new contract for individual subscribers over 65. Public announcement is to be expected within a few months. Since the inception of the Blue Shield plans in New York State in 1941, any person who enrolled prior to age 65 has been permitted to continue benefits at no increase in cost. Today, approximately 560,000 persons over 65 are covered by these plans. There is no need for Federal intervention, through this bill, in New York State. State and local governments have done an excellent job in providing for the aged. New York's Joint Legislative Committee on Problems of the Aging is a pioneer in the field and is nationally known. The Governor's Conference on Problems of the Aging, held in 1955, analyzed the problem confronting the aged, set goals, and implementation has taken place. The New York State Legislature is actively engaged in protecting aged voluntary insurance policyholders. For example, it enacted legislation that prohibits insurance companies from canceling, or refusing to renew, hospital and medical insurance policies which have been in force for 2 years. In conferences between the State society and the Hospital Association of New York State concerning H.R. 4700, it was agreed that the solution to the problem of the aging must be sought in the voluntary field, where representatives of both groups were convinced it will be found. Constructive and effective progress now being made by the people of New York State must not be obstructed or denied. In brief, the State medical society maintains that the evidence presented to date concerning problems of the aging is neither complete nor conclusive and may contain misinterpretations or misrepresentations. Federal intervention without more accurate knowledge of the problem's gravity and dimensions is logically untenable and socially dangerous. We, therefore, respectfully suggest that prudence dictate that no further action be taken on H.R. 4700. Certainly you will need to know the results of the White House Conference on Aging scheduled for January 1961. Your defeat of this bill will prove that our Congress believes in the free enterprise system and is doing everything possible to perpetuate it. Mr. FORAND. Thank you very much for coming to the committee and for the information you have given us. Are there any questions? If there are no questions, again we thank you. Dr. AZZARI. Mr. Chairman, I thank you for the opportunity of presenting my brief statement. Since the time alloted, however, did not permit a full discussion of our views, I request permission to submit this more detailed report in the record. Mr. FORAND. Your whole statement will appear. SUPPLEMENTAL STATEMENT BY RENATO J. AZZARI, OF THE MEDICAL SOCIETY OF THE STATE OF NEW YORK Mr. Chairman and members of the committee, my name is Dr. Renato J. Azzari, Bronx, NY. As a member of the board of trustees and past president of the Medical Society of the State of New York, I am here today to voice the vigorous and unalterable opposition of our organization, the third largest group of its kind in the world with 24,903 physician-members, to the enactment of H.R. 4700. I do so in keeping with the actions taken by our house of delegates and council. In this statement, I should like to expand upon my original remarks. No complete and conclusive evidence has been presented to prove the need for such legislation in New York State. On the contrary, there is ample evidence that there is no need for such a law in the Empire State. In officially opposing his type of legislation, our society pointed out that the general philosophy and approach inherent in it indicate, whether intended or not, that its enactment will help spread the growth of socialism in the United States by the creation of a great new bureaucracy within the already gigantic Social Security Administration. The society also held that the great majority of the American people and American physicians feel that the health care problems of the aged should be further analyzed and solutions sought on the local rather than the Federal level. The resolution adopted stated that the society opposed this kind of proposed law and all other similar legislation designed to make the care of the aged a Federal responsibility rather than a State or local responsibility, until a thorough study has been made of OASI and OAA. The numerous programs now being conducted efficiently and effectively in New York State by voluntary State, county, and local groups, make H.R. 4700 unnecessary. According to reliable information, there are 14,780,000 persons, 88 percent of the people of the State, now covered by some form of hospital insurance; 13,200,000 persons, 80 percent of the population, are covered by regular medical care and/or surgical insurance. It is recognized that the coverage in all instances is not complete. Much progress has been made in recent years in extending the benefits of voluntary plans to those participating in them. It can be expected that greater advancements will take place in the future. Exclusive of Federal aid, it is reliably estimated that New York spends almost $6 million a month ($72 million a year) on a caseload of 87,000 old-age assistance cases. This financial assistance includes other factors besides medical care. This portiortion is borne by the State government and local communities with Federal assistance. In New York any person who requires medical care but cannot pay for it receives that care, through public welfare medical care programs supervised by physicians in cooperation with the State medical society and its component County medical societies. This program in terms of medical standards, administrative efficiency and results has been classified as one of the best in the country. Reliable sources show that approximately $100 million a year is spent to provide medical care for the medically indigent. A centralized governmental program, such as H.R. 4700, will inevitably result in a diminution of responsiveness to varying individual and local situations, as well as a weakening of personal relationships and a lack of personal concern. Many of the voluntary agencies, now doing yeoman work in New York, would lose their incentive and perhaps disintegrate, as often happens when the Federal Government steps in. There can be only one interpretation of the proposed law-it is the compulsory socialization of medical care. The law would destroy the doctor-patient relationship and result in extensive compulsory taxation. Other segments of the population besides the aging will ultimately demand coverage. Such a law would undermine voluntary health insurance; gradually replace it. Few people would carry both Government and private plans in New York State. H.R. 4700 would destroy personal and family responsibility in regard to medical matters. It would stifle the initiative of individuals and families to care for themselves and their aging relatives, a virtue unfortunately already on the wane in many families. This responsibility rests primarily with the individual and his family and is a fundamental principal upon which our Nation was founded. The State medical society recognizes that social, emotional, medical and medicoeconomic problems exist, and are increasing, among our senior citizens. We have taken steps to meet these problems. Implementing and encouraging further expansion of the voluntary plans, in May 1959 the house of delegates strongly urged both Blue Cross and Blue Shield plans to develop programs for people over 65. The New York plans have responded to this request and steps already have been taken to provide more adequate medical and hospital care for the aged at a price they can afford. The legislative history in the consideration and passage of these resolutions included specific opposition to the very philosophies and detailed propositions in this bill. These resolutions constitute affirmative support for the continuation and extension of voluntary health insurance programs already existent. This is further evidence that the people of New York State do not need such legislation as H.R. 4700 proposes. Early this year, the Western New York Medical Plan, Inc. (Blue Shield Plan, Buffalo), offered everyone in the over-65 group a contract providing medical and/or surgical service benefits at no additional cost and with no reduction in benefits. There were no restrictions and no selections as to the kind of subscribers. No medical examinations were required nor were there any other qualifications necessary on the part of the subscribers. A total of 2,368 persons, ranging from 65 to 97 years of age, signed the contracts. We are currently advised that there has not been one claim under any of these contracts. This type of pilot study is being actively encouraged and will be further implemented in the future. The board of directors of United Medical Service, Inc. (Blue Shield Plan, Metropolitan New York), which covers some 5 million persons in 17 downstate counties, including New York City, has approved a new contract for individual subscribers over 65. Public announcement is to be expected within a few months. In this United Medical Service plan, as in other plans, persons in group enrollments may convert at age 65, to individual coverage at no increase in cost or decrease in benefits. In addition, Blue Shield has changed and is now enrolling in groups applicants who are over 65 years of age. Attention is called to the significant fact that today approximately 560,000 persons over 65 are covered by the Blue Shield plans in New York State. Among other activities designed to help the aged, on March 7, 1959, the State society cosponsored with the New York State Department of Health a statewide conference on medical society action in the field of the aging, at Utica, N.Y. The purpose of this meeting was to identify, discuss, and propose solutions to specific types of problems among the aged. From this beginning, coordinated activities have been developed and will be enlarged. These projects involve medical practitioners, departments of public health and voluntary health agencies. While the State society is very much aware that a major objection to the Forand bill is the tremendous progressive costs with which this generation and future generations of taxpayers would be confronted should it become law, our steadfast opposition is primarily from the medical point of view. The society is firmly convinced that this measure constitutes one of the gravest threats in history to the maintenance of the high standardsof medical care enjoyed in New York State and the Nation and to the medical freedom which is the inherent right of every patient and of every doctor of medicine. It would be another gigantic step toward Government-controlled inferior medicine for all the population. Although at first glance the bill appears to guarantee the patient's right to choose any hospital, surgeon, or nursing home in New York State, this apparent freedom of choice is deceptively limited. For the patient is required to select a hospital, nursing home or physician under contract to the Federal Government. In emergencies only could the patient choose a surgeon not participating in the plan. Note the word "emergency." Who among hospital administrators will agree upon what an "emergency" is? Delay in interpretation could be fatal. The definition of emergency should be left wholly in the hands of the attending physician who has diagnosed the case. In New York's highly concentrated urban centers and remote rural areas this type of operation would be totally imprac tical. Care for the older citizen calls for a cooperative attack on the problem by nurses, doctors, hospitals, social workers, insurance companies, and community leaders. Such care requires flexibility of medical approach and technique-not the rigidity inherent in a Government-controlled program, which this bill would set up. Although the society is not primarily concerned with economics, it is only fair to point out that the bill would result in absolute Government domination and control of the economic welfare of physicians. This welfare has always been in the hands of the medical profession, individually and collectively. The medical profession has always included in its services to the people a great amount of gratuitous or minimal cost services. There is no need for Federal intervention, through this bill, in New York State. State and local governments have done an excellent job in providing for the aged. New York's Joint Legislative Committee on Problems of the Aging is a pioneer in the field and is nationally known. The Governor's Conference on Problems of the Aging, held in 1955, analyzed the problem confronting the aged, set goals, and implementation has taken place. The New York State Legislature is actively engaged in protecting aged voluntary insurance policyholders. Recently it enacted legislation that prohibits insurance companies from canceling or refusing to renew hospital and medical insurance policies which have been in force for 2 years. Another law requires conversion privileges without evidence of insurability to a person who had been a member for 3 months and applies with 1 month. A 1959 statute permits hospital plans to pay for nursing and other services provided outside the hospital on the same terms as when provided to a subscriber in a hospital. In matters affecting the well-being of the individual person, Government should be the last, not the first, resort. Voluntary agencies working under the supervision of, or in cooperation with, State and local governments in New York State have made an excellent start and are showing fine progress. The State society has been and will continue to work with agencies. The remarkable progress that has been made over the recent few years should not now be thwarted by Government interference. Every opportunity must be given to a solution by voluntary means before resorting to the drastic means of H.R. 4700 bringing about Government intervention into private lives and into personal lives and into personal and family responsibilities. In brief, the State medical society maintains that the evidence presented to date concerning problems of the aging is neither complete nor conclusive and may contain misinterpretations or misrepresentations. Federal intervention without more accurate knowledge of the problem's gravity and dimensions is logically untenable and socially dangerous. We, therefore, respectfully suggest that prudence dictates that no further action be taken on H.R. 4700. Certainly you will need to know the results on the White House Conference on Aging scheduled for January 1961. Voluntary systems, such as those being employed with progressive success and constant improvement in the State of New York, often in cooperation with official State and local programs, with the active support and participation of the medical profession, are the only acceptable means by which social, emotional, medical, and medicoeconomic problems of senior citizens can be resolved. Conversely, the system of medical care that passage of the Forand bill would bring about, can never be made truly democratic or medically practical. Your rejection of this bill will prove that our Congress believes in the freeenterprise system and is doing everything possible to perpetuate it. Mr. ALGER. Is that the supplemental view that you are submitting? Mr. FORAND. Our next witness is Mrs. Jennie Herbon. Mrs. Herbon, for the benefit of the record, will you give your name, your address, and the capacity in which you appear, please? STATEMENT OF MRS. JENNIE HERBON, DETROIT HOUSEWIFE, 69, SOCIAL SECURITY AND OLD-AGE ASSISTANCE BENEFICIARY, IN BEHALF OF THE COMMITTEE ON HEALTH PROBLEMS OF THE UNITED AUTOMOBILE WORKERS RETIRED WORKERS CENTER Mrs. HERBON. My name is Jennie Herbon. I live with my husband in the Detroit Herman Gardens project, and my address is 8624 Rutland. Mr. FORAND. You may be seated. 44432 59 35 Mrs. HERBON. I am 69 years old and the mother of 10 children. Nine of my children, three boys and six girls, are living. Among them they have produced 32 grandchildren and 20 great-grandchildren. All three of my sons are veterans of World War II and all were injured in line of duty. I also have a daughter who was in the WAC and who was injured in France during World War II. My husband has been self-employed as a painter and decorator most of his life. He is not yet old enough to qualify for social security benefits. He has been quite ill for a number of years and was just released from Deaconess Hospital in Detroit after a severe heart attack. We live on an income of $70 a month from social security and $59 a month from old-age assistance. The social security benefit is based on my earnings during World War II as a drill press operator, tapping machine operator, and sander at Briggs Manufacturing Co. and the Excello Corp. In January 1959, when the 7-percent increase in social security went into effect, I received an increase of $4.50 from it. At the same time, my rent at Herman Gardens was raised $6 a month and my medical expense allowance under old-age assistance was cut from $12 to $10 a month. So you see, the net effect of the social security increase you gentlemen voted last year was that I lost $3.50 in real income. I know this is not what you intended would happen, but this is the way it actually worked out. At the same time, prices and living costs for food, clothing, and utilities also keep going up. So most older people, like myself, are fighting a losing battle trying to make ends meet. Of course, none of us are getting any younger and we have increasing needs for medical care. That's why the Forand bill is so important to us. It so happens that in April 1958, the Neighborhood Service Organization of Detroit did a survey of the 914 older people living in Herman Gardens, and I would like to tell you of some of the things they found concerning our health needs and medical care problems. They found that only 30 percent of the 914 had any form of health of hospitalization insurance. Eighty-eight percent said they were currently in poor health and in need of medical care. Only 10 percent said that they were in good health and not in need of medical care. Of those who said they were in poor health and needed medical care only 8 percent felt that they could finance the care they needed themselves or from their hospital insurance. The remaining 92 percent said that they would need some help from outside sources to meet the costs of the medical care they needed. About 12 percent said they needed dental care in addition to medical care and almost 80 percent of those needing this dental care said they would need outside financial help to meet the cost of such care. In addition to all this, 16 percent said they needed glasses, hearing aids, or false teeth, and over 90 percent needing these aids to good health said they would need outside financial assistance to purchase them. Finally, about 25 percent of those who said they needed medical or dental care stated that they had transportation problems in getting the medical care they needed because they were too disabled to travel to the doctor or the clinic. These facts show you why I, and many people in my age group, think you should act favorably upon the Forand bill, H.R. 4700. I |