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The legislation being considered by the committee is to be known as "The Social Security Amendments of 1960."
The bill, H.R. 12580, covers many phases of our social security program, but the one to which I will confine my remarks is known as title VI of the bill which would add a new title to the act to be known as "title XVI–Medical Services for the Aged."
It is my understanding that there is a possibility that the language of some of the other bills which have been introduced, dealing with this subject, may be substituted by way of an amendment for that contained in title VI of this particular bill.
In view of the time limitation, I have attached to my prepared statement suggested amendments for H.R. 12580, H.R. 4700 known as the Forand bill, and S. 3503 sometimes referred to as the McNamara bill.
My first recommendation is that any legislation enacted by Congress should, wherever possible use the word "health" rather than "medical."
This would mean that the title of the particular bill under consideration would be amended to read "Health Services for the Aged.”
There are many disciplines besides medicine which render professional services to the American people and particularly to the aged.
The profession of optometry to which I belong is one of the most important if not the most important, discipline outside of medicine and dentistry.
Practically all of our older citizens who are beneficiaries of the social security system have vision problems. The vast majority of these are patients of optometrists. Because this bill is designed to provide assistance in a field that is frequently referred to as "major medical” and deals particularly with cases involving surgery, some of you may question the necessity of providing optometric services for the beneficiaries of the proposed law.
One of the most common surgical operations performed on our older citizens is that for the removal of cataract. Well over 50 percent of the cataract cases are detected by optometrists and referred to ophthalmologists for surgical care.
Notwithstanding the fact that the American Medical Association has declared that it is unethical for a doctor of medicine to confer on a professional basis with optometrists, or to teach in the schools and colleges of optometry, nevertheless, á substantial number of these patients are sent back by the surgeon to the referring optometrists for postoperative refraction and the furnishing of corrective eye wear.
Were it not for the hostile attitude of the American Medical Association toward optometry, and particularly its section on ophthalomology, more of these patients would be referred back to the optometrists. In many instances it is much more convenient and results in a smaller expenditure of time and money for the patient to go to an optometrist for postoperative refraction and for his lenses.
Under these circumstances it is imperative that the language of the bill be broadened.
Senator Douglas. Mr. Chairman, may I ask the witness a question?
Doctor, you speak of the American Medical Association policy in terms of it being unethical for an M.D. to confer on a professional basis with optometrists?
Dr. McCRARY. Yes, sir.
Senator Douglas. Does that mean a doctor who confers with you would be liable for expulsion from the medical association ?
Dr. McCrary. He would be liable to discipline which may include expulsion.
Senator DOUGLAS. Do you know of any cases where doctors have been disciplined?
Dr. MCCRARY. I do not personally know of any cases.
Senator BENNETT. Do you know whether he was disciplined for that conferring?
Dr. McCRARY. No, I do not. My personal relations on a community basis with physicians is quite good, but this apparently in some areas it is my understanding that there is practically no interprofessional relationship due to this resolution.
Senator BENNETT. It isn't nationwide and it isn't automatic.
Dr. McCRARY. It is not automatic, I don't think. It is my understanding that this was a resolution adopted by the AMA house of delegates. Therefore it probably is nationwide.
Senator BENNETT. Do you have the text of the resolution ?
Dr. McCRARY. No, sir, but I will be happy to furnish it to the committee.
(The resolution referred to follows:)
RESOLUTION 77 OF THE AMERICAN MEDICAL ASSOCIATION, ADOPTED BY THE HOUSE
OF DELEGATES IN ATLANTIC CITY, JUNE 1955 Resolved, That it is unethical for any doctor of medicine to teach in any school or college of optometry, or to lecture to any optometric organization, or to contribute scientific material to the optometric literature, or in any way to impart technical medical knowledge to nonmedical practitioners.
Senator DOUGLAS. Well, such advice as you get is bootleg advice, is it not, that is it is advice which they offer you contrary to the declaration of the AMA.
Dr. McCRARY. Yes, sir, I would say that is correct.
Dr. McCRARY. If I may continue, sir. We would like to recommend that the beneficiaries of the program regardless of the form it takes, be accorded the freedom of choice of any practitioner duly licensed by the State to render the service to which the individual is entitled. We know only too well from past experience that an express mandate by Congress to this effect is indispensable if the individual is to possess this right.
As an example, permit me to remind you that by administrative action optometrists were originally excluded from participating in the aid to the blind program established by title X of the social security law.
In the interest of the beneficiaries of that title Congress by the 1950 amendments of that law, expressly required that State plans to be approved must make available the services of optometrists to the beneficiaries who desired to utilize them.
This has been of real benefit, particularly to beneficiaries living in smaller communities or rural areas where, in order to obtain services of opthalmologists or physicians skilled in diseases of the eye, the beneficiary must travel a distance of anywhere from 100 to 200 or 300 miles, while an optometrist might be his next-door neighbor.
To assure the beneficiary of this right, we respectfully recommend that there be added to H.R. 12580, title VI, section 601, "Sec. 1602(a) (6)” the following language: * * * and shall accord the individual freedom of choice of any practitioner duly licensed to render the service to which the individual is entitled.
This follows the same pattern as the 1950 amendment to the aid to the blind program except that it includes all duly licensed health disciplines.
The Senate on Friday of last week, by unanimous action passed H.R. 7966, the sole purpose of which was 'o accord a similar privilege to veterans entitled to outpatient vision care.
The same reasons which prompted both the House and the Senate to pass this bill without a dissenting vote, are equally applicable to the proposed amendment to the pending legislation.
The American Medical Association is a great advocate of freedom of choice among physicians. At the same time they advocate limiting the choice of the patient to members of the medical profession, even though other professions in the health field are regulated and licensed by the States, and their services utilized extensively by those who are free to choose.
When Henry Ford, Sr., was first approached about offering the public a choice of colors in Ford cars, he is reputed to have said:
“The purchaser is free to select any color he desires so long as it is black.” That is the way the medical profession regards the entire field of health care the individual should be free to select the practitioner of his choice so long as he is an M.D.
It is contrary to the public interest and American tradition for Congress to pass legislation providing health care for any group of our citizens, and leave it in the power of the executive departments of the Government to require the beneficiaries to select only members of the medical profession to render a service which can be provided by another profession in the health field which is duly licensed and regulated by State law.
If our aged citizens are to have the same freedom of choice of practitioner under Government-sponsored health care programs that they do prior to the time they reach the qualifying age, the amendments attached hereto as exhibits, or comparable amendments, are indispensable.
I have referred to our experience under the aid to the blind nrogram and vision care for the veterans. In conclusion I would like to mention briefly the experience of our profession in connection with our national defense.
The Army during World War II refused to commission optometrists and permit them to practice their profession. In the interest of the visual welfare of the Army (the Navy was commissioning optometrists and utilizing their professional services) Congress passed the Optometry Corps bill in May of 1945, over the strenuous opposition of the War Department and the American Medical Association.
While this bill was vetoed because World War II was drawing to a close, the administration because of this congressional action agreed to and did sponsor the Medical Service Corps law of 1947. This resulted in the commissioning of optometrists in the Regular Army, Navy, and Air Force.
There are now some 350 optometry officers on active duty in our Armed Forces, with ranks ranging from second lieutenant to colonel or the equivalent ranks in the Navy.
Even the Army Medical Corps now recognizes the invaluable services which optometrists are performing in caring for the vision of the man and woman in uniform and their dependents.
When some of the States have what are referred to as antidiscrimination laws, our National Government should not attempt to discriminate between professions that are duly licensed and regulated by State laws. The individual is entitled not only to assistance when needed but to freedom of choice as to who shall provide the health care services.
The detailed amendments are attached hereto as exhibits. (The amendments referred to follow :)
PROPOSED AMENDMENTS TO H.R. 12580 TO ACCOMPANY THE STATEMENT OF DR.
V. EUGENE MCCRARY, REPRESENTING THE AMERICAN OPTOMETRIC ASSOCIATION, JUNE 30, 1960
(Note: The page and line references are to the bill as introduced in the House on
June 9, 1960) Page 154, line 1, strike out the word “MEDICAL” and insert in lieu thereof the word “HEALTH”; line 5, strike out the word “MEDICAL” and insert “HEALTH”; line 9, strike out the word “medical” and insert ”health"; line 15, same amendment; line 17, same amendment.
Page 155, line 3, same amendment; line 5, same amendment; line 8, same amendment; line 13, same amendment; line 16, same amendment; line 17, strike out the semicolon and insert the following : "* * * and shall accord the individual freedom of choice of any practitioner duly licensed to render the service to which the individual is entitled ;'.
Page 156, line 6, strike out the word "medical” and insert “health"; line 21, same amendment.
Page 157, line 7, same amendment; line 10, same amendment.
Page 163, line 14, same amendment; line 15, same amendment; line 18, same amendment
Page 163, line 19, strike out the word “physician" and insert in lieu thereof the words “a duly licensed practitioner"; strike out the word “medically.”
Page 164, line 6, strike out the word “medical” and insert "health”; line 8, same amendment; line 12, same amendment.
Page 165, line 8, same amendment; line 12, strike out the words “physicians' services” and insert in lieu thereof "health services”; line 13, strike out "a"nd insert “an"; line 14, strike out “physician” and insert in lieu thereof "individual” and after the word “licensed" insert the words “to practice in the field of health care.”
Page 166, line 9, strike out the words "a physician” and insert in lieu thereof the words "an individual duly licensed to practice by the State in the field of health care."
Page 167, line 18, strike out the word "Medical" and insert in lieu thereof the word “Health."
Page 168, line 2, strike out the word “medical” and insert in lieu thereof the word “health"; line 22, same amendment.
Page 169, line 3, strike out the word “medical" and insert "health”; line 8, same amendment; line 24, same amendment.
Page 170, line 7, same amendment; line 23, same amendment.
Page 178, line 5, strike out the word "Medical” and insert "Health"; line 6, same amendment; line 9, same amendment; line 10, same amendment; line 12, strike out the word “medical” and insert “health”; line 13, same amendment; line 16, strike out “medical” twice and insert “health” twice; line 19, same amendment; line 21, strike out “medical” and insert "health”; line 22, same amendment; line 24, strike out “medical” twice and insert “health” twice.
SUGGESTED AMENDMENTS TO H.R. 4700 (FORAND BILL-FEBRUARY 1959) Page 7, line 10, strike out the period and add the following: "and except that in prescribing and furnishing corrective eye wear or lenses following eye surgery, such individual may select a duly licensed optometrist."
Page 11, line 16, after the word "dentists” insert “optometrists." Page 12, line 8, after the word “dentist” insert “optometrist.” Page 16, line 11, after the word “homes" insert “optometrists." Page 17, line 3, after the word “physicians” insert “optometrists." Page 18, line 14, after the word “physician” insert “optometrist”; line 15, after the word “home” insert the words "postoperative.”
PROPOSED AMENDMENTS TO S. 3503 (SOMETIMES REFERRED TO AS THE MCNAMARA
Page 1, line 3, strike out the word “Medical" and insert in lieu thereof the word “Health”.
Page 2, lines 6, 13, 20, 25, strike out the word “Medical" and insert in lieu thereof the word “health".
Page 3, line 7, same amendment.
Page 5, lines 14 and 21, same amendment; line 24, strike out the word “physician” and insert in lieu thereof “duly licensed practitioner”.
Page 6, line 1, strike out the word "physician" and insert in lieu thereof the word "practitioner"; line 3, strike out “medical” and insert “health”.
Page 7, line 25, strike out "medical" and insert “health”.
Page 10, line 5, after the word “homes" insert “(iv) clinics” after "and" strike out “(iv)” and insert in lieu thereof “(v)”; line 8, before the word "and" insert the word “clinics”; line 19, before the word “or” insert the word “clinic”; line 24, strike out“medical” and insert "health”.
Page 11, lines 6, 16 and 22, same amendment; line 13, after "hospital,” insert “clinic”; line 25, after the word "hospitals” insert “or clinics”.
Page 12, line 22, strike out the word "and". After the word "services” insert “and clinics”.
Page 14, line 3, after the word "agency," insert "clinic,” line 6, before the word “or” insert the word "clinics"; line 14, strike out "medical" and insert “health”.
Page 15, line 4, and in the balance of the bill, wherever the word “medical" appears, strike out the word and insert in lieu thereof the word “health”; line 10, before the word “or” insert “clinical services”.
Dr. McCrary. Mr. Chairman, I want to thank you for this opportunity to express the views of our profession, and to assure you I will be happy to answer any questions you or the members of your committee may wish to ask.
The CHAIRMAN. Any questions.
Senator DOUGLAS. Doctor, I take it you object to being placed in a medical leper colony.
Dr. MCCRARY. Well, let me say we feel that it is important for the health and welfare of the American people to have all disciplines who work in the health care field to be heard and to cooperate together in carrying on and caring for the health needs of the American people.
Senator Douglas. How long a period of study do the optometrists have to have?