(7) "Mental disease" means any condition classified as a neurosis, psychoneurosis, psychopathy or psychosis.

(8) "Personal assets" means a home and the land used and operated in connection therewith, or a mobile home used as a place of abode; household and personal possessions, including an automobile; and additional property not in excess of $4,500 in value, if single, or $7,500, if married, in any combination of real property, tangible personal property, cash value of life insurance, or cash or other liquid assets.

(9) "Physician" means a person licensed to practice medicine and surgery, and includes graduates of osteopathic colleges holding an unlimited license to practice medicine and surgery.

(10) "Prescribed" means a product or service requiring written or oral prescription by one having that authority under the laws of the state in which such act is performed.

(11) "Skilled nursing home" means a facility, licensed or approved as such by the state board of health or other state agency having jurisdiction over it, for the accommodation of convalescents or other persons who are not acutely ill and not in need of hospital care.

(12) "Spouse" means the legal husband or wife of the beneficiary, whether or not eligible for benefits under this chapter.

150.04 ELIGIBILITY. (1) Any resident of this state is eligible for benefits under this chapter who:

(a) Is within the intent of s. 150.02; and

(b) Has attained the age of 65; and

((c) Is a citizen, or has filed a declaration to become one; and

(d) Is not receiving old-age assistance; and

(e) Shows by a sworn statement on a form prescribed by the department that his annual income does not exceed $1,500, if single, or $2,500, if married; except that any applicant shall be eligible when all income in excess of these limits has been paid for health services available under this section, for insurance premiums covering the same or both.

(f) Has not conveyed, transferred or disposed of property so as to make himself eligible for benefits under this chapter.

(g) Satisfies the department which finds that the future annual income of the applicant, or of the applicant and spouse, probably will not exceed the amounts specified in par. (e).

(2) Persons eligible as beneficiaries shall not be denied the benefits of this chapter because of absence from the state.

(3) Every applicant shall receive notification in writing promptly as to the action taken on his application.

150.05 BENEFITS; EXCLUSIONS; PRIORITIES OF PAYMENT. (1) The department shall develop and adopt a plan providing payment of part or all of the charges for the following care and services for those eligible under this chapter: inpatient hospital care; skilled nursing home care when authorized by a physician; professional services performed by a physician or doctor of dental surgery in a hospital or skilled nursing home; outpatient services provided by a physician or through a hospital; and diagnostic services which require X-ray or laboratory procedures.

(2) Wherever, in its judgment sufficient funds are available, the department may authorize benefits in addition to those enumerated in sub. (1), such as drugs or care by a visiting nurse; provided all such additional benefits have been prescribed by the physician in charge.

(3) Benefits do not include any payments with respect to:

(a) Care or services for any individual who is an inmate of a public institu tion, except as a patient in a medical institution, or any individual who is a patient in an institution for tuberculosis or mental disease; or

(b) Care or services for any individual who is a patient in a medical institution as a result of a diagnosis of tuberculosis or mental disease, with respect to any period after the individual has been a patient in such an institution, as a result of such diagnosis, for 42 days.

(c) Care or services in any other private or public institution unless it has been approved by a standard-setting authority responsible by law for establishing and maintaining standards for such institution.

(4) Benefits do not include payment for that part of any services under this section which are payable through insurance, third party liability or any other federal, state, county, municipal or private benefit systems to which the recipient may be entitled.

Wisconsin has an old-age assistance program, second to none in the Nation. Attached is a copy of a portion of section 49.40, Wisconsin Statutes, which authorizes comprehensive health care at public expense for those in need.

(The information referred to follows:)

EXHIBIT A

STATEMENT OF STATE MEDICAL SOCIETY OF WISCONSIN RE H.R. 4222

(Excerpt from section 49.40, Wisconsin Statues, 1959, relating to medical care in public assistance cases)

"49.40. Medical care.—(1) The county agency administering aid to the blind, aid to dependent children, old-age assistance and aid to totally and permanently disabled persons may provide for medical care needed by recipients of such aids. A person shall be considered a recipient if at the time such care is authorized aid to the blind, aid to dependent children, old-age assistance or aid to totally and permanently disabled persons is being granted to him. The provisions of s. 49.11 shall not apply to this section. Medical care shall, as necessary be authorized by such county agency and allowed within money payments to the recipient under ss. 49.18(1) (a), 49.19(5), 49.22 and 49.61 (6) (a) or paid by the county agency in addition to or in lieu of such money payments; provided that the method of payment for any medical service either by money payment or vendor payment shall be determined by the department for the purpose of obtaining maximum federal participation. Medical care provided under this section includes hospitalization, home care when prescribed by a physician and nursing home care; physicians', dentists', and nurses' services: drugs, medical supplies and equipment; prosthetic appliances and other medical services as each is prescribed by a physician; optometrical services; transportation to obtain medical care; and prepayment of medical care."

Dr. ALLIN. In each of these achievements, the State Medical Society of Wisconsin has either led the way, or joined with others to bring about the desired progress. The list could be amplified many times. The above accomplishments are cited to provide the committee with assurance that medicine in Wisconsin, through the State Medical Society, has been a consistent and leading force for health progress in many areas, including mental illness, cancer, tuberculosis, safety, occupational health, sickness insurance, and in the very broadest possible sense, improved public health, and public welfare.

Let me emphasize that as a State medical society, our concern is with the health and well-being of each of Wisconsin's 4 million citizens, young and old alike. Our State has about 395,000 citizens who are age 65 or over. Their health care needs are met in direct proportion to their frequency and severity, just as we direct proportionate attention to the health care needs of some 400,000 youngsters under age 5 who have their entire lives before them. Where need exists, a remedy is devised.

As physicians we think it a genuine disservice to overstate or overemphasize the health needs of any segment of the total population. The problem of public and individual health is not susceptible to this kind of neat but unreal segmentation.

As physicians who treat the population from birth until death, we see no need for developing a scheme, at once drastic and dramatic, as proposed in H.R. 4222, to claim to do for the elderly through the Federal Government what can be and is being better accomplished locally. As physicians we believe that the health needs are being met more speedily, at lower cost, and with greater assurance of high quality of care at the local rather than the Federal level.

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We have thought it better in Wisconsin to meet real needs as they arose. Fortunately, tens of millions of American families already know that the costs of health care can be closely estimated and budgeted just as food, clothing, shelter, and recreation are budgeted in the average well-managed American family.

Yet, by some strange and illogical deduction, the supporters of H.R. 4222 would remove health care from the category of those expenses which can be planned for adequately in all but a small number of cases. They would remove it from personal responsibility and make it a Federal responsibility.

Adequate nutrition, shelter, and clothing are certainly as essential to good health as adequate immunization or medical care, yet no one has yet suggested that the Federal Government should buy food and clothing for everyone over 65 who is eligible for social security benefits, pay his rent and foot the bill for his vacations. As physicians we believe that the very thought of such a scheme should be abhorrent to every American.

In Wisconsin we have the normal day-to-day patient relationships in which all types of health care are being provided to our citizens of all ages. Most of these want to and can pay the costs. At least 78 percent of Wisconsin's citizens have some type of voluntary health insurance to assist them in meeting these costs through private insurance carriers and such plans as Blue Cross and Blue Shield. At least 51 percent of our citizens over 65 have purchased voluntary, prepaid coverage such as that provided by the Century Plan of Wisconsin Physicians Service, operated by the State Medical Society of Wisconsin, as basic protection for meeting the costs of illness and injury.

Wisconsin has a system of county and State hospitals which can come to the aid of those of any age who need medical or hospital care and find that their personal resources and local charitable contributions are unable to cope with their situation. Patients may upon referral by their family physician, be entered at the University of Wisconsin General Hospital as special rate patients for the care of any condition. Those who are totally unable to pay may upon certification of a county judge be referred to this hospital. Wisconsin counties have long provided for welfare recipients with chronic diseases, especially among those in the older age brackets. In addition, many who can pay part or all of their own way are likewise provided care in these hospitals.

In my city of Madison and its county of Dane, we have one of the finest systems for the care of medically indigent. These individuals have free choice of physician-all of whom agree to accept welfare and pension rates as full payment. The individuals are treated in all respects as private patients.

In the event that a person over 65 years of age cannot otherwise provide for his basic needs, he is eligible under Wisconsin law for oldage assistance under one of the most comprehensive programs of its type in the United States. Such a person must be 65 or older, but he may own his own home regardless of value and he may retain liquid assets not in excess of $500 and insurance with a cash value not exceeding $1,000.

While a lien is acquired by the State it will not disturb possession of this property during the recipient's lifetime, nor while such prop

erty is occupied by a surviving spouse or minor or incapacitated child. While this old-age assistance program provides cash to meet the individual's personal budget, it provides in addition that the individual shall be able to receive all-and I repeat all-necessary surgical medical-hospital, ental, pharmaceutical; in fact, all necessary health care, however and wherever it may be necessary to provide such care. In addition, should a person 65 years of age or older be fully capable of handling the day-to-day expense of food, shelter, clothing, and the like but find it impossible to handle his health care expense, this same Wisconsin statute provides that the old-age assistance program will provide for any and all health care he needs from the physicians and hospital of his choice.

Members of the committee, we regard this statute as a first-class example of what can be done without the King bill. It is an example of what enlightened and progressive thinking and planning jointly be tween counties, States and Federal Government can produce to meet the needs of the elderly of this Nation.

I feel this legislation which has worked so successfully for many years in Wisconsin is so significant that I believe your committee may wish to study it in detail, and it is attached to this statement as exhibit A.

Further, the last session of this Congress gave to the Nation the Kerr-Mills Act as a mechanism of providing within the American standards of free enterprise an equitable and effective method for providing health care assistance to those of the elderly who need it.

Wisconsin is movng ahead with implementation of the Kerr-Mills Act. The State Medical Society after conferences with the State De partment of Public Welfare, the Wisconsin Hospital Association and other voluntary and State agencies drafted and presented to the Wisconsin Legislature twin bills to provide for a health assistance act in Wisconsin. One of these bills-bill 550, A-has already been advanced a major step with preliminary acceptance by the assembly with a vote of 93 to 0.

The bill is now in the hands of the Joint Committee on Finance of the State legislature, and every effort is being made to bring about its passage into law during 1961.

I am attaching an exhibit B to this statement a copy of this proposal, and I wish to say regarding it that I believe it incorporates the true spirit and intent of the Kerr-Mills Act. It is not just an other piece of relief legislation.

(The material referred to above follows:)

EXHIBIT B

STATE MEDICAL SOCIETY OF WISCONSIN RE H.R. 4222

(As amended, engrossed, and sent to the joint committee on finance on June 20, 1961)

STATE OF WISCONSIN

IN ASSEMBLY

SUBSTITUTE AMENDMENT No. 3, A., TO BILL No. 550, A.

June 5, 1961-Offered by Messrs. PoмMERENING and QUINN.

To create 20.670 (25), (26), (58) and (59) and chapter 150 of the statutes, relating to health assistance for certain aged persons, granting rulemaking power, providing a penalty and making an appropriation.