ishing is further demonstrated by our own State's old-age assistance cases which have declined from 58,000 in 1958 to 43,000 in 1963, and which are declining in number progressively each quarter. If Congress, in its wisdom, rejects the social security approach and thus opens the way for further acceleration of the varied-plans approach, it will, we believe, be responsible for providing the best method by which all of our people will be able to pay for and receive the best quality medical care in the world. In conclusion, we would liken our programs in Washington State, and in other States, to a 3.000-yard ball of string which has some loose ends in the first several feet, but the rest of the ball is intact and will serve its useful purpose. And, even the loose ends can be joined together and made useful. On the other hand, our experience in Washington State tells us that a start on the social security approach to medical care will unravel and snarl that whole 3,000-yard ball of string until it is a huge armful of tangled twine, snarled and knotted, and almost completely useless. EXHIBIT I [From the Congressional Record, Jan. 24, 1963], HOUSE OF REPRESENTATIVES (Legislative day of Tuesday, January 15, 1963) WASHINGTON STATE DOCTORS PLAN FOR MEDICAL CARE OF THE AGED (Mr. Stinson asked and was given permission to extend his remarks at this point in the Record and to include an article from the Seattle Times.) Mr. STINSON. Mr. Speaker, the attached article from the Seattle Times demonstrates the willingness of Washington members of the medical profession to voluntarily alleviate the medical problems of our senior citizens: "KING COUNTY MEDICS PIONEER PAST-65 PATIENTS' PLAN "(By Hill Williams) "The King County Medical Society has discovered-to its surprise that it is pioneering in a new method intended to make sure older persons get needed medical care. "The society on July 1 put a plan into operation under which persons over 65 who felt they could not afford doctors' care could apply for reduced fees. "The plan was aimed at helping persons who had a little too much savings or income to qualify for State welfare aid but who felt that doctors' bills were a hardship. "We didn't realize that we were pioneering,' a society spokesman said. 'We thought we were using a plan tried out in St. Louis. But it turned out to be a very small trial in St. Louis County, so now we have the most experience in the country. There has been a tremendous amount of interest in our plan by groups for the aging and by other medical societies.' ""The society's past-65 plan has no connection with medical-insurance plans of the King County Medical Service Corp. There are no premiums in the past-65 plan. And it does not cover hospital bills. Here is how it works. "A person who thinks he may be eligible talks to his own doctor, or goes to the society office, 105 Cobb Building, and is interviewed. "(Current income standards on this plan: Applicants can qualify if income does not exceed : Single person, $2,500; married couple, $4,000.) "The interviewer asks the amount of income and savings the applicant has, how much he is paying for medicine and what his living expenses are. Then a committee of six doctors screens the applications. "Persons found eligible are given a card to show their physician. It entitles them to a specific percentage reduction in fees. More than half (65 percent as of September 1963) of the society's members have agreed to take part in the plan. "Some doctors, who have not formally agreed to participate, have honored the cards anyway. "The past-65 plan has been approved by trustees of the Seattle-King County Pharmaceutical Society. Patients are urged to show the card to their pharmacist, who may be able to give them some price break. 44 Many of the people we've interviewed tell us their doctors have been treating them all along at reduced rates,' a member of the screen committee said. 'Many tell us that drug prices are the biggest hardship.' "Applicants have varied from a woman who had no income and was living on her savings of about $2,500 to a couple who had $19,000 in the bank and $400 a month income. The woman was given the biggest possible reduction. The couple was rejected. "The society has issued 165 cards (5121 as of September 1963) and has rejected only 35 applicants. Those rejected were urged to apply again if their situation changed and they thought themselves eligible. (As of September 1963, 76 applicants were rejected due to possession of adequate income.) 66 "The society does not require bankruptcy or a 'pauper's oath' for eligibility. 'Many applicants have incomes of about $100 a month and are trying to stay off welfare,' a committee member said. 'We feel like encouraging them.' "The society's standards are flexible. But if an elderly couple had a small income and a couple of thousand dollars saved, the society would be inclined to give them a fee reduction. But, if the applicants were hanging on to substantial property or savings, the society would inform them it feels they should use at least part of it. "The plan is open to persons over 65 who have lived in King County at least a year. "The society has tried to spread the word about the plan through retired person's clubs and similar groups. "We had heard that there was a medical need in King County, not being met by welfare, composed of older persons barred from welfare aid by small savings accounts or property,' a committee member said. "We are trying to reach this group. So far, the response has been very gratifying, although we haven't found a great many cases we can help. ""We are most happy to explore any we hear about.'". Hon. WILBUR MILLS, WEST VIRGINIA STATE MEDICAL ASSOCIATION, Chairman, Committee on Ways and Means, House of Representatives, Washington, D.C. Wheeling, W. Va., November 10, 1963. DEAR CONGRESSMAN MILLS: I should like to take this opportunity to submit for your consideration the views of the West Virginia State Medical Association concerning H.R. 3920 which we understand will be under study by your committee starting November 18, 1963. I am Dr. D. E. Greeneltch, a practicing physician residing in Wheeling, W. Va. Since August 1961, I have served a term as president and also as chairman of the council of the West Virginia State Medical Association. As a medical society officer I have been intimately concerned with the preservation of equitable and adequate health care for the aged citizens of our State. To my knowledge there has not been a single confirmed instance where a person has been denied medical care in West Virginia because of inability to pay. According to figures supplied by the Research and Planning Division of the Blue Cross Association, the estimated civilian population of West Virginia as of January 1, 1963, was 1,752,154 persons. Of this number 162,950 (9.3 percent) were 65 years of age or over. Let us consider the various mechanisms under which this aged group received medical care in a State admittedly suffering from a certain degree of economic depression. The report of the Subcommittee on Health of the Elderly, U.S. Senate, published in October 1963, states that 26,568 different aged individuals received medical care under the West Virginia MAA program in fiscal 1962 at a combined Federal-State cost of $3,683,418. 1 It is interesting to note that many of the 512 persons who have been issued reduced-fee cards, are persons whose income is low enough that they could apply for and probably receive old-age assistance or medical assistance to the aged (MAA). These persons apparently prefer to remain independent of old-age assistance and medical assistance to the aged, and they are extremely well pleased with their reduced-fee cards which entitle them to physicians fees, sometimes reduced to 5 percent of the usual charge, depending on the individual's financial situation. The annual report of the West Virginia Department of Welfare for fiscal 1962 states there was an average of 17,987 persons on the old-age assistance rolls. These individuals are entitled to complete medical care as well as subsistence awards. A sum of $1,471,323 of combined funds was expended in fiscal 1962 to provide medical care under this program. Thus, in fiscal 1962, a total of 44,555 aged citizens of West Virginia received medical care at a combined Federal-State cost of $5,154,741. It can be assumed that those individuals on OAA received all their medical care under this program since they are a totally indigent group. However, since preenrollment is not practiced in the MAA program the 26,568 individuals receiving care under this program must necessarily have been ill in some degree. This would represent a utilization percentage in MAA of 25.9, if we accept an earlier estimate of the department of welfare that 102,500 of our senior citizens could qualify. Contrary to reports that were circulated in 1962 the West Virginia MAA program has never been in financial difficulty. Each year since the inception of this program, in October 1960, there has remained a sizable surplus from funds appropriated by the legislature. This would indicate that the need for financial assistance by this medically indigent group is being met. There has been a tendency by the department of welfare to siphon off excess funds from MAA to implement new welfare programs, instead of constantly working to further improve the scope and effectiveness of this program within the sums appropriated for this purpose. Since March 1962 the joint conference committee of the West Virginia State Medical Association has been meeting monthly with the commissioner of welfare in an effort to improve both the MAA and other medical programs administered by this department. In addition nine regional medical committees meet with area administrators to adjudicate and settle differences arising between physicians and local offices. An investigation of the possibilities of insuring eligible clients of the depart ment of welfare through Blue Cross-Blue Shield, or by independent health insurance carriers is now going on and a progress report will be made to an interim committee of the legislature later this month. In late 1962 a panel of physicians from the Kanawha Medical Society worked without remuneration with the cooperation of the department of welfare in reviewing the medical eligibility of the aid to dependent children caseload in Kanawha County. This study is continuing and the commissioner of welfare has requested funds to form such review panels in all nine welfare divisions of our State. This collaboration must continue. Up to this point we have been discussing the utilization of existing provisions for providing medical assistance for the aged under the Kerr-Mills Act. We believe it was never the intent of Congress that these programs should supply total medical care to our aged but merely to assist those who need help. We feel that this intent is being realized in West Virginia. It is the belief of the physicians of West Virginia that voluntary health insurance will expand to cover most of our aged population. The November 4, 1963, issue of Best's Weekly News, a publication of the insurance industry, states that the Insurance Association of America estimates 60 percent of persons 65 years of age or over were protected by some form of health insurance at the end of 1962. Many new health insurance programs have been introduced since that date. A communication from Blue Cross Association states that 20,898 West Virginians over 65 years of age were covered by Blue Cross-Blue Shield policies on January 1, 1963. Although I do not have the statistics for those senior citizens covered by commercial insurance carriers, my own practice would indicate a greater number of people are insured by these companies than by the Blue plans. The 1962 statistical abstract of the United States indicates 76.8 percent of all West Virginians carry health insurance. The Health Insurance Institute lists benefits of $56,457,000 paid to West Virginians in 1960. We would remind members of your committee that these figures represent the ability of citizens from an economically depressed State to provide for themselves through voluntary mechanisms. We have been made aware of certain allegations that the individual States do not have sufficient tax revenue to meet available Federal matching funds for carrying on an adequate Kerr-Mills program. It is our contention that if such tax revenue can be made available in West Virginia, an economically depressed State, similar funds should certainly be available in States that are in better financial condition. In addition to voluntary insurance and welfare programs, a sizable number of our older citizens are provided complete medical care without charge through fraternal organizations, as beneficiaries of the United Mine Workers of America Fund, and as patients in various West Virginia State hospitals (7,119 beds) and Veterans hospitals (1,462 beds). As physicians we are intensely interested in the health and welfare of all our people. We remain unalterably opposed to the enactment of any laws that would finance the health care of all our aged through a compulsory social security tax. We consider such legislation unnecessary, ill conceived, and unfair to the lower income group. It is our impression the enactment of H.R. 3920 would be an irrevocable move. If this bill became law, further expansion in each succeeding Congress would ultimately cover all aspects of medical care with certain deterioration in the quality of this care being the end result. We appreciate this opportunity to explain the West Virginia story to your committee. Very truly yours, Mr. LEO IRWIN, D. E. GREENELTCH, M.D. KERN COUNTY MEDICAL SOCIETY, Bakersfield, Calif., November 15, 1963. Chief Counsel, House Ways and Means Committee, DEAR SIR: We, the members of the Kern County Medical Society, want to express our opposition to H.R. 3920 for the following reasons: (1) The provision of hospital care by the Federal Government for all persons age 65 and older under the terms of this bill irrespective of needs or means is the overt establishment of a system of socialized medical care. (2) The provision of benefits-instead of moneys-to social security recipients is a radical departure from the principle and concept of social security. In addition to the deprivation of discretion in the use of benefits by providing services, instead of moneys, the logical extension of some benefits would lead to provision of other necessities of life-food, clothing, and housing. The intrusion by the Federal Government in every detail of life of an entire population age group is a deprivation of rights and freedoms inherently guaranteed by our Constitution. (3) The needy aged are well provided for by existing public welfare and assistance programs. The near or potentially needy can be protected by further and proper implementation of the Kerr-Mills law. The unneedy should not be given benefits at the expense of the rest of our citizenry. (4) The blanket inclusion of all aged in a governmental hospital service program will ultimately destroy the voluntary health insurance system which has already enrolled over 55 percent of those past 65; and which is rapidly closing the needs gap by providing more comprehensive and inexpensive policies for this age group. Almost 80 percent of those under 65 have demonstrated their individual initiative by voluntarily availing themselves of health insurance. Yours truly, THOMAS V. REESE, M.D., President, Kern County Medical Society. LOS ANGELES COUNTY MEDICAL ASSOCIATION, Mr. LEO IRWIN, Chief Counsel, House Ways and Means Committee, DEAR MR. IRWIN: Enclosed please find a resolution unanimously adopted by the Los Angeles County Medical Association at its meeting on Monday, November 4, 1963. We would appreciate it if this resolution could become a part of the hearings record of the House Ways and Means Committee on H.R. 3920, which commences November 18, 1963. Very truly yours, RICHARD L. TAW, M.D., RESOLUTION Whereas the House Ways and Means Committee of the House of Representatives of the U.S. Congress will hold hearings on H.R. 3920, known as the King. Anderson bill, beginning November 18, 1963; and Whereas H.R. 3920 supports the same basic principles as the King-Anderson proposal, H.R. 4222, which principles were defeated in the U.S. Senate in 1962; and Whereas this association has consistently opposed compulsory medical care through the social security system: Therefore be it Resolved, That the council of the Los Angeles County Medical Association, representing 8,000 physicians, reaffirms its opposition to H.R. 3920 and directs that a copy of this resolution be sent to Mr. Leo Irwin, Chief Counsel, House Ways and Means Committee; Further, that a copy be sent to each of the following: Congressmen from Los Angeles County, the U.S. Senators from California, and to the chairman of the House Ways and Means Committee of the U.S. Congress. ORANGE COUNTY MEDICAL ASSOCIATION, Orange, Calif., November 7, 1963. Mr. LEO IRWIN, Chief Counsel, House Ways and Means Committee, DEAR MR. IRWIN: It is requested that this statement be made a part of the record of the public hearings to be conducted by the House Ways and Means Committee public hearings on H.R. 3920, November 18 through 27, 1963. The more than 1,000 physicians of Orange County, Calif., urge all members of the House Ways and Means Committee to do everything within their powerboth collectively and individually-to reject and defeat the King bill, H.R. 3920. This Nation's wage earners, most of whom are in the modest and low income bracket, and their employers would pay a compulsory tax to provide money for the hospital care of all the Nation's elderly (about 171⁄2 million Americans over 65), most of whom are self-supporting. H.R. 3920 maintains a pretense of solving the medical care needs of the aged when, in fact, it offers only limited hospital and/or nursing home care, and would cover only a small portion of any elderly person's total medical bills. It would cover less than 25 percent of the cost of an individual's illness. The King bill also sets up rigid and complete control in Washington under the Secretary of Health, Education, and Welfare. He has the power to select the patient's hospital and physician, plus full authority to veto the patient's own physician's judgment. The hospital staff committee in each institution is empowered to determine the admission of aged patients and their length of stay, as well as being required to review the medical necessity of the services performed. Thus a committee set up under H.R. 3920-not the patient's physician-could decide when an individual's hospitalization would be started and/or terminated. Hosiptals and nursing homes, to qualify for payment, must sign an agreement with the Secretary of HEW. The institution must perform to the satisfaction of the Sercetary per the terms of the bill or he has full authority to terminate the agreement. The bill will increase the social security tax 16 percent with the burden falling heaviest on the small wage earner. The $5,200-a-year clerk will pay as much as the $50,000 corporation executive. With the medical care tax added to the automatic social security tax increase which became effective January 1, 1963, employers and employees would be paying 40 percent more tax than they were in 1961. With further automatic increases already in the law, they would be paying 76 percent more by 1968. The first year alone would cost wage earners and employers of California $172.2 million in additional payroll taxes. These figures are based on the lowest estimated cost of the plan. When one realizes that the social security fund is already more than $300 billion in arrears in cash to meet retirement obligations to all covered by the program since its inception, how do you expect it to pay for this additional program? |