except as it enables the aged patient to have more free choice and a better relationship with his doctor by preventing the aged from being pauperized by costly hospital and nursing home care. Incidentally, the Blue Shield does socialize the physician to the extent that he is paid for services to Blue Shield members by a third party according to a fee schedule. The AMA also states the King-Anderson bill "would lead to the decline, if not the end, of voluntary health insurance." Actually, it would free such insurance of the heavy utilization and costly medical care of the aged.

Question. Dr. Butler, doesn't the AMA denounce this bill as socialized medicine?

Dr. BUTLER. Of course the King-Anderson bill is socialized medicine as is the Kerr-Mills act; Public Law 86-778, veterans medicine, and the medicine of our State, county, and city hospitals. Indeed 25 percent of our health and medical care is socialized medicine financed through Government agencies and much of this socialized medicine is of high quality. In addition, there is the medicine socialized by having financed through private groups distributing the cost by prepayment; such as Blue Cross-Blue Shield, H.I.P. in New York, the Kaiser prepayment services in California, and many others. So we don't need to be afraid of a foot in the door of socialized medicine. Socialized medicine is a major part of our medicine today. We should be concerned with its quality and economy, and its prevention.

The King-Anderson bill would provide paid-up insurance for some 13.5 million social security and 0.5 million Railroad Retirement Act beneficiaries. The KerrMills Act, Public Law 86-778, would give assistance to those not eligible for benefits under the King-Anderson bill and those whose medical care exceeds the benefits of that bill. Thus, the two bills are complementary.

Question. Dr. Butler, I take it you are saying we need both the present law and the proposed bill?

Dr. BUTLER. It is not a question of the one or the other. The King-Anderson bill will prevent the need of extending welfare medicine under the State acts that implement the Federal Kerr-Mills Act or Public Law 86-778. The KerrMills Act will provide the needed care not covered by the King-Anderson bill.

The need and soundness of using social security as a means of obtaining paid-up insurance to cover the cost of medical care in old age has been endorsed by President Eisenhower's White House Conference on Aging and by such high-ranking Republicans as Governor Rockefeller, Marion B. Folsom, and Arthur Larson. The American Public Health Association at its recent meeting in Detroit adopted a resolution stating in part, "whereas the burdens of the costs of good care for the aged can be minimized for the aged, their families, contributors to voluntary insurance plans, charitable agencies, and taxpayers through arrangements, effective through the worker's lifetime, which provide paid-up insurance for the older years and whereas it has become evident that appropriate and feasible ways to provide for sound financing of adequate health services for a growing proportion of older persons in the United States are essential, therefore, be it resolved *** that the American Public Health Association support appropriate proposals, including social security mechanisms, to provide for sound financing of adequate health services, to be available to the aged individual without means test and on a paid-up basis without addition fees for payment for services rendered in institutions, outpatient departments, and organized home care programs." Thus the association endorses the essential provisions of the King-Anderson (i.e., the administration) bill. Question. You have told us what several Republicans and the American Public Health Association thinks of the King-Anderson bill. What about the AMA? Dr. BUTLER. Well, would that the AMA would spend on supporting the KingAnderson bill the millions of dollars budgeted this year for opposing this bill by speeches, full-page advertisements, lobbying, and pamphlets distributed through the mails and from doctor's waiting rooms. Thousands of doctors regret that the AMA by dragging its feet to resist medicine keeping abreast of change is muddying waters that should be kept clean if we are to see the problems of our aged with a clarity essential to their constructive solution. And, thousands of doctors, who are fairly and fully informed as to the need of medical care for our increasing aged, the problems of providing such care, and the proposed solutions, endorse the social security approach of the King-Anderson bill as the best way to assure our assuming in our working years the responsibility of financing with foresight the personal, continuing, and good quality medical care the majority of us will inevitably need in aging and should receive with dignity.

The Honorable BENJAMIN A. SMITH,

Senate Office Building, Washington, D.C.

81 CROSS STREET,

MALDEN, MASS., March 19, 1962.

DEAR SENATOR SMITH: From the Boston newspapers I have seen your name mentioned in connection with the various public meetings of aged citizens, in which their need for cost-of-living increases and medical care on the home and office visit level was aired, and I was interested to read your statement: "I wish all the Senate Members were here to hear this testimony." You further stated that you would bring the matter to their attention, and that the first order of business at the next session of Congress would be the social security law.

This information brought comfort and hope to the hearts of many social security pensioners who have been completely neglected as far as cost-of-living increases and adequate medical care are concerned.

Since the newspapers did not carry the time of these special meetings, it was impossible for all interested pensioners to attend, so I beg permission to state the personal problems of my sister and myself, which are duplicated many times over throughout the social security pension groups.

We worked during the depression years for very low wages, mistakenly thinking that we were being patriotic by helping to keep the wheels of industry turning, although we could have been better cared for if we had worked under WPA, or other Government agencies. We kept our jobs during the war years, when wages were stabilized, unless one worked under union rules, so our wages were once again below average. Our beloved President, Franklin D. Roosevelt, established the social security law, but it omitted many fields of service, among them educational, in which I was employed, with the result that I had to earn my social security pension after retirement, on a part-time basis. My sister worked from the time the law was established until she retired in 1949, but continued for some years on a part-time basis. The net result of our labors: Social security pension for my sister, $69 per month; for myself, $71 per month. Since I worked in a college I paid into a pension fund and from that receive $66.67, after 25 years of service, making our net income $206.67, less Blue Cross-Blue Shield which is deducted by the college. Out of this we must pay $65 per month rent, approximately $8 per month gas and electric, and $6 telephone (and since we have each had to telephone for emergency treatment we feel this is a necessity).

Until 2 years ago I was able to type theses and reports and earn a little money toward cost-of-living expenses and medical care, but a bout in hospital put an end to this. Until June this year my sister was able to earn a little money toward such expenses, when she became seriously ill and her activities had to end. For 5 years she has been under the doctor's care for excess fluid and angina, but following this attack she had to have the doctor twice a week at $6 per visit, and pills costing $10.60 per month for one kind, $5.25 per month for a second kind, and two other kinds costing $2.25 and $0.95 quite a goodly sum out of a pension of $69 per month. Consequently, in October 1961 she applied to the welfare department for medical aid. In order to get this we had to reduce our joint savings to $1,000, since a welfare recipient must also be a pauper. In addition, I had to justify my earnings over the previous 10 years in order to satisfy the welfare board that all of the money was not my sister's. In addition to this, I finally had to sign a paper saying that all of the money was mine. I made it quite clear that this was an untrue statement, but they insisted it be signed. Truly the wealthiest nation in the world, and the only one which requires its needy aged to be paupers. Our inability to earn money to help with our medical expenses stems from the fact that my sister is 78 years of age, and I shall be 76 in May-not usually considered productive years. Unfortunately, I need medical care at this time, with badly abscessed ears, which are attributable to my efforts to save on medical care and rely on my own medication, which in the end is more costly, but it is necessary to avoid doctor's fees where possible, In a speech made in Portland, Oreg., by our President, when he was campaigning for his high office, he said:

"With the cost of living continually spiraling upward, with the cost of basic items continually rising, $72 a month or $1,000 a year cannot pay for even the basic rudiments of a decent and dignified old age. And, even worse, the substandard incomes, the poverty and neglect, tend to destroy the morale and selfrespect of our older citizens.

"And this poverty and hardship becomes heartbreak and despair when illness threatens. No costs have increased more rapidly in the last decade than the cost of medical care. Medicine and drugs are more expensive than ever beforehospital rates have more than doubled; doctor bills have skyrocketed.

"And these rising costs have had their greatest impact on our older citizens. Almost 20 percent of all those on social security must use one-quarter to one-half of their meager annual incomes for medical expenses alone. Those over 65 suffer from chronic diseases at almost twice the rate of our younger population; they spend more than twice as many days restricted to bed, and they must visit a doctor almost twice as often. And even these impressive figures do not tell us of the uncounted thousands who suffer from lack of needed medical care, from lack of vital drugs and from lack of hospitalization, simply because they cannot afford to pay the bills.

"Of course, some of those who are now uncared for can get free health care. But such public assistance is often painstakingly slow; the tests for giving it are often rigid and unrealistic; the care itself is often impersonal and inadequate." I have quoted the speech to this extent to give you the context leading up to the last paragraph, to point up the fact that in granting my sister medical aid the board made her an allowance of $10 per month. Presumably this is because we like together, but when she has paid her share of the rent $32.50 she has $46.50 per month to cover living expenses. As I said, I also need medical care; my office visit costs $5 and my pills $6.95 per week. I suffer from arthritis and suffer great pain because I cannot afford to take treatments; also I suffer from low blood pressure and cannot afford to get my shots as often as the doctor would wish; in fact, I wait months between visits to his office unless it is an emergency, as is the case at present with my ears.

I see by Friday's paper that Congress passed a bill for a Federal-State welfare program along lines recommended by President Kennedy, which would boost the budget for welfare payments by $140 million. The welfare recipients in Massachusetts, by the boast of many of them, receive as much as $118 per month. By President Kennedy's own statistics the average amount of social security pensions is $72 per month. On what basis does he and the legislators arrive at the conclusion that the welfare recipients should receive still greater pensions, while the social security pensioners should continue to live in poverty and hardship while the bill which would give them aid is kicked around like a football? The need of social security pensioners is to have their pensions increased to an amount equal to the existing welfare pension in each State, with medical care on the house and office visit level-aill the care now enjoyed by welfare pensioners, many of whom have not contributed in any way. The social security pensioners have at least a small sum upon which the legislators can build; they also, for the most part, have some health insurance, which would pay part of their hospita! bills. Surely they are entitled to "the peaceful and decent life which their years of productive labor have fully earned and which a grateful America should gladly provide which America must provide." (Excerpt from speech made by Senator Kennedy in Portland, Oreg.) Our great need is now, not next May or next June. The $140 million appropriated should be spent now on bettering conditions of social security pensioners. How can intelligent legislators discriminate so disgracefully against one group of hard-working people, and give so much to a group. many of whom contributed nothing? This is America. Such discrimination is alien to our creed.

The social security bill which the President signed giving a cost-of-living increase to widows was the most disgraceful piece of discriminatory legislation ever enacted. As you know, all people under social security paid the same percentage on their salary-the males paid no more for their dependents, but pensions for these people would come out of contributions made by social security contributors without dependents. These men received a much higher rate of pay than women, consequently the widows, in the greater majority of cases, were able to save and invest more for their old age, yet they received an increase which was denied to single people and working widows. By this action the President created a group of people existing on the very lowest level of living conditions and medical care. If, as he stated in his speech at Portland, Oreg., he felt the substandard incomes, the poverty and neglect, tend to destroy the morale and self-respect of our older citizens, he may be assured the social security pensioners in this substandard category have just about hit rockbottom.

Please accept my apologies for this long letter. Legislators are apt to deal with statistics. You heard facts at the meetings for the aged which you have attended, and I hope I am not out of order in adding to the facts which you have accumulated.

Respectfully yours,

LUCIA M. HUNT.

Senator SMITH. I declare the meeting adjourned. Thank you very much.

(Whereupon, at 4:55 p.m., the hearing was adjourned.) O