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pressed. This has come about because of the basic structure of the AMA in which democratic rule ends at the county level. There is no opportunity to vote directly for a State representative to the house of delegates, for the executive committee, or for the officers. There is no two-party system, no minority leader, no minority reports, no proportional representation, no effective mechanism of balance and control. As has been said before, there is no effective forum from which a minority opinion may be expressed. As a result, so-called organized medicine has never been more disorganized.

Surveys show a substantial proportion of members of State medical societies have elected not to become members of the AMA. As recently reported in the New York Times, in New York State alone 8,000 of the 26,000 members of the New York State Medical Society were not members of the AMA.

As a result of this alarming situation, more and more State societies are making membership in the AMA compulsory. This has resulted in the extremely unfortunate situation whereby certain AMA members are compelled to pay dues and assessments to support political lobbying over which they have very little control, and in many instances with which they violently disagree.

I have taken this time not to burden you with the family problems of the AMA, but in order that your committee may better evaluate the testimony of organized medicine which you have heard, and will continue to hear. Today, so-called organized medicine speaks for only a fraction of the physicians in the country-probably the smallest fraction in the last 15 years.

In closing, may I say that the board of directors of the Group Health Association of America appreciates the opportunity of appearing before the Ways and Means Committee to testify in favor of this significant and timely legislation. We urge you most strongly to pass without further delay H.R. 4222 and thereby make available an orderly savings program so that people under social security during their working years may be given the opportunity to invest a part of their earnings which will enable them in the years when their earnings are the lowest and their need for medical care the highest, to enjoy with dignity the benefits of the best of American medical care which they themselves will have earned.

I thank you.

The CHAIRMAN. Dr. Esselstyn, we appreciate, sir, your bringing to us the views of the Group Health Association of America. Are there any questions?

Mr. King?

Mr KING. Dr. Esselstyn, I could not permit you to leave the witness chair without expressing my satisfaction with your testimony. What represents the membership of your organization, Doctor? Dr. ESSELSTYN. I did not get the question.

Mr. KING. Who represents the membership of your organization? Dr. ESSELSTYN. Our membership is made up of the group practice, direct-service plans around the country, the cooperatives such as the cooperative in Seattle, the cooperative here in Washington, the laborhealth plan, such as the LHI in St. Louis, the so-called community plans such as the health insurance plans of Greater New York, and many groups around the country who are independent groups.

Most of them are consumer sponsored, most of them are interested in prepayment, comprehensive care, and group practice and direct service and in plans that are operated either by or in the interest of the

consumers.

Mr. KING. How many physicians and surgeons generally will be associated with your group?

Dr. ESSELSTYN. I feel that would be difficult to say. There are over a thousand in HIP alone, as you know. It would be several thousand. Mr. KING. I do not like to get into disputes but when you mention the conduct generally of the American Medical Association, I cannot help making one comment. It has nothing to do with medical care. It has to do with coverage under the social security system of doctors. As you well know, they are the only professional group, other than a few understandable exceptions that are not covered, by their own insistence before this committee. Yet in the State of California, my State, I have had reliably reported to me that no less than three unofficial polls have been taken of members of the profession in that State, and this is not the case of a minority report that you mentioned in your statement with respect to the organization, this is a case evidently of a majority being thwarted in their desire to be like other citizens covered under the social security system.

Dr. ESSELSTYN. I might say that in my State of New York for the last 3 years we have passed resolutions in favor of placing the doctors under social security. We have also attempted to have the membership polled. The house of delegates has consistently refused to poll the membership, saying this would be informational only and this is policy which is in the hands of the house of delegates alone.

Mr. KING. I am pleased to know that, Doctor. I am not being overcritical. I only am interested at times when this same organization joins with others and condemns the closed shop and other practices of the organized labor movement, and I have not been able to determine that there is much difference in the conduct within the official family with respect to its members as will be found in quite a number of unions throughout the country where the voice of the membership is thwarted or forbidden by one method or another. Thank you again.

The CHAIRMAN. Are there any further questions?

Mr. Utt?

Mr. UTT. On page 6 of your prepared statement, Doctor, you are referring to the large defection of doctors from the American Medical Association in New York. Then you say as a result of this they are proposing to make membership in the AMA compulsory and compel them to pay dues and assessments to support political lobbying over which they have very little control and in many instances with which they violently disagree. I assume that you point this out with considerable consternation?

Dr. ESSELSTYN. I think this is factual.
Mr. UTT. You think what?

Dr. ESSELSTYN. I think this is factual.

Mr. UTT. You have pointed out with some alarm. Now, I think that is inconsistent with your statement that this legislation should be passed because its very basis is compulsion. I do not want to come under it. I want to buy my own health insurance. Yet you are going to compel me, along with the Christian Scientists and the Amish

people, to participate in a program they do not want, because the majority says they have to do it. That is the inconsistency that I think there is in your statement.

Dr. ESSELSTYN. I think I mentioned at the start that apparently everybody in Congress has appreciated the fact that the financing of any program of this sort has got to be compulsory. Certainly the Kerr-Mills program is financed by compulsory taxation.

Mr. UTT. Of course, that is the part that I do not like, the compulsion against the will of the individual to do certain things that he does not want to do. But in that there is plenty of room for disagreement, of course.

That is all.

The CHAIRMAN. Any further questions?

Mr. BETTS. You say that the cost of medical care has continued to rise until it stands at 160.9. What is that?

Dr. ESSELSTYN. It is the consumers' index.

Mr. BETTS. Thank you.

The CHAIRMAN. Are there any further questions?

Dr. Esselstyn, we thank you, sir, again for coming to the committee. Dr. ESSELSTYN. Thank you.

The CHAIRMAN. Is the Reverend Jordan in the room? Apparently not. Without objection, if he desires to do so, he may extend his remarks in the record.

Mr. KING. Mr. Chairman, I have just been handed a telegram indicating an interest in H.R. 4222. It is signed by Frank Madison Reid, presiding bishop of the Second Episcopal District, African Methodist Episcopal Church. I ask unanimous consent that it be included in the record.

The CHAIRMAN. Without objection, it may be included in the record.

(The telegram referred to follows:)

Congressman CECIL R. KING,

New House Office Building,

House of Representatives,

Washington, D.C.:

HENDERSON, N.C., July 27, 1961.

We strongly urge that health benefits be provided for the aged through social security as incorporated in your bill, H.R. 4222. We ask that Ways and Means Committee take favorable action now for these older people.

Their need is critical. Not only is this legislation of great importance to all Americans, but it is of particular significance to members of our denomination. Our church believes in preserving the dignity and independence of all mankind commensurate with our faith in Christian doctrine. We believe that social security provides the best means to secure health care for our older citizens and at the same time preserve that dignity and independence so essential to christian belief. FRANK MADISON REID,

Presiding Bishop of the Second Episcopal District, African Methodist Episcopal Church.

The CHAIRMAN. Dr. Andrus?

Dr. Andrus, we recall with a great deal of pleasure your previous appearance before the committee.

STATEMENT OF DR. ETHEL PERCY ANDRUS, PRESIDENT, AMERICAN ASSOCIATION OF RETIRED PERSONS, AND THE NATIONAL RETIRED TEACHERS ASSOCIATION

Dr. ANDRUS. May I present Mr. William C. Fitch, the executive director of our two associations.

The CHAIRMAN. We are glad to have him with us.

Dr. ANDRUS. Mr. Chairman and members of the committee, my name is Ethel Percy Andrus. I am president of two organizations representing approximately one-half million members, the National Retired Teachers Association and the American Association of Retired Persons.

I would like to express our appreciation for this opportunity to present the views of our members and the recommendations of our associations. I shall be presenting testimony in favor of H.R. 4222 with certain changes or modifications.

The opinions which I am presenting were stated before the platform committees of both major parties. In Los Angeles our medical goal for the elderly was summarized as the need for a "medical care program within the reach of retirement incomes, available as a matter of right and not charity." In Chicago I suggested "that through a trusteeship an optional medical-care program of maximum values at minimum cost, be established, utilizing for economy's sake the structure of social security as a notifying and withholding agent."

I know of no one working in this field of aging, sensitive to their needs, who would deny that the problems of health and the cost of medical care constitute the greatest threat to the fulfillment and enjoyment of the gift of added years.

The membership of the two groups I represent presented to the White House Conference on Aging testimony as to retirement conditions as they, the retirees, experienced them. Their answers, over 36,000, are available for examination.

Our members bore witness, as shown in the graphs in the two publications of report, that, as to medical care, 86.5 percent report as being in reasonably good health, and 86 percent carry some form of health insurance, not necessarily that made available by ourselves.

For these reasons, we desire to go on record as approving in general and in spirit the need of making available optimum health care to the aged as one of the essentials of a satisfying way of life. We believe, also, that the mechanism of social security offers a natural vehicle for implementing the health care program.

We also commend the purposes set forth in the act and especially endorse the clause that qualifies the services to be provided

in a manner consistent with the dignity and self-respect of each individual, without interfering in any way with the free choice of physicians, without the exercise of any Federal supervision or control over the practice of medicine by any doctor or over the manner in which medical services are provided by any hospital.

We hope that the plan, as offered, may be modified to recognize both (a) the individual's freedom of choice and (b) the equality of opportunity.

As to the individual's freedom of choice, we realize that many indi viduals of 65 or over do not wish any type of medical care for religious reasons; many would prefer a wider type of coverage than that offered; many feel themselves already protected through insurance, membership in health plans, and so forth; yet all those who are social security beneficiaries are forced to participate and to share in its attendant expense.

We note, too, that the privilege to elect insurance coverage is granted to persons retiring under the civil service system. They are given the right to decide on whether they want or need insurance and the rights to select whichever plan best suits their needs and economic status. I believe non-civil-service retirees, as American citizens, are entitled to the same privilege.

As to equality of opportunity, we realize that 4 million oldsters would not be eligible for these benefits, including teachers in States where social security is not granted teacher retirees.

We realize that the Kerr-Mills Act was not intended as the ultimate answer toward meeting the medical needs of America's aging.

HEW lists only 11 States as having instituted programs of medical assistance for the aging and 21 States as unlikely to implement it in 1961 or 1962, with the annual cost for the potential eligible population of 10 million aged, well exceeding $1 billion.

We feel definitely, however, that the King bill has within it the answer to meeting our goals for a positive health program if two modifications are included:

(1) The elimination of its compulsory feature; and

(2) Provisions for the inclusion of older persons not currently covered by social security.

We therefore offer a recommendation for the elimination of the compulsory feature. We urge that the King bill be modified to accept the principle already enacted into law by this Congress in its health plan adopted for civil service employees. That principle recognizes the right of the individual to choose to accept or to refuse-freely to select from a variety of protections offered by private industry that one best suited to his felt needs, his religious convictions, and his purse.

Added to this service would be withholding of that portion of the individual's social security benefits to correspond with the cost of the premiums of the coverage selected. You might be interested to know that a similar voluntary program of private health insurance has been in effect in California for the past 2 years serving State retired employees.

Our second recommendation is that this right of free choice or refusal of protective coverings, be made available to all older persons not currently covered by social security, that the administration of the

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