STATEMENT OF THE MEDICAL ASSOCIATION of Nevada, RE H.R. 4700, BEFORE WAYS AND MEANS COMMITTEE, HOUSE OF REPRESENTATIVES, BY LESLIE A. MOREN, M.D.

Mr. Chairman, I am Dr. Leslie A. Moren, a general practitioner, member of the Elko Clinic, Elko, Nev. I represent the Nevada State Medical Association though the views I express are shared by many other responsible citizens, from all walks of life, in Nevada. We wish to register before this committee our opposition to H.R. 4700, known as the Forand bill.

We oppose this bill in its entirety as a matter of principle, and will not take up the time of your committee discussing individual features or proposals contained in H.R. 4700.

First, H.R. 4700 represents unwarranted regulative interference by the Federal Government in a sphere of human problems that are more expeditiously and less costly handled on the State and local levels. We in Nevada have had many examples of bureaucratic controls handed down by rigid regulations coming through channels and working to the detriment of our citizenry. We are fed un with such controls, having the effect of law, plaguing us almost daily and making more nettlesome and costly the conduct of our practice of medicine. The staffs to develop and oversee the rules and regulations empowered by H.R. 4700 would add tremendously to the cost of providing good medical care and services to the persons snowed under by this bill without adding one bit to the actual care received by patients. The very nature of this proposal makes it a political dice game, to be changed perhaps by each session of Congress with the statisticians calling the turn and forgetting, conveniently, the impacts on the recipients or purveyors of the services.

Second, the individual doctors in Nevada and the Nevada State Medical Association are justly proud of providing the best possible medical services to all classes and age groups, resident or transient, in our great State. Every doctor gives tremendous portions of time, effort, heartache, and plain hard work to the care of indigent and low-income patients, accepting this as part of his professional and personal duty to society. This is part of the heritage and ethics of our great profession. H.R. 4700 would do much to break down this feeling of personal responsibility of individual physician to his patient. It matters not how pious the language of the bill, stating the Government is not authorized to interfere in hospital administration or in the practice of medicine, for the "rules and regulations" herein stated or implied, and certain to be forthcoming should the bill become law, there will inevitably follow the intervention of a bureau between patient and doctor, working far too often to deprive the patient of the best individual care he deserves. Statistics mean much in helping to determine possible courses to pursue in the diagnosis and treatment of illnesses, but they are completely invalid regarding an individual patient's problem. No two ulcers are alike. No two coronary attacks are identical. Yet this bill would soon permit the dam of regulations to burst, and the "orders to conform" would require that patients' problems would have to be put in neat orderly slots or cubbyholes so regulations, for the sake of controls, would not be abused.

Be not amused at this picture of how medical care would deteriorate. Last November I participated in a month-long medical service study tour of West Germany. One of the startling, tragic problems I learned about in that great nation, where 85 percent of the population is covered by the smothering blanket of their social welfare program, is that the general practitioner on the welfare panel must see 50 to 80 patients in his office daily. Gentlemen, that permits the doctor barely enough time to say "How do you do, this is Thursday, goodbye," much less afford any time adequate for thoughtful and careful diagnosis or for considerate and sound plans of treatment. No doctor can rest easy thinking of his patients when bureaucratic controls force him to work under such conditions. The principle of compulsory health insurance, embodied in H.R. 4700, and based on inadequate studies of needs, or solutions, would end in the loss of medical care standards placing first the best interests of the patient.

Third, the source of control of medical practice would, under the Forand bill, pass from individually responsible doctors, responsible to patient, colleagues, and community, to a hydraheaded, pass the buck, invisible bureaucracy that would defy, deny, and refuse to recognize personal patient needs. The current pressures of local welfare boards, prodded by State welfare boards already partially controlled by Federal boards that get into the act because of "regulations" now in effect due to Federal-State matching moneys, would be inten

sified by the addition of more regulatory commissions of the Federal Government to the point where doctors cannot afford useful time for patients.

The Forand

At the present time, the American Medical Association, and the component State and local medical societies, are cooperating with other organizations in a thorough, intensive study of the problems of aging and of the aged. We hope this study will provide factual data that may help point the way toward better understanding of the needs in this field, and toward possible practical solutions for providing improved, zestful, useful living for our elder citizens. bill assumes that Federal agencies alone have the knowledge and potential skill to solve this, and by providing controlled compulsory health insurance, ignoring the necessity for consideration of other socioeconomic factors playing an integral part. Such action truly exemplifies putting the cart before the horse. Lastly, H.R. 4700 would strike a crippling blow to improving and expanding efforts of private insurance companies to make available voluntary insurance programs for elderly people. These programs, by both nonprofit and for-profit associations and companies, carry on the vital traditions of personal responsibility so necessary for the preservation of our great Republic. We as responsible and concerned citizens must resist all attempts, by whatever group, to chip at the pillars or freedom essential to individual rights.

STATEMENT OF THE NEW HAMPSHIRE MEDICAL SOCIETY RE H.R. 4700, 86TH CONGRESS, THE FORAND BILL, HOUSE WAYS AND MEANS COMMITTEE, JULY 9, 1959

My name is Clinton R. Mullins, a physician and surgeon of Concord, N.H. I am president of the New Hampshire Medical Society and of the New Hampshire & Vermont Physicians' Service, more commonly referred to as Blue Shield.

Ours is one of the senior organized medical groups in the Nation, the society having been formed in 1791.

Not unmindful of the economic pressures now on us all, physicians of our State have repeatedly, year upon year, given of themselves, their talents and professional experience to provide medical care for all requiring such service, regardless of the individual's ability to meet the financial obligation.

Because of this philosophy of service, physicians of New Hampshire look with a jaundiced eye upon socialized medicine, advocates of which envision the Social Security Act as a vehicle for providing comprehensive Government health care.

The physicians of New Hampshire do not favor H.R. 4700, nor any similar type of legislation. The need this measure would allegedly fill is already being met by those whose responsibility it is to provide broader medical services. It is my pleasure to inform this committee that in New Hampshire, more than 42 percent of our people over 65 are already enrolled in Blue Shield. If you take into consideration the new social security qualifying age of 62 for some eligibles, another 12 percent would be added.

Statisticians of our plan have determined that coverage for this older age group has increased 8.2 percent since 1950.

With more than 54 percent of those in the social security age group already participating in Blue Shield, and a lesser, but nonetheless significant, number covered by other insurance carriers, it appears obvious that the problem viewed by the sponsor of this legislation-at least in New Hampshire-resolves itself as no problem at all.

It would serve no useful purpose for me to attempt to detail even some of the reasons why physicians of New Hampshire do not favor this measure. These reasons have been stated by other organized medical groups already and will be reemphasized during this hearing.

This whole scheme to tinker with the Social Security Act reminds me of a New Hampshire farmer friend of mine. He was telling me about his egg business one day and made the remark:

"No matter how hard you scramble bad eggs, you just can't make a good omelet out of 'em."

That is what we think of H.R. 4700, too.

PRESENTED IN BEHALF OF THE MEDICAL SOCIETY OF NEW JERSEY BY F. CLYDE BOWERS, M.D., PRESIDENT, THE MEDICAL SOCIETY OF NEW JERSEY, IN OPPOSITION TO H.R. 4700 (FORAND)

As president of the Medical Society of New Jersey, I am privileged to be the spokesman for the more than 6,500 physicians who are its members and for the approximately 3,000 members of its women's auxiliary.

Founded in 1766, the Medical Society of New Jersey witnessed and assisted at the birth of the United States of America. Almost seven generations of our members have as citizens-loved and served their country, and-as physicians have loved and served their fellow men. It is pricisely because of that twofold dedication-to our country and our fellow men-that we of the Medical Society of New Jersey, as citizens and as physicians, wish to record ourselves in fundamental opposition to the principles which H.R. 4700 embodies and to the effects which it would bring about.

We view this measure not only as incompatible with the economic health and stability of our Nation, not only as a dire threat to the maintenance of high standards of medical care, but as corruptive of the character of our citizens and destructive of their rights and responsibilities as freemen. We view it, in short, as a threat to our vitality and well-being as a people, as an instrument for the silent and subtle abandonment of our basic forms of government, and for the substitution instead-by calculated, sinister, and implacable steps-of a Socialist welfare state.

The United States of America, thanks to God, and our distinguished progenitors, established a form of government which exalts the rights of the individual above those of the state, which makes the citizen the master and government the servant, and finally which trusts to the initiative, industry, judgment, responsibility, and integrity of the citizens to insure their own well-being and the Nation's life and survival.

Across the years and the generations intervening since the birth of this Nation, we of the Medical Society of New Jersey-with fervent delight-have witnessed the triumph of this type of citizen, of this form of government, of this way of life. We and all other patriotic Americans have gloried in the achievements and triumphs of our great Nation. We hold it to be the greatest, most enlightened, and best Nation the world has ever known. We want it to continue and to go forward as such, despite the envy and the machinations of other peoples and their leaders, and despite the efforts of those within our boundaries-through guile or ignorance-to bring it to disaster.

The source of the strength and greatness of the United States of America lies in the character and resourcefulness of its citizens. On them our Nation depends. Once the character of our citizens is debauched-as by dishonesty it can be debauched-and once the strength of our citizens has given way to induced debility, our Government will topple and fall. Save for the strength which the people give it, it has no strength of its own.

This is the fundamental fact underlying all legislation that would and does encourage the citizens of the United States to depend upon and draw their strength from the Government; they cannot do so and remain free. And when the citizens have lost or surrendered their freedom, the United States will no longer be a free country but a slave state.

If that is what others want, that is not what we of the Medical Society of New Jersey-as citizens and as physicians-want or are willing ever to accept. That is why-basically and unremittingly-we oppose H.R. 4700; and that is why we oppose, and will continue to oppose, any and all legislation of like character.

We view it as leading to the abandonment of our free Republic and to the establishment of a welfare state. We regard it as constituting as great a threat to the welfare of our people and of our country as do the forces of our enemies directed against us from without.

Permit me to offer the rationale of the position of those whom I have the honor to represent.

As citizens

We believe that it is right and proper for government to provide for citizens those necessities which they cannot provide for themselves.

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We believe, with Lincoln, that this Nation was conceived in liberty-individual liberty for every citizen-and that that liberty was wrested from, and should be protected against, the tyranny of the state.

We believe that individual liberty demands in the citizen initiative, independence, and an abiding sense of personal responsibility.

We believe that these three qualities must be encouraged and sustained in our citizens if they are to have within themselves the strength to meet and best the challenges of life.

We believe that our Government derives its strength from, and depends upon, its citizens.

We believe that any system which encourages citizens to draw their strength from and to be dependent upon government is therefore hostile to the true good of the citizens and of the Nation.

We believe that our national history splendidly demonstrates the power and greatness that flow from the vigor and valor of free citizens working with united strength.

We believe that anything which would diminish the freedom or impair the vitality of our citizenry should be resisted as a threat to the welfare of our country.

As physicians

We believe that free and responsible citizens should provide for their own health care, and that tax programs should be so curtailed as to leave such citizens the financial means—either by personal savings or private insurance— to make such provision.

We believe that it is the function of government to insure health care for only those citizens who are not in position to take care of themselves, and that in doing so government should employ only the simplest and least restrictive means. We believe that this can be done within the limits of proportionately expanded and properly adjust voluntary insurance programs.

We believe that physicians and patients alike have the right to be free from governmental domination and control.

We believe that the maintenance of high standards of medical care and continuing progress in medical research and development are only possible in the absence of governmental domination and control.

Permit me likewise to summarize our opposition to H.R. 4700. Specifically we oppose H.R. 4700 because—

(1) It falsely and fatuously assumes that when the citizen reaches the age of 65 (a) he becomes automatically and immediately the victim of disease and debility, and (b) he becomes automatically and immediately incompetent and paunerized-mentally and financially incapable of taking care of himself.

(2) It is a blank check for a potentially unlimited tax program, which threatens to become an equal if not greater burden to all citizens than is the income tax.

(3) It offers, at the expense of the taxpayers, to provide health service for all recipients of social security benefits (16 million of them at the present time) without regard for their individual ability to pay for the costs of such benefits themselves.

(4) For the really indigent who have not accumulated social security entitlement it makes no provision at all.

(5) It would adversely affect the health care of all citizens not receiving social security benefits (but who supply the social security tax money to pay for those who are) by encouraging the overuse of hospital facilities by social security claimants.

(6) It would make available to social security beneficiaries only the services of those hospitals, nursing homes, or physicians under contract to the Federal Government.

(7) It would give to an agency of the Federal Government the power-through interpretation of what constitutes "reasonable costs"-to set fees for the services of hospitals, nursing homes, and physicians-the power of life and death over their economy.

(8) It would give full administrative control of the program to an agency of the Federal Government-thus expanding the bureaucratic power of the Central Government over the sovereign States and the individual citizens.

(9) It is a giant step forward in the socialization of our Government and our lives, exalting and increasing the power and control of the Federal Govern

ment, by invading and restricting the autonomy of the sovereign States and the freedom of the individual citizens.

In conc usion, we call attention to the fact that our case against H.R. 4700 is not bound up exclusively with the damage it will do to the standards of medical care, or with the way in which it will ride roughshod over the rights of physicians and patients alike. We do oppose it for these reasons but, more importantly, we oppose it because of the deeper and more deadly damage it will do to us as a people and a nation.

It is our conscientious conviction that H.R. 4700 is perniciously bad legislation. Of it Patrick Henry might well have been thinking when he said: "The question before the House is one of awful moment to this country. For my own part I consider it as nothing less than a question of freedom or slavery ***" We hope you will see it as such and reject it. If you do so, the Nation—and, indeed, the world-will be in your debt.

Hon. WILBUR D. MILLS,

Chairman, Committee on Ways and Means,
House of Representatives, Washington, D.C.

NEW MEXICO MEDICAL SOCIETY, Albuquerque, N. Mex., July 10, 1959.

DEAR MR. CHAIRMAN: The New Mexico Medical Society wishes to express its appreciation for the opportunity to present its case to your committee, on H.R. 4700. The members of our State medical society are opposed to this bill for the reasons set forth in this presentation.

The American people as a whole, and the medical profession, have become aware of the problems that are being presented by the rapid increase in the number of our aged population. It should be emphasized here, however, that people 65 years of age and older, although they are increasing in great numbers, actually are not as old as these people were two or three decades ago. With the increased longevity, the physiological age of people is remaining younger over a much longer period. Certainly, these people should be allowed to continue to be active and to continue to assume personal and community activities and not be placed "on the shelf," so to speak, to become wards of the state and gradually deteriorate. Such a state would be enhanced by legislation that would relieve them of any financial responsibility for their health. It is well known that the elderly citizen who continues to be active and interested remains in a healthy environment, which is a big factor in his continued good health. One of the most important aspects of this, to the community, is that as long as these older people are active and productive, they will be contributing to the economy of the community rather than being dependent on such economy. The evidence that our people as a whole have become interested in this program is the progress that is being made in reaching a solution to the problem. True, no definite solution has been made as yet, but there is much evidence that progress is being made.

Our health insurance underwriters have developed hospital and medical insurance plans which are now in effect in many States. Such a plan was inaugurated in New Mexico approximately 4 months ago. This plan offers these people more hospitalization than that proposed by the social security legislation and the physicians have agreed to accept a low fee schedule for these services. This fee schedule is approximately 50 percent of the average medical fee schedule in the State. Such a plan gives to the individual a complete freedom of choice of physician and complete freedom of choice of hospital and does not require any contract between any of the interested parties.

Plans are also being developed in the State to construct apartment buildings for the elderly group. These apartments would have facilities that would make it safe and easy for these elderly people to enter and leave their apartments. Services will be available in these apartment buildings for medical and nursing care when needed. In addition, recreation facilities are being planned in the apartments, where social functions, parties, and other recreational activities may be held by this group of elderly people. This again we feel is most important in contributing to the happiness of these people, which in turn is a big factor in their health.