We hated to lose him to Nashville, but he is doing a fine piece of work over there. It was my privilege on yesterday to introduce Dr. Johnson from my home. I am glad now to have the opportunity of introducing Mr. Smith, who will probably be in a position to give the committee his views contrary to Dr. Johnson's.

The CHAIRMAN. Mr. Smith, we recall your previous appearance before the committee.

You are recognized, sir, for 5 minutes.

STATEMENT OF STANTON E. SMITH, PRESIDENT, TENNESSEE STATE LABOR COUNCIL, AFL-CIO

Mr. SMITH. Thank you very much, Mr. Chairman.

Thank you, Mr. Frazier, for those very kind remarks.

Gentlemen of the committee, my name is Stanton E. Smith. I am president of the Tennessee State Labor Council, State branch of the AFL-CIO, representing approximately 175,000 union members in

Tennessee.

Together with their families, they constitute a sizable proportion of the population of our State.

In the brief time allotted to me, it is not possible to make a comprehensive statement of the case for providing hospitalization, nursing home care, and surgical services as an earned right paid for by the recipient during his productive years of employment, as an integral part of the social security program of the U.S. Government.

Moreover, you have heard from and will hear from experts on this subject who are much better qualified to discuss the technical aspects of this problem than I am.

What I would like to do in the time at my disposal is to point up our support of H.R. 4700, the bill introduced by Mr. Forand, as the most practical and comprehensive method for meeting some of the basic health needs of our older citizens whose income and resources are not adequate to pay for the increased need for medical services, particularly hospital, nursing home, and surgical, which normally come with old age.

The overwhelming preponderance of the older citizens simply do not have sufficient resources to pay for these services on a current basis, either directly in fees or in premiums for insurance coverage by private carriers, even if adequate coverage were available.

The report prepared for this committee by the Department of Health, Education, and Welfare clearly supports this statement. As of June 1958, some 16 percent of those over 65 had no resources or substantially none and were forced to rely on public assistance to keep body and soul together.

In 1956 and 1957 three-fifths of all people 65 and over had less than $1,000 in money income and only one-fifth had more than $2,000. Of the couples with husband aged 65 or over who had their own household, generally the most well-to-do among the aged, only 15 percent reported income of $5,000 or more.

Although I have not found comparable figures for Tennessee alone, it must be assumed that they are substantially worse since the per capita income is substantially lower in our State than the national

average.

It is inconceivable that anyone would contend that these older people as a whole are financially able to meet the cost of their medical needs. And we are compelled by conscience to reject the alternatives that these citizens, in the evening of life, should be compelled to rely on charity, public or private. That alternative is destructive of human dignity and unworthy of this wealthy Nation.

Improved insurance coverage, now drastically inadequate, will not solve the problem except for the few who can afford it.

Lowered fees by members of the medical profession will not solve the problem, people with less than $2,000 income cannot afford any fees except by the sacrifice of their daily bread.

Moreover, the doctors are entitled to reasonable fees for their skilled and socially valuable services and should not be expected to add to the already sizable amount of contributed services many of them now render.

In our view the right answer to this problem, and we do not pretend there are no difficulties involved, is through the extension of the social security program as proposed in H.R. 4700 so that these health services can be acquired as an earned right, paid for in advance by the recipient during his active working years.

We sincerely hope this committee will give favorable consideration to this measure.

The CHAIRMAN. Mr. Smith, we thank you, sir, for bringing to us the views of the Tennessee State Labor Council.

Are there any questions?

Mr. BAKER. I, too, welcome to this committee Mr. Stanton E. Smith, whom I have known favorably for many years and whom I regard as one of the outstanding representatives of the trade union movement. The CHAIRMAN. Mr. Älger.

Mr. ALGER. Mr. Smith, I want to comment on the language in the sentence in the statement where you said: “*** an earned right, paid for in advance."

You are aware that the people covered, over age 65, will have the right even though they will have made no payment of any kind?

Mr. SMITH. That is a necessary premise for starting a program of this kind, but when the program has been started, as it goes on the people will be paying for that as a part of the social security program. Mr. ALGER. I understand, Mr. Smith.

Mr. SMITH. Yes, I was fully aware of that. That is necessary, of course, to make a transition.

The CHAIRMAN. Thank you, Mr. Smith.

Mr. SMITH. Thank you very much.

The CHAIRMAN. Our next witness is Dr. Vincent W. Archer. Dr. Archer, will you please identify yourself for the record, giving us your full name and address, and the capacity in which you appear.

STATEMENT OF DR. VINCENT W. ARCHER, MEDICAL SOCIETY OF VIRGINIA, CHARLOTTESVILLE, VA.

Dr. ARCHER. Mr. Chairman and members of the committee, I am Dr. Vincent W. Archer, of Charlottesville, Va. For more than a quarter of a century, 35 years to be exact, I have been chairman of the Department of Radiology of the University of Virginia.

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Mr. Chairman, Dr. Harold Miller, one of our respected family physicians of Woodcock, Va., one of our rural areas, accompanies me. He will not testify, but will help me in some of the questions which may be asked. He is also a counselor of the Medical Society of Virginia.

Personally, as past president of the American College of Radiology and the Medical Society of Virginia, and a member of the house of delegates of the American Medical Association, I have been long concerned with the problems being considered so earnestly by this committee.

As the other medical societies which have presented statements or sent letters to this committee, the Medical Society of Virginia is vigorously opposed to the enactment of H.R. 4700.

Without going into the details as to our reasons for this opposition, suffice it to say that we sincerely believe that a program of this nature would be bad from the viewpoint not only of the aged beneficiary, but the entire population as well.

When services are provided as free they generally are cheapened in the eyes of the recipient and there is a tendency toward abuse. The most common abuse is unnecessary or overutilization which would reduce the availability of facilities for the acutely ill. This, of course, also unnecessarily adds to the cost of the service.

Another feature that must be considered would be the cost of Federal administration.

As I stated previously, for 35 years I have been head of a department in a State teaching institution. It is my very definite observation that the further administration gets away from the recipient the more brokerage there is in administration and the more costly the operation per item becomes.

It is our opinion that the medical care requirements of the aged are being met constructively. Moreover, they are being met at the local level by the voluntary, coordinated effort of many thousands of dedicated men and women.

Many organizations concerned with the care of the sick have been and are doing much to work out a solution, not only of the medical, but of all the problems of this group.

May I insert parenthetically that the Virginia Council of Health and Medical Care, consisting of representatives of all the voluntary agencies concerned with health in Virginia, has and is doing an excellent job and has been complimented on editorially in the New York Times and in other papers throughout the Nation.

Obviously the rapid increase in health care insurance in the recent past has done much to relieve the problem. This past year has seen a tremendous growth in the number of programs offered specifically to the aged. Admittedly, these programs can be improved. We are sure they will be. Before one can walk, one must crawl.

We are convinced that the mere existence of a problem does not necessarily mean that the Federal Government must enter the pic

ture.

In my own State of Virginia, in response to the resolution of the American Medical Association's house of delegates in December 1958, a special insurance policy related to the maximum income of social security recipients is under serious consideration. We are con

vinced that as programs of this nature become more widespread, the competition of the marketplace for the ever-growing number of the aged can only result in better and better coverage for this group. As an example of that I have with me a letter that I got under date of June 15, addressed to the Medical Society of Virginia for the proposed senior citizen contract by Blue Cross and Blue Shield.

This committee will also be interested to learn that the Medical Society of Virginia has 47 component societies, most of which have local committees appointed specifically for the purpose of establishing programs for the aging and chronically ill.

Surely such efforts as these deserve the opportunity to solve the problem that exists, and in the manner in which important problems of this type have always been solved, at least by us, at the local level.

It is recognized that some unfortunates may not be able to meet even the reduced cost of the policies now being considered by the Virginia Blue Shield and those available through commercial carriers. Historically these have been the responsibility of their families, their local communities, and their State.

In Virginia those who are unable to pay are provided the best possible care through the cooperation of the medical profession, the hospitals, the druggists, and the local communities. This is as it should be.

The Medical Society of the State of Virginia, therefore, believes that the Congress should leave to the States and local communities. the responsibility for the solution of this problem.

As one who is reaching the end of a long medical road and sees the gates of the retirement pasture opening to receive him-that is 1 year and 2 weeks from today-may I beg you gentlemen to block any noble experiment-I remember prohibition too vividly-and withhold decision until all of the facts are in. Please protect our descendents as well as ourselves.

May I parenthetically put in a plug for medical education, having been a medical educator for 35 years. There was brought out this morning the question of impact on medical education.

That is so true. Having served on the admission committee of the medical school, we are worried about the quality of the applicants to medical school. I grant that the numbers are still sufficient to fill all places, but the quality across the board-and that is not confined to the University of Virginia, the Medical College of Virginia--but all across the Nation talking to people, the quality, the average quality, of the medical student applying for admission to medicine is dropping due to a feeling of possible insecurity for the future.

This, gentlemen, is a real problem so far as medical education is concerned.

In behalf of the Medical Society of Virginia, I wish to thank the committee for this opportunity to present our views.

If there are any questions, I will be happy to try to answer them. The CHAIRMAN. Dr. Archer, we thank you, sir, for bringing to us the views of the Medical Society of Virginia.

Are there any questions?

If not, Doctor, we thank you, sir, very much.
Dr. ARCHER. Thank you, sir.

The CHAIRMAN. Without objection, the committee will adjourn until 1:30 this afternoon.

(Thereupon, at 12:20 p.m., the committee recessed, to reconvene at 1:30 p.m., same day.)

AFTERNOON SESSION

The CHAIRMAN. The committee will please be in order.
Our next witness is Mr. Tompkins.

Mr. Tompkins, although we recall your previous appearance before the committee, will you for purposes of this record again identify yourself by giving us your name, address, and capacity in which you appear?

STATEMENT OF PATRICK A. TOMPKINS, COMMISSIONER OF PUBLIC WELFARE, COMMONWEALTH OF MASSACHUSETTS

Mr. TOMPKINS. Mr. Chairman and members of the committee, my name is Patrick A. Tompkins. I am Commissioner of Public Welfare for the Commonwealth of Massachusetts and have been for 14 years. I am grateful for this opportunity to speak in support of H.R. 4700, legislation introduced by Hon. Aime J. Forand, Congressman from Rhode Island.

The CHAIRMAN. Mr. Tompkins, will it be possible for you to conclude your statement in the 15 minutes we have allotted to you? Mr. TOMPKINS. I am pretty confident I can.

The CHAIRMAN. If you omit any parts of it your entire statement will appear in the record.

Mr. TOMPKINS. Thank you.

I have devoted 31 years of my adult life to the profession of social work, the first 5 years in private family and children's agencies and the last 26 years, other than an interruption for military service in World War II, as a city, county, and State administrator of public welfare in the States of New York and Massachusetts. I have served on a number of national social work and public welfare committees including the policy committee of the American Public Welfare Association and as chairman of the National Council of State Public Welfare Administrators.

I have had and still retain an intense and continuing interest in the broad, national prospective of the Nation toward the disadvantaged of our fellow Americans and, despite the dramatic and spectacular attention frequently focused on killer diseases, juvenile delinquency, and the occasional contagious epidemics such as infantile paralysis, I have been and remain of the same conviction that the most challenging of all social problems in America today and for the foreseeable future is adequate, protective, and medical services for aged people.

This committee with its staff has access to the many formal studies conducted by voluntary and governmental organizations representing city, State, and Nation that have been conducted during the last 25 years on the problem of aging. Some such studies have been particularly focused on specialized problems such as housing, employment, gerontology, rehabilitation, leisure-time interests and opportunities, retirement plans, or assistance plans. Others, such as the recently published study of the aging conducted by the Massachusetts