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Using the Kerr-Mills means that as a basic formula, those whose means exceed Kerr-Mills minimum qualification, but are less than twice such qualification, 20 percent of the premium should be borne by the individual; less than five times, 40 percent; less than 10 times, 60 percent; less than 20 times, 80 percent; all others 100 percent. May I emphasize that such factors and percentages are under no circumstances to be considered guidelines or a properly researched formula ; rather they are recorded for the purpose of demonstrating that, properly analyzed and promulgated, a working formula can be devised.

Free enterprise for medical care for our seniors, as I have outlined in capsule form, does not involve inequities, hardships, bickering of interests; rather it presents a truly cooperative solution. Fundamental standards, forms and rates must be established, and this can be developed through diligent work of interested professionals. A committee might be formed consisting of forward-minded specialists dedicated to the task of perfecting Americare. Such a committee might wish to have in its membership a staff expert from the Federal Government, the medical - association, the hospital association, the insurance industry, the legislative branch of the Government, and the U.S. Chamber of Commerce.

When, after all the work is done and free enterprise goes forth to fully handle our seniors problems of medical care, a massive continuous program of orientation of our elders must be maintained. When we have solved the what and how, we must be sure that all of the seniors are completely informed. An example of senior health care information ably administered is that conducted by Edwin J. Larson, dynamic veteran insurance commissioner of Florida. Each of his regional offices has a thoroughly trained expert to counsel the seniors on matters of health insurance.

Gentlemen, there have been years wasted by controversies, promotions, arguments and so many time and dollar consuming energies on the subject of health care for elderly Americans. During these years of argumentation on the subject, a staggering number of millions of dollars have been utterly wasted in process. When I think of what these millions could do for research in cancer, heart, glaucoma, muscular dystrophy, multiple and arterial sclerosis, and so many other life shorteners, I am moved to urge, gentlemen, move ahead now with Americare. We now know that all of us—all of our interests-governmental, medical, legal, industrial, social-want the same objective. Call it Americare, or what you wish. Free enterprise backed by the power of our free economy—to insure (and reinsure) that our elders—all ages, all stages of health, wealth and society, shall not want for proper health care.

STATEMENT OF THE NATIONAL COUNCIL OF SENIOR CITIZENS TO THE HOUSE WAYS

AND MEANS COMMITTEE

Mr. Chairman and members of the Ways and Means Committee, I am John W. Edelman, acting president of the National Council of Senior Citizens.

The National Council of Senior Citizens is an educational and action orga: nization composed of over 1,700 member clubs and groups with a combined membership of approximately 2 million persons. This organization grew out of the discussions held at the 1960 White House Conference on Aging. This group of senior citizen club leaders were determined not to let the fiindings of that Conference go unheeded. Congressman Aime Forand, a former colleague of yours, initiated and founded this national council despite ill health. He continued as president until further illness last summer, when at his request he became the council's bonorary president. The council's prime goal, but by no means its only concern, has been from the outset to build public support for, and understanding of, health care for the aged through social security.

A MESSAGE TO THE MEMBERS OF THE WAYB AND MEANS COMMITTI

During the coming days you will be deciding whether to initiate new legislation concerning health care for the aged. Congressman Forand submitted his proposal over 712 years ago. The House Committee on Ways and Means passed medical assistance to the aged amendments over 312 years ago. You must judge Dow as to whether the essential health needs of older people of this Nation are being met adequately. If you do find that these needs are not being adequately met, you must, in all conscience, decide to send new legislation to Congress, aimed at dealing with this widespread and urgent need.

During the November 1963 hearings of this committee, hundreds and hundreds of older persons, often at personal sacrifice, came to see and hear what was going on. Why did the older people come and sit listening so patiently? What was on their minds? A primary question in their minds was—is the Ways and Means Committee going to seriously consider this problem of health care or is this “just for show." By and large, they went away just saying that (with the exception of two or three members), they felt the committee, and its chairman were going at the business of collecting evidence in a sincere manner.

Our members, virtually all of them quite elderly, studied very carefully the demeanor and attitudes of all of the Representatives who are members of the House Committee on Ways and Means and who attended the hearings. The question our people pondered was this: Will the Members of Congress make decisions on the basis of fact or will they permit their previous support of the MAA program to influence their thinking despite the evidence that this pro gram is not actually meeting the needs of so many of our older citizens? As our people climbed on their buses to return to their homes, nearly all of them felt that the Committee on Ways and Means was determined to arrive at a decision based on the actual facts of the situation.

Especially and mainly our people came to these hearings because of actual experiences and convictions growing out of what they themselves had seen and some had suffered that the present means of financing health care in old age is inadequate and lacking and would with the advance of years get worse unless something is done.

The officers of the national council, realizing the limited time allotted for senior groups did not testify orally in order to allow the senior citizen club leaders to make brief appearances. We felt that you mould be more interested in hearing them. We are now submitting our written statement for inclusion in the record.

TABLE OF CONTENTS
A. What is the financial condition of older people in America ?

1. Income figures according to the U.S. census.
2. Further inancial information.

3. Assets.
B. What has happened to hospital costs?
C. What are the health care problems of older people ?
D. What are the health care costs for the aged?
E. Case histories concerning health care problems.
F. What are the health care problems and costs of senior citizens living in rural areas?
G. What is the impact of health care of the aged on State and local taxes ?
H. What is private insurance doing to meet these problems—What can it do?
I. Case histories concerning hospitalization and private insurance.
J. Medical assistance for the aged.

1. Number of people helped.
2. Limitation of benefits.
3. Transfers.
4. Means test.

5. Belden Associates study.
K. American Medical Association position.
L. Rationale.
M. Recommendations.

1. Kerr-Mills bill.
2. King-Anderson bill.
3. Javits bill.
4. Bow bill and others of the same nature.
5. Summary of recommendations.

A. WHAT IS THE FINANCIAL CONDITION OF OLDER PEOPLE IN AMERICA ?

1. Income figures according to the U.S. census

The U.S. Census Bureau reports income for older people has improved slightly during the past decade, but incomes of this group have not improved as rapidly as for the general population. For the year 1961, in cases of single individuals 65 and over, 45 percent had $1,000 or less per year income, two-thirds had less than $1,500 income per year, three-fourths had less than $2,000, 1.2 percent had $10,000 or more income per year. (See table A for a State-by-State analysis of the 1960 census data.)

For the year 1961, in cases where families were headed by persons over 65, one-third had less than $900 a year income per person, 40 percent had less than $1,000 a year income per person, two-thirds had $1,750 or less, and 1.2 percent had $4,800 or more per year. While the median family, where the head of household was 65 or over, had an income of $3,074 per year, the average income per person was $1,220 per year.

Any way you look at it, two-thirds of the people over 65 are living on a marginal or submarginal budget.

Mr. Heller, Chairman of the Council of Economic Advisers, this month announced that the average income has just reached $2,500 per person per year. The average income of persons of all ages runs roughly double the personal income for people over age 65.

TABLE 1.-Incomes of older people

[graphic]

$863

607 1, 250

900

637 1,260 1, 400

964

830 1,287 849 647 745 955 865 799 866 851 681 742 836 798 995 840

606

767 1,058

858 1,237

863 854 786 871 642 853 834 776 958 824 829 629 798 639 703 828 823

718 1, 151

704

Number of persons

65 and over

1960 1

1965 2

16,560,000 18, 243,000
261, 000 284, 000

5,000 6,000
90,000 112, 000

194, 000 205,000 1,376, 000 1, 571, 000

158,000 172, 000 243,000 267,000 36,000 40,000 69,000 75,000 553,000 699,000 291, 000 321,000 29,000 33, 000 58,000 62,000 975,000 1,056, 000 446, 000 476,000 328,000 340,000 240,000 252,000 292, 000 312, 000 242, 000 272, 000 107,000 111,000 227,000 259,000 572, 000 609,000 638,000 708,000 354,000 381, 000 190,000 202, 000 503,000 532,000

65,000 66,000 164,000 172,000 18,000 23,000 68,000

72,000 560,000 635,000

51,000 59,000 1,688,000 1,894,000 312, 000 352,000

59,000 61,000 897,000 963,000 249,000 267,000

184,000 199,000 1, 129,000 1,218,000

90,000 97,000 151,000 166,000

72,000 75,000 309,000 339,000 745, 000 845, 000 60,000 67,000 44,000 45,000 289, 000 323,000 279,000 298,000 173,000 185,000 403,000 435,000 26,000

29,000

4,761, 957
81, 581

1, 321
28, 713
66, 346
381, 828
46, 617
64,897

9,502 14, 768 193, 721 83, 809

6,891 19, 440 271, 594 132, 187 97, 905 73, 556 91, 276 69, 596 28, 572 57, 777 141, 918 189, 553 104, 055

61, 076 148, 471 20, 356 51, 302

5, 218 17, 436 153, 183

16,478 451, 843 93, 756 18, 108 254, 709 79, 667 57,271 303, 644 22,876 43, 322 22,364 94, 442 230, 739 19, 312 11, 372 80,583 82, 907 54, 394 117, 705

8,290

$3,074

$1,220 1, 860 657 3, 324 1, 175 3,094 1, 273 1,750 684 3,681 1, 594 3, 238

1, 361 4, 666 1,859 3,7631, 487 5, 636 2, 159 2,830

1, 230 2,051 738 4,726 1, 370 2, 843 1, 241 3,741 1,546 2,9201, 232 2,796 1, 210 2,825 1, 228 2, 106 785 2, 164 787 2, 926 1,194 3,940 1,504 4, 190 1656 3, 140 1, 303 2,929

1, 236 1, 606

548 2, 512 1,059 3,286 1, 392 2,838 1,234 4, 165 1,750 3, 432

1, 430 4, 209

1, 664 2,718 981 4,077 1,644 2,184 756 2,871

1, 162 3,370

1,381 2,170

908 2,999

1,333 3,553 1, 372 3, 542 1,389 1,995

654 2, 549 1,067 1, 969 721 2, 434

966 3,230 1,357 2,947 1,218 2,858 1,017 3,247

1,091 2,477 894 3,043 1,277 3,369 1, 422

832 1, 116

1 U.S. Census, 1960.
: U.S. Bureau of Census, unpublished projections, 1963.
8 Social Security Bulletin, January 1963.

2. Further financial information

Only 17 percent of the men and 5 percent of the women over 65 continue to work full time. The percentage of persons over age 65 who are still working has steadily declined since the U.S. census first included questions on employment. The average income of the men still working was $3,980 in 1959.

Seventy percent of people over 65 (12.5 million) now receive social security with an average social security check of $76 a month, $66 for a widow, $129 for an aged worker and wife ($64.50 per month per person).

Half of the retired people in this country have almost no income other than their social security payments averaging about $70 a month, or roughly $17 a week. As we understand the intent of Congress, there never was any intention or expectation that social security alone would be sufficient for a person to live on.

One out of eight (242 million) receives public assistance payments averaging $60 a month with an average of $15 a month medical care payments. The heaviest concentration and lowest payments are in the Southern States.

Less than 8 percent of the aged (1.2 million) had private pension plan checks coming, according to the Department of Labor in 1958. Average payment per month is $75. In 1930, about 5 million in labor force were covered ; roughly 242 million could expect to benefit.

In 1950, about 10 million were covered and 5 million could expect to actually receive checks.

In 1958, about 19 million of the 65 million in the labor force were covered by private pension plans, and about half can expect to eventually benefit from these plans.

Roughly half of the people covered will not benefit from the plans they are currently under because they will change jobs and lose pension rights or because the company will go out of business. Most people now working who are covered by large manufacturing companies with a labor-management agreement are located in the northwestern part of the country. These are usually the people who are also getting the larger social security payments.

The pinch of poverty among the elderly is felt most severely by widows age 65 and over. The average yearly income for widows and single women who by choice or necessity (usually both) live with a relative was a dreadful low of $350 as recently as 1961.

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