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STATEMENT OF HON. EDWARD J. PATTEN, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF NEW JERSEY, SUPPORTING MEDICAL CARE FOR THE AGED THROUGH SOCIAL SECURITY

Mr. Chairman and members of the Ways and Means Committee, I strongly urge that the committee report favorably the administration's hospital care for the aged proposal financed through social security.

I have received heavy mail from my constituents favoring this legislation, the principal sponsor of which is Representative Cecil King, of California, and I also feel very strongly that it should be passed and enacted into law.

Although the Kerr-Mills program helps provide some of our aged citizens with medical care, it is inadequate and also subjects the recipients to a humiliating means test.

America's aged citizens, which number about 15.5 million, need in a very urgent way hospital insurance that would protect them against the high cost of inpatient hospital, outpatient hospital diagnostic, skilled nursing home, and home health services. It is estimated that about half of our country's elderly lack health insurance, making them vulnerable to financial catastrophe. Please include this statement in the record.

Hon. WILBUR MILLS,

CITY OF PHILADELPHIA, November 20, 1963.

Chairman, Ways and Means Committee,

House of Representatives, Washington, D.C.

DEAR CONGRESSMAN MILLS: I am enclosing a statement which summarizes my views on the hospital insurance benefits bill (H.R. 3920) which is presently before your committee and respectfully request that it be inserted in the committee record in lieu of a personal appearance.

With all best wishes and kindest personal regards, I remain,

Sincerely yours,

JAMES H. J. TATE, Mayor.

STATEMENT OF MAYOR JAMES H. J. TATE ON HOSPITAL INSURANCE BENEFITS BILL (H.R. 3920)

One of the most serious domestic issues of our time is the fact that a majority of the 172 million Americans over 65 years of age are financially unable to meet the rising costs of medical care in their advancing years.

In Philadelphia alone, we have approximately 307,000 senior citizens who are over 65. This number will increase as the wonders of medical science continue to lengthen our life span.

But the fact that millions of these older citizens throughout the Nation-and our thousands in Philadelphia-will be faced with hospital and medical bills they cannot afford is a matter of great concern. The concern falls on everyone-not only the senior citizens.

The children of those who are over 65 often are faced with a financial crisis created by such illnesses. There is no way to anticipate such obligations, nor is there a present way to guard against them.

Let us look at the facts that we can discern. Our senior citizens will require more hospital care-three times as much as the rest of the population-as they get older.

They will be hospitalized for longer periods of time—an average of 15 days, or twice as long as younger people.

Their bills will be higher. In the 65-plus group, the total bill in more than half the hospital cases is more than $800. It is less than $200 for only 1 in 20. And while hospital bills are getting higher all the time-the average cost per day in 1946 was $9.39, compared with $32.33 in 1960 and $35 in 1963—the older patients keep getting less able to pay.

The annual income of the average aged couple has been estimated at approximately $2,530 or $1,200 per person. This is less than half that of younger couples.

These are the facts. They constitute the core of the problem-a problem that becomes more serious each day. It is estimated that by 1967 there will be 20 million persons over 65, and by 1972 the number will grow to 23 million.

It is up to us to insure that they live-not merely exist-to a ripe old age with honor. A growing problem of such magnitude is one of society's as a whole.

There is a solution to this problem through pending legislation in Congress. President Kennedy's program, as embodied in the proposed hospital insurance benefits bill (H.R. 3920) would make one small addition to our present social security system. This would make it cover illness as well as old age.

The bill is simply a national hospital insurance system. It would provide full hospital care for 90 days for each illness, and up to 180 days of skilled nursing home care after hospitalization. Other features include home health services as well as outpatient hospital diagnostic services. The patient would pay $10 a day for the first 9 days of hospitalization, and the first $20 for outpatient services.

Of course, such a program must be paid for. The cost would be met by a small increase in the social security deduction. It is estimated that a typical payment would be as little as 2 to 3 cents a day per worker.

The new program would include standard safeguards for the freedom of patients to choose their own doctors, hospitals, and nursing homes. And doctors would continue to have full responsibility for decisions on patient care, including the need for hospitalization. The proposed legislation will not permit the Federal agency to interfere in any way with hospital administration, nor would it supervise or control the practice of medicine. Patient-doctor relationships would not be affected.

It is a fallacy to believe that all of the aged who need care are getting it today. More accurately, this could be termed wishful thinking. This is true even here in Philadelphia, where we like to take pride that anyone who needs medical care-regardless of status or creed-will get it at our fine city hospital, Philadelphia General, our health centers, and other institutions. But studies show that many who have real need postpone hospitalization or treatment simply because they are too proud to ask or to accept charity, or because of the expense of the treatment.

The President's program would assure this health protection for our senior citizens as a matter of right, through social security, not through charity. There would be no means or income test, no proof of poverty, no visit to a welfare office.

Putting it directly, the hospital insurance program will help social security do the job it was designed to accomplish-provide dignity and independence for the Nation's older citizens.

A recent nationwide poll showed that 2 out of 3 persons who were interviewed favored a social security tax increase to pay for health insurance for the aged. The prominent individuals and groups who support the principles of the President's program include the Governors of more than 30 States, the A.F. of L. and CIO and affiliated unions, the American Nurses Association, American Public Health Association, American Public Welfare Association, the Council of Jewish Federations and Welfare Funds, the Family Service Association, the National Council of the Churches of Christ in the United States, the YWCA National Board, the National Council of Jewish Women, the National Council of Senior Citizens, the National Farmers Union, and the National Association of Social Workers.

It is incumbent upon us in Philadelphia, to give our wholehearted support to the President's program, as embodied in hospital insurance benefits bill (H.R. 3920). I urge the members of the House Ways and Means Committee to approve the passage of House bill 3920.

CITY OF BALTIMORE,
November 18, 1963.

Hon. LEO H. IRWIN,

Chief Counsel, Committee on Ways and Means,

House of Representatives,

Washington, D.C.

DEAR MR. IRWIN: Due to the heavy schedule of official business, I am unable to attend the public hearings on the subject of medical care for the aged.

Too often as I have traveled through this city and other cities of the Nation, I have witnessed the fact that people who have spent most of the lives contributing to the amazing growth of the economy are now forced to live in degrading conditions-dependent, isolated, and lacking in adequate medical care.

The senior citizens of this Nation have not asked for charity; they have asked only for the opportunity to spend their retirement in dignity, in respectable

surroundings, in good health, and in an environment which allows them to continue contributing to their neighbors and their communities.

President Kennedy is not of my political party, and I hold no brief for him; but I go along with such Republicans as Governor Rockefeller and Senator Javits in holding that in this particular instance he is right, or more nearly right than his opponents. After all, it is not a partisan issue. In fact, it is not a question of policy at all, for we are already committed to the policy of assisting the aged. The dispute is over how the assistance shall be handled, and I can't see how a question of that sort affects the basic tenets of either of the major parties. We are not deciding what to do, but merely how to do it; and on a matter of bookkeeping I am willing to admit that a smart accountant may be right, even though a Democrat.

Years ago, we found that there are two facts that we have to face. One is that under the American standard of living, people live longer than they used to live. This means that the total number of people over 65 years has been increasing rapidly. The other fact is that even under the American standard, old people cannot do as much work, and are subject to more aches and pains than people in the prime of life. That means that as a man's income goes down, his doctor's bill go up.

When your expenses go up as your income goes down, you are headed for trouble, I don't care who you are. Millions of our older people are in trouble, serious trouble, already, and more are getting into trouble every day. Nor is the trouble confined to the old. Any decent man whose parents are too old and feeble to do a full day's work feels obliged to help them out. If it were simply a matter of keeping them fed and clothed it would not be such a serious problem, for in modern America one strong, skilled worker can support a pretty large family.

But it is a different proposition when illness strikes. Hospitals and surgeons and medicines and nurses and appliances-wheelchairs and crutches, and all the other things needed for treatment--are not cheap, and there is no way of making them cheap. When all that falls on a man who is trying to help out the old folks, it is often too much for him. He is in trouble, for he has to do one of two things, neither of which a decent man likes to do-he must let the old people suffer, which makes him feel like a dog-or he must see his wife and children suffer, which also makes him feel like a dog.

Now, I am eternally opposed to pushing any honest American into a situation in which he will feel guilty, no matter what he does. I am in sympathy with the old people; but I am even more in sympathy with their children when they are being broken down by the burden of paying the old people's medical bills. If there is any way in which our Government can relieve them, they ought to be relieved.

We admit that, and we have taken steps for their relief, but we have taken them in such a way that it is hard for self-respecting people to obtain relief. Under the Kerr-Mills law, it is possible for old people to obtain medical aid from the Government. They must pass what is called the "means test" which is a form of pauper oath. You must swear that you have nothing, can earn very little, and have no relative capable of taking care of you.

In the old days, before we had given much real thought to the problem, it was still possible for old people to escape starvation. They could go to the poorhouse. But the poorhouse was eventually abolished largely because there were so many who would rather die and literally did die before they would endure the shame of going there. Today, there are many who feel that the means test is a reflection on them and, if they have children, on thier children; and they will suffer for years rather than take it.

What would you think of a man who is willing to give a dollar to a crippled beggar, but not unless the beggar will first go down on his knees and kiss the man's boots. Do you call that charity? Of course, you don't. You call it 'taking advantage of misery in a hateful way. Do you think the recording angel in heaven gives that man credit for his dollar? I don't-well, maybe so; but if the angel credits him with the dollar, at the same time he charges him for humiliating the beggar.

I feel that the means test takes all merit out of the help we give our old people, and I favor the administration bill because it abolishes the means test. It goes further than that. It abolishes the giveaway element in the whole scheme except as it may apply to those who are already old and in need. They will not live very much longer and after that it will not be a giveaway, it will be a form of insurance.

The American Medical Association is fighting the bill bitterly, but not all doctors. Its argument is that no doctor wants a Government official coming around and telling him how to treat his patient. Of course he doesn't; but the bill doesn't say one word about how a doctor shall treat his patient, nor about which doctor a man must call in. The AMA admits this, but says "Just wait a few years and you will see bureacrats dictating to doctors."

There are many doctors, however, some themselves members of the AMA, who cannot support a policy of denying aid to people who need it now out of fear of something that may happen 20 years hence. I believe they are right. The bill as it stands does not give the Government authority to interfere with the private practice of medicine. If it is ever to gain that authority, it must have new laws. If the people who will be running this country 20 years hence can't prevent such laws, that's their lookout. We cannot neglect our duty because we are afraid the next generation will negelect theirs.

Socialism and communism, for instance, are, in my opinion, pernicious political doctrines. But it is the things that are dangerous, not the words. If any suggested policy is just and sensible, you can't make it wrong and foolish by calling it socialistic or communistic. For my part, I believe that the policy of providing medical care for the aged through old-age and survivors insurance is just and sensible; and I am not to be frightened out of that belief by allegations that it opens the door to socialism. It isn't socialism in itself; it is a form of insurance; and I don't believe that insurance is a bad thing, or can be made bad by calling it something else.

So I urge you to make up your minds in this as in other matters, by examining things, and not their names, never letting theory take priority over fact. For we have the highest authority for it that it is the truth, and only the truth, that shall make you free.

For these reasons, I ask the Committee on Ways and Means to give favorable approval to the medical care program for our aged citizens.

Sincerely,

HOUSE WAYS AND MEANS COMMITTEE,

THEODORE R. MCKELDIN, Mayor.

JERSEY CITY, N.J., January 21, 1964.

U.S. House of Representatives, Washington, D.C.:

A walk through the charity wards of the Jersey City Center could convince even the most hardhearted of the drastic need, now, for passage of the medicare bill. Our senior citizens have not spent their lives helping to build this Nation so that their late years could see them degraded and disgraced by being forced to declare themselves as paupers in order to remain alive. I speak for many thousands in urging passage immediately of the medicare bill.

THOMAS J. WHELAN,
Mayor of Jersey City, N.J.

CHICAGO, ILL., November 21, 1963.

Congressman WILBUR D. MILLS,

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

I regret that because of urgent city business I will be unable to testify before the Committee on Ways and Means on the subject of medical care for the aged. As our population of elderly people increases, it is becoming more imperative that medical care for our senior citizens be provided in a way which is not based on an oath of pauperism. Certainly our social security system offers the most fair and equitable way of meeting this urgent need.

Mayor RICHARD J. DALEY.

CITY OF DETROIT COMMON COUNCIL,
November 7, 1963.

Hon. WILBUR MILLS,
Member of Congress,

House Office Building, Washington, D.C.

DEAR CONGRESSMAN MILLS: As president of the Detroit Common Council, I come in contact with thousands of our citizens during the course of a year. A great many of them have asked me to speak out in support of the King-Anderson bill, which is now under consideration by your Ways and Means Committee.

It is my belief that the great majority of Detroiters support enactment of the bill. Please allow me to add the weight of that belief to the testimony you will hear. In addition, I hope that you will not mind a few of my personal ideas concerning the matter.

A brief look at the statistics points to the vital need for this legislation. At the turn of the century, only 1 person in 25 was over 65; today that proportion is (happily) 1 in 11.

Hospital costs have risen from an average of $9.39 per day in 1946 to $35 in 1963 and there is no end in sight. Three-fourths of our senior citizens earn less than $2,000 per year and yet the average person over 65 spends $220 per year on health needs-double the average for younger persons.

Under the Kerr-Mills Act, which involves State matching funds, $196 million has been paid to the States by the Federal Government through 1962. The weakness here is that the States determine the amount of participation; 85 percent of the funds went to only four States (California, Massachusetts, Michigan, and New York). Half of the 85 percent went to New York. This is a considerable drain on the treasuries of the States which use it most and the local option often means that coverage is nonexistent or inadequate.

I take issue with this act in all due respect to the fine intent of its authors and in full knowledge of the many worthwhile benefits achieved under its provisions.

Old-age assistance (OAA) is limited to those without sufficient income to meet living expenses. It does not cover the great majority of senior citizens who subsist on limited means. In addition, the program has a great many other prohibitive limitations.

All of these facts constitute impressive testimony on behalf of the King-Anderson bill. Opponents of the bill claim that 55 percent of the Nation's senior citizens (9 million) are covered by private health insurance programs; and that the percentage will rise to 75 percent by 1970.

However, these figures leave two important questions unanswered. First, is the coverage adequate? And second, can our senior citizens afford to pay the rising costs of private insurance programs?

The only equitable solution, so far advanced, is the King-Anderson bill, which meets the health needs of the aged on a national basis.

Thank you for taking the time to consider my rather lengthy epistle. I sincerely hope that it will aid you and your colleagues in the weighty decision you will soon make.

Very truly yours,

ED. CAREY.

CITY OF DETROIT, COMMON COUNCIL,

October 30, 1963.

CONGRESSMAN WILBUR MILLS,

Chairman, House Ways and Means Committee,
Washington, D.C.

DEAR CONGRESSMAN MILLS: I understand that the House Ways and Means Committee has scheduled public hearings on the King-Anderson medical care bill for early November.

May I take the liberty of urging that the King-Anderson bill be voted out of committee onto the House floor for public debate? As helpful as the Kerr-Mills bill has been in some States of our country, it seems to me that the King-Anderson measure would be a giant step forward in helping to relieve the financial drain on State and local tax resources. The King-Anderson bill provides an approach to meeting the severe medical needs of a great segment of our older citizens. I do hope that your committee will see fit to permit full-scale House debate on this urgently needed measure.

Thanks very much for your kind attention.

Sincerely yours,

MEL RAVITZ, Councilman.

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