which he put what it was was a discussion of Federal aid to education and research.

I think, however, you have to realize that the American Medical Association today is not a united organization. There is a very strong and growing minority who have very definite feelings.

The American Medical Association today is changing very rapidly.

I think the action of the association in Atlantic City, and I am sure you are familiar with this, in which they endorsed group practice and closed panel plans, is just an evidence of the great social conscience which is beginning to come in this organization under such enlightened leadership as Dr. Leonard Larson, who appeared here before this committee.

I think we have great faith in the future of the American Medical Association. You give them 5 minutes more and they will be on the positive side of this program.

Mr. ALGER. Maybe the appeal then for time which has been asked here several times before is well grounded. I guess all of us agree that if the doctors themselves did not disagree, they would not be human because I do not know of any groups in this world who do not argue among themselves, including families.

That is all, thank you.
The CHAIRMAN. Are there any further questions of Dr. Esselstyn?

Doctor, we thank you again for your appearance and bringing your views to the committee.

Dr. ESSELSTYN. Thank you, sir.
The CHAIRMAN. Our next witness is Mr. John G. Galloway.

Our colleague from the State of Alabama, Mr. Huddleston, will introduce Mr. Galloway.



Mr. HUDDLESTON. For the record, I am George Huddleston, Jr., the Congressman from the Ninth Alabama District.

It is a privilege to present the next witness to this great committee, Mr. John G. Galloway, who is appearing here to represent the International Association of Accident and Health Underwriters.

He is an outstanding member of my constituency. He comes from Birmingham, Ala., and has long been active in the civic affairs of that community.

As one of the founders and presently a member of the board of directors of the Birmingham Better Business Bureau, he has rendered yeoman service in the cause of civic improvement.

As past exalted ruler of the Elks of Birmingham, and a Mason, a Shriner and teacher in the adult Sunday School class of a Methodist

Church in Birmingham, he has made substantial contribution to the life of our community.

Mr. Galloway has been in the accident and health underwriting profession for better than 20 years. Practically all of his adult life he has spent in this particular occupation.

He is a past president and member of the board of directors of the International Association of Health and Accident Underwriters. When he speaks on the subject under study by the committee today, I am sure he speaks from a vast store of experience and personal knowledge.

Mr. Galloway has with him here today the present president of the International Association of Accident and Health Underwriters, Mr. Oakley Baskin from Buffalo, N.Y. Mr. Baskin, I understand, will not testify, but will asist Mr. Galloway in his presentation.

I thank you, Mr. Chairman. The CHAIRMAN. Thank you, Mr. Huddleston, for your introduction of Mr. Galloway.

Mr. Galloway, you are recognized, sir, for 15 minutes. STATEMENT OF JOHN G. GALLOWAY, ON BEHALF OF INTERNA


Mr. GALLOWAY. Chairman Mills, and members of the committee, I want to thank Hon. George Huddleston for his gracious presentation of me to this committee. I assure you that it is indeed a pleasure and a privilege for me to have this most unusual and outstanding opportunity as a layman and a small business man from Alabama.

During the past 20 years, as he says, I have faithfully served the people of Alabama as an independent insurance agent.

As is true of most insurance men, I have tried to be active in civic and community work and hope I have contributed something in my small way to the service and betterment of my country and my profession.

My name is John G. Galloway, from Birmingham, Ala. I am an independent small businessman and have been engaged in the insurance business during the past 20 years as an agent and general agent representing a number of different insurance companies on a straight commission basis.

I am here today representing the International Association of Accident and Health Underwriters, composed of 90 local and State affiliated chapters, organizations comprised of persons active in the merchandising, distribution, and servicing of health insurance.

I am sure I also voice the sentiment and feeling of many thousand insurance agents throughout the country.

We are the people at the grassroots level who sell health insurance to the public.

I agree in full with certain previous witnesses, such as Mr. E. J. Faulkner and wholeheartedly endorse all that he has said.

We are opposed to H.R. 4700.

We recognize the work, thought and humanitarian goals that Representative Forand had in mind in drafting this bill, and the leadership he has exhibited in trying to do something for the aged. We are

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