Conversation 890-023

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Good afternoon, President.

How are you?

Good to see you.

Sit down here.

Sit down.

I've got a few more pictures you can have for your father.

Oh, thank you.

Just down the gym, I guess you have a terrific load off your shoulders apart.

I appreciate the way

you know, the medical profession, supporters for our policy, you know, for the most part, and a strong national defense, and also the way you're putting the baton on our side to fight with some sort of responsible budget.

And I know that some of your members don't agree with most of them, too, but I'm grateful for that.

Because you're an influential group, not just like the very...

I mean, I can well understand that they say, well, thank my God, we've got enough problems fixing the human body, but I apologize, but you don't fix the body, you apologize, you won't have any opportunity to do much with the human body.

That's what our duty is down to.

So we appreciate your action, the action of the medical profession in politics, in the way that you have, and standing for what is right in general.

So...

Well, certainly we want to say thanks for that, Walter Mark, and tell you that we are strongly supportive of your activities.

As a whole, throughout our professions, we have a group of 200,000 people.

You've got individual bankers, you've got...

People along the line of either extreme, we try to keep them under the umbrella of the American Medical Association.

We're doing a very good job, actually.

We're bringing them back now.

More than ever.

Good.

We've got to have them on the air, or else they're running out like a bunch of jackasses making fools of themselves, too.

Absolutely.

We are very appreciative of your first

term in office, and as you know, we have supported you all along, and we are going to continue to support you because we believe in your philosophy.

Well, let me ask you a question.

Let me get directly to the thing that I know you want to discuss, as I have, obviously, had a reading on.

First, let me indicate to you my views about controls and philosophy.

I'm against them.

I don't believe in controls.

It was one of the terribly difficult decisions to have to oppose those ceilings on meat prices.

It had to be done, hardly, because they were just going, frankly, hog wild.

Hog wild, cow wild.

And fortunately, we did it at the time.

The housewife, Boycott, had already brought the prices down some, so maybe this would help.

But if we hadn't put it on, we would have had the labor duties then making unconscionable demands for increased wages.

And then that would have set off the new wage price in different places other than food.

So we had to have a bargain.

I want you to note that as far as this is concerned,

that my own views with regard to controls, price controls, et cetera, are that this country's better off without them.

Investment control is the market, investment.

Like I said, look at even the food prices in the West.

The strongest enforcement, as far as the food prices is concerned, is the housewife.

The housewife, I mean, what she's going to buy and so forth, and she's going to get strawberries in the house season, and they're going to sell.

saying the truth out of other things.

Now, it's a hard thing to talk about her, and the old man wants to eat at the table every night, and she's got to go buy it.

But as many, I believe in the free markets, and the law of supply and demand, all of the things that are considered to be sort of out of fashion, he says.

I think it's true also in your profession.

I know that, I know, I know the type of profession, I know your costs are gone, to be honest.

I hope, too, that the way that the price ceiling on this thing is long.

Do you feel it's long?

I mean, that it's too stretched?

No.

Let me clarify.

Yeah, go ahead.

My position is this.

We are wholeheartedly in favor of your program of controlling inflation, and they come.

No question about it.

as long as we are in the midstream and treated as and in the first and second phase, we were given restrictions to the subcommittee and council.

We took it upon ourselves on a voluntary basis, not required by anything that had been passed, but the Board of Trustees took action to disseminate information to all of our people.

and tell them that we wanted them to hold the cost and prices down, which they did, illustrated by the fact that the percentage dropped from 8.1 to 2.4 into the period.

It's the best, actually, according to the data we have.

The thing that I say now, in setting up the original discussion with regards to this,

We came into a conflict with the committee originally, and that is that they divided positions into two groups.

The institutional providers were set up on the one category, and the non-institutionals are outside practitioners on the other category.

We objected to this, but we took it in our stride and helped in every way we could to control this.

You made a statement that I want to be sure if I leave nothing else with you today, I'll get this to you.

It's very important to my mind.

There is health care, and there is medical or physician care, which are two animals in the same pen.

But the doctor itself, in this price, is the one that's been controlled.

The health care given to the institutions is where your pricing remains at a high level.

Now, we talked to Secretary Weinberg about this, and he understands the fact that there is a differential between the two areas.

If you separate positions from the health care program, which is the overall program, then you find that we've been discriminated against because of several factors.

The small business was taken out of it.

The institutional position was taken out of it,

Then we were restricted in problems within our own practice.

You took all the others out, the legal profession, all the dentists, all of the, excuse me, not the dentists, but other professional people, the offices and architects and those who take them out.

They have, and I'm going to leave this graph with you, and I have another document that's on the way over.

It wasn't quite finished.

It's all right, the office, and I'm going to leave it with you.

The fact is that

These features of why we are being apologetic to our members right now are the fact that we have been introducing a lot in a discriminatory fashion.

And when I spoke to Mr. Rumsfeld back in December, I left him some of the same documents and showed the same evidence.

The fact being that we felt then equalization we would accept without any hesitation.

minimal control which you are have already expressed this morning that you're not in favor of control minimal control cannot affect our organization structure we are in favor of working but when the phase three came through we were discriminated again and immediately we have uprising from our state societies with federations societies our county societies

the distant groups of unions and other groups that are trying to create a disruption in our program.

So what we are trying to do, and we need advice from you and from the administration, is some character on this Phase 3 program, or if you're going to keep control zone, give us some relief for some of these areas that we referred to in this document, the three that I mentioned.

Another illustration.

In my own office, the last two weeks, we've lost two girls that have been with us one six years and one three and a half years.

Key people within the office, because they could not get a raise, but they can go outside and get a job at another firm at $200 more a month than we're paying them, and we only can increase their salaries 5.5.

This is hurting us.

The other factor is there are many doctors that have gone into groups

And the freeze has come on their salary.

They've been working two years and a half on those spaces and no increase in income other than 5.5%.

Where today a doctor moves in and he stays three years, you don't equal partnership in the group.

But this is impossible in the present.

So we're getting discriminated against in three or four areas.

But if we can get any of these carrots back to us, then we can continue to do a job of educating our people

that we've got to keep costs under control.

Now, I've spoken only in one phase, and that is the physician costs.

The thing that you and the council are really interested in, controlling health care costs.

The 80% of the total budget for health is health care.

That's institutional care.

Now, we as doctors can help.

But the doctors right now are not in any frame of mind to help.

A frame of mind to help.

You can help on that, don't you?

We can help with the renters from that.

We can do lots of things.

We can help with ESRO, which we took a positive stance on last fall after it was put into effect in Cincinnati.

We set up a task force to go all out to make this thing go.

And the only way it can go is by position support because the positions are the party's responsibility.

And the doctors today in this country have again said, why should we do a PSRO?

We got kicked in the mouth in Phase 1, 2, and now 3.

Let's see what the administration is going to do to help us.

And I tell them that my relationship with the next Secretary Richardson and the members of your staff during the last two and a half years, we've had a wonderful report, and I want to keep that.

I appreciate it, but you've got constituents that are already being held away.

Let me say that after we meet, you rank immediately.

Dunlop.

Is he around?

Yes, he is.

I worked him all half the night last night.

You met Dunlop?

I haven't met him.

First class correspondence.

First class, man.

He's a great, great expert.

He's still a decent follow-up.

people will listen and get all the facts and so forth.

Now, second point is that whatever is done in this area, and I don't want to decide it.

I want to see what the recommendations are.

Don't give the socializers down in the Congress

You know, you're aware of my position with regard to the Kennedy bill and all that, sir.

Oh, absolutely.

And it will remain.

It will remain.

I'll remain.

If the Congress should ever be sued, that's it.

I'll veto it.

But I don't know.

We'll certainly have to sustain you.

But my point is, we have to realize that

You can do a little about that, but you really aren't responsible.

You're not the ones who did it.

But what we want to do here is not to take some action.

You can see, I don't want to take any action that will stir up the animals down there on a hill such that they'll say, aha!

The administration, as a result of its close ties to the American Medical Association, is now raising health care costs, raising the things there, and so forth, and everybody's not paying the bill.

In other words, we've got to find, shall we say, subtle ways to handle this.

And so could you talk to him along those lines?

In other words, obviously, I know there's no politics in the American Medical Association.

But I do know that you can think politically when you talk to Donald Trump.

That's what we've got to do.

I understand the problem.

And let me tell you, if you let me speak, we do have a problem down there.

I was over to talk to Mr. Rodgers just two days ago, and I came up for a speech before the Rotary Club, and he pointed out the very thing that you were referring to.

Who's that?

Who'd you talk to?

Congressman Rodgers, Paul Rodgers.

Oh, yeah, Paul Rodgers.

And he was...

He's trying to enlist our support for a confrontation, which we aren't interested in supporting at all in this area, and we told him so.

But the point I'm really making is, since you mentioned politics, we have a pretty good nest egg already for 1974.

But our people are saying, we don't want to do anything as far as committing ourselves to anybody for six, eight months until we see what's going to happen.

And they're very concerned about the phase three because it is disrupting us.

The union people, some individuals are forming unions and what they're saying.

Union of doctors.

They have two different groups, some that belong to the AFL-CIO, some that are going alone as their own unions.

And they say they have 25,000 members.

I doubt this very much, but nevertheless, they have enough to get the voice of the press

and the television to disseminate information that we aren't doing anything in Washington to help the physicians.

But we as union members will be in position to do something because we're going to strike.

But we don't want any part of this area to happen whatsoever.

But if we don't get something to stop this rapid rampage that started primarily in the state of California and in Florida and in Nevada.

So we have to

real formative activities going on that create problems for us.

We, as a board, and I, as chairman, want to support you 1,000 percent.

We have to – we have to look at this thing, though, that we can get something to give us some real firm evidence to take back that we're going to have problems.

Already, there are 10 resolutions on phase three from the various states coming in for

Well, look, we have to understand we're on the same wavelength.

We have to... We understand that whatever the problem is, we're fighting at the same time.

Let's try to keep this understanding as we can.

You were talking to him a while ago.

Has he already had this method before?

He's had correspondence with associations.

Of course.

What has he done?

He has not been, however, looked at this situation.

Can you arrange a meeting?

Yes, sir, I will.

And report back to me just what the situation is.

As a matter of fact, we're getting heat.

Some people say phase three is too tough and we're getting heat.

A lot of people say it's tough enough.

Well, you're always going to have to.

If you look at the actions that we have, overall, I'm here this round, and I'm here to accept this.

I'm going to show it now.

All services are aligned.

It's perfect.

The legal and green have been up higher.

The thing that's in the front of the room on institutional care is that the way of medicine is down here.

The law is in this category right now.

Oh, I think we've been bragging about it.

Oh, yeah.

We didn't brag too much.

I'm afraid we got you all... Well, it isn't a fact of bragging, but it's a fact of recognizing the real factors and yet coming around to see that we're not getting some relief.

Put this in the other.

I'll get it.

Don't worry.

I'll get it.

I won't be able to read it today.

But I'll, but I, as soon as you get it over, get it, come on, get it, if you don't get it, it's afternoon.

It'll be, it's here before you.

Yeah, and I'm going to encourage you, I'll be here in the morning.

You and I.

Well, I appreciate it.

We can talk about a lot of other things.

This is a prime interest of mine.

Well, you, you, you, you've got your job to do, and you've done it, and I, that's why I'm here.

For you.

Love you, and I tell you,

It's disgusting for these people, and I say this about everything in this country, but for these people who come in and they raise hell about the high cost of medicine, and they say it would be great if we had a different system.

I said, well, I've been all over the world.

I said, when somebody's really sick in England or any other country where they've got socialized medicine, and they've been afforded, where do they come for their operations?

Now, we've got the best medical care in the world.

You know it and I know it.

We've got the best doctors in the world.

Now, the thing is that we don't want to have a system.

This is another subject.

This is why we've got to fight this.

I don't want to have a system that in terms of getting the quantity of care increased

And the costs, shall we say, borrowed properly.

I don't want to have a system that's going to impair the quality.

It's the quality that's here.

The medicine's the one we're most interested in.

It isn't just that.

Look, it isn't great that you just have some free medicine.

Not that it's good.

Anyway, not that it's free.

But the other thing is they say the important thing is that you be able to

afforded out to be able to go to a doctor.

Uh-huh.

That is the most important thing.

The important thing is that when you got the dough to get that doctor, you want a doctor that can take care of it.

I mean, that's what's important.

And so many of these attempts to leapfrog for that thing say, gee, let's just say medical care is the right of every person and it should be at a certain amount.

Well,

You've got these highly trained people that have got to do the job.

Believe me.

They don't have to do the work.

Honestly, they're pretty active.

That's what it gets down to.

You don't get to do it.

It gets down to .

You could be just a bunch of, you know, just the next one.

So my feelings are very strong enough.

But let me echo the remark you made about quality in the way we're recognized worldwide.

I just got back from my role in the place.

Thank you.

Two weeks ago, last month, that's right.

There's no question about it.

Europe feels the same way, and they don't have to take the fellow's position on quality to see it.

We know there are weak spots, but we don't want to erase the excellency of this program in this country by making a new program of indoctrination and new decisions of health care delivery.

We need to train over the places that took out the quantity and not maintain our quality.

We've got areas that we're trying to improve.

We all should.

Don't let, look, as I said, we're all fighting the same thing.

But don't get into the position where the demagogues up here are able to put the A to M in the position of being the rich, strong doctors and so forth saying the hell with the public.

You don't want to get into the game.

I mean, it's not true.

It's not a fair charge.

But you know these people.

I'm aware of this problem, and we're trying to maintain it.

I remember one year, for instance, or many, many years ago, one of my very active supporters in 1964 said,

Where did you go to school?

Where did you take your work?

Elon, I don't know.

Did you go to medical school?

Yes.

And I think you and all the graduate students are living in the same area, I recall.

Isn't it still a good medical school?

It's one of the top ten in the country.

One of the top five, I'd say, if I'm not mistaken.

Oh, I remember we used to sit in the steps of the law school and watch the nurses walk by.

Oh, they loved it.

You would call for it?

Occasionally, yes.

All right.

This is all for a moment, for all your hard work and support.

Also, I want to talk to you about your wife.

That's the president's name, your wife.

Don't call the president your wife.

Well, I know you've been wanting to come in for some time, and like I said, my sympathy is there.

I want to talk to you about it.

Let's see what we can do.

Well, we can come up with something on your side and the other side.

We don't want anything to disrupt our relationship.

We don't want to be with you.

We don't want to get in touch.

Let's just not stir up those animals.

You know what I mean, right?

Thank you, sir.

Pleasant trip to California.

You were there.

I worked at Duke probably in the years, 35 to 48.

I stayed at 48, 37.

I stayed at Duke for 48, except for my tenure in the Philippines doing the service.

You stayed at Duke?

Yeah.

I was there.

I finished residency training in the OPC line.

Yeah.

I stayed on that.

I went to Burlington.

The track was there after I was on the stand.

Right.

It's sad to do it before that.

Yeah.

Four or five or six years.

Very, very great.

You told me I've never been there.

or with their examinations.

I don't want to find out what's wrong with me, sir.

Oh, you're all right.

Good luck.