Remarks at a Meeting With Medical and Hospital Leaders To Prepare for the Launching of Medicare.

Mr. Vice President, Secretary Gardner, my good friend Senator Anderson, ladies and gentlemen:

Not many weeks ago Secretary Gardner briefed me and subsequently I asked him to bring to the Cabinet meeting a briefing on what preparations we had made in connection with the very significant event in the lives of all of us--namely, the launching of a new program called Medicare in this country.

I was so deeply impressed with that briefing that I decided to call together at the White House America's most respected and most responsible health and hospital leaders to continue the discussion we began that day. Now, all of you may not be respected and all of you may not be responsible--we will have to see, after you have left town!-but that was our judgment. And we do not claim that all of the respected and responsible are here either, but we do feel that you are a very good cross section and rather representative. That is why you have been asked to come here.

We have started the countdown for medical care in this country. In 15 days from now, we will begin the greatest contribution to the well-being of older citizens since social security was launched 30 years ago. We so much want this program to be a success. I believe that every good American wants it to be a success. I believe that each of you share that hope.

So I want to welcome you to this meeting that we have called, for what I believe to be a very noble purpose, and that noble purpose is to improve the life of our people.

A little later on I will elaborate on some of my thinking in the last few weeks about calling together the Director of the National Institutes of Health and the directors of the nine individual institutes, as well as the Surgeon General, and asking them to commune with the leaders in respective fields in this country, so that in the days ahead we can put as much effort into prolonging the prime of man's life as we are in extending our knowledge of outer space. They both have good purposes. I am not sure they have equal effort and equal funds.

Now never before, except in mobilizing for war, I think, has any government made such extensive preparations for any undertaking as we have made in connection with medical care.

I have one stenographer just assigned to me to write letters to Gardner and ask him if he has thought of this or that. Because I know that out of 200 million people in this country there are still left a few "I told you so's"--even in my own party.

And these people take peculiar delight in saying, "Why didn't they do so-and-so?" And these cynics say, "If they had only done so-and-so," and "Why couldn't they have anticipated this?" The fellow that does not have the responsibility always has the suggestions as to how it could have been done better.

So we are trying to anticipate those things and trying to plan for them--trying to get everyone cooperating and working together, to see if we can't do as efficient a job as a voluntary society and a democratic society Can do.

In the past year, through a massive program, we have tried to reach virtually every American over 65 years of age with the news about medical care. Now we may not have reached every one of them--we have tried to, I said. But more than 90 percent of them--between 17 and 18 million--have signed up for elective medical benefits.

Now, to do this we have sent thousands of workers out in the country, into the field, to consult and exchange views with hospital authorities. We have held more than 2,000 meetings with members of the health profession-to say nothing about the hours that we spent testifying before Senator Anderson and Congressman King and the other committees.

We have opened around-the-clock medical care information posts to handle questions about this new venture. We have earnestly, genuinely, sought the advice and the cooperation of the people who could be constructive and who could be helpful--the American Medical Association, the American Hospital Association, and the various high professional groups in this country.

And this morning I want to publicly pay them tribute for their response and for their patriotism and for their public spirit.

Now in these last 15 days we are coming around the bend and we do not want to let up. We are going to try to be in contact with every hospital. We will be available to every doctor and to every hospital officer in this Nation to deal with any problem that may arise.

I have asked that the Governors be specially briefed. I have asked that the Congressmen and the States be specially briefed. I have asked that we send field people to the areas where they need further information and where there is still work to do. And that is being done this week.

But the work on today's agenda is for you to decide. What we asked you to come here for is to help us by giving us advice on how we can best help you to prepare, at the community level, for as smooth and as successful an operation as can be had in this kind of a venture.

Then it will be your job to get action-action at the community level--to solve the problems which could hamper this program.

Now we know there are going to be problems.

One of them arises from compliance with the laws of the land, specifically the Civil Rights Act. In some communities older people may be deprived of medical care because their hospitals fail to give equal treatment to all citizens and they have discrimination practices.

Well, we believe the answer to that problem is a simple one and that Congress has given it in the law itself. We ask every citizen to obey the law.

A majority of hospitals--we think more now than 80 percent--have already assured us that they will. And I am hopeful that most of the others--when it is understood and when it is explained--will make an attempt to come into compliance. But we cannot rest easy as long as any of our older citizens lose their rights because of hospital defiance or because of delay.

Now we are going to hear about these cases. Mr. Rayburn, who served here 50 years, used to say that it is typical of the American people to give more recognition to a donkey that will kick a barn down than to a carpenter who will build one.

That applies to all of our people. And to those who still stand outside the gates I want to say this: Please comply. If you discriminate against some older citizens in your community, then you make it very difficult for the whole program.

The Federal Government is not going to retreat from its clear responsibility and what the Members of Congress have written into the law. And I hope that you will not retreat either.

So you are here today to help us make this reality clear to your communities. Because there is always a last minute hope that we can "fudge it" a little bit and we can prolong it and "it won't be necessary." Now that is one problem and it is a serious problem for the 20 percent group, as you can see.

Another problem will face some communities, and that is, their hospitals are always crowded and Medicare is going to add to the patient load. And if the hospital is already crowded, why, we just make present bad matters worse. Now, we do not think this is a national problem--in every State in the Union and in every community. It arises only in certain localities. We have identified those particular localities where we think the problem is most severe.

Eighty-eight counties have serious overcrowding now and we think that is where our problems are going to be. This affects about 3 percent of the Nation's population. And you are going to have ample coverage of that, ample pictures of it, and ample articles about it. I want to prepare you in advance. They are going to broadcast it good. It is going to affect, we think, about 3 percent, and we want to minimize it as much as we can.

In each of these communities your leadership can be helpful and, we think, will be necessary to try to insure the efficient use of hospital beds and efficient use of medical manpower, and to work out wise programs for handling the patient load.

We all know from our experiences in other programs--it may be a local box supper or a local football game on Thanksgiving--we know there are those who abuse their privileges.

And there will be some abuse from all these millions of people under Medicare-because we are all human beings. There will be some who will demand unnecessary treatment. There will be some who want to "fix it under the table," who want a special privilege. There will be some who make unusual requests for hospital care.

Now when these demands arise we want to appeal to you, and through you as leaders down to the very bottom of the grass roots, to try to help us stand firm against these abuses.

Washington is no place to patrol matters in 50 States. The farther you get away from the community, the less efficient you are and the more expensive you are. So we hope that at the local level this can be done. Now we think that these abuses--that you can watch after them better than anyone else; and we want to help you in any way that you think we can help.

There is another problem which deserves attention, and one that we are watching closely. With the start of medical care there may be growing pressure toward higher prices for hospital and medical services.

There is something about full employment: We work for years to try to get jobs for all of us; we work for years to try to get to where we can buy certain things; and as soon as we do, although we sell a lot more of them, people like to raise their price a little bit so they can raise their profits a little bit. That is human nature.

We must try to be concerned with these higher prices for hospital medical service or we can undo a lot of the good that we have done. So we ask the responsible medical societies and professional leaders to take the lead in trying to help us prevent unreasonable costs for health services. And the best prevention is intelligent self-restraint by doctors and hospital officials.

Now I hope your discussion of these and other problems today in your own meetings will be bold and frank and thorough. I hope, too, that you will enter into these discussions knowing that you are a very select group in which great trust is placed and which bears great responsibility, and that in my judgment the little program that you will have at your meeting and your participation here in this meeting will make history that your descendants will be proud of.

We still talk about Abigail Adams hanging out her washing here in the East Room. Now you are not going to hang out any washing here today, but you are doing something much more significant and much more enduring--and something that your descendants are going to take great pride in.

In a little more than a fortnight, for the first time in the history of America, every senior American will be able to receive hospital care--not as a ward of the State, not as a charity case, but as an insured patient.

I am not 65 yet, but I have known a good many people in my lifetime that were 65; and they have been mighty dose to me. And I have seen the skim over their eyes when they looked at me, wondering whether they were going to be welcome in their sister-in-law's home, or whether their brother-in-law would be happy when they are all there using the one bath, or how they were going to pay the doctors or for the medical services--and how grateful they were for the consideration that the preacher and the women of their church had extended to them in times of illness, and how they loved the doctor that could come anytime in the night, who gave his whole life, even away from his own family, and waited to have his bills paid year after year after year, in drought or insects or too much rain or too little!

And I know that those people over 65 know that this is really heaven itself that they no longer have to wonder how their son-in-law or their brother-in-law or their sister-in-law is going to feel, that they have some little hope that they can get into a nursing home, or if the pain gets in the right place they can go to a hospital where they can get some care--not with a tin cup in their hand saying, "Please, ma'am," but because their Government has provided for it as it has social security.

One of the most memorable events in my life was standing in the Speaker's office in this Capitol, and hearing a man talk about the socialism of social security--how dangerous it was. He was close to me, he was such a good man--and so genuinely believed that it would destroy this country. And I pled with him: Please, please, please go and support that measure; and he finally did. And as I recall, less than a dozen voted against it on final passage.

I look back 30 years now and see how far we have come. No longer would an enlightened, constructive man feel that way about social security. There is not 1 out of 100 who would think of repealing it.

And I think in due time you will feel this way.

I heard Mrs. Johnson say to Secretary Gardner the other day: "Your life must be an interesting and exciting one. Tell me about some of the things that you are doing that excite you the most."

And he said, "I think the thing that gives me the greatest sense of achievement and the greatest satisfaction is reading the letters, and hearing the stories, and participating in the work, and doing the planning, and staying up around the clock to see that this burden, this yoke, this 'sack of cement' that these old people have been carrying on their shoulders, is removed--and they now can see the sight of the Promised Land when finally with their card they can go in and have some medical treatment as a result of their Government's planning, and their own planning, and the hospital planning, and the medical planning."

So this is a great accomplishment, a great achievement. It is not just an image or an appearance. It is not something we are just talking about. We are right in sight of the Promised Land--and we do want it to be successful.

Now there are going to be doubters and there are going to be detractors. There always will be. They complain about the consequences. I want to-for their benefit, although I do not want to give them over-recognition, but I want to anticipate it and I want you to anticipate it because you will see it serialized--I want to recall the words of Bernard Shaw and he said, "Nothing is worth doing--unless the consequences may be serious."

I remember a very controversial man in our community. One time when I went to him and asked what he thought about a doubter and detractor who appeared on my horizon very often, he said, "Very little harm; very little good." And there're people that--that really leave little behind them. Very little harm, very little good. You don't have to doubt them, you don't have to detract them, you don't have to pay much attention to them, because what they do is not very controversial. Now we believe-in this country, in the Congress, in the Nation, in the White House--that this job is worth doing. And with your help we think we can do it.

And I am calling, very shortly, a meeting (I want to serve notice on Secretary Gardner publicly because I don't want to give him a chance to object privately) of the Director of the National Institutes of Health and the directors of the nine individual institutes, as well as the Surgeon General of the Public Health Service. I am asking them to come here to meet with me for the purpose of hearing what plans, if any, they have for reducing deaths and for reducing disabilities and for extending research in that direction.

I firmly believe that if we can pull together these men and if we can hold such a meeting and follow it up with having them have meetings with other experts in the 50 States in these particular fields, and then come back and meet with me 3 months later--when I take that checksheet and see just what they have, like when you take a car in to get it filled with--the tires filled and the radiator checked and all those things--we will go down their checklist and we will see what specific efforts they are going to make to reduce deaths among the leading killers, especially arteriosclerosis of the heart and the brain, and various forms of cancer, and to reduce disabilities such as arthritis and severe mental and neurological diseases or illness.

You know it is only since 1945 that death from tuberculosis has ceased to be considered the will of God. And it is only since the early fifties and the development of the Salk vaccine that polio is no longer striking terror in the heart of every mother, every parent, in this country.

Now actually a great deal of basic research has been done. I have been participating in the appropriations for years in this field. But I think the time has now come to zero in on the targets by trying to get this knowledge fully applied. There are hundreds of millions of dollars that have been spent on laboratory research that may be made useful to human beings here if large-scale trials on patients are initiated in promising areas. Now Presidents, in my judgment, need to show more interest in what the specific results of medical research are during their lifetime, during their administration. I am going to show an interest in the results. Whether we get any or not I am going to show an interest in them.

And I hope that meeting with the head of the NIH and the individual institute directors might energize--or make a contribution, I guess, is a better way to put it, to plans for specific results. And that is, specific results in the decline in deaths and disabilities.

At present, a very small percentage of research money is spent on clinical research to test new drugs and treatments on human beings. And until we do this, we won't have any major new ways of reducing deaths and disabilities. But after I have heard plans which may not be specific today, I will then ask these men to return to me to give me more concrete proposals and recommendations that they have received from you and from their own knowledge, say, in 3 months. And then I would hope that for whatever time is allotted me in the White House, that about every 6 months we could come back and see what progress we are making. Because these men are now responsible for over a billion dollars of research and training money. And I want them to be sure that they have the best defined programs and goals that can be originated in this country.

To do what? To prolong the prime of life for all of our people. Now, if I can hold two or three such meetings, I feel that with the deep sympathy and interest and leadership of the President, we will be able to get more results for the survival of our people than anyone else has ever done in the history of mankind. Think about what a laudable objective that is!

I would like to start children to school earlier. I would like to keep them there longer. I would like for them to be prepared better. And I would like to lose fewer of them when they discover America, and keep all those that discover America living as long as possible--and living in a wholesome and constructive and happy atmosphere as long as possible.

It gives me great satisfaction to walk into a home where a person that is 93 years old can go into his shower in his wheelchair and turn it on by himself, or where a crippled lady who is 84 does not have to bend over to open the refrigerator because it is on a platform especially designed for her.

So I want to see us use all the knowledge we can--to better prepare our children so they are better prepared as our adults, and their eyes are tested, and their teeth tested, and that their mental retardation problems are detected early, so that we can save at least a part of this great waste.

Do you know we are taking in in the neighborhood of $10 billion more this year than I thought we would take in a few months ago? (I said in the neighborhood; that gives me flexibility, I hope, because we really don't know until we get the income tax payments calculated. But we are going to take in several billion more.)

That is a wonderful feeling--to have that much more coming in. Now why is it coming in? Because more people are working. They are being paid more money. And as this unemployment is reduced, as their skills are developed, as they are upgraded, as they are promoted, as they earn more--then we get more. And that gives you more to do this research to prolong life and to better educate people.

And what we are doing in this country is contagious. It is spreading to other areas of the world. I can't imagine any field of endeavor, unless it is preaching or teaching or public life, that can be as satisfying as healing the sick and ministering to their needs--and seeing that in this country.

Look at the problem we have in Vietnam. They earn $65 a year and they die at 35. That is their average life expectancy. But because of the leadership of you and your profession and your group, our life expectancy, because we're Americans, is more than doubled.

We can't be satisfied with that. We are going on and do a better job. And the first job we are going to get on with is medical care, July 1. And then there are going to be other and equally important developments down the road.

Thank you so much for coming.