NEVADA STATE MEDICAL ASSOCIATION, Hon. WILBUR MILLS, Chairman, Ways and Means Committee, U.S. House of Representatives, Washington, D.C. MR. CHAIRMAN: I am Dr. William A. O'Brien, president of the Nevada State Medical Association; I am in private practice in the city of Reno, in anesthesiology. In addition to the views of the association, I reflect the attitude of a great cross section of the citizens of Nevada in registering opposition to H.R. 3920. The proponents of this measure have paraded a bewildering array of statistics, conjectures, and pseudo facts in an intemperately hasty effort to secure its passage before the citizens at large discover that it will impose an additional and increasingly burdensome tax measure. The proponents have gulled the unwary into the belief that somehow a tax is not a tax, that it is a contribution. They vehemently and repeatedly state that it is a purchase of insurance, in an attempt to cloak the facts with the generally accepted language of the private insurance industry. Yet, nowhere, has any proponent attempted to prove that the approach contained in the King-Anderson bill will provide a higher quality of care or make it more readily available. Mr. Chairman and members of the committee: Persons over 65 able to meet their health needs should be expected to do so just as they meet the needs for food, clothing, and shelter. Persons over 65 who cannot provide these services for themselves should be the concern of the family and of the community first, and when these resources are not adequate, the services offered in the Kerr-Mills law should be available on a needs test, not a means test, basis. Opponents of H.R. 3920 do not agree that all wisdom is vested in Federal agencies, and that they alone have the knowledge and skill to solve, once and for all, the problems of financing health care for the aging. The opponents of this bill do know that H.R. 3920 is only the first of a series of steps developed by certain social planners to socialize medical care completely, not only for the elderly, but for every citizen of the Nation. We, as responsible and concerned citizens, will continue to resist all such attempts to chip away the foundation stones on which are erected the pillars of individual freedom. We urge you to join with us and to remain steadfast in forestalling the efforts of the few to invade the lives of all. Without Federal "help," dictate, or intervention Nevada physicians and Nevada hospitals can and will continue to provide good medical care to all within our borders. Sincerely yours, WILLIAM A. O'BRIEN III, M.D. THE NEW HAMPSHIRE MEDICAL SOCIETY, LEO IRWIN, Chief Counsel, House Ways and Means Committee, DEAR MR. IRWIN: The New Hampshire Medical Society which I head this year as president is interested in H.R. 3920, the King-Anderson bill, scheduled to be heard by the House committee for which you are counsel later this month. While we shall not request time to be heard as an organization, I believe our statement contains certain specific information to warrant its consideration by your committee as a part of the committee's permanent record I am a practicing physician in Colebrook and have personal knowledge of medical needs of people in my area, how these needs are being met and the extent of existing programs in their impact upon this need. The simple fact is that in New Hampshire the scope of medical services now available to the population of 609,000 is sufficiently broad to meet medical requirements of persons whatever their economic status. The measure passed earlier by Congress and identified as the Kerr-Mills medical assistance to the aged (MAA) program in New Hampshire has shown a steady increase in the number of inquiries and applications for benefits since its inception here in September 1961. By October 1, 1963, the active caseload under Kerr-Mills here reached 1,083 It jumped to this new level from a midyear figure of 732. In September 1963, 172 new cases were added, MAA has liberalized its eligibility requirements several times and broadened services provided. Such modifications have been endorsed by the New Hampshire Medical Society, which has strongly supported the program from its inception. You will please find enclosed a new folder we have just issued on this subject. The State commissioner of health and welfare has estimated the program, once the public is fully aware of its possibilities, will encompass an average caseload of about 20,000 persons. There are now about 73,000 people over 65 in New Hampshire, of whom 40,000 have private insurance coverage. About 28,370 are considered eligible for KerrMills. Others who have no insurance are independently wealthy. At the start of the program in September 1961, single persons with annual incomes of $1,200 or less a year and married couples with incomes of $2,400 or less were eligible. Under the present program, however, single persons may have an income up to $1,800 with cash assets of $2,500 if single and couples may have an income up to $3,000 with cash assets of $4,000. Applicants may own their own home and there are no liens on property. Services provided.-The number of days of hospitalization allowed patients under this program has been raised from 7 to 12, plus approved extensions of stay. The number of physicians' home and office calls have been increased from 6 to 18 a year, and the program provides for 14 physician's calls for each 30 days of hospitalization. Recently, recipients of MAA were authorized payment of prescribed drugs at a rate of $10 a month or $120 within any fiscal year. Since its inception, the MAA program has provided surgery and laboratory and X-ray services. Financial.-The New Hampshire Legislature authorized an original appropriation of $500,000 for the biennium 1961-63. During the recently completed legislative session an appropriation of $600,000 was authorized, which is supplemented by a Federal matching share of approximately $702,644, for the MAA program through June of 1965. Neither physicians, health-welfare officials, nor the majority of the public in New Hampshire find any reason whatsoever for the Federal Government to impose upon the citizens of our State the vast new medicare proposal embodied in H.R. 3920, the so-called King-Anderson bill now pending before your committee. American Medical Association officials have estimated passage of this type legislation would cost New Hampshire taxpayers $5.5 million in additional taxes the first year alone. The MAA program in the State has been referred to by the commissioner of health and welfare as being equal to coverage extended by private insurance plans. Regarding other assistance programs.-The State presently has a caseload of about 4,200 on old-age assistance (including aliens). In the fiscal year 1961-62, $1.9 million was spent on medical care for persons over 65 in the State's old-age assistance, and aid to the needy blind programs. Economic statistics.-The median income for a couple over 65 in this State is $2,400, according to U.S. Department of Commerce figures. It is estimated that 771 persons per 1,000 population over 65 draw old-age survivors disability insurance under social security, a total of 52,428. The average person over 65 is hospitalized for an average stay of 6.9 days per admission under MAA and 14.4 days under OAA, with a frequency ratio of 1.3 admissions. At present, 1,525 persons over 65 in nursing homes are drawing MAA benefits. General objections.-The vast majority of physicians in New Hampshire believe MAA holds the key to the solution of the problem of health care for the aged. They believe prepayment plans, combined with a system that helps those who need help, is far superior to any system that provides only partial benefits indiscriminately to millions of well to do, even wealthy citizens. The New Hampshire physician, like others throughout the United States, stands ready and willing to provide medical treatment to all regardless of ability to pay and does so. May I also point out the progress in broad health care benefits out by private purveyors in the insurance field. With Blue Cross-Blue Shield, for example, which is a single plan covering both New Hampshire and Vermont, the medical profession has developed a full payment program for senior citizens of these States. There are now 8,000 enrolled in this special plan which enables those 65 years of age and over to utilize their Blue Cross-Blue Shield as full payment for services rendered. Of the approximately 425,000 people in New Hampshire and Vermont enrolled in Blue Cross-Blue Shield, some 58,000 are 65 or over. It may interest you to learn that an evaluation of this uncompensated service by physicians of the Granite State approximates $1 million a year. We are a small medical society of 717 members. Concluding that one-half our number contribute a modest figure of $3,000 a year in services not fully compensated for, this brings the amount to more than $1 million which physicians here are glad to provide to hold the line against further Federal encroachments in health care fields, especially when there is no proven need here that such encroachments can be instituted in the public good under the proposal now before you. Respectfully and sincerely, WILLIAM H. GIFFORD, M.D., President. STATEMENT OF THE MEDICAL SOCIETY OF NEW JERSEY IN OPPOSITION TO H.R. 3920 (KING-ANDERSON) (By Jerome G. Kaufman, M.D., President) My name is Jerome George Kaufman. I am a doctor of medicine, specializing in internal medicine and practicing in Essex County, N.J. I have the honor to be the president of the Medical Society of New Jersey, and in that capacity it is my privilege to be the spokesman for the approximately 7,200 physicians who are its members and for the 3,000 ladies who constitute its woman's auxiliary. The Medical Society of New Jersey was founded in 1766. It witnessed and assisted at the birth of the United States of America. For almost 200 years, our members as citizens have loved and served their Nation and as physicians have loved and served their fellow men. In that dual capacity we have sought for, and continue now to seek, the true good of our country and of our fellow citizens. In consequence, we wish to record ourselves as being fundamentally opposed to the principles embodied in H.R. 3920 and to the effects which it would bring about. We know and the history of our country amply demonstrates that the greatness of our Nation is directly derived from, and is inseparably bound up with, the independence, the self-reliance, the industry, the strength, and the vital resourcefulness of its individual citizens. Our country has grown great through the might and the magic of energetic free men and women, who, inspired by ambition and enriched by deserved rewards, have supported, improved, and strengthened their country out of the abundance of their own resources. The strength and indomitable vigor of our citizens have kept them and their country free and secure. Government has hitherto depended upon such citizens, with magnificent results for both the citizens and the country. So, we contend, it should continue to do, because only so long as it does will the country and the citizens have the genius and the power to survive and prosper. It is because we recognize in H.R. 3920 a threat to this wholesome relationship between our citizens and their country, because we see in it a mechanism to reduce citizens to a State of hazardous dependence upon government instead of upon themselves-with true peril to the freedom and security of both-that we urge the rejection by the Congress of this unsound and dangerous measure. I offer the following official declarations of the house of delegates of the Medical Society of New Jersey as summarizing the policy position of the society with reference to the relationship between our Government and its citizens in the area of the provision of, and payment for, necessary health care *** The Medical Society of New Jersey-in common not only with other members of the medical profession but with all who are dedicated to the preservation of a sound character in our people and in our Nation and to the maintenance of a sound and well-balanced national economy-is "for": 1. The retention by the individual citizen-and of that citizen's family-of the responsibility and the right to select, arrange, and pay for his own necessary health care. 2. The limitation of tax burdens upon the individual citizen and his family so as to leave to them the financial means of meeting this responsibility. 3. The development and widespread utilization of adequate and economical private voluntary health insurance coverages as the best means of enabling such individual citizen and his family to meet this responsibility. 4. The intervention of government to assist only those citizens who need health care and are themselves demonstrably incapable of meeting the costs for it. 5. The maintenance of a minimum of Federal governmental intervention and control. We hold that the assignment of responsibility for financing necessary health care should be in the following order: The individual citizen; the family; local voluntary agencies; local, county, State, and Federal Government * * * each to take over only when the prior agent of responsibility cannot meet the need. Because of this point of view, we support the principle of the Kerr-Mills law as essentially preferable to the principle of the King-Anderson bill, and all like legislation. In consequence of what it is "for," the Medical Society of New Jersey is necessarily "against": 1. Any policy or program that would relieve or wrest from the individual and the family the right and responsibility to be independent, self-sustaining; self-reliant, and free. 2. Any policy or program that would so multiply burdensome taxes upon the individual citizen and his family as to deprive them of the financial means to retain and exercise the right and responsibility to be independent, self-sustaining, self-reliant, and free. 3. Any policy or program that would encourage government, at any level, tỏ eliminate or supplant voluntary free enterprise systems of insurance coverage, or of any other fundamental business or service operation. 4. Any policy or program that would enlarge for government, at any level, entrance into and influence over the lives, rights, and duties of individual citizens * * * in short, any policy or program that would give to government the control and direction of the lives of citizens instead of reserving to citizens the control and direction of their lives and of their government. The Medical Society of New Jersey considers it sufficient to point out that just as, since 1766, its members have supplied the best possible medical care to the people of New Jersey, so they will continue to do. The society adds this assurance-in reaffirmation of its frequently declared policy-"No one in New Jersey will be denied necessary medical care because of inability to pay." In declaring our support of the principle of the Kerr-Mills law, we recognize that between the soundness of that principle and the practical effectiveness of the implementation of that principle in the 50 States of the United States there can and does exist wide disparity. The principle of the Kerr-Mills law is that governmental financial assistancethrough a system that is locally administered-should be supplied to all people over 65 years of age who need health care and cannot themselves afford to meet the costs for it. We contend that that principle is sound and just and fully compatible with fundamental logic and morality. In the areas where it is alleged that the Kerr-Mills law is not satisfactory in its operation, we submit that the remedy lies not in abandoning the Kerr-Mills law and its principle, but in improving the local implementation of the law, so that its full good will be realized and not stifled by the ineptness or inadequacy of local programs. We hold that the Kerr-Mills law offers to the States a splendid instrument for dispensing social justice to those over 65 who need to be helped, but that that instrument can and will be effective only in proportion as it is properly and competently used. Contrast the principle of the Kerr-Mills law with the principle embodied in the proposed health care program to be paid for by increased social security taxes. The principle of the proposed social security program is that Government should underwrite the costs of certain limited hospital services for all people over 65 years of age, just because they have attained that age, and without regard to their own ability to pay for that care themselves. Consider the absurd potential of the acceptance of such a principle, if carried to its ultimate extremes * * * If the proponents of this bizarre program have any basic postulate, it must be the indefensible contention that it is the function and obligation of government to make itself responsible for the health care of its citizens, without discrimina tion, once those citizens have attained the age of 65. But why favor people over 65? Why discriminate against all other citizens of all other ages? Are they not equally important and equally deserving in the view of government? Obviously, as some forthright proponents of King-Anderson have openly declared, the present limited concern for those over 65 is only the "foot in the door." It is the clear intent of supporters of King-Anderson to universalize the program later. In contradistinction to the thinking inherent in King-Anderson, it has always been the American concept-a concept inseparable from the right of personal liberty-that government may properly do for its citizens only those things that they cannot do for themselves. Conversely, it is the obligation of government (1) to encourage its citizens, as far as lies within their power, to take care of themselves and their families; and (2) sedulously to avoid taking upon itself any responsibilities which the citizens prefer to reserve, or should reserve, to themselves. It is precisely because government has already exceeded its proper limits of operation that citizens find themselves unable financially to be responsible for their own and their families' needs. With every enlargement of the operations of government at all levels, tax levies grow progressively greater upon citizens, in order to provide the ever-increasing amounts of money necessary to meet the expanding costs of government. If our citizens are to be independent, self-sustaining, and free, not more but less government taxes are the indicated remedy. Yet the proposal of H.R. 3920 is to supply hospital services to people over 65 years of age, regardless of their ability to provide and pay for them, themselves, by increasing social security taxes upon wage earners-thus depriving those wage earners still more of the economic fruits of their labors. After a work life of constant taxpaying, the wage earner, under this proposed program, will have only the uncertain hope that when he is no longer employable the social security tax take will be sufficiently large to provide the care that he will need but which he will not have been able to make provision for by means of his own earnings, investments, and genuine and dependable insurance coverages. To sum up: We speak for the limitation of governmental expenditures and the reduction of taxes so that American citizens in their working years can, out of their own resources, provide for their own needs and the achievement of their own goals, for themselves and for their families. We speak for the perfection in application of the principle of the Kerr-Mills law to the end that for those people over 65 years of age who are not able to provide and pay for their own health care needs, Government may render financial assistance, in proportion to those needs, under a program locally administered. We speak against the proposal indiscriminately to provide governmental underwriting of the costs of hospital health care services to all people over 65 years of age out of funds to be realized by increasing social security taxes imposed upon wage earners in their working years. We speak against the intrusion of Government into the lives of citizens in any way that will unnecessarily impair the freedom, the self-reliance, the independence, and security of those citizens, because we are convinced that such intrusion on the part of Government is not only invasive of the basic rights of citizens but will jeopardize the economic soundness, strength, and stability of the Government. Passage of H.R. 3920 would, by governmental estimate, immediately impose a new social security program liability of $35 billion on today's wage earners, who need their present earnings to educate their children and provide for their personal and family needs in all areas, including health care. This $35 billion is the administration's estimate (all too frequently overly modest) of the cost of providing King-Anderson benefits to the eligible recipients, who will not have paid in as much as a dime to the program. It has been indicated by present leaders of Government that what is most needed for the economic health and vitality of our country today is a tax reduction. Surely such a philosophy is not reconcilable with an increased social security tax liability of $35 billion. It should be our aim and purpose to give help to those who need help. In that spirit we urge the House Committee on Ways and Means to give help to all our citizens by rejecting H.R. 3920-and any similar legislation-and to promote instead only programs that are consonant with the economic and moral welfare of all our citizens and with the economic stability and strength of our country. |