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Mr. Chairman, Dr. Harold Miller, one of our respected family physicians of Woodcock, Va., one of our rural areas, accompanies me. He will not testify, but will help me in some of the questions which may be asked. He is also a counselor of the Medical Society of Virginia.

Personally, as past president of the American College of Radiology and the Medical Society of Virginia, and a member of the house of delegates of the American Medical Association, I have been long concerned with the problems being considered so earnestly by this committee.

As the other medical societies which have presented statements or sent letters to this committee, the Medical Society of Virginia is vigorously opposed to the enactment of H.R. 4700.

Without going into the details as to our reasons for this opposition, suffice it to say that we sincerely believe that a program of this nature would be bad from the viewpoint not only of the aged beneficiary, but the entire population as well.

When services are provided as free they generally are cheapened in the eyes of the recipient and there is a tendency toward abuse. The most common abuse is unnecessary or overutilization which would reduce the availability of facilities for the acutely ill. This, of course, also unnecessarily adds to the cost of the service.

Another feature that must be considered would be the cost of Federal administration.

As I stated previously, for 35 years I have been head of a department in a State teaching institution. It is my very definite observation that the further administration gets away from the recipient the more brokerage there is in administration and the more costly the operation per item becomes.

It is our opinion that the medical care requirements of the aged are being met constructively. Moreover, they are being met at the local level by the voluntary, coordinated effort of many thousands of dedicated men and women.

Many organizations concerned with the care of the sick have been and are doing much to work out a solution, not only of the medical, but of all the problems of this group.

May I insert parenthetically that the Virginia Council of Health and Medical Care, consisting of representatives of all the voluntary agencies concerned with health in Virginia, has and is doing an excellent job and has been complimented on editorially in the New York Times and in other papers throughout the Nation.

Obviously the rapid increase in health care insurance in the recent past has done much to relieve the problem. This past year has seen a tremendous growth in the number of programs offered specifically to the aged. Admittedly, these programs can be improved. We are sure they will be. Before one can walk, one must crawl.

We are convinced that the mere existence of a problem does not necessarily mean that the Federal Government must enter the pic

ture.

In my own State of Virginia, in response to the resolution of the American Medical Association's house of delegates in December 1958, a special insurance policy related to the maximum income of social security recipients is under serious consideration. We are con

vinced that as programs of this nature become more widespread, the competition of the marketplace for the ever-growing number of the aged can only result in better and better coverage for this group.

As an example of that I have with me a letter that I got under date of June 15, addressed to the Medical Society of Virginia for the proposed senior citizen contract by Blue Cross and Blue Shield.

This committee will also be interested to learn that the Medical Society of Virginia has 47 component societies, most of which have local committees appointed specifically for the purpose of establishing programs for the aging and chronically ill.

Surely such efforts as these deserve the opportunity to solve the problem that exists, and in the manner in which important problems of this type have always been solved, at least by us, at the local level.

It is recognized that some unfortunates may not be able to meet even the reduced cost of the policies now being considered by the Virginia Blue Shield and those available through commercial carriers. Historically these have been the responsibility of their families, their local communities, and their State.

In Virginia those who are unable to pay are provided the best possible care through the cooperation of the medical profession, the hospitals, the druggists, and the local communities. This is as it should be.

The Medical Society of the State of Virginia, therefore, believes that the Congress should leave to the States and local communities the responsibility for the solution of this problem.

As one who is reaching the end of a long medical road and sees the gates of the retirement pasture opening to receive him-that is 1 year and 2 weeks from today-may I beg you gentlemen to block any noble experiment I remember prohibition too vividly-and withhold decision until all of the facts are in. Please protect our descendents as well as ourselves.

May I parenthetically put in a plug for medical education, having been a medical educator for 35 years. There was brought out this morning the question of impact on medical education.

That is so true. Having served on the admission committee of the medical school, we are worried about the quality of the applicants to medical school. I grant that the numbers are still sufficient to fill all places, but the quality across the board-and that is not confined to the University of Virginia, the Medical College of Virginia—but all across the Nation talking to people, the quality, the average quality, of the medical student applying for admission to medicine is dropping due to a feeling of possible insecurity for the future.

This, gentlemen, is a real problem so far as medical education is concerned.

In behalf of the Medical Society of Virginia, I wish to thank the committee for this opportunity to present our views.

If there are any questions, I will be happy to try to answer them. The CHAIRMAN. Dr. Archer, we thank you, sir, for bringing to us the views of the Medical Society of Virginia.

Are there any questions?

If not, Doctor, we thank you, sir, very much.
Dr. ARCHER. Thank you, sir.

The CHAIRMAN. Without objection, the committee will adjourn until 1:30 this afternoon.

(Thereupon, at 12:20 p.m., the committee recessed, to reconvene at 1:30 p.m., same day.)

AFTERNOON SESSION

The CHAIRMAN. The committee will please be in order.
Our next witness is Mr. Tompkins.

Mr. Tompkins, although we recall your previous appearance before the committee, will you for purposes of this record again identify yourself by giving us your name, address, and capacity in which you appear?

STATEMENT OF PATRICK A. TOMPKINS, COMMISSIONER OF PUBLIC WELFARE, COMMONWEALTH OF MASSACHUSETTS

Mr. TOMPKINS. Mr. Chairman and members of the committee, my name is Patrick A. Tompkins. I am Commissioner of Public Welfare for the Commonwealth of Massachusetts and have been for 14 years. I am grateful for this opportunity to speak in support of H.R. 4700, legislation introduced by Hon. Aime J. Forand, Congressman from Rhode Island.

The CHAIRMAN. Mr. Tompkins, will it be possible for you to conclude your statement in the 15 minutes we have allotted to you? Mr. TOMPKINS. I am pretty confident I can.

The CHAIRMAN. If you omit any parts of it your entire statement will appear in the record.

Mr. TOMPKINS. Thank you.

I have devoted 31 years of my adult life to the profession of social work, the first 5 years in private family and children's agencies and the last 26 years, other than an interruption for military service in World War II, as a city, county, and State administrator of public welfare in the States of New York and Massachusetts. I have served on a number of national social work and public welfare committees including the policy committee of the American Public Welfare Association and as chairman of the National Council of State Public Welfare Administrators.

I have had and still retain an intense and continuing interest in the broad, national prospective of the Nation toward the disadvantaged of our fellow Americans and, despite the dramatic and spectacular attention frequently focused on killer diseases, juvenile delinquency, and the occasional contagious epidemics such as infantile paralysis, I have been and remain of the same conviction that the most challenging of all social problems in America today and for the foreseeable future is adequate, protective, and medical services for aged people. This committee with its staff has access to the many formal studies conducted by voluntary and governmental organizations representing city, State, and Nation that have been conducted during the last 25 years on the problem of aging. Some such studies have been particularly focused on specialized problems such as housing, employment, gerontology, rehabilitation, leisure-time interests and opportunities, retirement plans, or assistance plans. Others, such as the recently published study of the aging conducted by the Massachusetts

Commission on the Adult of State Needs, the newly developed study of the U.S. Senate, and the projected 1961 White House Conference on the Aging have been and will be more comprehensive and directed to the totality of the problem, the economics involved, plus specific procedural steps of a constructive character that must be taken to forthrightly meet and treat with all problems besetting aged people. There is no disagreement that certain of these remedial and corrective plans and programs should originate and in substantive measure be supported by local administration and the consolidation and use of all local resources both voluntary and tax supported. Others such as an economic floor for the basic maintenance of aged people in dignity and with decency, whether through the employment or retirement plans or the guarantee of adequate public assistance programs, require and demand the initiative, administrative leadership, and forceful implementation of the National Government.

The great Congress of the United States of which your honorable committee is such a cogent, wise, and prudent voice, with the enactment of the Social Security Act, formally declared in 1935 that the economic problems of people of America were of national concern and by corollary demanded national action. The Congress of that time, and seven subsequent Congresses, particularized the economic problems of the aged people of America by the original creation of titles I and II, respectively the old age assistance title and the old age insurance title of the Social Security Act. It is not without significance that these are the first two titles of this great and inspirational American Magna Carta for the American workingman and his family.

Indeed, it is not unreasonable to attribute the subsequent congressional improvements to the basic titles of the Social Security Act to many of the conclusions warranted by the many scientific studies of the problems of the aging.

Throughout this quarter century of progress, Congress has both prudently and with commendable foresight emphasized the high desirability of self-contributory insurance against the economic threat of old age. It has repeatedly extended coverage to uncovered groups of workers, broadened both tax and wage base, increased monthly benefits. Other improvements specifically directed to the economics of aging and improving the insurance title, and with which your committee is quite familiar have also been legislated into law.

The lion's share of this progress has been initiated in this committee or by your predecessors on this committee. You both individually and collectively are to be commended and the country at large to be congratulated on your continuing interest, research, and action with respect to this most challenging of all social problems facing America. In more recent years your committee has focused its attention and efforts on a specific phase of the economics of everyday life for the average, solid, decent American breadwinner and his family. The creation of both the disability insurance and assistance titles of the Social Security Act, the specific recognition of the major role medical care plays in the daily economic life of the needy by your medical care amendments of 1950, 1956, and 1958 give evidence that this fearsome, threatening shadow of the future, medical need and medical cost, have been of concern to Congress and specially the concern of your committee.

Over the years, a multiplicity of legislative proposals to meet this catastrophic threat to the unproductive years of our growing millions of decent, God-fearing, aged Americans have been presented to the Congress. None have been enacted to date. During my more than 26 years as a city, county, and State executive of public welfare programs, I have never observed and never known of the widespread interest, enthusiasm, support, and acclaim that H.R. 4700 has evoked. On this score, Mr. Chairman, I would like to offer for the record a resolution passed by the Association of Massachusetts Public Welfare Local Administrators on April 2, 1959, at which 196 out of 240 present on that date unanimously endorsed by resolution H.R. 4700, and I will offer that for the record.

The CHAIRMAN. Without objection, it will be received. (The material referred to follows:)

RESOLUTION

Whereas the legislative committee on Federal legislation has reported favorably on the intent of old age insurance hospitalization as contained in H.R. 4700, Mr. O'Neill, director of the Worcester City Welfare Department, introduced the following resolution:

"Be it resolved, That the Public Welfare Administrators Association of Massachusetts go on record strongly endorsing Federal legislation known as H.R. 4700, a bill to provide hospital, medical, surgical, and convalescent services to recip ients of old age and survivors insurance: And be it further

"Resolved, That this resolution be forwarded to the State Commissioner of Public Welfare, Patrick A. Tompkins, for presentation to the Congress of the United States."

The motion was seconded by Mr. Salvatore Abate of the city of Everett and was unanimously passed by the membership present.

The above motion was offered at the regular monthly meeting of the abovenamed association on April 2, 1959, and was attended by 196 of 240 duly enrolled members from the cities and towns of the Commonwealth of Massachusetts.

Mr. TOMPKINS. Although I have access to many professional bulletins and pamphlets, to reports of substantial and responsible committees of the aging, to many alternative proposals for financing medical care, I have not heard or read one forthright, or for that matter, even one thinly veiled suggestion that H.R. 4700 is not good medical care. To the contrary. The medical proposals in Congressman Forand's legislation seem to cross all the "t's" and dot all the "i's" of the philosophy of purchase of medical care as currently set forth by the American Medical Association and Massachusetts State Medical Societies.

The proposal provides for free choice of physician which in substance means that professional medical services begin with the general practitioner and then proceed on professional referral to the specialists, the hospital, the nursing or convalescent home and allied professional services such as nursing, therapy, and medication. Any declarative statement, implication, or innuendo that such medical procedures, fortified by Federal law constitute socialized medicine must, therefore, spring from ignorance of the facts, lack of kindly or charitable instincts, lack of knowledge of the scope and magnitude of both the problem and the legislation, blind opposition to social change, acceptance of the status quo, or a combination of these lacks of virtue. The method of payment is no different from methods presently employed by many units of Federal, State, and local government, including the Veterans' Administration.

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