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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

hospital of your own choice with care being supplied by your own private physician.

Through legislative enactment funds have been set aside and the Blue Cross and Blue Shield plans have been designated as the fiscal agents for Colorado's hospitals and doctors, almost all of whom are cooperating thus in giving health care to our aged. In effect these pensioners are holding Blue Cross hospitalization and Blue Shield medical care coverage and are using it in the same fashion as though they were buying insurance themselves. In this particular instance the funds are paid from various State excise and sales taxes. The care is still being administered, however, at a local level where we have an opportunity to see actually what the aged pensioner is receiving for his money.

We have a strong feeling against the Federal Government becoming involved in this type of health care. Predominately we worry in Colorado about the tremendous shrinkage in tax dollars that pass through the Federal Treasury. When we send a dollar to Washington it comes back to the community as a mighty small piece of change. We are sure that this is wasteful and extremely dangerous, with taxes ever mounting and becoming an almost insufferable burden to bear. We of the medical profession have been accused of narrow sightedness and selfinterest in opposing this legislation. These charges are made by people who themselves have special interest in the legislation. Health, gentlemen, in all of its aspects and ramifications is our business, just as government is your business. We do have a better working knowledge of what is good and what is bad in health matters as regards the general population than any other group. We doubt very seriously that the Hoffas, the Becks, and the Reuthers have contributed anything to the advancement of modern medical care, as we know it today.

The very fact that has brought the problems of the aged into focus is the increase of life expectancy during the past 55 years. It is medicine, with its skills and techniques and its devotion to duty, which has raised the estimated expectancy from 47 years in 1900 to 70 years in 1955. During all of this time it has been the system of medicine that has evolved in this country (the greatest the world has ever known) which is responsible for this change. For a few persons now to suddenly come on the scene and insist that what American medicine has been doing for 55 years is wrong and that only they know what is best in medical care is absurd. The choice that is being presented seems to be for our country to abandon all that we have that has proven to be workable and good, in favor of a type of Federal centralization and control which has been proven in other countries to be inferior.

I would like to urge, gentlemen, that this proposed legislation be discarded and that every encouragement be given to the care of our aged at the local level by whatever plan seems to best fit each given situation. It is common knowledge that the growth of voluntary health insurance plans, even in its short history of operation, has already covered a large segment of the aged population. This can be increased and strengthened if given a chance. The free enterprise system is not dead, gentlemen, nor is it decadent. If given only a fair chance it can solve the problem which we have before us. The solution is not in wasteful Federal centralization and control. This approach to the problem will only lead to compounding more problems as time goes on. The ever-increasing population of the aged will assure this. Their medical management cannot be accomplished by waving the magic wand of Federal legislation followed by the creation of another bureaucracy with all of its weaknesses and faults. Aging is a continuing problem that we all must face and it should be faced at the community level.

STATEMENT OF THE CONNECTICUT STATE MEDICAL SOCIETY, RE H.R. 4700, 86TH CONGRESS, SOCIAL SECURITY AMENDMENTS OF 1959, BY ELLWOOD C. WEISE, SR., M.D.

I am appearing here today as the representative of the 3,220 physician members of the Connecticut State Medical Society, who have authorized me to present the views of the medical profession in my State concerning the Forand bill, H.R. 4700.

It is the considered opinion of our society that H.R. 4700 is not merely another program which, if enacted, must of necessity increase the already heavy burden of taxation on all the people. While the unquestionably tremendous cost of this scheme is a matter for major concern to every taxpayer, our examination of the

Forand bill has disclosed in it a basic but undeclared provision which is of far greater importance to Americans than money. This well-concealed foundation on which all of the other provisions rest, reflects a philosophy which we believe to be foreign to our way of life and one which seeks to make legal the abrogation of the cherished freedoms of every man, woman, and child in the Nation. Connecticut doctors have always viewed Forand-type bills as pieces of "foot in the door" legislation, which are designed to further break down the traditional American system and open the way for full-scale Government control of our economy. Once the basic freedoms of those who provide medical care have been surreptitiously taken away, the writing will be on the wall for every other productive segment of our still comparatively free society. Nor will the inalienable rights of the present and future recipients of medical care on these terms remain inviolate.

This was the primary reason which caused our house of delegates, on April 29, 1958, to go on record as being opposed to the Forand bill and allied bills. This opposition was neither blind, nor selfish, nor political. Since 1958, our attitude toward the Forand bill has not changed. We still consider it to be a costly, illconceived, and potentially dangerous legislative measure to which we are unalterably opposed.

Over the years, refinements and modifications of the original proposals have been made, each designed to entice first one group in the medical care field and then another into lending their support to the bill. These several enticements have not had their planned effect. They have not been successful because they have failed to conceal the basic danger of the program. We fervently hope that the members of this committee will consider it significant that as recently as June 1959, a joint statement was made by the Joint Council To Improve the Health Care of the Aged, which was subcribed to by representatives of the American Medical Association, the American Hospital Association, the American Nursing Home Association, and the American Dental Association:

"All four member organizations of the joint council are unequivocally opposed to compulsory Government health insurance for any segment of the population." It has been frequently stated by some that organized medicine merely opposes legislation; that it has a negative attitude and that while rejecting the hastily contrived solutions to health problems offered by others, proposes none of its own. If indeed such statements were ever true in the past, it has been forcefully demonstrated that this is not the case today. Under the competent direction of the American Medical Association, component State and county medical societies all across the Nation have been diligently working to determine the health care needs of the aging and are giving their fullest cooperation to allied health agencies in the development of prepayment and insurance plans to meet these needs. This job is being done by people who are really qualified to undertake it and they are making almost unbelievable progress toward their goal, all within the framework of a free society and at almost no cost to the Government.

Connecticut physicians are actively participating in this work. Through the Connecticut State Medical Society, they have been represented at the First National Conference of the Joint Council To Improve the Health Care of the Aged. In preparation for the White House Conference on the Problems of the Aging, to be held in 1961, our Committee on Aging is planning to hold joint meetings with Connecticut chapters of the American Dental Association, the American Hospital Association, and the American Nursing Home Association and to participate with these agencies in a New England regional meeting for the purpose of working out methods of providing medical care to our senior citizens at reasonable cost. On April 28, 1959, our house of delegates unanimously adopted the resolution:

"That the Connecticut State Medical Society pledges its continued support to the development of effective health and prepayment programs for all individuals, including those over 65."

The society is conducting a relative value study which will be of aid to Blue Shield and private insurance carriers in making better programs with broader coverage available to those over 65 at the lowest possible cost.

In pursuing these several efforts, some rather startling facts have come to light.

(1) There are approximately 200,000 residents of Connecticut over age 65. (2) Of these, well over half have some form of insurance against hospital costs, more than 100,000 being entitled to protection by Blue Cross alone.

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