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Plainly, the retirement needs peculiar to the medical profession require an altogether different approach. Mindful of this fact, the AMA strongly supported enactment of Public Law 87-792, the SelfEmployed Individuals Tax Retirement Act of 1962. This law is designed to provide prepaid pensions for all who are willing to save. It enables self-employed persons to set aside a portion of their current earnings, on a tax-deferred basis, for themselves and their employees, for their retirement.

We have said before, Mr. Chairman, and we repeat: We believe that our country is so diversified and that the people earn their livings under so many different conditions that it is wise public policy for the self-employed to be accorded the opportunity to participate in a flexible retirement system on a voluntary basis. It fits the economic pattern of their lives.

For the reasons outlined here, we submit that section 8 of the pending legislation represents action which would be both unnecessary and unreasonable. We urge the committee to reject it.

And now with your permission, Mr. Chairman, Dr. Annis will continue our presentation.

Senator SMATHERS. Doctor, did you make the statement with repect to section 8 relating to your position with respect to coverage of doctors before the House Ways and Means Committee?

Dr. WELCH. I don't think this came up. It did not come up, Senator.

Senator SMATHERS. The matter did not come up before the House Ways and Means Committee?

Dr. WELCH. Not at the time that we were having our hearing.
Senator SMATHERS. Yes.

Senator RIBICOFF. Mr. Chairman, I wonder if we couldn't ask a few questions on this phase before we go to the second phase. Senator SMATHERS. Yes, indeed.

Senator Gore, do you have any questions?

Senator GORE. Doctor, could not the same statement you have just made, except for the patient-doctor relationship, be made with respect to lawyers?

Dr. WELCH. I suppose it could be, Senator.

Senator GORE. What about architects?

Dr. WELCH. Well, I am not familiar enough with the architects' situation to be able to answer your question.

Senator GORE. With the exception of teachers, the members of most professions will be at the peak of their earning capacity in their sixties. That would certainly be true of lawyers, would it not?

Dr. WELCH. Well, again I couldn't be sure. I would assume you are probably correct, Senator, but I could not be sure about it. I don't know the various age categories or income levels of attorneys.

Senator GORE. Well, my knowledge is not precise either. I was merely trying to indicate to you that many other groups, particularly professional groups, would have earning-age situations not unlike that of doctors.

I agree with you that if a doctor maintains his health, he is very useful and very much in demand at 65, even at 70. Unfortunately, doctors have no more assurance of being in good health at 65 or 70 than most of us do.

There are few certainties in this life. This was the only point I wished to make, Mr. Chairman.

Senator SMATHERS. Senator Carlson, do you have any questions? Senator CARLSON. Dr. Welch, how recently have you conducted a referendum on the feeling or thinking of the physicians as to inclusion under the social security program?

Dr. WELCH. We have not conducted a so-called poll of physicians by the American Medical Association. Our decision in this matter has been made by the house of delegates which is representative of physicians throughout the United States and is selected on the basis of 1 delegate for each 1,000 members of the American Medical Association in each State.

We feel this is a representative type of government, and these individuals hold hearings on the subject in what we call reference committee meetings which are similar to the hearing which you are holding here today. The most recent of these was the middle of June, less than 2 months ago, when the house voted against inclusion of physicians in the social security program.

Senator CARLSON. I would state that the doctors and physicians in my own State, by writing, have certainly expressed, generally expressed, their opposition to inclusion.

However, we had some testimony before this committee within the last day or two that questioned the method and the reliability of the referendum or poll that you have taken.

Have you anything to say on that?

Dr. WELCH. Well, we actually, as the national association, have not taken a poll. There have been polls taken in various States, the results of which are a little bit difficult to interpret because of the difference in the way that the question was asked in the poll.

For instance, in one State there was a vote for inclusion of physicians by the vote of the majority opposing it if a bill like the Keogh bill were passed. The Keogh bill has been passed, so the actual situation in that State would be in opposition to inclusion of physicians Senator CARLSON. That is all, Mr. Chairman.

Senator SMATHERS. Senator Ribicoff?

Senator RIBICOFF. You say, Doctor, that physicians aren't in favor of being covered by social security.

How about the doctors in Massachusetts?

Dr. WELCH. The doctors in Massachusetts

Senator RIBICOFF. That is your home State.

Dr. WELCH. Yes, it is, Senator. The doctors in Massachusetts have voted in a poll for social security coverage.

Senator RIBICOFF. The vote in Massachusetts was 3,253 to 988, is that right?

Dr. WELCH. You may be right, Senator, I don't know.

Senator RIBICOFF. So basically when you talk about how doctors feel you are not talking about doctors' feeling in your own State of Massachusetts.

Dr. WELCH. This would be true, but again, Mr. Senator, I am not sure how the question was asked. At times a question has been asked, Are you in favor of inclusion under social security? and when a second question has been asked, Are you in favor of voluntary inclusion? the question is answered differently. Therefore, I can't answer you as to just exactly how this question was asked in the poll taken in Massachusetts.

Senator RIBICOFF. How do you think doctors feel in the State of Connecticut, right next to Massachusetts?

Dr. WELCH. I would have to rely on you for that, Senator.
Senator RIBICOFF. Would it surprise you to know that in a poll in
Connecticut that doctors voted 1,391 to 504 for inclusion in social
security?

Dr. WELCH. It wouldn't surprise me if you say so, Mr. Senator.
Senator RIBICOFF. How about the State of Illinois?

Dr. WELCH. I can't give you the figure.

Senator RIBICOFF. 3,964 to 1,962 to include-to be included under

social security.

Senator SMATHERS. What State was that?

Senator RIBICOFF. Illinois.

Senator SMATHERS. Do you have Florida there, just as a matter of curiosity?

Senator RIBICOFF. Yes.

The vote in Florida was 957 for, 714 against of those who replied. Dr. ANNIS. Mr. Smathers, may Í

I

Senator SMATHERS. I wonder if the distinguished Senator from Connecticut would tell us who took this poll?

Senator RIBICOFF. Well, these polls were taken by different methods, by different groups, and different people.

They were discussed by Senator McNamara in the Congressional Record of June 13, 1963, at pages 10217-10219. These are the figures that I am taking out of Senator McNamara's statement placed in the Congressional Record. I would like to include the poll results in the record at this point.

I believe that one of the physicians who testified the other day also submitted for the purpose of the record some statistics.

Senator SMATHERS. Without objection, we will put that in the record.

(The figures referred to follow :)

Results of 18 State polls of physicians on the issue of social security coverage

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1 The California poll is a 1-in-10 poll of the State's 21,045 physicians, conducted by the Honest Ballot Association.

SUMMARY OF 18 POLLS

27,426 physicians favor coverage; 62.5 percent of all physicians voting.

16,330 physicians oppose coverage; 37.5 percent of all physicians voting.

The 43,756 physicians who cast "yes" or "no" votes represent 46 percent of all physicians in these States.

Senator BENNETT. Does that show the year in which each of these polls were taken?

Senator RIBICOFF. No, they don't. They don't show the years as I see it, Senator Bennett. They came over a period of time, I would say, different times during the last 4 or 5 years.

Dr. WELCH. Mr. Chairman

Senator SMATHERS. Yes, sir, Doctor.

Dr. WELCH. Florida is one State in which the expression changed pending the passage of the Keogh bill. So that if the Keogh bill were passed, 58 percent of the physicians would then oppose social security. Senator RIBICOFF. Are you aware of a publication called Medical Economics?

Dr. WELCH. Yes, sir, I am.

Senator RIBICOFF. Is it a reputable magazine?

Dr. WELCH. I would say it is a very widely read magazine on the particular subject with which it deals.

Senator RIBICOFF. On the different phases of medical economics? Dr. WELCH. Yes, that is true.

Senator RIBICOFF. Does it have a fairly wide circulation among doctors?

Dr. WELCH. Yes, it does.

Senator RIBICOFF. Would it surprise you or do you recall that an independent poll conducted by Medical Economics showed nearly 2-to-1 majority in favor of coverage under social security by the doctors?

Dr. WELCH. Again, I would not be able to comment on this, not knowing the number of people who replied to the poll and not knowing the type of question that was asked.

Senator RIBICOFF. What I am curious about is, why hasn't the AMA the courage to poll its own members, under your own auspices by a questionnaire that you send to them? I am curious after so many years yours is the only expression excluded, and why you have never undertaken to poll your own members of the AMA.

Dr. WELCH. Senator, I don't think it is a matter of courage. There is a great deal of education involved in this. I will tell you of a little experience I had 2 weeks ago that illustrates the education that would be necessary to conduct a poll that would be worth anything. I sat down to lunch in a drugstore next to a doctor whom I had known for a great many years who is approximately my age. He said, "Why doesn't the American Medical Association favor the inclusion of physicians under social security?"

I asked him, "When are you going to retire?"

He said, "I am not going to retire."

He had a mistaken idea that if he were included under the social security program when he got to be 65 years of age he would automatically begin to get a check.

I think this illustrates very graphically the problem which the American Medical Association would have in polling the physicians throughout the country, just the same as I believe the Congress of the United States would have difficulty in having a referendum on every subject which was being considered.

Senator RIBICOFF. Doctor, do I understand you to say that the doctors of America have a lower standard of intelligence than the average person in America?

Dr. WELCH. Oh, no, I wouldn't say that at all, Senator. I think a lack of information does not involve a matter of intelligence of the individual.

Senator RIBICOFF. Well, don't you think the doctors know about as much of what goes on as the average worker in America, all of whom are covered?

Dr. WELCH. Well, this depends upon, when you say what goes on, what you are talking about.

Obviously this physician had no appreciation of what the social security system is.

Senator RIBICOFF. But a man who works with a pick and shovel or works in a grocery store or insurance office does not get an automatic retirement benefit if he works after 65 either; isn't that correct?

Dr. WELCH. Yes, this is true.

Senator RIBICOFF. So in this respect he is exactly the same as the doctor.

Dr. WELCH. This is true. I am just answering your question about why we have not had the courage to hold a poll. It has nothing to do with courage, it is a matter of judgment, a matter of decision of the house of delegates which represents the physicians of this country. Senator RIBICOFF. Well, how about the wives and children of doctors?

Dr. WELCH. You mean protecting them?

Senator RIBICOFF. Yes.

Dr. WELSH. Well, I think

Senator RIBICOFF. Under survivorship.

Wr. WELCH. Yes, I think this is important to some individuals. I think when a young physician dies and leaves a family of small children, this becomes a very important consideration to the people who know him. But I think again you weigh the advantages in these particular situation against the overall picture, and you cannot be swayed by the emotion that occurs in an occasional case of this type

Senator RIBICOFF. Have you ever known of a doctor aged 35, 37, or 40 who has died, leaving a widow with two or three children?

Dr. WELCH. Yes, I have, naturally. I have been in practice for 35 years in a large metropolitan area. Physicians that I have known personally have died at a young age. I have known of those unfortunate situations.

Senator RIBICOFF. And certainly between 35 and 40 a doctor hasn't been in practice long enough to start having put aside a nest egg.

Dr. WELCH. Generally, I would agree with you. However, many of them do have a substantial amount of life insurance.

Senator RIBICOFF. But many of them don't.

Dr. WELCH. Yes, I would agree with you.

Senator RIBICOFF. At that

age.

Dr. WELCH. I would agree with you, Senator.

Senator RIBICOFF. Don't you think that the widows and orphans of doctors are entitled to as much protection as the widows and orphans of dentists and architects and day laborers and clerks and plumbers? Don't you think that the family of doctors are entitled to protection?

Dr. WELCH. Well, you put this again on an emotional basis.

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