Medical Care for the Aged

(In addition to the statements and material printed in the record of the hearing, the Committee on Ways and Means received numerous communications from individuals and organizations commenting upon various aspects of the subject of medical care for the aged. In general, all of the major points and comments made in these communications were covered by the testimony in the hearings. It is not feasible, in view of the expense and space which would be involved, to include all of these individual communications in the printed record of these hearings. However, such communications are available in the committee files for use of the committee and the staff. In particular, special note has been taken of those communications which have indicated novel or unique problems not covered by the witnesses in public testimony.)

(The following material was submitted for the published record of the hearing:)

STATEMENT BY GOV. RICHARD J. HUGHES, OF THE STATE OF NEW JERSEY, SUBMITTED TO HOUSE WAYS AND MEANS COMMITTEE, JANUARY 23, 1964

I should like to take the opportunity during these most important hearings on health care for the aged by the House Ways and Means Committee to restate my support for the principle of health care for the aged financed through social security.

I submit this statement as Governor of the State of New Jersey, not as chairman of the Committee on Public Health and Welfare of the National Governors' Conference. But I would urge my fellow Governors throughout the country, who daily face the problems caused by the lack of adequate health care for the aged, to lend their support to the principle of hospital and nursing home care through social security.

As a nation we have made a beginning in the fight to secure adequate medical care for the aged. Under the Kerr-Mills program, we provide medical services to those who depend upon public welfare. But, it is important to remember, as our late President Kennedy observed during his great fight for medical -care, “* * * welfare medical assistance helps older people get health care only if they first accept poverty and then accept charity."

As a nation we have an obligation in charity to provide for those unfortunate souls living in a condition of poverty. But we also have an obligation in social justice to those millions of Americans who live in modest, adequate circumstances-but adequate only as long as they escape the financial burden of illness. And it is not an exaggeration to say that today most older Americans live under the shadow of the fear and fact of increased medical expenses in the context of declining income.

Helpful as it is to the medically indigent, the Kerr-Mills program was never intended to meet the health needs of the vast majority of Americans. In New Jersey, for example, we estimate that in the coming fiscal year, our new medical assistance for the aged program will provide health services for approximately 23,000 persons in addition to some 17,000 receiving medical benefits under old-age 'assistance.

Thus, about 40,000 New Jerseyites are expected to receive some health services under these programs. When this figure is compared with the more than 600,000 persons over 65 in New Jersey, it is evident that these programs only protect a small percentage of our citizens. 2103

27-166-64-pt. 5——3

It does not appear likely that the private insurance industry can provide adequate health insurance at a price which most of the elderly can afford to pay. They are, in the language of the industry, poor health risks and the premiums for "bad risks" run high-too high for most older Americans.

The only sensible approach, I believe, is through national health insurance as a logical extension of the social security system.

Those who speak of the "compulsion" of such a health insurance program should explore the ramifications of the burden of medical expenses upon the elderly. What of the compulsion of cost which keeps elderly people from adequate medical care when they have need for it? What of the compulsion faced by their sons and daughters who, in trying to raise their own families, often are forced to divide limited resources between their children and their elderly parents? The millions of people in such circumstances must find it difficult to comprehend the exact nature of compulsion allegedly contained in a hospital insurance program financed through social security.

Fortunately, it appears that the imaginary fears about the social security approach to health insurance are being dissipated. A most significant indication of a new consensus was the position taken by the distinguished bipartisan panel, the National Committee on Health Care of the Aged. After long and careful study, this committee recommended acceptance of the principle of financing public health insurance through social security. The national program proposed by this committee has been incorporated in a bill introduced recently under the auspices of several Republican Senators.

This development is most encouraging, for it opens up the real possibility of an accommodation and the passage of a bill. The specific details remain to be worked out, but it seems clear now-with this bipartisan agreement on basic principle of financing through the social security system-that those who are truly interested in the establishment of a sound program of health care for the aged should be able to compromise their differences without obstacles of political partisanship.

The people are waiting for Congress to act. I would urge Congress to fashion a program of health care for the elderly which will meet their needs and which, in the years to come, will be recorded as another great achievement of Congress in the building of a better America.

STATE OF WASHINGTON,

EXECUTIVE DEPARTMENT,
Olympia, December 6, 1963.

Hon. WILBUR D. MILLS,

Chairman, House Ways and Means Committee,
U.S. Congress, Washington, D.C.

DEAR CHAIRMAN MILLS: With regard to current congressional hearings on Federal legislation to provide health care for senior citizens under the social security system, I wish to urge passage of such legislation.

Washington State has 286,000 residents 65 years of age and older, and as elsewhere statistics indicate that this segment of our population is rapidly increasing. The medical needs and costs for our senior citizens are much greater as compared with other age groups.

It is my view that the King-Anderson bill, or similar legislation based on a contributory insurance method, is the most plausible program for financing and meeting the health needs of our older citizens. Such a program has high merit for many reasons, including the following:

1. The contributory insurance system will provide adequate in-patient care and home nursing care for our senior citizens by virtue of "right" rather than by a degrading means test.

2. The contributory insurance principle provides for sharing of high cost of care for this group and gives promise of reducing the financial burden placed upon the Federal Government and the State for financing medical programs for the needy out of the general revenue account.

3. In the present form the King-Anderson bill and similar legislation preserves the opportunity for the elderly to choose from a number of approved insurance plans and does not threaten free choice of physician or of health facility. Again, I give full endorsement and urge upon the Congress favorable action on this type of legislation.

Sincerely yours,

ALBERT D. ROSELLINI, Governor.

Hon. WILBUR D.. MILLS,

CONGRESS OF THE UNITED STATES,

HOUSE OF REPRESENTATIVES, Washington, D.C., February 8, 1964.

Chairman, Committee on Ways and Means,
House of Representatives, Washington, D.C.

DEAR MR. CHAIRMAN: Enclosed is a statement in support of H.R. 3920, to provide under the social security program for payment for hospital and related services to aged beneficiaries.

It will be very much appreciated if my statement may be made part of the record of the committee hearings. With every good wish,

Sincerely yours,

JAMES ROOSEVELT,
Member of Congress.

STATEMENT OF HON. JAMES ROOSEVELT, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF CALIFORNIA, IN SUPPORT OF THE MEDICARE BILL (H.R. 3920, THE KING-ANDERSON BILL)

Mr. Chairman, members of the committee, I appear before you today to urge the committee to expedite consideration and report out at the earliest possible time meaningful legislation to provide medical care for our senior citizens. Time is running out for a whole generation of Americans.

The committee has heard many witnesses, and has had presented to it an abundance of facts and figures on this subject. Some witnesses have stated this legislation is unnecesary. I believe it is as necessary as our maintaining the thrust and purpose of Western civilization, as necessary as our maintaining our national pride and self-respect, and as necessary as defending ourselves against military aggression.

Few other bills have evoked as much response from the general public, and particularly those for whom the legislation is intended. The central point is that the need is very great, and the vast majority of our older people do not have the means to care for themselves. This "vast majority" of which I am speaking is made up of retired people who struggled through their working lives to set aside money for their nonearning later years. But the forces of inflation, particularly in the area of medical expenses, has far too often resulted in the necessity of expending a family's life savings for one illness. In addition, the cost of private hospital insurance has spiraled to such an extent that payment of further premiums has imposed such an impossible financial burden such policies must be given up. Further, many private insurance companies have an age limit to their coverage, and hundreds of thousands of those who have carried insurance over a period of years have been notified at age 65, or even less, that such policies are being canceled by the insuror. Most of these people find they are not accepted by another insuror.

While some witnesses before the committee have agreed-indeed urged that the need is obvious and great, they have argued that some new procedure should be utilized to solve the problem. It seems to me the most efficient and economical procedure should be the one which is already in operation, the one with which we are already familiar--the social security system.

Certainly we cannot be absolutely positive that the costs of this plan are precisely anticipated, or that the tax rates set out in the bill will prove perfectly adequate to balance the costs. But these are details that can be perfected with experience and do not, in my opinion, justify further delaying institution of this important program.

Mr. Chairman, I have some very vivid memories, very personal memories, of the controversies that raged when the first social security bill was put forward. There were predictions of dire consequences, breakdowns in the moral fabric of America, and expressions indicating little faith in the American people. All of these fears have proved to be without foundation, and the social security principle is a sound one.

With your permission, I should like to comment briefly on S. 2421, introduced by the Honorable Jacob K. Javits. Senator Javits, whom I respect and admire greatly, was ably assisted in working out his bill by the former Secretary Fleming of Health, Education, and Welfare. These gentlemen are conscientiously seeking some acceptable legislative solution to what must be ranked as one of

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