The CHAIRMAN. The next witness is a very good personal friend of the chairman, a doctor from Batesville, Ark., who is the immediate and past president of the Arkansas Medical Society engaged in the practice of medicine at Batesville, primarily confining his practice, as I understand, to surgery. Dr. Monfort, we are very pleased to have you with us this morning. I want the members of the committee to know that you are one of the outstanding physicians of our State. I am sure they will be interes ed in the presentation of your views. You are recognized. STATEMENT OF DR. J. J. MONFORT, M.D., PAST PRESIDENT, COUNTY MEDICAL SOCIETY, AND IMMEDIATE PAST PRESIDENT AND FORMER MEMBER OF COUNCIL OF ARKANSAS MEDICAL SOCIETY Dr. MONFORT. Thank you, sir. Mr. Chairman and members of the committee, after what you have said, I would like to hear you keep on talking, it sounded so good. The Arkansas Medical Society appreciates this opportunity to express its views on H.R. 4222. I am J. J. Monfort, of Batesville, Ark., where I have practiced medicine for 25 years. I am past president of my county medical society, and a former member of the council of the Arkansas Medical Society, for my district. For several years I served as secretary of the State medical society and I am its immediate past president. I am in the private practice of medicine, limiting my work to surgery. I am a member of the American College of Surgeons and the American Academy of General Practice. I feel like the country boy seeing his first Christmas tree, being in such august circumstances here. The CHAIRMAN. You feel perfectly at ease because you are talking to a bunch of country boys. Dr. MONFORT. The Arkansas Medical Society, I would like to say, is comprised of 1,260 individual physicians in 60 county medical societies. There are approximately 1,500 licensed M.D.'s in the State, so our organization represents 84 percent of the doctors in Arkansas, The society was organized in 1875, and its original purposes, unchanged to this day, are: 1. To extend medical knowledge and advance medical science; 2. To elevate the standard of medical education, and to secure the enactment and enforcement of just medical laws; 3. To promote friendly intercourse among physicians; 4. To guard and foster the material interests of its members, and to protect them against imposition; 5. To enlighten and direct public opinion in regard to the great problems of State medicine, so that the profession shall become more capable and honorable within itself, and more useful to the public in the prevention and cure of disease, and in prolonging and adding comfort to life; and 6. To maintain medical ethics and to secure compliance with the art of medical practice. The first medical school in Arkansas was started in 1876, as the result of the society's efforts, and has been supported by the society through countless legislative battles every 2 years to the present. The present outstanding University of Arkansas Medical Center in Little Rock is a direct result of years of unremitting work and financial and time expenditures by the society and its members. The State board of health was originally formed and has been supported ever since by the medical society. This type of information we give so that you know we are trying to be progressive. The State tuberculosis sanatorium, with one of the best records in the Nation, was established with the help of the society. The State cancer commission, caring for medically indigent cancer patients and conducting cancer discovery clinics regularly throughout the State, has been operated for many years by members of the society without any charge whatsoever to the patient or the State. There are innumerable other projects of the society, which would take much too long to name. I think I can say that in the history of Arkansas there has been no worthy undertaking for the health of the people that has not been originated by the medical profession, backed by it, and, at least in some measure, supported financially or with free professional services. Arkansas doctors have never requested, and do not receive payment, from the welfare department for professional services to welfare recipients. The attitude of the medical profession in Arkansas has always been that medical care is as personal as a thing can be and it is a personal responsibility of the doctor and the patient or his family, or community, or the State. Only when all of these break down is there any need for outside help and interference. We favor the continued operation of the Kerr-Mills law because we believe it comes closer to taking all of these things into consideration than any other Federal legislation which could be written. Our society favored its passage and went on record with our congressional delegation to that effect. When the law was passed, the council of the Arkansas Medical Society formally approved it, and public urged the State government to implement the law in Arkansas as expeditiously as possible. As is so often the case, our willingness to do something had to be matched with money to do it. Accordingly, when our legislature met in January, we campaigned with its members to appropriate sufficient money to make Kerr-Mills effective in Arkansas. The result, with the OAA and MAA Federal matching money and other funds available, will be a $12 million program in Arkansas, a State with a population of only 1.700,000. The plan for implementation of the Kerr-Mills legislation in the State of Arkansas will cover, for medical care purposes, 70,000 people in addition to those already covered by other Government programs. It is anticipated that 6,000 to 7,000 people per month will receive services such as nursing home care, dental care, hospitalization, eye care, and physicians' services. The plan outlines payment for 10 days of hospital care or a maximum of 30 days per illness in 111 participating hospitals in the State. It authorizes payment for residents in out-of-State hospitals. I think perhaps I should clarify the difference between the 10 and 30 days mentioned in that the welfare department allows at this time 10 days' hospitalization and if you need more the doctor may request it and it will be granted provided the welfare medical advisers see fit to say that the extension is worthwhile. The State legislature has appropriated $2 million for the medical aid to the aged program and in order to speed the implementation of the program, the State department of welfare is urging all who are eligible to establish their eligibility prior to illness or the submission of claims so there will be no delay in caring for these patients. The commissioner of welfare states that there are 3,646 beds in licensed nursing homes at the present time, and there are 24 nursing homes that have recently opened, are ready to open, or are in the planning stage as Arkansas prepares to implement the Kerr-Mills legislation. The Arkansas Medical Society has supported medical and hospitalization insurance policies for people over 65 and these are currently available in our State by Blue Cross-Blue Shield, and various commercial insurance companies. In Arkansas the Bureau of Census statistics show that there are 194,000 people age 65 and over. Of this number, 103,600 are covered by social security, and 37,265 are gainfully employed; 55,300 persons are receiving old-age assistance, among these there are 1,394 cases of hospitalization per month at an average cost of $133.09, totaling $2,226,269 for the year. These are from the welfare department statistics. The total nursing home population in Arkansas is 3,646. As of June 1, 1961, 2,487 of these were public assistance cases. This does not include 60 aid to the blind cases and 378 aid to the permanently disabled cases. In view of the foregoing activities of the State of Arkansas, in providing for the medical care of our aged, we feel that H.R. 4222 will not furnish any care needed and not provided under the KerrMills law. An official of the Arkansas State Department of Welfare states unequivocally that the Kerr-Mills law is going to work in Arkansas and that it will adequately cover the medical services of all the aged citizens of Arkansas who need help. H.R. 4222 will not provide for thirty-six to thirty-eight thousand of our indigent citizens who are currently covered under the KerrMills legislation. It will only be an added tax burden on a class of our citizens who can least afford it. The majority of the people in my area are self-employed and the social security tax is now 412 percent. If the tax is increased, it will work a hardship on most of these people. It is my opinion that the situation with relation to health care of the aged in Arkansas does not justify our forcing our aged citizens under the bureaucratic control set up by the King-Anderson bill. In conclusion, Mr. Chairman, the Arkansas Medical Society feels that social security provision for medical care is unnecessary in caring for our older citizens. We appreciate the opportunity that you have afforded us in voicing our objection to the passage of H.R. 4222. Thank you, sir. The CHAIRMAN. Dr. Monfort, again we thank you, sir, for bringing to us the views you have expressed in behalf of the Arkansas Medical Society. I want to congratulate you on the presentation of your views. Are there any question of Dr. Monfort? Thank you very much. Dr. MONFORT. Thank you, gentlemen. The CHAIRMAN. Mr. McLain. Mr. BETTS. I would like to ask unanimous consent to insert in the record a letter dated July 13, 1961, from the Ohio Medical Association, regarding H.R. 4222. The CHAIRMAN. Without objection it may be included in the record at this point. (The letter referred to follows:) Hon. JACKSON E. BETTS, OHIO STATE MEDICAL ASSOCIATION, Member of Congress, Eighth Ohio District, DEAR CONGRESSMAN BETTS: Having been advised that the House Ways and Means Committee will hold hearings on H.R. 4222 in the near future, I respectfully present this statement to you as a member of that committee and for the information of the committee as a whole. My purpose is to give you (1) the views of the Ohio State Medical Association regarding H.R. 4222 and (2) some facts and comments on what is being done in the State of Ohio to cope with the health problems of our aged citizens. I am sure you are aware of the fact that the Ohio State Medical Association has consistently opposed the enactment of any plan or scheme of Governmentcontrolled compulsory health insurance. H.R. 4222 falls into that category. WHY H.R. 4222 IS OPPOSED The association's opposition to H.R. 4222 and similar measures is based on the belief that such legislation (1) would not meet the needs of the situation; (2) would endanger the standards of medical care rendered; (3) would be inordinately expensive; (4) would probably destroy private voluntary medical and hospital insurance plans; (5) would lead inevitably to a system of compulsory health care for the entire population; (6) would enlarge an already bursting Federal bureaucracy; (7) would interfere with the rights of physicians employed in hospitals; (8) would interfere with the doctor-patient relationship. OHIO RECOGNIZES THE PROBLEMS In presenting these arguments against H.R. 4222, we do not imply that we believe our ever-expanding aged population is not confronted with health problems, in fact, not only health problems but economic, social, educational, psychological problems, or a combination of such. We recognize that the situation confronting our senior citizens is a challenge not only to the medical profession but to all citizens. The medical profession of Ohio, I am proud to say, has joined with other individuals and groups to meet this challenge. Something is being done about it in Ohio, as the record will show. We believe that Ohio will be able to do a satisfactory job in helping aged citizens meet their health problems, as well as other problems, through activities and programs already in operation or planned, making additional Federal legislation unnecessary. SOME FUNDAMENTAL QUESTIONS The association in its consideration of this general question has given serious thought to the following fundamental questions which dare not be ignored: What are the primary needs of older citizens? Are they economic, social, educational, medical, psychological, or a combination? Where does the priority Who should be responsible for meeting these needs? The individual? The family? The community? The Federal Government? The aggregate of society? Where does the primary responsibility lie? When should these needs be met? In the years before senior citizenship? Or on a catch-as-catch-can basis when they become critical? How can various groups help meet these problems? SOME BASIC CONCLUSIONS Moreover, our study and research have led us to the following conclusions which I believe are vitally important and must be taken into consideration by those who will be called upon to make a decision as to the best ways to meet the challenge presented by our senior citizens: 1. The basic problems of the aged are much the same as those that confront other age groups; 2. Preparation for later years must begin early with emphasis physiologically in youth-psychologically in middle years; 3. Social, economic and medical concepts must be directed at giving the senior citizen a chance to help himself; 4. Failure to provide opportunities for self-help may well bring disaster; 5. We cannot isolate the aged. A POSITIVE HEALTH PROGRAM Realizing that the medical profession can, and should, play an important role in this field, even though health in its broadest aspects is only one of the several problems which confront the aged, the Ohio State Medical Association has endorsed and used as a general guide for its activities, the following positive health programs for older citizens: 1. Stimulation of a realistic attitude toward aging by all people. 2. Promotion of health maintenance programs and wider use of restorative and rehabilitation services. 3. Extension of effective methods of financing health care for the aged primarily through voluntary nonofficial programs or official programs administered on a State or local basis. 4. Expansion of skilled personnel training programs and improvement of medical and related facilities for older people. 5. Amplification of medical and socioeconomic research in problems of the aging. 6. Cooperation in community programs for senior citizens. WORK OF OSMA COMMITTEE The association has an active committee on care of the aged which heads up the work of the medical profession of Ohio in this field. Many of the 88 county medical societies in the State have a similar committee. The work of the State committee has fallen into the following general categories: Review of the activities of other organizations in the area having to do with aging and the aged. Liaison with such organizations and offers to advise them on the medical aspects of their programs. Cooperation with other organizations in improving health care services and facilities. Assistance in taking inventory of the medical and related facilities and services available to the aged, such as nursing homes and homes for the aged. Encouragement of the development of a central agency in each community, designed to supply information on facilities and services available to the aged. Study of the various mechanisms which aid in financing the medical and related services required by the aged. Arousing the interest of both physicians and the public in the problems which confront the aged. Cooperation in exploring the entire area of employment, retirement, and reemployment. WHAT WE STAND FOR Permit me now to summarize those things which the Ohio State Medical Association supports. The association is committed to the following to help Ohio's aged persons to meet their problems. We believe that fulfillment of the activities |