board" requested from each hospital a copy of any contract with radiologists so as to insure compliance with laws prohibiting corporate practice. (3) Unlimited authority for control and supervision-and interference-lies in the hands of the Secretary of HEW when a hospital is defined as an institution which "meets such other conditions *** as the Secretary may find necessary ***" (4) It is proposed that the amount paid for services "shall be the reasonable cost of such services, as determined in accordance with regulations establishing the method or methods to be used in determining such costs for various types or classes of institutions, services, and agencies." Standards for quality of hospital services would be leveled by budgetary needs of the regulating body. At that time interference would have determined a standard level for medical care for all groups. EFFECT OF PROPOSED LEGISLATION ON HEALTH CARE It is human to demand that to which one is entitled. With free care, this would increase and our acute general hospitals would become institutions for chronic care. This would affect our national economy. Inability to obtain early care will protract illnesses. While we symptomatically treat for months an incurable cancer patient, a wage earner would be waiting this same number of months for a hernia repair which would permit him to be gainfully employed. We have just opened a new wing for our hospital providing a 100-percent increase in beds. Today, after 1 year, we have a 4- to 6-week waiting period for elective admissions and a 1- to 2-week waiting period for urgent admissions. The need today is for nursing homes and old age living quarters. Lacking these and with Government provision of hospital care, our hospitals would be filled with those over 65. This is confirmed by the present Assistant Secretary of HEW in a statement at the time of the hearing on H.R. 4700 when he said, "There are very few nursing homes that would presently meet the requirements of providing truly skilled nursing home service." He accordingly did not include nursing homes in a desirable program. H.R. 4222 proposes a new concept for the social security system in this country. It substitutes provision of services for dollar benefits. Government established payment would affect the manner in which medical services are provided by a hospital, would affect the selection, tenure, or compensation of hospital employees, and would affect the quality of care deemed necessary by the physician. Where this level is lowered because of payment limitations, it would be lowered for all age groups. COSTS, FACTORS INVOLVED It is very difficult for anyone to give any estimate as to cost of any Governmentfinanced health program. The history of all such plans is that projections were low and the final cost was limited only by arbitrary budget allotment. It has been estimated that by 1975 we will be a nation of 220 million people. The slowest growing group, the taxpaying segment, will increase by about 20 percent. The underage group will increase by 35 percent and those over 65 will increase by 52 percent. This will have an unpredictable effect on future costs of this legislation. The greatest unmet needs for the over-65 age group today are companionship and living quarters. I repeat that lacking these, hospitals will carry the burden. It is my firm conviction that voluntary health programs are more effective than government programs. Certainly the experiences in Great Britain have been disastrous. THE NATIONAL HEALTH SERVICE IN GREAT BRITAIN "No government could afford to pay for hospital services as you in the United States have grown to demand them." This was the comment to me from the medical director of a large well-known hospital in Great Britain. In this hospital with wood floors and old iron beds there are 32 beds to a ward and two private rooms to each ward. One common bath and tub exist. There is 0.8 of an employee including doctors for each patient. The significance of this figure can be appreciated when one considers that in the United States we have 2.5 employees caring for each patient, excluding doctors. The British hospital solution to an arbitrary reduction in dietary budget was second-quality meat, reduction in food varieties, and breakfast without eggs or bacon unless the family furnished the raw food for preparation. Waiting lists are long for admission to hospitals. Examples of tonsil admissions were cited of a wait from 1 to 7 years. Private philanthropy has ceased to exist. Twenty-one percent of the hospitals were constructed before 1861 and 45 percent before 1891. Hospital construction has been almost nil since the inception of the national health service system in 1948. There were 2,000 health centers to be built. Only a few have been completed. In 1954 the capital expenditure was one-third that of 1938 and in 1956 only one-half of that spent in 1938 was budgeted. The hospital length of stay is much longer than that in our voluntary system; 19 days overall where in our area 10 days overall is considered excessive. I saw evidences of abuse, interference, and bureaucratic regimentation. The dean of a medical school told me that the quality of medical students had deteriorated since the system was established. Leaders in medicine told me that they were sending their own sons to the United States for hospital training because the hospital experiences were on such a higher plane in this country. We know that we are attracting good students from England in our training programs, and they do not wish to go back. The reverse is not true. The general practitioners to whom I talked have lost the zeal so important to the practice of medicine. One commented to me that he was only the traffic cop spending most of his time finding a bed for his patient and then he was out of the picture. The hospital is the diagnostic center for inpatient and outpatient. Patients wait for hours in these clinics. Cafeterias are set up to feed them over the meal hour. In one hospital women are examined with a curtain drawn between them and the physicians, five or six, so that the patient is just a number. There has been a growing resentment to the direct costs which have had to be added to the program because of poor estimates of its cost. It was predicted that the system would cost £170 million and would never go over that because of improved health which would result. The first year cost was £431 million. In 1958 the cost was £763 million. In 1960 the cost was about £800 million in spite of added direct costs and increased taxes, and it is predicted that the cost will be a billion pounds by 1965. The health of the nation has improved but not to the degree of improvement in the United States. While this may have been the best answer for Great Britain, it is not the acceptable answer to you, me, or the American public. ALTERNATE PROPOSALS I object to the principles of H.R. 4222. I believe that a means has been established for assistance to those in need through the Kerr-Mills bill. This measure has not been given ample opportunity to prove itself. Universal implementation should be encouraged. The Government's role in assistance to the needy should be to assist in expansion of community facilities and services for the health care of aged and others. SUMMARY In conclusion, I oppose passage of the Health Insurance Benefits Act of 1961 because: I. Proposed legislation does not answer existing unmet needs, yet advocates a compulsory program irrespective of desire or need, which will answer needs already being met. I have related how one community handles these problems with State-Federal assistance. Local needs are best known by local authorities and can be best met by team approach. This measure would destroy community initiative and family responsibility. II. Conflicts exist within this bill which are both misleading and contradictory-prohibition against interference. These conflicts represent a "footin-the-door" approach to Federal control of all health services. III. The effects of H.R. 4222 lead to a decreased quality and quantity of all health care. Our general hospitals would become chronic hospitals when the need of the over-65 age group is much greater for companionship, than for acute medical beds. Philanthropy would not continue under Government influenced operation. The hospital rather than the family doctor would become the diagnostic center. The young patient with the acute curable disease entity would have his earning power depleted and illness protracted while he waited for a bed used to symptomatically treat an incurable process, which could be treated elsewhere. A new concept is proposed for the social security system in this country, one which substitutes provision of services for dollar benefits. IV. Costs for provisions of H.R. 4222 are totally unpredictable and would continue to rise. Needs can be better determined and satisfied locally at much less expense than through a centrally controlled organization. V. Experiences of the national health service in Great Britain are cited which would demonstrate weaknesses in the proposed legislation. VI. Alternate proposals include wider implementation of the Kerr-Mills bill, with local responsibility for health care. The role of the Government lies in assistance to local programs. If one part of the population is without food, the Federal Government does not assume responsibility for feeding all of the group. Yet food, shelter, and clothing are primary, and without these there is no need for health care. No other country on earth boasts better health care for its citizens than does the United States. No other country on earth is freer of governmental intervention in health care. Honorable members of this committee, in my opinion this is not just a coincidence, and I believe that H.R. 4222 establishes governmental intervention. The CHAIRMAN. That completes the calendar for today. Without objection, the committee adjourns until 10 a.m. tomorrow. (Whereupon, at 6:10 p.m., the committee adjourned, to reconvene at 10 a.m. Tuesday, August 1, 1961.) HEALTH SERVICES FOR THE AGED UNDER THE SOCIAL SECURITY INSURANCE SYSTEM TUESDAY, AUGUST 1, 1961 HOUSE OF REPRESENTATIVES, Washington, D.C. The committee met at 10 a.m., pursuant to recess, in the committee room, House Office Building, Hon. Wilbur D. Mills (chairman of the committee) presiding. The CHAIRMAN. The committee will please be in order. Our first witness this morning is our colleague from Michigan, the Honorable John D. Dingell. Mr. Dingell? Mr. Hayes of the International Association of Machinists. Mr. Hayes, please come forward. Mr. KNOX. Mr. Chairman. The CHAIRMAN. Yes, Mr. Knox. Mr. KNOX. May I ask to have inserted in the record one telegram and one letter from constituents of mine who have requested they be made a part of this record? The CHAIRMAN. Without objection, they will be inserted at the appropriate place in the record. (The communications referred to follow :) VICTOR A. ΚΝΟΣ, House Office Building, Washington, D.C.: LANSING, MICH., The principles and practices of Government-supplied health care for the aged as expressed in Kerr-Mills bill has the complete support of the Michigan State Dental Association. Health care for the aged under the bill now being considered by the House Ways and Means Committee (H.R. 4222) is not, we believe, in the best interest of all citizens. On behalf of the Michigan State Dental Association, I would like to express our opposition to H.R. 4222, and to request that the contents of this wire be placed in the minutes of your committee's hearing. Sincerely, Hon. VICTOR A. KNOX, House Ways and Means Committee, FRED A. HENNY, D.D.S., JACKSON DISTRICT DENTAL SOCIETY, U.S. House of Representatives, Washington, D.C. DEAR SIR: As secretary of the Jackson District Dental Society, I am writing to express opposition by our society to H.R. 4222. |