data and experience gained in Bartholomew County will prove useful in the development of other similar programs in many counties of Indiana. The Indiana State Commission on the Aging and the Aged has from the outset evinced great interest in the study. Inasmuch as the State commission's funds do not permit establishment of community projects, the Bartholomew County retirement study is serving the commission as a laboratory and as a pilot project. It is our further belief that the information and data garnered in Bartholomew County will prove of value to many other communities in the United States and to the whole "aging" movement. Nationwide attention has already been attracted in many ways, as illustrated by the recognition given to this study by the U.S. Department of Health, Education, and Welfare in the February 1958 issue of its publication, "Aging." INSURANCE FOR THE AGED The physicians of Indiana have offered to the people of Indiana since 1946 a complete hospital, medical, and surgical insurance program. This protection has been available to all regardless of age, color, or creed. It has been available to all without regard to physical condition, and no physical examination has been required. It provides for complete payment for a semiprivate room in a hospital and full payment for all hospital services, regardless of cost. It provides for all professional services in the hospital, as well as emergency outpatient hospital services. In addition, it provides for payment for surgery in the hospital, home, or physician's office, and for the physician's call on the patient in the hospital for medical cases, surgery calls being covered under the surgery section. This program costs a single individual $7 per month or the family of two or more $12.40 per month. We are, therefore, of the opinion that H.R. 4700 does not meet the need nor solve the problem for the people who are covered or eligible for coverage under social security. We firmly believe it is only a vote-getting mechanism and a means to further increase the tax burden upon the people of this Nation. Under present findings on a national basis, less than 1 percent of the people will receive benefit from this program, and even that benefit will be limited. The truly indigent will not be covered, as the great majority of them are not participants in social security. We believe further study should be made of the people falling in this age group, and that such study should be made upon a local basis. This is the only true means of finding what problems, if any, exist, and then intelligently developing a program to met any found problems. We believe the proposals in H.R. 4700 are ill advised, unrealistic, and usurp from the people the right to exercise their own initiative in solving their needs at the local level. Therefore, we respectfully request your committee to continue to hold this proposed legislaton until such time as the communities of our Nation have an opportunity to complete work now being undertaken. Private initiative, self-reliance, and human ambition have been the strength in building our great Nation-not confiscatory taxes and Government paternalism. We work as doctors of medicine to extend the life and improve the health of the people of America-we do not subscribe to any program which would bring about moral decay in the self-reliance and self-initiative of these same people. Let us think about ways to rebuild our Nation and our people to new ambitions and new strength, and stop the weakening process which is a part of paternalism. We, the medical profession-and we feel we can say the same for the religious groups and the people of every community throughout the land-can assure you those who are unfortunate will not be allowed to suffer in want. But we believe we can accomplish this better and more economically than it can be done by Federal legislation. Thank you for the opportunity to present our views. TESTIMONY OF GLENN R. PETERS, M.D., ON H.R. 4700, THE FORAND BILL Mr. Chairman and members of the Ways and Means Committee, my name is Glenn R. Peters. I am a doctor of medicine, practicing surgery in Kansas City, Kans., and am currently president of the Kansas Medical Society. I am grateful for the opportunity Mr. Mills has afforded the medical society I represent to express our view on H.R. 4700, the bill intending to provide certain medical and hospital benefits to that segment of our aging population that can qualify under the social security program. The Kansas Medical Society and I, personally, as a physician, hope the committee will see fit to reject this measure upon the grounds that have already been presented to you by representatives of other medical societies. These include the radical expense Mr. Forand's proposal will incur upon the public, the deviation of this proposal from the standards of democracy upon which this Nation was founded, and the demonstrable fact that the benefits here offered can more adequately and more economically be obtained through other means. I wish to support the views of spokesmen from other medical societies on those arguments and beg to discuss only the last-mentioned point—the fact that other programs can offer a more adequate solution at less cost than is to be provided in the bill now under your consideration. First, by way of introduction, may I remind you that no one will deny the existence of a problem with reference to health care of the aged. We also admit to the argument that this problem is as yet in large measure unsolved. We must remember, however, that the problem is a new one which was not even anticipated when the present aged population was building its retirement program. In 1900 life expectancy in the United States stood at 49 years. The jump to 70 years was never seriously expected until it had suddenly been attained. So the problem came upon us before we were prepared to meet it. Even this is not as disastrous as may be deduced from statistics. I know that the aged ill are being cared for in Kansas. I know they will continue to be cared for and that the ability to pay is not a prerequisite for medical attention. Therefore, it is contrary to fact in my State to suggest this bill must pass if the aged are to escape neglect by the medical profession. We believe the aged do not want charity, and we propose they do not need charity, even when offered in the disguise of Federal assistance, whether it is doled to them from the right hand of welfare or by the left hand of social security. All over this Nation, and that includes the State of Kansas, people are now becoming dedicated toward giving our aging population a solution that will leave them independent and will retain for them the dignity of choice in their health care. In direct opposition to some public expression on this subject, I am convinced the average senior citizen would still prefer to handle his own affairs if the way to do so might be shown him. The suddenness with which this problem came upon us left everyone unprepared, but we have reason to be encouraged over the enthusiasm with which all segments of the population are exploring the subject. Today, we do not have the answer, but the answer will be found, and it will be a better solution than here offered under H.R. 4700. Of that I am sure. I am sure, also, that this better solution cannot be achieved if the present bill is enacted into law because the sheer magnitude of Federal intervention will stifle free enterprise. So it appears to the Kansas Medical Society that the Federal Government can afford to take a long and serious look at what is being tried, that calm judgment should rule on whether such efforts have a reasonable chance for success, and that the gentlemen on this committee should weigh with care the question of whether the Federal Government would serve the aged better by assuming their obligations and prescribing the circumstances of their care or by assisting local or private projects that could function if a stimulus were offered. In Kansas we are trying a variety of experiments and will attempt still more in a most sincere effort to solve this problem. Commercial insurance companies, national as well as local in scope, are now searching statistics for an estimate of the basic cost for health care of the aged. We have a firm commitment from some, and believe others will follow, that they will write such insurance at cost with no profit to the company if the medical profession will contract to make this a service, as contrasted with an indemnity plan. In Kansas we already operate a service program under Blue Shield, and I believe I know Kansas physicians well enough to gamble they will do this for the aged population, also, if the fees for service are at least reasonable and if insurance companies will prepare contracts with realistic benefits. We are spending many hours on this effort and believe a low-cost insurance-type program can be evolved that the aged will like, that the insurance company can sell, and that the physician will respect. The variations open under such a plan are endless. Could, for example, Blue Shield write the basic coverage, only, and leave all supplementary benefits to other insurance companies? Could more hospitals, as are some in Kansas at this time, build separate convalescent or nursing home units where day care is drastically cheaper than hospital rates can ever become? Could there be value received from an experiment now conducted in one county in our State where Blue Shield is paying home nursing care and even housekeeping expenses where necessary to convalescents who, except for such care, would have to remain in hospitals? Is the work of the Health Insurance Council which, in Kansas at least, consists of representatives of health care agencies in addition to insurance companies of interest to the Federal Government? All these and others are being considered. Some are in operation. Others will be soon, and in other States the story is similar. Studies are now underway also at the Federal level which could well point toward solutions that might make H.R. 4700 an ill conceived and regrettable action. It appears to us that not only would a long look be advisable, but any action taken before these surveys have had an opportunity to prove themselves would be most unfortunate. We will be happy today or at any time to give you the details of all the projects we are exploring. I did not do so now in deference to the extreme pressure upon your time. I do, however, most respectfully suggest that the people of this Nation have a remarkable ability for working out their destiny even in the face of considerable odds. It appears to us in Kansas that the new problem of the aged is not exceptional in this regard. Until now, health insurance coverage simply wasn't available to the aged. We do not know they cannot pay a reasonable amount for this nor that these people or their families might not prefer to do so. We do not know yet whether present costs might be sharply reduced if physicians, hospitals, pharmacists, and insurance people cooperate toward that end. We have begun an effort to learn that answer. We do not know whether people might like to purchase a health policy during earlier years that will be paid in full when they reach the age of 65, with benefits available for life. There are a great many other questions which might be answered without Federal intervention if a little more time could be obtained. I have tried to present an argument through the introduction of a question. The point is philosophical as to the proper role of Government in the personal affairs of its citizens. I can and will be pleased to support with detailed accounts the suggestions I inserted as illustrations, but for the purpose of my present intent, I think the position of the Federal Government is the basic problem. Quite simply stated, if it is less than politic to do so, I would close my presentation by most respectfully suggesting that providing health care for senior citizens is each individual's responsibility. Once an adequate insurance plan is devised, should family, private, and local resources remain insufficient, the Federal Government might then become much concerned. But for the Federal Government to provide benefits regardless of need before either the problem or its ultimate solution is understood and before other resources have been explored, as will be the case if H.R. 4700 is now enacted into law, appears to me to be not only an unnecessary Federal activity, but quite probably unduly expensive for all citizens, and certainly out of keeping with the position I believe the Government should adopt in domestic intervention. This last is my personal conviction, but I firmly believe it to represent the opinion of the great majority of the members of the Kansas Medical Society for whom I speak, and in this belief, I submit that opinion as the principal reason the Kansas Medical Society at this time opposes the passage of H.R. 4700. I wish to thank Mr. Mills for granting me this opportunity to express my views and each member of this committee for your courtesy. RESOLUTION OPPOSING THE FORAND BILL Whereas legislation has been proposed that would amend the Social Security Act to provide for the Federal purchase of certain health care services 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 problem; 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 Louisiana State 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. MAINE MEDICAL ASSOCIATION, Re H.R. 4700, the Forand bill. The Honorable WILBUR MILLS, Chairman, House Ways and Means Committee, DEAR MR. MILLS: After due consideration of this proposed legislation, the Maine Medical Association does hereby go on record as unanimously opposed to H.R. 4700, the Forand bill. Very truly yours, CARL E. RICHARDS, M.D., Chairman, the Council of the Maine Medical Association. THE MASSACHUSETTS MEDICAL SOCIETY, Hon. WILBUR D. MILLS, Chairman, Committee on Ways and Means, MY DEAR MR. MILLS: The Massachusetts Medical Society is strongly opposed to H.R. 4700, the Forand bill. Our members are aware of and disturbed over Federal encroachment on the practice of medicine via social security legislation, and as responsible citizens, we cannot help but be alarmed at the constant amendments to the Social Security Act made without regard for the ultimate soundness and stability of the program. We recognize that there is definitely a problem of providing hospitalization and surgical care for certain elderly persons. But, we feel that precipitous action by Congress to provide such care through the Social Security Act is dangerous not only to the national economy, but also to the practice of medicine. We suggest that before Congress acts hastily the program be studied carefully in order to determine the extent of the problem and whether or not it can be solved on a voluntary basis by Blue Shield, Blue Cross, and private insurance companies. Steps have already been taken in Massachusetts to solve the problem. Blue Cross and Blue Shield have eliminated the 65-year age limit for original enrollment. It is estimated that more than 40 percent of the 500,000 persons over 65 in Massachusetts are protected by Blue Shield. Health insurance protection for elderly persons is fast becoming as prevalent as it is for the employed population, shown by the fact that the gross of coverage for the aged population has, in large measure, come about in the last 5 years alone. We should like to stress that it is unknown what percentage of the aged population is actually medically indigent and cannot afford medical care. It is emphasized that a good percentage of this group may in all probability not be affected by enactment of H.R. 4700 because they are not social security beneficiaries. Although social in nature, these questions are pertinent: What would be the effect of such legislation on the moral fiber of the young people? Will they forego preparing for old age knowing that the Government would take care of them in the declining years of their lives? Will children of aged persons no longer feel a responsibility for their care? We believe that once such a bill is enacted, other segments of the population would take steps to become included, and from the proved experience of the disability provisions of the Social Security Act, there is no reason to doubt that there would be attempts to lower the age to 60, then 55, etc. We feel that the health insurance industry has already proved its ability to handle the extensive insurance needs of our growing population and that adequate coverage of citizens 65 and over is becoming well established. We urge that you oppose H.R. 4700. CARL F. MARALDI, M.D., Chairman, Committee on National Legislation. MINNESOTA STATE MEDICAL ASSOCIATION, Representative WILBUR D. MILLS, Chairman, Ways and Means Committee, DEAR CONGRESSMAN MILLS: The physicians of Minnesota fully recognize the health care needs of our older citizens and are totally sympathetic toward development and expansion of effective and sound methods of meeting this need. Together with the people of Minnesota, we are actively improving and augmenting medical care facilities as outlined below. Hospital and nursing home construction in Minnesota both public and private, has shown rapid growth in the past several years, and at the current rate of growth, it will approach the ideal requirements in the near future. In Minnesota we have already reached 93 percent of the ideal number of first-rate general hospital facilities for the State as set out by Hill-Burton standards. With regard to nursing homes, the 1957 Minnesota Legislature considered but did not pass a Hill-Burton-type measure to stimulate construction of new facilities. In the interim, the need for new nursing homes having been demonstrated, private, public, and church organizations have been busily at work. So much has already been accomplished that the 1959 legislature gave only casual consideration to the previously proposed measure. Progress is so rapid that additional requirements, as established by the Minnesota State Department of Health, have been reduced from 7,006 beds just a year ago to 4,980 at the present time. This remarkable progress by voluntary effort will be further augmented by legislation just passed that empowers municipalities to build and operate nursing homes. For the medically indigent group of people over 65 years of age, comprising 7 percent of our senior citizens in Minnesota, and 0.7 percent of our population, unlimited medical care is now provided, with local administration and free choice of physician and facility without the restrictions imposed by H.R. 4700. For the remainder of our senior citizens, some 300,000 in number, steps to provide medical care at reduced rates are being taken. These are in the form of reduced insurance costs, reduced fees, and lower hospitalization costs. These are exemplified by a new low-cost service-benefit Blue Shield plan for those over 65; the development of minimal-care units in the hospitals; and the establishment of nursing homes adjacent to existing hospitals. Our industries are using and expanding prepayment insurance plans for retired workers, and unions are making plans in connection with welfare funds. The physicians of Minnesota are actively participating in the solution of the general problems of the aged by full cooperation with other groups and other disciplines of endeavor. They represent a nucleus of citizens eager to help any plan which might solve the increasing health problems of our older citizens. The physicians of Minnesota are opposed to H.R. 4700, however, for the reasons given below, and we urge instead encouragement of existing mechanisms to successfully meet the problem. Exact information is lacking as to the needs of the aged for health care. One has only to review the lack of information demonstrated by the planning committees for the 1961 White House Conference on Aging at the local levels and to note, also, the resultant creation of the large number of local and regional groups for this purpose. No clear-cut, concise data are available, except as impressions. To embark on a program of legislation of the type outlined in H.R. 4700 at this time is akin to treating a patient without making a diagnosis. The kind and amount of medical needs of the aged should be accurately determined before legislation is considered. |