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Dr. McCrary. The present requirements are 6 years at college level in some of our schools, and 5 years in the others.

Five years is the minimum.

Senator DOUGLAS. That includes liberal arts and then medicine, too; I mean optometry, too?

Dr. MOCRARY. Yes, sir.
Senator Douglas. Courses in physics and in vision and so forth?

Dr. McCrary. Yes, sir; the subject matter in the preoptometry, premedicine, predentist is basically the same for the 2 years and then as you study in a more particular area of the field, we cover physiology and anatomy, psychology, physics, pathology, all of the various aspects.

Senator Douglas. So you are not corresponding school doctors? Dr. McCRARY. Positively no, to my knowledge.

Senator Douglas. How do you account for the attitude of the American Medical Association ?

Dr. McCRARY. Well, sir, that is a big question. I think frankly that there is basically an economic reason for it. I think basically that is the segment of vision care rendered the American public; there are two groups which render this care and that as a result of this there is some economic rivalry existing. This is my personal opinion, and I am speaking now as an individual giving his personal opinion.

This is my feelng, and this seems to be the basis.

Now to point up an illustration; In the Armed Forces, I had the privilege of holding a commission in the Medical Service Corps of the Navy.

I have served 2 years on active duty from 1951 to 1953. There is no problem with any professional cooperation when the economic factor is removed. I would say that interprofessional relationships were beautifully cooperative and I might add, too, for the benefit of the patient because when these differences take place, it is the patient ultimately who loses.

Senator DOUGLAS. You make a very serious charge, sir.

Dr. McCrary. Well, we are quite concerned about this. We in optometry are quite anxious to resolve these differences because we feel it is in the public interest to do so.

Senator Douglas. Have you tried to adjust this by conciliation with the AMA?

Dr. McCrary. Yes; there has been in past years a committee known as the Interprofessional Committee on Eye Care which had representatives from medicine, optometry and opticianry, this committee operated, I believe, lived about 6 years and was disbanded about 5 years ago; it was disbanded in 1955, as a result of the action of the house of delegates of the AMA.

We would like to see this problem resolved and we would like to make every effort to do so.

Senator Douglas. So you resort to legislation only as a last resort.

Dr. McCrary. Yes; we feel that the optometrist is well trained to render the unique services which he offers to the public and he should not be disenfranchised from rendering this service.

Senator DOUGLAS. Thank you.
The CHAIRMAN. Any further questions?
Thank you, Doctor.

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Senator HARTKE. Mr. Chairman, before the next witness is called I would like permission of the committee to insert in the hearings at this time a resolution approved by the Governors' Conference on June 29, 1960, advocating the medical care under the framework of the old age survivors and disability system and recording the vote of 30 for and 13 against with 11 not voting and also, not a part of the resolution but the statement that all the Governors present indicated they were for the principle of national health insurance plan for the aged although they voted, some voting against disapproved of OASDI financing.

The CHAIRMAN. Without objection, the insertion will be made a part of the record.

(The document referred to follows:)



Whereas the Governors' Conference for many years has been acutely aware of the growing number and complexity of problems faced by our increasing population of senior citizens, including health and medical care, employment and income maintenance, provision of suitable housing, and enrichment of leisu e time activities; and

"Whereas the most pressing of these problems is the financing of adequate health and wedical care: now, therefore, be it

Resolved by the 52d annual meeting of the Governors' Conference, That Congress be urged to enact iegislation providing for a health insurance plan for persons 65 years of age and over to be financed principally through the contributory plan and framework of the old age survivors and disability insurance system; and be it further

Resolved, That the States support and participate actively in the forthcoming White House Conference on Aging to the end that public and private agencies be stimulated and encouraged to develop approaches to all the problems of the aging.

Vote: 30 for ; 13 against; 11 absent or not voting.

Vote for (30): Alabama ; Egan, Alaska ; Arizona ; Faubus, Arkansas ; Brown, California ; McNichols, Colorado; Ribicoff, Connecticut; Collins, Florida ; Docking, Kansas; Combs, Kentucky; Maine; Furcolo, Massachusetts; Williams, Michigan; Freeman, Minnesota ; Blair, Missouri; Montana ; Nebr“ska ; Sawyer, Nevada ; Meyner, New Jersey, New Mexico; Rockefeller, New York; DiSalle, Ohio ; Oklahoma; Rhode Island ; Herseth, South Dakota ; Tennessee; Texas; Vermont; Rossellini, Washington; Nelson, Wisconsin.

Vote against (13): Delaware; Georgia ; Idaho; Illinois, Indiana; New Hampshire; North Carolina ; South Carolina ; Utah; Virginia ; West Virginia ; American Samoa ; Virgin Islands.

Absent or not voting (11): Hawaii; Loveless, Iowa ; Louisiana ; Maryland; Mississippi; North Dakota ; Oregon; Pennsylvania ; Wyoming; Guam; Puerto Rico.

The CHAIRMAN. The next witness is Dr. Hugh E. Chance, International Chiropractors Association.

Dr. Chance, take a seat, sir.



Dr. CHANCE. Mr. Chairman and members of the committee, I have with me Dr. S K. Keiser of Lancaster, Pa., chairman of our committee on legislation; previously in the room but he had to leave was Dr. John Thaxton, our vice president, from Raton, N. Mex.

I wish to correct an impression that may have occurred because of the reference to the title Doctor which appears on the witness list. I have a J.D. degree in law, and it should be, perhaps, Mister instead of Doctor.

My name is Hugh E. Chance. I am executive director and general counsel of the International Chiropractors Association with headquarters in Davenport, Iowa. Its membership represents a nonprofit professional association of thousands of practicing chiropractors throughout the United States.

First of all I wish to express appreciation to the committee for making time available to call attention to the significant fact that II.R. 12580, title VI in its present form does not permit the eligible individuals; namely, those over 65 who qualify for benefits, to use or employ chiropractic services.

This, notwithstanding the fact that chiropractic is the secondlargest healing art in the United States (estimated at over 20,000 now in practice); notwithstanding the fact that chiropractors are licensed to practice in 46 of the 50 States; and notwithstanding the fact that between 30 and 40 percent of the family groups in the United States make some use of chiropractic services each year. It is also significant that more people in the older age brackets go to chiropractors than do people in other age groups.

We wish to urge that the people who are to be the beneficiaries of this legislation should have freedom to choose the doctor and the method of health services; that those who are chiropractic patients should not be completely discriminated against.

We are not involved here with any consideration of the relative merits of one system of healing versus another system. Nor are we concerned with legal recognition of chiropractic. That matter is for the several States to consider and, as we have already indicated, 46 of them have granted legal status to the chiropractic profession.

What we are concerned with here is permitting the beneficiaries under this proposal to make use of services already recognized by the vast majority of States.

For this reason, it is proposed that title XVI, Medical Services for the Aged, section 1606(e), H.R. 12580, be amended as follows:

(e) The term “physicians' services” means services provided in the exercise of his profession in any State by a physician, osteopath, or chiropractor, licensed in such State; and the term “physician” includes a physician, osteopath, or chiropractor licensed in such State. * * *

This amendment as presented would guarantee the continuance of benefits already offered through most State old-age assistance programs successfully operating today. To fail to include chiropractic in some manner in this legislation presently before your committee, or other legislation now before the Congress, would in effect cancel or abrogate the right of a potential of several million citizens to use a healing service proven to be of great personal value.

In conclusion and on behalf of the members of the International Chiropractors Association I again wish to express appreciation to the distinguished members of this committee and the honorable chairman for the courtesy of granting time for this presentation.

The CHAIRMAN. Thank you. Any questions?

Senator HARTKE. What I would like to ask, implied in your statement is that you approve, generally speaking, of the type of legislation which would give care in problems of health as I understand it to the aging; is that right?

Mr. CHANCE. Yes, the association is sympathetic to this move. It has not, however, taken any definitive action on any particular proposal.

Senator HARTKE. Nor on the method of financing?

Senator HARTKE. Your sole concern at this time is that when and if legislation is approved that it be amended generally along the lines which you have indicated ?

Mr. CHANCE. That is correct.
Senator HARTKE. Thank

Senator CURTIS. I am trying to locate section 1606(e).
Mr. CHANCE. It is on page 165, down about the middle of the page.
Senator CURTIS. Of this

publication? Mr. CHANCE. No, of the House bill, H.R. 12580, it is on lines 12 to 16.

Senator CURTIS. Is that term defined in the present law relating to medical assistance for old age assistance?

Mr. CHANCE. The reference is back to section 1101, subparagraph (a)(7) in the 1956 social security law, and all that that says on reference is that osteopaths are included in the term “physician," so by using

Senator CURTIS. In other words, does this take a different definition of physician here than existing law?

Mr. CHANCE. Yes, properly speaking, although this is not up for amendment at this time, and that is the reason we did not ask for it as only this particular bill is up for consideration at this time.

Senator CURTIS. But are we going to have—here is the social security law, which is quite a volume in itself--are we going to have under the social security system, under the various titles more than one definition of physician? I am not quarreling with your position.

I am trying to get the thing straight. I notice that in the compilation of the social security law, section 1101, paragraph 7(a)(7), the term “physician” and “medical care" and "hospitalization” includes osteopathic practitioners and the services of osteopathic practitioners and hospitals within the scope of the practice as defined by State law.

Are chiropractors excluded under this?
Mr. CHANCE. Yes, they are.
Senator CURTIS. Osteopaths are included ?
Mr. CHANCE. Correct.

Senator CURTIS. Do you know what the legislative history of that was?

Mr. CHANCE. No, I am sorry, I do not. Senator Curtis. You are speaking now of the definition if the new title is accepted ?

Mr. CHANCE. Yes.
Senator CURTIS. Is that what you would like to have?
Mr. CHANCE. Yes, sir.

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Senator CURTIS. You are not making that recommendation as to the existing law elsewhere unless the draftsmen say that is the way to do it?

Mr. CHANCE. Yes, we have no particular choice of wording or choice of location on this section but we say when services are provided for the aged qualifying under this bill or any other bill which the Congress might choose to pass that the chiropractors should be included.

Senator CURTIS. Thank you.
The CHAIRMAN. Senator Curtis, do you have any further questions?
Senator CURTIS. No.
The CHAIRMAN. Thank you very much.
The next witness is Mr. Wilbur J. Cohen.

Senator Douglas. Mr. Chairman, I think is it well known that Dr. Cohen is one of the leading authorities in the Nation on the whole subject of social security. He was a distinguished member of the Social Security Administration for many years and has now for some years been at the University of Michigan. I don't know anyone in the country who knows more about the problems of social security and old age than does Dr. Cohen.

I must say I await his testimony with great interest.
Dr. Cohen. Thank you, Senator Douglas.


FARE ADMINISTRATION, UNIVERSITY OF MICHIGAN Mr. COHEN. I had at this late hour thought that I might forgo my testimony and spare the committee this extra labor. But as I sat in the back of the room, thinking that it was only Senator Byrd and myself here today who 25 years ago sat in the Finance Committee when it was first considering social security I thought I ought to take advantage of this historic occasion to say a few words to the committee.

This is the 25th year, Senator Byrd, of the Social Security Act. A lot has transpired in that time, and I think it is well worth an opportunity to reflect on some of that experience.

I am testifying here in several capacities. I was a member of the Advisory Council on Public Assistance appointed by the Secretary of Health, Education, and Welfare pursuant to the amendments adopted by this committee in 1958, which requested that a thorough evaluation be made of the public assistance program. Some of the amendments in the House-passed bill, reflect the views of this Advisory Council on Public Assistance, whose report has been made to you, but the recommendations of which have not yet been put into the record.

In part, the House Committee on Ways and Means did consider some of the recommendations of the Advisory Committee, and I should like to comment briefly upon them.

I should like to ask permission first to insert in the record a statement of the American Public Welfare Association on this bill since as a member of their welfare policy committee, I have been asked to represent them here today, too. I should like to summarize, after putting the statement in the record, their main views.


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