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Our reason for recommending the change to medical service rather than surgical service only in H.R. 4700 is that many of the chronic illnesses of older people which require hospitalization call for the services of a medical doctor and not a surgeon. Cardiac conditions are a primary example.

Medical rehabilitation for physical restoration purposes is another vital service which should be included. Arthritis and other crippling diseases which can be ameliorated through physical restoration services frequently require periods of hospitalization substantially longer than the 120-day maximum provided for in H.R. 4700. The results achieved in enabling such persons to become ambulatory and take care of their needs more than justifies the inclusion of this service.

The inclusion of disability insurance beneficiaries between the ages of 50 and 65 among those eligible for benefits under H.R. 4700 is our third recommendation. These individuals are faced with the same financial difficulties as persons receiving old-age pensions and should have adequate medical care available to them under this type of contributory insurance program.

According to the Social Security Administration, more than half a million old-age pension recipients are also receiving public assistance under the aid-tothe-aged program. Similarly, approximately 25,000 recipients of retirement pensions and disability insurance payments have found it necessary to go on the public assistance rolls in the aid to the blind and aid to the permanently and totally disabled categories. There can be no question that the high cost of medical care is a highly significant contributing factor. How much better it would be for the country economically and for the individual psychologically if he received adequate medical care because he had insured himself for it and no longer needed public assistance to make ends meet.

Approximately 175,000 blind people-or nearly half of our blind populationare over 65. Many are blind from cataracts and other conditions which frequently accompany aging. An adequate medical care program under the social security system would make many operations for sight restoration possible operations which just aren't being performed because the people concerned cannot afford them.

At the recent convention of the American Association of Workers for the Blind, held in Detroit, Mich., July 5--10, 1959, a resolution urging enactment of H.R. 4700 was unanimously adopted. This resolution was referred to the convention by the AAWB home teachers group, workers who know firsthand from going into the homes of blind persons how much good this type of insurance program would do and how much it is needed.

The American Foundation for the Blind respectfully urges the Committee on Ways and Means to take favorable action on the proposed legislation, incorporating the modifications recommended above.

HOUSE OF REPRESENTATIVES,

Washington, D.C., July 16, 1959. Hon. WILBUR D. MILLS, Chairman, Committee on Ways and Means, House of Representatives, Washington, D.C.

DEAR CHAIRMAN MILLS: Enclosed you will find a copy of a resolution adopted by the common council, city of West Allis, Wis., in support of H.R. 4700.

Your consideration in making the resolution a part of the record of the hearings
on this bill will be appreciated.
With best wishes, I am
Yours sincerely,

CLEMENT J. ZABLOCKI,

Member of Congress.

OFFICE OF THE CITY CLERK, CITY OF West ALLIS, Wis.,

July 14, 1959. I hereby certify that the attached is a true and correct copy of a resolution adopted by the common council, city of West Allis, Wis., at å regular meeting of said common council held on the 7th day of July 1959. (SEAL]

PHIL ELLIOTT, City Clerk.

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RESOLUTION 10103

By Alderman Sterzinger

Whereas there is presently pending in the Congress of the United States a bill known as the Forand bill, H.R. 4700, which provides for medical and surgical benefits to retired persons under the social security system and also provides for an increase in contributions for this purpose to the present social security fund by one-fourth of 1 percent for employees and one-fourth of 1 percent for employers and three-eighths of 1 percent for self-employed persons on earnings up to $4,800 a year; and

Whereas there are many West Allis residents who have attained eligibility in the social security system and are in need of such benefits: Now, therefore, be it

Resolved by the mayor and Common Council of the City of West Allis, That the city of West Allis is in favor of such legislation; and be it further

Resolved, That the city clerk transmit a certified copy of this resolution to Senator Alexander Wiley, Senator William Proxmire, and to Representative Clement J. Zablocki; and be it further

Resolved, That Senators Wiley and Proxmire and Representative Zablocki are hereby urged to favor this legislation. Adopted July 7, 1959.

PHIL ELLIOTT, City Clerk. Approved July 10, 1959.

ARNOLD W. KLING, Mayor.

STATEMENT OF THE MEDICAL AsSOCIATION OF ALABAMA

The Medical Association of Alabama requested appropriate time to testify before the Ways and Means Committee, in opposition to H.R. 4700. Since time was not available we trust that this statement will be included in the printed record.

I am Dr. M. Vaun Adams, of Mobile, Ala. I am a member of the house of delegates of the American Medical Association and chairman of the committee on legislation of the Medical Association of Alabama. I have been in the private practice of pediatrics for 28 years.

The membership of the Medical Association of Alabama is opposed to the philosophy of government which has been embodied in the Forand bill (H.R. 4700). It is contrary to the thoughts of the pioneers who made this Nation great, contrary to the thoughts of the responsible citizens (and taxpayers) who make their own living, who believe in individual initiative and self-determination.

Legislation of this type will, without doubt, socialize the practice of medicine, as it has in many other countries. It will eventually destroy and socialize all of the learned professions. This regimentation of the profession will tend to stifle the ambitions, dull the spirit, and have detrimental effects on the character of younger generations. Such mobilization, as is proposed, will result in the deterioration of medical practice as it is known today.

The tremendous progress of scientific medicine has been accomplished under the free enterprise system, without paternalistic governmental decree. It is unrealistic to assume that any bureaucratic agency, administered under political guidance, can ever hope to achieve such an enviable record. Where any type of legislation, interposes a third party between the physician and his patient, the gradual disintegration of health care is inevitable.

The medical profession strongly advocates the utilization of voluntary pre paid health insurance and hospital insurance. The evolution of newer types of insurance coverage, such as the deductible, the catastrophic and the participating are prime examples of progress in voluntary health insurance.

We believe that each State and county, particularly each county, should take care of those who are unable to care for themselves. In 1957, the Legislature of the State of Alabama established a plan for the care of the medically indigent. Appropriations will be increased every 2 years, according to the plan.

Even now approximately 50 percent of elderly persons, who are medically indigent, are already registered on the welfare program in Birmingham, Mobile, Montgomery, and Huntsville. We believe this is a community responsibility.

The medical profession is working, and will continue to cooperate and work with all agencies interested in solving the problems of the aged. Lest you be misled, however, only a small part of the problems of the aged are caused by lack of medical care. Many elderly people, because of fear or for other reasons, refuse to take advantage of available medical care. We must strive hard to preserve our own individual freedom as well as our community freedom.

Any discussion of social security, and its ramifications, naturally gravitates to economic feasibility and the national debt. It troubles many of us to watch the soaring cost of government during the last two or three decades. At some time in life every man must make an accounting of himself, to himself, and so it should be with the Government. The unpredictable cost of unrestrained social and health legislation could easily cause economic chaos.

The experience of other nations shows that the cost of executing compulsory health plans will far exceed the original estimates. There will certainly be a serious shortage in hospitals, nursing homes, beds, nurses, and in X-ray as well as medical technicians.

Without doubt, the ultimate goal of the sponsors of the Forand bill is the complete socialization of medicine, and then the socialization of dentistry and all the other professions. They are attempting to destroy a way of life which has accomplished great deeds and has also given us independence, individuality, and freedom.

The Medical Association of Alabama wishes to thank the Ways and Means Committee for the opportunity of presenting some fundamental and basic concepts, which we believe are of the utmost importance in a discussion of H.R. 4700.

STATEMENT OF JESSE D. HAMER, M.D., REPRESENTING THE ARIZONA MEDICAL

ASSOCIATION, ON H.R. 4700

Mr. Chairman and members of the Ways and Means Committee, my name is Jesse D. Hamer. I have been engaged in the private practice of medicine in Phoenix, Ariz., since 1928. I am a past president of the Arizona Medical Association, and I represent the doctors in my State in the house of delegates of the American Medical Association.

The doctors of Arizona are becoming increasingly concerned with the tendency which has grown in recent times whereby the Federal Government is looked to for the solution of problems which were previously handled by the individual, his family, or his local community. We sincerely believe that the fostering of this attitude can only result in a diminution of the freedoms Americans have historically enjoyed.

We believe that H.R. 4700 is but one more paying block on the road to complete Government control in the daily lives of Americans. We therefore oppose its enactment.

The committee has been informed of the programs already in existence or in the process of expansion in many of our States and communities which are leading to a solution of the health problems of the aged. This action has been stimulated, to some degree, by organizational promotion in each of the States in preparation for the White House Conference on Aging in January 1961. Recently 900 individuals gathered in a preliminary workshop preparatory to this conference at Ann Arbor, Mich. Under the direction of the Department of Health, Education, and Welfare, State and local groups are being encouraged to study and develop sound public health programs for their people and to exchange ideas concerning the most constructive experiments that are already in operation in many of our communities.

Health should be one of the functions of the community's total way of life; and furtherance of health goals should be dependent upon local initiative, support, and participation. Health should also be closely related to such factors as housing, nutrition, and the basic standard of living. Therefore, the first steps toward dynamic planning for health is the formation of local and State citizens' councils wherever they do not already exist to serve as the conscience of the community on all matters of general welfare.

These councils can bring together lay and professional groups for the study and solution of health problems not only for the aged but for all segments of the community. In many instances the local health department, State health department, hospital authorities, medical societies, public welfare departments,

State and local officials have joined forces. Such councils are gathering factual data to establish the nature of health needs and to develop methods for effective implementation of programs to meet them.

It is through the encouragement of these grassroot movements with intimate, face-to-face associations, and the satisfaction to be derived from the sense of sharing in a creative activity that these problems can and will be solved.

It is through such planning as the White House Conference on Aging that our citizens will learn by direct participation in planning for their own health and that of senior citizens that the problem is closely enmeshed with their daily lives. This can only end in a broadening and strengthening of the availability of local facilities.

In order to have fewer sick people, the development of preventive health programs based on constant research should go hand in hand with the expansion of curative facilities. We should have positive aims for the reinvigoration of the human mind, body, and spirit and not merely be interested in the alleviation of a suffering created to a great extend by our social defects.

Far too much of our welfare work is now devoted to compensating people for misfortune that might have been prevented. To be sure, we must protect the sick, the weak, and the incompetent. But it is high time that we spend more of our energies in protecting the well, the strong, and the talented if our Nation is ever going to develop its fullest human, civic, and ethico-political capacities. Our responsibility must be the creating and protecting of the gifted individual while improving the status of the less fortunate through health care or otherwise.

We accept the premise that good medical care should be made available for all the people. How can it be financed for the low-income groups? Can voluntary health insurance take care of the major needs for hospitalization and medical care?

We believe that it can be done_even with the lower income groups. Doctors historically have lowered their fees commensurate with the individual's ability to pay. Blue Cross and Blue Shield are making available new and better policies at a reasonable charge for the oldsters.

We, in Arizona, that is the medical profession and those charged with the responsibilities of administering hospitals, have through this State's Blue Cross-Blue Shield plan been doing something concrete and constructive about the aged for a number of years. In fact, we have engaged in this activity for nearly 10 years.

And just what has this activity been? First, let me say, it has been manifold in conception. For example, where aged people enroll in Arizona Blue CrossBlue Shield groups they have been eligible for coverage and benefits the same as anyone else regardless of how old they may be. Their ages, or the fact that they might utilize the services more frequently, have in no way affected their rates or placed limitation on their benefits. In other words, they have been eligible for coverage identical to that available to people at younger age levels. So this is prime example No. 1 of how we have been providing for the aged in our State.

Secondly, we have periodically made nongroup enrollment available to Arizona residents under 65 years of age. What this means is that people enrolling before they reach 65 on a nongroup basis could continue to carry their Blue Cross-Blue Shield after reaching 65 with no fear of cancellation, no reduction of benefits, or no increase in dues because of their age. It is a fact that many people, leaving their place of employment where they had hospital-surgical-medical coverage other than Blue Cross-Blue Shield, discovered that they had to give up their coverage upon termination or retirement. These same people have come to Blue Cross to get coverage to replace the commercial coverage which they lost.

Thirdly, in this connection, we feel it is pertinent to point out that a Blue Cross-Blue Shield member leaving a group is not terminated by the prepayment plan, but rather is carried as a direct payment member, regardless of his age or the amount of utilization registered against him.

And fourthly, only recently Arizona Blue Cross-Blue Shield has come forth with what is popularly known as a senior citizen certificate. This particular type of coverage is for people over 60 years of age with no age limit whatsoever. This, together with the previous group and nongroup coverages, now makes it possible for practically every bona fide resident of the State of Arizona who is in good health to obtain hospital-surgical-medical coverage. At the present time the senior citizen program is being offered on a semiannual basis. Our

senior citizen certificate has been offered to the general public very recently. It was advertised and promoted extensively, and a healthy response is anticipated.

Various independent insurance systems in industry, labor unions, and private carriers are offering policies for health protection to those aged 65 and over. To achieve a realistic goal, the medical profession will throw itself wholeheartedly behind all cooperative insurance plans whether for hospitalization or medical service. Altogether, we can foresee within the next few years most of the older generation who desire such coverage in possession of such a policy.

Health programs must be continually built from the individual and community level upward. The process need not be slow if the State and public health officers, the medical profession, and insurance industry will do their share and mesh their efforts with those of the hometown folks. With determination, applied intelligence, and constructive effort on every level of government, and between civic and professional leaders, we can continue to improve the health picture for all and make it possible for every American family to obtain the medical service it needs.

The Arizona Medical Association appreciates this opportunity to submit its opinion on this subject.

RESOLUTION OF ARKANSAS MEDICAL SOCIETY, FORT SMITH, ARK,

Whereas legislation has been proposed that would amend the Social Security Act to provide for the Federal purchase of certain health care service for social security beneficiaries; and

Whereas such legislation would further increase social security taxes which are already scheduled to reach 9 percent of payroll-up to $4,800 income; and

Whereas care for the older citizen calls for a flexibility of medical approach and technique—not the rigidity inherent in Government controlled programs; and

Whereas the proposed legislation is a political approach to a health program; and

Whereas a nationalized program of this sort would weaken the patient-physician relationship; and

Whereas a bureaucratic system for solving individual health problems of the aged would result in political abuses and administrative waste: Now, therefore, be it

Resolved, That the Arkansas Medical Society does hereby go on record against adoption of H.R. 4700 introduced in the 86th Congress by Representative A. J. Forand, of Rhode Island.

STATEMENT OF THE COLORADO STATE MEDICAL SOCIETY RE H.R. 4700, 86TH CONGRESS

AMENDMENTS TO THE SOCIAL SECURITY ACT

Mr. Chairman, my name is Irvin E. Hendryson. I am a practicing physician in Denver, Colo., and I am appearing here before your committee on behalf of the practicing physicians of the Colorado State Medical Society and also on behalf of the overburdened taxpayers of our State, who see in this proposed legislation, H.R. 4700, further establishment of bureaucracy, further waste, and further centralization at the Federal level of matters that we feel should be directly handled at the local level.

Aside from these indicated and obvious dangers, we feel it is our duty to warn you that this proposed legislation will not provide the kind of medical care that we all wish for the aged. The regulatory mechanisms written into H.R. 4700 in dealing with the contractual arrangements which will be made through the Department of Health, Education, and Welfare with hospitals and physicians, are certain to deprive the aged patient of his free choice of hospital and his free choice of physician. It will substitute a type of medical care which is far inferior to the high standards of medical practice as we know them today.

There are other ways of getting at this problem which have been tried in various forms in many States. In Colorado we have established a plan which has been in operation now successfully for a period of 18 months. It provides hospital, medical, and surgical care for recipients under our old-age pension plan. It permits the patient to select his own physician, and it permits him to be hospitalized in the hosiptal of his choice. There are no strings attached concerning which physician may be available under the plan. As it now stands the recipients of this medical care are provided the same care you would be provided in a private

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