The State is also developing plans for a Governors' conference to be held prior to the White House Conference on the Aging. This we feel is one of the very important reasons why legislation of the type provided by H.R. 4700 should not be passed at the present time. I believe we all agree that when groups are working on a solution to problems such as these, that these groups should be given the opportunity to see what can be accomplished before enacting legislation that would automatically terminate the activities of such groups. Further, we feel that H.R. 4700 is the type of legislation that is dangerous for our country in that it is one of the most forward steps toward that of a welfare state. This, I am sure we all agree, we want to avoid if possible. Such a state would not only destroy the incentive of our population but would also destroy the incentive of the medical profession. This has been definitely shown by the progress in those countries in which such a system exists. On the other hand, one can point to advances made by American medicine as being far more rapid than that of any other country in the world. All of this has been accomplished under an entirely free enterprise system. The members of the State medical society are also quite concerned about the cost of this program and, certainly, the effect that it may have on the overall cost of our Government. We are sure that no one knows at this time just what the cost of such a program would be. However, we well know the figures presented by those who have made an analysis are quite alarming, beginning with the estimated cost of $2 billion annually at the onset, and rising within a very short period to several billion. This is something that we as individuals cannot really comprehend. There is a serious question in our minds as to whether or not such a great and unpredictable drain on the present social security funds might not jeopardize the entire purpose for which the Social Security Act was intended; namely, that of providing financial protection for the aged citizens. The New Mexico Medical Society sincerely recommends that House bill 4700 now before the Congress, not be favorably considered by your committee. I wish to thank you very kindly for the opportunity of making this presentation to you. Sincerely yours, LEWIS M. OVERTON, M.D., President. DEVILS LAKE, N. DAK., July 7, 1959. Representative WILBUR D. MILLS, Chairman, Ways and Means Committee, House of Representatives, Washington, D.C. DEAR MR. MILLS: As president of, and representing the North Dakota State Medical Association, I wish to officially register our opposition to H.R. 4700, the Forand bill. It is our considered opinion that this piece of legislation is not needed, and we offer the following reasons to support this opinion. 1. The cost would be at least $2 billion a year. 2. The Forand bill would increase social security taxes. There is no proof that these increases would be sufficient to pay for the program. Cost estimates are invariably short, as we are now witnessing under the Federal highway construction program. 3. The recipient would not be free to choose his own physician, hospital, or nursing home. 4. The great majority of Americans-those who are not receiving social security payment-would be adversely affected by passage of the Forand bill. Overuse of hospitals by social security claimants seems certain to occur. 5. Political abuse and waste can be expected. 6. The Forand bill would certainly raise havoc with voluntary health insurance programs which are currently rapidly increasing their overall coverage of the 65-years-and-older group. 7. Government action at this time would be hasty and unwise, since all the facts of the problem are not known and have not been fully evaluated. Sincerely yours, JOHN C. FAWCETT, M.D., President, North Dakota State Medical Association. STATEMENT OF THE OKLAHOMA STATE MEDICAL ASSOCIATION RE H.R. 4700 TO THE WAYS AND MEANS COMMITTEE, U.S. HOUSE OF REPRESENTATIVES, JULY 17, 1959, BY ALFRED T. BAKER, M.D. H.R. 4700, all of its provisions and implications, are unanimously and unalterably opposed by the physicians of the State of Oklahoma. The following paragraphs are intended to represent only a few basic objections to this legislation; objections which are shared by many intelligent Oklahomans from all walks of life and fields of endeavor. H.R. 4700 presupposes a national state of emergency on the basis of questionable supportive evidence. Pressure for its passage comes on the eve of the White House Conference on Aging, a national study which will very likely result in recommendations completely divergent from those contained in the bill in question. H.R. 4700 therefore represents a paradox of logic; its supporters embrace a line of reasoning that permits them to solve a problem before it is defined. There are other considerations which raise grave doubts as to the timeliness and need for such drastic regimentation of our elder citizens. Does the provision of health care for the aged represent an insurmountable obstacle that can only be squelched by Federal spending, or does it simply present another challenge for the physicians, allied professions, hospitals, insurance, and prepayment companies to overcome through normal channels of progress? Voluntary and prepaid health insurance programs are already solving the financial aspects of health care and, with physician cooperation and encouragement, such companies are accelerating their efforts on behalf of those persons over the age of 65. Oklahoma physicians have faith in such programs and confidently look to a future of even higher health standards through the provision of expanded coverage to include the aging segment of the population. Medical progress under a free enterprise system and the fruits of the free enterprise system itself are responsible for the increased longevity that has inadvertently created this challenge. The hard-earned success story of American medicine and its allied professions and organizations must not be scuttled in favor of legislation which would write the first chapter of an ill-fated, regressive history of regimented and inferior health care. It is ironic that the product of medical and economic progress is now being wielded against us by those who would destroy an important part of the economic foundation of our great Nation. General economic inflation and its effect on fixed-income groups is the real villain of the aged. More Federal spending will only add to the inflationary plight of our senior citizens. Energetic pressure groups sponsoring H.R. 4700 could better serve the elderly by directing their activities toward the reclamation of a solvent government and sound money. Federal domestic spending programs should be curtailed until a balanced budget is achieved and a start made toward reducing the huge national debt. The increased Federal taxes believed to be necessary to support H.R. 4700 will not be welcomed by those who fully understand the hazards of socialized medicine. To make matters worse, rampaging costs of socialized medical programs in other countries would indicate that the estimated tax increases are overly conservative and shamefully misleading to those who are anticipating a "blue sky" medical program for a nominal paycheck deduction. Wage earners are already pleading for relief from the tax burden and should not be enticed into such a scheme without full understanding of the consequences. When the brunt of the tax increase is felt by union wage earners, it is not unlikely that the labor officials who are vociferously supporting H.R. 4700 will make demands on management for compensatory wage increases. Government spending will again take its inflationary toll. The passage of H.R. 4700 would trade health care freedom for a regimented program that would actually lower the quality of care available to our senior citizens. It would not only fail to solve the real problem of the elderly-living on a fixed income in an inflationary economy-but it would actually aggravate an acute discomfort into a chronic malady. Health care financing can be adequately dealt with through a cooperative approach on the part of the health professions and the organizations offering voluntary health protection. A stable economy would make the task easier and would also ease the cost of living strain that has been imposed upon our fixedincome groups. H.R. 4700 is a poor palliative for the plight of the aged. Oklahoma physicians oppose this legislation with unanimity which is only exceeded by their enthusias tic support of a concerted effort to provide even higher health standards for people of all ages through voluntary enterprise. STATEMENT PREPARED FOR PRESENTATION TO U.S. HOUSE OF REPRESENTATIVES My name is Arch Diack. I am an individual physician practicing general surgery in Portland, Oreg. I have strong feeling about the Forand bill and what it means to both our elderly citizens and to the profession of medicine. I am making these statements in behalf of the physicians of Oregon, and as official spokesman for the Oregon State Medical Society. The old-age problem that has recently burgeoned on the scene is due directly to the advances of medical science. Millions more of our people now live to old age. Modern medicine has in fact populated Mr. Forand's political world. Society's treatment of our elders has varied from abandoning old Eskimos in the snowbank to placing the native elder in a position of tribal sage and adviser where usefulness and self respect were maintained to the end. Now today, nobody, least of all the doctors responsible for "promoting" our citizens into old age want to deny our senior citizens adequate care. By the same token, if you think that doctors abhor the thought of socializing old folks, you are absolutely right. Our real problem is to keep Americans who are over 60 years of age useful, self-respecting participants in society as long as possible, and with their dignity and individuailty left intact. Indeed, the antithesis of good health is to feel unwanted, unproductive, and generally useless to oneself and one's community. Physicians understand these needs well. These same people have been our patients through life, and we hear constantly of their hopes and desires to remain individuals, rather than be reduced to dependent wards of society. Physicians, trained of necessity to be individuals, have an inherent fear of control over the quality of service they mav render. To most of us the following is fairly obvious, if the Forand bill passes: The tax increase proposed to cover "free health care" would soon prove inadequate (as has the care of families of service personnel). This inevitably will lead to some sort of restriction by administrators, which in effect will dictate the quality of medical care offered or limit the choice of physicians to those willing to practice "cheap" medicine, and to indivdual physcians this is abhorrent both for themselves and for their patients. Although the actual requirements of the old-age group are little understood and much work remains to be done to know exactly what the economic-social problem actually is, physicians in Oregon have gone on record strongly supporting a local cooperative physicians plan for offering the elderly patient, who is medically indigent, good prepaid medical care with free choice of physician at a reduced fee schedule. Physicians, if not the general public, are well aware that the term "free health care" is composed of a large "half"-hospital, nursing home, medicine or institutional costs, and a "small" half-physicians' fees for medical and surgical services. Health care must be kept as a strictly personal and individual service to preserve the citizen's individuality and to maintain the tremendous superiority of American medicine. THE RHODE ISLAND MEDICAL SOCIETY, To the Members of the Congress of the United States: In view of the hearings on H.R. 4700 (the proposal to amend the Social Security Act to provide for the Federal purchase of certain health services for social security beneficiaries) you should know what Rhode Island is doing to aid its older citizens to meet their health care costs. Here are some of the highlights: 1. Rhode Island has the highest enrollment for its Blue Cross hospitalization program and its physicians service (Blue Shield) surgical-medical plan of any State in the Nation. More than 75 percent of the State's population is enrolled in Blue Cross and 65 percent in physicians service. 2. There is no age limit for either Blue Cross or physicians service in Rhode Island. Approximately 70 percent of the people in the State who are over the age 65 have Blue Cross, 50 percent have physicians service, and 400 are enrolled whose ages range between 90 and 99 years. 3. Under the physicians service program the surgical fee, as well as that of the assistant surgeon and the anesthetist, are completely paid for the subscriber and his spouse when the annual income is less than $3,000, thus assuring an elderly retired couple complete surgical cost indemnity. 4. The number of persons over 65 years dependent upon aid from the State department of social welfare has steadily declined in recent years (31 percent in 8 years), an indication that the voluntary programs are meeting their needs. 5. In a recent (January 1959) appraisal of the provision of aid by the Rhode Island Department of Social Welfare to meet medical costs for persons on public assistance, George E. Bigge (member, U.S. Social Security Board, 193746) stated: ** "In the field of medical care it is difficult to find comparable experience in other States with which to compare the experience in Rhode Island * Only 12 States have undertaken to provide comprehensive services such as Rhode Island provides ***” "The relatively low expenditures (per capita) he (the director of medical services) attributes to close cooperation with the professional societies which has enabled him to set standards and fees which are extremely reasonable * "In another connection the director enumerated total free services to public assistance recipients (exclusive of GPA) in Rhode Island during the year 1956-57 totaling $552,099 * * * as further evidence that the professions are cooperating wholeheartedly in attempting to provide medical care at a reasonable cost to the State." 6. The Rhode Island Medical Society is not content to consider the present programs as complete, and it is currently engaged in a study of additional methods to aid older age persons meet any costs for their health needs. We in Rhode Island see no justification for subsidization of the hospital and surgical care costs of social security beneficiaries when the accomplishments of our voluntary system have been so successful. We believe that what has been done and what will be done in Rhode Island to aid the aged-and for that matter all citizens-to meet their health need costs at the local State level can and will be duplicated in similar manner in all the States. We believe that the Congress can best aid all citizens, and particularly those in the older age category, by halting the inflation which, as the President noted publicly recently, is a "robber and a thief that takes the bread out of their (older persons) mouth, the clothes off their backs, and it limits their access to the medical care and facilities they need." We believe that the medical profession and hospitals will do their part to bring about continued improvements in voluntary health insurance programs, but we are convinced that we must have equally strong support from employers, labor organizations, insurance companies, and the people themselves. We believe that our common efforts must be directed toward developing programs for keeping elderly people well and productive through proper health maintenance and proper living. A healthy elderly person, with the assistance of voluntary prepayment health plans, will not only be in a position to purchase a major portion of his health care needs, but, in our opinion, he will want to do so because of the maturity and wisdom through living experience that has given him increased years of life. JULY 9, 1959. ALFRED L. POTTER, M.D., President. STATEMENT OF THE SOUTH CAROLINA MEDICAL ASSOCIATION RE H.R. 4700, 86TH CONGRESS, HEALTH BENEFITS FOR AGED UNDER SOCIAL SECURITY, BEFORE COMMITTEE ON WAYS AND MEANS, HOUSE OF REPRESENTATIVES, JULY 17, 1959, BY DR. JOSEPH P. CAIN, JR., PRESIDENT-ELECT The purpose of this statement is 1. To publicly reaffirm the continued interest and concern of the South Carolina Medical Association with the problem of adequate medical care for our senior citizens. 2. To show that the Forand bill is inadequate to solve the problem of medical care for the aged. 3. To point out what steps have been taken in the State of South Carolina to care for this problem. 4. To show that such legislation as the Forand bill is entirely unnecessary in solving the problem in South Carolina. All persons over 65 fall into one of the following categories: 1. Those who are covered by OASI. 2. Those who are unable to care for themselves and are on the welfare rolls of the State. 3. Those who have a modest income and/or own some small piece of property and are able to support themselves until some catastrophic illness comes along. 4. Those who are financially independent or who are well cared for by their family or from some other means. The Forand bill would take care of only the first group. In South Carolina this means only about 25,000 out of the approximately 175,000 over age 65, or less than 14 percent. From this standpoint alone, it would seem ridiculous and unfair to spend billions of dollars on a program which would leave 86 percent of the aged not protected. Even so, this care would not be adequate. The bill proposes to give services of a surgical nature only and this limited to acute cases. In our hospitals, in patients over 65, 12 are admitted for medical care for each one requiring surgery. It would seem, therefore, that any program which omits medical care, would be woefully inadequate for this group. Surgical care: The fact that surgical care under the Forand bill could be given only by a member of the FACS or member of a surgical specialty board, or a member of the surgical staff of a hospital accredited by the Joint Commission on Accreditation, would in many cases unnecessarily remove the patient from the care of his family physician, whose long acquaintance and intimate knowledge of his patient is of vital importance in any geriatric problem. I would like to point out in this regard that, even though accreditation is desirable, less than half of the hospitals over the country have this accreditation. It is by no means necessary in order for a patient to get adequate and satisfactory medical care. All of the hospitals in South Carolina are licensed by the State board of health, which guarantees that they are adequately staffed and equipped to render good medical care even though only 27 out of 81 are accredited by the Joint Accreditation Board. Certainly, it is obvious from this figure that most of our people of all ages go to hospitals that have not yet received the nod of the Accreditation Board. When any legislation attempts to restrict the choice of physicians or hospials in any way, it is interfering with free choice which should not be denied any citizen; and when it directly or indirectly restricts care in their local hospitals, it is adding to the problem rather than helping it. From the points above it should be clear that the Forand bill is an attempt to extend the benefits of OASI, and only that. It should not be confused in any way with a solution to the problem of medical care for the aged. In this regard it is totally inadequate. Next, I would like to show what has been done in South Carolina in order to help with this problem: 1. At the present time, 16,000 persons over 65 are enrolled in the Blue Cross-Blue Shield plans in our State. 2. Approximately 7,000 other persons are insured with other commercial companies operating in our State. 3. Blue Cross-Blue Shield in South Carolina is now offering a comprehensive hospital and medical care plan to be sold to persons over age 65 who desire it. The rate for this contract including both hospital and medical care would be $5.80 per month per person. This would include medical care as well as surgical care and would provide a free choice of physician and hospital without restrictions. In order that this program be offered to the people at a reasonable rate, the physicians of South Carolina have agreed that their fees collected under Blue Shield should be approximately two-thirds of those which they collect under the ordinary service contract. 4. In addition to this contract, the South Carolina medical care plan is also offering a prolonged illness contract, for those who want it. This would cost approximately $2.25 per family per month, and would materially extend the benefits of the basic Blue Cross-Blue Shield contract. |