Hon. WILBUR D. MILLS, BRAZORIA COUNTY [TEX.] MEDICAL SOCIETY, Chairman, House Ways and Means Committee, DEAR SIR: As president of the Brazoria County Medical Society, I wish to state the opposition of the society to the King-Anderson bill. It is requested that this statement of opposition be included in the printed record of the hearings. It is a tragic reflection on present-day government that it should be necessary to have to write a letter opposing a bill that would serve as the opening wedge not only to destroy the most efficient and effectual system of medical care the world has ever known but would, in addition, serve to deteriorate the quality of any medical care the aged could expect to receive in the years to come. The opposition to this bill is, in essence, less the struggle to preserve freedom of the physician to render the best possible care to his patient, but more the attempt to prevent still further erosion of the rights of the individual. The advanced years of life should be years of dignity and respect and not those subject to the whims of bureaucratic control whether in health or infirmity. The King-Anderson bill is an inequitable bill, the actual cost of which could be phenomenal. It is an unnecessary bill, designed for what its proponents consider to be a political advantage of the moment without consideration of its deleterious impact on generations yet to come. Action to provide the full implementation of the Kerr-Mills Act, plus the ever expanding coverage offered by private insurance programs, obviates any need for alternative proposals. Under these the citizens of this Nation can enjoy more efficient, far less costly, and a higher quality of medical care than could ever be supplied by any governmentcontrolled program. I wish to express my personal appreciation and that of the Brazoria County Medical Society for the stand you have already taken in opposition to the KingAnderson bill. It is encouraging to know that there are men of your caliber working to preserve the principles that made this the great Nation that it is. Respectfully yours, FREDERICK C. TURNER, M.D., President, Brazoria County Medical Society. GALVESTON COUNTY MEDICAL SOCIETY, Galveston, Tex., November 21, 1963. Hon. WILBUR D. MILLS, Chairman, House Ways and Means Committee, SIR: On behalf of the Galveston County Medical Society, I wish to express the society's opposition to the King-Anderson bill H.R. 3920, which hearings are now being conducted by your committee. The statistics which are being prepared by the Texas Medical Association and which will be introduced in these hearings bear out the increasingly successful functioning of the Kerr-Mills program in Texas. It is noteworthy that the University of Texas medical branch hospitals in Galveston provide treatment for many indigent and near-indigent elderly citizens referred from all over the State of Texas, and I assure you that the payment for such health care through OAA and non-OAA, is correspondingly high and very satisfactory, in line with the overall statewide experience. In addition, the introduction of the Texas 65 plan has been enthusiastically received and this should further augment the plans for financing the health care for the aged on a voluntary basis at the State level. I have had the opportunity to discuss this matter in Washington with the Honorable Clark W. Thompson, Congressman from the 9th District, and he has assured me that his stand on the proposed legislation hinges-as he stated last year-on the adequate functioning of the Kerr-Mills program in Texas. It is my belief, therefore, that if the facts and statistics presented before your committee are appraised objectively, realistically, and impartially, there should be no question as to the efficacy of the existing Kerr-Mills legislation supplemented by private insurance and other funds in successfully financing the health needs of our older population through voluntary means. Very truly yours, CARROLL T. ADRIANCE, M.D.. President. STATEMENT BY DR. ROBERT A. FRISCH, PRESIDENT, THE MEDICAL SOCIETY OF MILWAUKEE COUNTY (WIS.) Mr. Chairman and members of the committee, my name is Dr. Robert A. Frisch, a physician in the private practice of internal medicine in Milwaukee, Wis. This statement in opposition to bill H.R. 3920 is made by the over 1,400 members of the Medical Society of Milwaukee County in the interest of the over 1 million patients whom we serve. The physicians of our community, through the Medical Society of Milwaukee County, have pursued an active program of community health improvement since the establishment of the society in 1846. It is our primary objective to continue to provide the people of this county of over 14 million people with the highest quality medical care available—anywhere. Our society has continually studied means of rendering the best medical care to those we serve. This has included support of legislation proposed by local, State, and National governing bodies. We are opposed to the King bill-H.R. 3920-because of our sincere conviction that its passage would result in a lower standard of health care for the people of our community. We believe that only through freedom of medical practice can we continue to provide our citizens of every age group with highquality health care. We further believe that this piece of legislation-H.R. 3920-is superfluous. Through voluntary health insurance plans, an increasing number of persons are being protected against the costs of sickness. Through surgical care, the Blue Shield plan of the Medical Society of Milwaukee County, we have helped people of Wisconsin to budget their health care costs for the past 20 years. Surgical care Blue Shield now protects 84,000 persons over age 65, and the number is steadily increasing. In the coming year, the people of our community who are unable to provide for their own health care will be able to seek assistance under the Kerr-Mills law which has been enacted in our State. This law will prove an important adjunct to the old-age assistance program which has long helped needy persons in Wisconsin. The people of Wisconsin have available to them the help provided under the Old Age Assistance Act, workmen's compensation, cooperative health care plans, Blue Shield and other voluntary health insurance plans, and, soon, will have the Kerr-Mills law. All of these were designed to help those who need help. These plans came into existence through the leadership or cooperation of medicine in our State. This is the situation in Wisconsin. These are our reasons for declaring that passage of the King bill is unnecessary to help the people of the Milwaukee community whom we serve. We fully realize that while many States have equal means of providing for those people who require assistance in tending to their health needs-people in every age group-there are some who do not. But while Government action may be necessary to correct the situations in these area, the best solution to achieve adequate programs to meet the needs of our senior citizens-or our children— or our people in any other age group is through action at the local or State level. In summary, may I ask you to remember that the private practice of medicine which has enabled us to achieve a longer and more healthful life has always been eager and willing to help extend the best possible medical care to all persons. Our Nation is making increasing progress in meeting the health needs of our ever-growing population through the expansion of many voluntary programs. On behalf of the physicians and the people of Milwaukee County, I ask you to take no action which will obviate these programs. I ask you to report unfavorably on H.R. 3920. Thank you for providing me the opportunity of presenting this statement to you. Hon. WILBUR D. MILLS, STUDENT AMERICAN MEDICAL ASSOCIATION, Chairman, Committee on Ways and Means, U.S. House of Representatives, House Office Building, Washington, D.C. DEAR SIR: I am writing on behalf of the Student American Medical Association, in regard to the King-Anderson bill (H.R. 3920) which is presently being considered by your committee. The Student American Medical Association is an autonomous organization with 19,000 active medical student members in 77 of the Nation's 87 accredited medical schools, and over 30,000 affilitate intern and resident members. In order to briefly acquaint you with the purpose of the Student American Medical Association, I will quote from the constitution of our organization, which states, "The objects of this association shall be to advance the profession of medicine, to contribute to the welfare and education of medical students, interns, and residents, to familiarize its members with the purposes and ideals of organized medicine, and to prepare its members to meet the social, moral, and ethical obligations of the profession of medicine.' Inherent within the objects of our association is the further goal of helping to maintain the established high standards of medical care within the framework of the American free enterprise system. My purpose here is to express our opposition to H.R. 3920; elaborating on the background of our past and current adverseness to the concept of utilizing the social security system in providing medical care to the aged. In July 1961, our then president, William B. Weglicki, Jr., appeared before the Committee on Ways and Means of the U.S. House of Representatives to state our opposition to H.R. 4222. This action was the result of more than 2 years of active study and investigation by SAMA members and national SAMA committees of the various health care plans for the aged. President Weglicki voiced the opinion of our 1961 house of delegates that, "We recognize that there are many problems inherent in maintaining the present high standards of medical care in this country, such as those that are due to a rapidly increasing population, as well as an increase in longevity of the people of this country, and we are deeply concerned with finding solutions to these problems. We believe that the medically indigent aged patients receive adequate care through existing programs and agencies if they inform and avail themselves of the opportunities offered. However, we recognize another group of elderly patients who are very much in need of new aid, and these are the borderline cases, who, through pension or employment, are self-sufficient until a crisis, such as long-term illness, exhausts their finances and 'pauperizes' them. This is a tragedy which must be prevented." He further stated that much of our concern over this segment of the aged population was alleviated by the passage of the Kerr-Mills Act (Public Law 86-778). That if State legislatures properly enacted this law; there would be no need for a social security financed health care program. In 1962 our house of delegates reiterated its support of the Kerr-Mills law and continued its opposition to the enactment of King-Anderson-type legislation. In so doing, it gave as its reasons the conviction that "We feel legislation utilizing the social security mechanism, such as the King-Anderson bill (H.R. 4222), will lead to a limitation of the freedoms inherent in the American free enterprise system by restricting the patient's choice of hospital and by subjecting the physician to unnecessary Federal interference and regulation. That such legislation will lead to a poorer quality of medical care for all our people by overcrowding existing hospital facilities and by deterring capable and potential students from entering into medical training by the threat of Government control. That the health care problems of all our people can be solved through the use of the voluntary health insurance mechanism and by the implementation of the KerrMills law and the utilization of existing State and local laws for our needy, and near-needy citizens." The 1963 house of delegates voiced its opposition to the King-Anderson bill (H.R. 3920) and the Holland file (H.R. 53) for the above same reasons. Even more significant was the adoption of the following recommendations to SAMA members: 1. To encourage and/or work with voluntary health insurance organizations in all States to increase the supply of reasonable and comprehensive voluntary health insurance, particularly for the aged. 2. To recommend to all physicians that they should make their patients aware of the need and availability of such health insurance. 3. To support medical assistance to the aged (MAA) programs pursuant to Public Law 86–778 (Kerr-Mills) as means for assisting medically indigent senior citizens, and to urge those States which lack adequate MAA programs pursuant to that law to enact such programs or to improve the provisions of presently inadequate programs. 4. To recommend to Congress that further Federal programs for direct medical care assistance should not be enocted as long as voluntary health insurance organizations demonstrate their ability to meet the demand and need for adequate health insurance, and as long as (Kerr-Mills), where adequately implemented, are sufficient to provide assistance to medically indigent senior citizens. I think that I can best summarize our present stand and activity in this area by quoting the following adopted proposal, "That the members of the Student American Medical Asociation endeavor to inform the American public of all of the ramifications involved in social security medical care, including the belief that its history indicates that it is motivated more by political considerations than by the medical and economic needs of the aged; that it will result in an unecessarily expensive Government program of questionable value which will lead to bureaucratic control of the health care of the American people." I trust that the foregoing remarks will serve to impress upon you and the members of your committee, that as medical students and future physicians, we claim the right to this voice as our stake in the future of American medicine. My sincere appreciation to you and your committee for consideration of these comments. Respectfully yours, ROBERT O. VOY, President, Student American Medical Association. AMERICAN ASSOCIATION OF MEDICAL CLINICS, Hon. WILBUR D. MILLS, Chairman, House Ways and Means Committee, DEAR SIR: Enclosed are 50 copies of a resolution adopted by the American Association of Medical Clinics dealing with suggested modifications of the Kerr-Mills law and the care of the aging on which subject it is understood that the House Ways and Means Committee will resume hearings shortly. The suggestions are constructive in nature and are based on the experience of the members of the legislative committee and of the members of this association at the working level of the law. Very sincerely yours, EDWIN P. JORDAN, M.D. SUGGESTIONS FOR IMPROVEMENT OF THE PRESENT KERR-MILLS LAW 1. Removal of the single agency requirement so that the OAA and MAA programs will be separate agencies. 2. Provide more flexibility of administration of the income and resources provision so that some method can be devised to give medical care to an individual who is placed under a financial hardship due to long illness. 3. Establish a medical advisory committee within each State, two-thirds of the members of which shall be doctors of medicine. 4. Free choice of hospital and physician should be assured the patient. Resolution adopted by the delegates to the annual meeting, American Association of Medical Clinics, September 27, 1963. STATEMENT OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS, RE H.R. 3920, 88TH CONGRESS, 1ST SESSION, HOSPITAL INSURANCE ACT OF 1963 Mr. Chairman and members of the committee, at the request of the Executive Committee of the American Academy of Orthopaedic Surgeons, Dr. Alvin J. Ingram appeared before your distinguished committee on August 2, 1961, to express our opposition to H.R. 4222, the Health Insurance Benefits Act of 1961. This statement and an extension of his remarks were published in "Health Services for the Aged Under the Social Security System," hearings before the Committee on Ways and Means, House of Representatives, 87th Congress, 1st session, on H.R. 4222, volume 3, pages 1477-1486. During the past 2 years, the American Academy of Orthopaedic Surgeons has continued to exhibit deep interest in providing medical care for the physically handicapped of all ages. We have and will continue to render our professional services to those who need them, regardless of their ability to pay. The opportunity to express to this distinguished committee our opinion in regard to H.R. 3920, 88th Congress, 1st session, known as the King bill, is appreciated. We oppose this bill because we are convinced that a federally controlled, compulsory hospital and medical care system is not needed, is not wanted, and if enacted would prove harmful to all concerned. Statistics submitted to this committee by the American Medical Association, various State medical associations, and other witnesses, prove that the KerrMills law not only can, but is working to assist increasing numbers of needy individuals to obtain health care. The diversity and variety of programs in operation in the several States need not be considered a weakness; rather it should be realized that experience is being accumulated which will contribute to a more equitable solution of the problem. The health insurance industry has continued to make great strides in the past 2 years and has submitted statistics to indicate that the percentage of the aged population covered by quality health insurance increases each year. The enactment of H.R. 3920 would place the Government in unfair competition with one of the most rapidly growing segments of our economy: the health insurance industry. Hon. Thomas B. Curtis has submitted information to this committee indicating that while medical care for the aged under social security was once desired by 65 percent of those questioned, recent surveys and polls have indicated that the majority of the individuals questioned, in almost every poll conducted, is opposed to medical care for the aged under the social security program. The American Academy of Orthopaedic Surgeons continues to hold the opinion that through "the power of the purse" the Secretary of Health, Education, and Welfare would be, in effect, the czar of the health industry. He would thus, of necessity, control hospitals, nursing homes, and the relations existing between the two. He would also control through "the power of the purse" those branches of medicine whose practices are limited to hospital settings, such as anesthesiology, physical medicine, X-ray, and pathology. We continue in our opposition to this bill on the grounds of professional and political philosophy which was expressed and documented in the previous testimony before your esteemed committee, and which is recorded in the proceedings of the hearings referred to above. In conclusion, we call your attention to the testimony of the American Medical Association and the various State medical associations and others in opposition to H.R. 3920 and similar legislation, and request that you place the American Academy of Orthopaedic Surgeons, and the vast majority of orthopedic surgeons of America, on the side of the American Medical Association, and in opposition to this bill. Please accept this expression of our appreciation for your willingness to enter this statement into the record of these hearings. Respectfully, AMERICAN ACADEMY OF ORTHOPAEDIC ALVIN J. INGRAM, M.D., Special Representative. CLINTON L. COMPERE, M.D., President. CHARLES V. HECK, M.D., Secretary. STATEMENT OF THE AMERICAN SOCIETY OF INTERNAL MEDICINE, RE H.R. 3920, HOSPITAL INSURANCE ACT OF 1963 (By Joseph F. Sadusk, Jr., M.D.) Mr. Chairman and members of the committee, I am Dr. Joseph F. Sadusk, Jr., a duly licensed physician of Washington, D.C., and I speak in opposition to H.R. 3920. I represent the American Society of Internal Medicine, a confederation of societies of internal medicine in 46 States, the District of Columbia and Puerto Rico. We represent nearly 8,000 physician-specialists in internal medicine. Our |