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trouble is that the material that was given to us was in general terms. It was not a bill that we could study, and that is why I would be very anxious to see that.

Senator Douglas. Did you have representatives here yesterday to hear Secretary Flemming?

Dr. LARSON. Yes; I didn't get in until late afternoon.

Senator Douglas. Did they make a report of the Secretary's testimony?

Dr. LARSON. Yes, but I don't recall that that was discussed, that is by our representatives.

Senator Douglas. Well, the Secretary's testimony was very clear on this point, that out of a total cost of approximately $1,600 million or possibly $1,800 million, seven-eighths of the cost would be met by Federal and State subsidies shared equally between the Federal Government and the States, and that the benefits were to include not merely the cost of nursing home and home nursing and not merely X-ray and diagnostic facilities but were also to include physicians'

There was a provision, which is similar to the one in the projected Anderson bill, that a large portion of the initial costs should be met by the aged person himself or herself, but with physicians' costs ultimately met by Federal and State contributions not merely for the needy but all those included in the plan. They would be virtually 100-percent coverage. Have I not made an accurate statement of Secretary Flemming's proposal ?

Mr. STETLER. I didn't hear that. But we will comment on that generally that our attitude on this proposal would not turn on whether physicians' fees were covered but whether or not the group being encompassed in the program were needy. If the administration proposal would cover all over age 65 I think we would say we would not approve it, we would be opposed to it.

Senator Douglas. The administration's plan is not confined to the needy, it includes the needy but is not confined to it, so you would be opposed to it?

Mr. STETLER. I am sure we would, but I would like to study it and state specifically.

Senator Douglas. In other words, you take the position that whatever system is devised should be confined to those on old-age assistance.

Mr. STETLER. No, sir; as the Mills bill or this H.R. 12580 provides the present old-age assistance and then another near-needy category, which would be relatively new.

Senator DOUGLAS. A thin number around the old-age assistance recipients.

Mr. STETLER. That would depend upon your State determination.
Senator DOUGLAS. Thank you.
The CHAIRMAN. Any further questions?

Senator CURTIS. Mr. Chairman, we have a busy day and I will not take time to ask questions, but I will say to Dr. Larson that your three-page summary has some very fine principles laid down in it. One of the things that aggravates the problem of health care for anybody is inflation, and the proponents of larger and larger and larger Federal Government may be rendering a little help here and there in their alleged solutions but they are complicating the problems and creating hardship in every household in America.


I am glad you were here.
Dr. LARSON. Thank you.
Senator GORE. Mr. Chairman, I have some questions.
The CHAIRMAN. Senator Gore.

Senator GORE. Like you, Doctor, I have not yet had an opportunity to read the administration's bill. I did have the advantage of hearing Secretary Flemming's testimony at considerable length yesterday. Even so, I doubt that we could fruitfully engage in an examination of the problem or of the proposal in detail, and it may be you will want to return to the committee after you have had an opportunity to study it.

In my brief examination of Secretary Flemming yesterday afternoon,

it appeared clear that there was a qualifying period, the duration of which was not specified, in which the elderly person would be required to pay $24 per year. There was some confusion in the testimony as to whether that w be for 1 year or 2 years. In fact I didn't get the impression that the administration had reached a firm conclusion on that or that it would be applied uniformly.

Secondly, it proposes to apply not a means test but an income test. I cited the illustration in which a couple might be worth a net of $250,000, and you can construct a situation where one has assets of up to half a million dollars or perhaps a million dollars, and still be eligible to pay $24 after he had been advised by a physician that major surgery or hospitalization might soon be necessary, and be eligible for hospital treatment and other medical care without limit. Would you favor that?

Dr. LARSON. It seems to me that is essentially what was given in the press long before Mr. Flemming appeared before this committee yesterday.

Senator GORE. Now that $24, isn't that a registration fee?
Dr. Larson. No, they called it an enrollment fee.

Senator GORE. All right, an enrollment fee. But it would be compulsory.

Dr. LARSON. In order to participate in the benefits.
Senator GORE. Yes.
Perhaps I have used the wrong word. It would be a prerequisite.
Dr. LARSON. Yes; that is right.
Senator GORE. Fór eligibility.

Dr. Larson. Now, the quarter of a millionaire, if one could call him that, could become eligible, but as I understood the original proposal of the administration it was to the effect that for those over a certain level of income there would be no Federal or State participation, dollarwise.

Maybe that has been changed.

Senator GORE. No. There would be an income test, but I know of at least one Member of the Senate who can testify that a man can own many acres of farmland now and receive no net income at all.

Dr. LARSON. I agree.
Senator GORE. He may be very lucky not to sustain a loss.
Dr. LARSON. That is right.

Senator GORE. There are many instances and many ways in which people can find themselves possessing substantial amounts of property measured in dollars, but who have no substantial income.

Dr. LARSON. In other words, they have assets.

Senator GORE. And I believe the proposed income limit for a couple would be $3,800 a year.

I will not proceed further to ask you about the administration plan. I only did this much to illustrate the point that I believe the administration has tried hard to reach the catastrophic illness, the long illnesses, the health tragedies that come to families, but in doing so, it seems to me that the administration may have erred, as your association may have erred, in overlooking the opportunity for preventive medicine. Now, I have introduced a bill, several people have introduced bills. Contrary to the McNamara bill, the bill I have introduced does provide for payment for visits to doctors' offices, home calls by doctors, as well as outpatient care and nursing home care. It seems to me, Doctor, that everyone concerned with this problem ought to try to approach it in the most realistic and practical way. You referred to one of the limitations and that is the availability of hospital beds. Within the past 2 weeks my own mother was required to wait for 10 days to obtain a hospital bed in Nashville, Tenn.

This brought home to me the scarcity of hospital facilities. Therefore, it seems to be very necessary that we begin with maximum emphasis upon preventive medicine, upon the care of a doctor at a time when a stitch in time might avert this catastrophe.

Would you comment on that?

Dr. LARSON. I agree that preventive medicine is very, very important. The question is how to provide it. Now there is a great deal of resistance on the part of the public. I have heard that in some instances, at least, where these facilities are available free of charge even, under a plan, for instance, that the participants in the plan either don't know about it or are reluctant to take advantage of it.

That is being broken down gradually, Senator. We find in our own practice that more and more people are coming in and saying, “I want a checkup," and it is surprising to me how many are fully aware of what a checkup should include.

Now it takes time to do that. We can't charge anywhere near what it costs us to do it.

We are glad to do it because it is a service to our people, and occasionally, as you say, a stitch in time saves nine. We discover a latent diabetes or a case of leukemia, cancer of the bowel or of the stomach, something like that. Those cases are relatively few but to the individual in which you find them, it is worth any amount of effort and money.

Now, how are we going to provide facilities, doctors, nurses, all the ancillary services to take care of millions of people in this country who, through education, which may take some time to accomplish, would be wanting that preventive type of service?

I am strong for preventive medicine, Senator Gore, and I hope the time will come when we have better screening mechanisms than we have now for that or to discover some of the more obvious conditions that a patient is unaware of and for which something can be done.

Senator GORE. And if done early it might not only prevent a long

Dr. LARSON. That is true.
Senator GORE. Costly hospital stay but it might even save a life.



Dr. LARSON. That is true. I think diabetes, unknown to the patient, for example, discovered, adequate treatment outlined may require a few days in the hospital, to get the patient under control, as we say. He goes home under a strict regime, can take care of himself from then on, and he gets along just fine so long as he follows the instructions but unless he knows what he has, and something is done to relieve him of his situation, he can't be cured, some day he comes into the hospital in a diabetic coma, and that may require not only emergency treatment but may be expensive and require a lot of people, laboratory work, but possibly days and even weeks in that hospital. So the preventive side of this is certainly very important. There is no question about it

Senator GORE. Well, Doctor, this being true, I included in the bill I introduced provisions to which I have referred. I tried to emphasize the kind of care that is most available now, and I agree with you that there are not nearly enough doctors. We have erred seriously either in not putting our medical schools to greater use or in not multiplying them, but, nevertheless, medical care, clinical care, nursing care, the ancillary health services to which you refer, are more plentiful now than hospital beds, as scarce as both are. Am I correct in that?

Dr. LARSON. I think so.

Senator GORE. Well, then, although I must say that I was not unaware that this provision in a bill might generate more opposition, nevertheless it seemed to me absolutely essential to a practical and realistic approach to the problem of health of our people. I know some people regard it as a political problem and a political issue. So far as I am concerned it is a human problem and I appreciate your testimony here.

I thought Secretary Flemming made a fine contribution yesterday. We may not agree with all of his recommendations but at least he and his

staff have given the problem a great deal of study and made some helpful suggestions.

You, too, have been helpful today.
Dr. LARSON. Thank you.

Senator GORE. I would like to ask one other question. What was the position of the AMA in the Miami meeting with respect to the House bill?

Dr. LARSON. You mean the bill before us right now?
Senator GORE. Yes.

Mr. STETLER. The statement that was in this brief statement which quoted it was the action taken earlier in this month in Miami. It did not relate specifically to the Mills bill because there were so many proposals pending in Congress, our house of delegates merely announced its general policy. Now that policy when you read it does coincide with the principles in the Mills bill so that is why we do support it today, in our testimony.

Senator GORE. Thank you.
The CHAIRMAN. Any further questions?
Thank you very much, Doctor.
Dr. LARSON. Thank you, sir.

(The following letters were subsequently received for the record :)


Chicago, Ill., June 30, 1960. Hon. HARRY F. BYRD, Chairman, Senate Finance Committee, U.S. Senate, Washington, D.C.

DEAR SENATOR BYRD: In a separate statement submitted today, I presented the views of the American Medical Association with respect to title VI of H.R. 12580, 86th Congress, now pending before your committee. This measure also provides for the compulsory inclusion of physicians under title II of the Social Security Act. This letter is written for the purpose of restating the position of the American Medical Association in this regard.

As far back as 1949, the house of delegates of the AMA went on record as opposing the inclusion of physicians under social security on a compulsory basis. This position has been restated by our house of delegates regularly once or twice a year since 1953. This policy statement was amended by our board of trustees in 1954 to remove any objection to the voluntary inclusion of physicians under the act.

Following the clinical meeting of the association in December 1955, many of the State medical societies, at the suggestion of the house of delegates, conducted a poll of their members on the question of compulsory inclusion of physicians under social security. Although uniform questions were not asked in these State polls, it can be concluded from the results that a majority of the profession is still opposed to compulsory coverage. It is true that several State medical societies have endorsed coverage of physicians. Our house of delegates, however, of 200 physicians representing every State, has overwhelmingly rejected proposals for coverage. The most recent action of this body in opposition to compulsory coverage for physicians was taken at the association's annual meeting held in Miami Beach earlier this month.

OASDI does not fit the economic pattern of the practicing physician. Selfemployed doctors rarely retire at age 65. Therefore, the compulsory tax which would be imposed upon them, were they covered under the social security system, would be unjust and unreasonable. Physicians who are able to work prefer to keep right on practicing medicine. A survey of this point shows that over 85 percent of the doctors between the ages of 65 and 72 are in active practice. Over 50 percent of the physicians who retire do so after the age of 74. Thus, if forced under this program, the typical physician would be required to pay social security taxes until age 72 before he would receive benefits.

Finally, and perhaps most important, physicians have seen social insurance programs in other nations used as a vehicle for the establishment of socialized medicine. They have fought against the Wagner-Murray-Dingell bills of 1949 and the Forand bills of today. They know that the OASDI system constitutes the principal avenue by which socialized medicine advocates hope to achieve their goal. Naturally, they are highly sensitive to their inclusion in a system which may eventually be used to abridge their freedom as a profession.

For the aforementioned reasons, the medical profession is opposed to the compulsory coverage of physicians under title II of the Social Security Act. or any of the members of your committee desire further information concerning our position, I would be happy to supply it. Sincerely yours,


If you

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Chairman, Senate Finance Committee,

Washington, D.C.

DEAR SENATOR BYRD: In my capacity as chairman of the Pima County Medical Society, committee on legislation, I am taking this opportunity to express the society's unqualified opposition to any Forand-type proposals which purport to provide health care benefits by means of OASDI.

With the House passage of H.R. 12580 (Mills bill) and its probable early consideration by the Senate Finance Committee, undoubtedly many amendments will be offered from the floor of the Forand type. We urge continued and

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