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Dr. FORTUNE. Mr. Chairman and members of the committee, my name is Carl Fortune. I am a practicing physician in Lexington, Ky., where I practice internal medicine.

I am here today to present the views of the Kentucky State Medical Association on H.R. 4700, urging that this bill not be reported favorably by the committee.

Some 10 years ago the Kentucky State Medical Association, made up of more than 2,000 members, began to realize the necessity for the physician to do more than to treat the physical and mental ills of his patient. Now more and more physicians in our State have accepted the responsibility of helping the patient to solve his socioeconomic problems pertaining to medical care.

In 1949 the Medical Association sponsored and financed the Blue Shield medical care plan in the State that has had a phenomenal growth which has and is making it possible for 585,000 people to budget their medical bills.

The association has encouraged and worked with commercial insurance companies to develop similar plans.

The association and Blue Shield are now working in the State on the development of a special plan to provide medical care for the aged on a reduced fee basis that the patient with limited income and resources can afford.

In fact, Mr. Chairman, the medical profession in Kentucky for many years actually has been taking care of the aged, accepting a reduced fee or no fee at all, depending upon the patient's circumstances.

The association has supported a liberalization of the Workmen's Compensation Act and various public health measures which accrue to the public's improved health care.

Recently, after careful study, the Kentucky State Medical Association has set into motion a new policy expanding the health care of the aged in our State. Included in this program are requests for new construction and enlarging of present facilities for nursing homes; experimentation in the adding of a functional wing to existing hospitals for convalescent care; utilizing existing facilities such as heat, laundry, food, etc., thus cutting down on the overall costs.

This policy also calls for a visiting nursing service to provide for the chronically ill in the home, operating under the supervision of the family physician, closer cooperation with the nursing homes, and encouraging a program of education on making greater use of the skills of our senior citizens.

Apartments for the aged are being developed in urban areas of Kentucky. One such project will have nearly 200 units located in the downtown area where aged couples can live and in the event of illness they will be near to doctors and medical facilities.

Níembers of this association are actively cooperating with the Governor's Commission for the Aged in Kentucky. Eight physicians are on this Commission which plans to employ an executive director and is embarking on an extensive survey and action program in the State.

Kentucky physicians, working as a part of the health service team,

had their part in contributing to the situation which now finds the average life expectancy at the age of 70 instead of age 50 as it was at the turn of the century. In view of this development, we will do all we can to find the answers to this problem we helped create.

Tremendous strides have been made by the medical profession, hospital groups and the insurance industry in meeting the problems of health care for the aged. This is as it should be—it is the American way. This is the economical and effective way. This is the method that preserves the dignity of the individual, the integrity of the community. It is the way that has made the United States the great country it is. This would be destroyed if H.R. 4700 is enacted.

Gentlemen, you have been very kind to let us present this testimony; to give you reasons why we, in the Kentucky State Medical Association, feel H.R. 4700 should not be reported favorably.

May we close our statement by urging you to remember that this problem has always been handled at the local and State levels. There is every reason to believe that it is still the problem of the individual, his family, the community, religious groups and local political subdivisions working with the various private purveyors of insurance coverage to solve in the American way.

The CHAIRMAN. Doctor Fortune, we thank you, sir, for bringing to us the views of the Kentucky State Medical Association.

Mr. Watts, we thank you for your introduction of Doctor Fortune.
Are there any questions?
If not, thank you, sir.
Dr. FORTUNE. Thank you, Mr. Chairman.

The CHAIRMAN. Our next witness is Doctor Twente. Our colleague from Mississippi, Hon. John Bell Williams, is accompanying the Doctor to the witness table and desires to introduce him.

We are pleased to have you here, Mr. Williams, and we are glad to have you introduce Doctor Twente.



Mr. WILLIAMS. Thank you, Mr. Chairman.

Mr. Chairman, and members of the committee, it is my great privilege to introduce to the committee a very dear friend of mine of long standing, and a man recognized as one of the most skilled surgeons in the Southern States. He is Dr. George E. Twente.

Dr. Twente is not a native of Mississippi. He was born in Thebes, Ill., Mr. Mason's home State. Dr. Twente tells me that Thebes is a town of 90 people. As a matter of fact, he was born 7 miles out in the country. He was educated at the University of Illinois, interned and took his residency at St. Louis City Hospital, served in the military service during World War II as a major, and came to Mississippi about the same time that I came to Congress, about 13 years ago.

Since that time he has become a leader in his own profession. He is recognized throughout Mississippi as a leader in the medical profession there. His practice is limited to general and thoracic surgery. He is a Fellow in the American College of Surgeons, and Diplomat of the American Board of Surgery. He is a consultant in cardiac surgery to the Mississippi State Crippled Children's Service, and

instructor in surgery at the University of Mississippi School of Medicine.

Mr. Chairman, it is a privilege for me to have the opportunity to introduce my friend to this committee. I can assure you that he is well qualified in every way to speak on this legislation in behalf of the Mississippi State Medical Association.

The CHAIRMAN. Mr. Williams, we thank you for this very fine introduction of our next witness, Dr. Twente.

Will it be possible for you to conclude your statement in the 5 minutes allotted to you?



Mr. Chairman and members of the committee, I have with me Mr. Roland B. Kennedy, executive secretary of the Mississippi State Medical Association who will help me in case of questions.

The CHAIRMAN. Will it be possible for you to conclude your statement in 5 minutes?

Dr. TWENTE. Yes, sir.

The CHAIRMAN. If you omit any parts of it, do so with the understanding that it will appear in the record in its entirety,

Dr. TWENTE. To insure our compliance as to time allocation, I will merely summarize the text of our testimony, but I respectfully request that the statement submitted be included in its entirety in the printed record.

The CHAIRMAN. It will be.

Dr. TWENTE. We physicians appreciate your committee's focusing attention on the field of aging, something that we of medicine have long considered a matter of vital interest to all segments of American society.

In opposing H.R. 4700 we are not ignoring health care needs of our senior citizens. Conversely, we reaffirm our concern for, and dedication to providing quality and quantity medical care for all the citizens of our State regardless of economic circumstances, age, section, race, or creed.

Regarding these pursuits, we can report positive achievements in Mississippi in health care of the aged, mostly by non-Federal means.

Our Blue Shield-Blue Cross plan has developed a contract geared to the health needs of our senior citizens, or bringing both hospital and physician care at reduced rates.

Further, we are working with insurance companies and Mutual of Omaha is offering an excellent over-65 contract in our State. We are implementing a high impact program of scientific instruction for physicians at county medical society level, on health education and restorative and rehabilitative service for the aged.

Our programs for social economic research are being expanded in this connection. Growth of medical and related facilities in Mississippi since 1946 has been astonishing. With near optimum geographical distribution, we have constructed more than 3,350 additional hospital beds in 107 separate projects, bringing our total of acute

and special purpose beds to 13,300 in 144 licensed institutions, including a new 100-bed facility for the aged and chronically ill.

Our 78 licensed nursing homes offer 1,800 beds, and we are supporting expansion of this service. A threefold, nonduplicating care plan for the indigent is now providing, without Federal funds, (1) 98,000 days of care annually in all but 5 of our 82 counties, (2) 103 patientdays in 4 State charity hospitals, (3) 55,000 days of care in our new University Teaching Hospital.

In furthering these 256,000 days of hospital care for the indigent, each year our physicians provided professional service gratuitously, and this sound program is being further improved.

In our judgment, H.R. 4700 offers no solution not attainable by nonFederal means, but is but another step toward universal federalism.

We feel that this bill, if enacted, would impair both the quality and quantity of medical care, and consume huge tax sums, while failing in its stated purpose.

The European experience that nationalized health programs seems to prove that Federal medicine is not good medicine. The Mississippi physicians would not presume to come to your committee voicing abject negativism or seeking their own economic interests. We dislike having to interpret our position and dedication in terms of hundreds of thousands of days of cheerfully given unremunerated service to the aged and indigents.

In opposing H.R. 4700, and all similar measures, for the reasons stated, the Mississippi State Medical Association pledges its total energy and resources toward bringing quality and quantity medical care to all citizens of our State.

Thank you.

The CHAIRMAN. Thank you very much, Dr. Twente, for a very fine statement representing the viewpoint of the Mississippi State Medical Association.

Are there any questions?
Mr. Mason?
Mr. Mason. Mr. Chairman?
The CHAIRMAN. Mr. Mason.
Mr. Mason. I just want to say that while Illinois produces some
big men who have become leaders down in the South in medicins, the
South produces some big men who become leaders in Congress. The
man who introduced you is one of those.

Dr. TWENTE. We are very cognizant of that, sir.
The CHAIRMAN. Mr. Alger.

Mr. ALGER. I would not let the opportunity pass either to say the same thing that my distinguished senior colleage said. I concur. In regard to your statement, at the top of page 5, where it says, “unmet needs,” I can assure you that after listening for 5 days, as I have to the best of my ability, the proponents of this legislation, no matter how much commendation we may give them for building a fire rinder the whole subject, have not begun, to my mind, to produce any documentation showing that there is a need now for a Federal program. Your statement supports that. I want to commend you for that.

Dr. TWENTE. Thank you, sir.
The CHAIRMAN. Any further statements or comments?


Thank you again, Doctor.
Our next and final witness is Dr. Price.

Dr. Price, will you identify yourself for the record by giving us your full name, address, and capacity in which you appear. STATEMENT OF LEO PRICE, M.D., DIRECTOR, UNION HEALTH

CENTER, ILGWU Dr. PRICE. My name is Leo Price. I am from New York City. I am a physician and director of the International Ladies Garment Workers Union Health Center in that city. I am also a member of the American Medical Association and have been a member of its commission for the study of medical care plans. I also serve as a member on the medical advisory board of the Department of Health, Education, and Welfare.

The CHAIRMAN. Dr. Price, you are recognized for 15 minutes, sir. Dr. PRICE. I will be able to stay within the 15 minutes.

I am, and have been for years, vitally interested in providing health services to workers. The nature of the beneficiaries of the medical care program I direct has shown me the need of hospitalization insurance for old-age, survivors disability insurance beneficiaries.

The union health center in New York, owned and operated by the ILGWU, dates back to 1913, and was the first attempt of a union to provide some medical care for its members. Today, it serves 140,000 workers in the metropolitan area, providing ambulatory care for them. It is staffed by 140 doctors, 40 nurses and aids, about 50 X-ray and various diagnostic laboratory technicians, together with nutritionists, pharmacists, and a clerical staff of about 250. As many as 1,800 patients are served in a single day. In 1958, approximately 50,000 garment workers, both active and retired, received service at the center.

In addition to the medical care provided at the center, the health and welfare program of the union provides cash sickness benefits which vary among the 29 local units affiliated with the center. In general, however, these cash benefits are much below the present costs of medical services. An example is the common payment of $10 per day for hospitalization, very much less than the present hospital ward rate. Only one local contributes toward payment for home care, and only for home care of the member, not the retired member.

As of today, 57 percent of the patients are women, and 43 percent are men; 74 percent are over 50 years of age. In 1943, 1 out of 12 patients was over 65 years of age; now 1 out of every 2 patients is over 65 years of age.

For the entire group, the rate of utilization is 22 percent. Of the 14,000 retired members which we serve, the rate of utilization is about double, i.e., 45 percent. In some groups, as many as 75 percent come to the center, while in some of the younger people it drops down to 15 percent. However, the retired group as an average use the place twice as much as the active member. In some groups we have as high as 85 percent using the center. This group of retired workers, while they are entitled to receive ambulatory medical care at the center, are not eligible for hospitalization at $10 a day, surgical benefits, etc.

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