"We would like to have you ou know that since 1961, 1962, and 1963 I have had three operations and have been in the hospital on those separate occasions. My hospital bills amounted to over $3,000 altogether. My income is $76 a month and my husband's income, both from social security, amounts to $40, which is a total of $116. If either of us get ill again, where will we get the money for hospital bills, when our savings have been almost gone.

We

"We don't want the Kerr-Mills bill. We don't want to sign as paupers. worked all our lives and paid for everything we received, and we feel that medicare through social security is the only thing for senior citizens like us. We worked all our lives and were independent. We would rather die than sign a pauper's oath.

"ESTHER LEVINSON, HOL"JOSEPH LEVINSON,

C

"Miami, Fla.”

"We are very anxious that the medical care bill become a law according to our President Kennedy's version, as we are in such a situation as many, many others are.

"For the past 2 years we have spent for doctors and hospital bills over $1,500. Our income is $157 a month social security. Both of us must have daily medicines which equals to about $10 per week. As you can see this is a large drain from the small lifesavings we have.

"Hope the medical bill will go through as it will be a great help to the senior citizens.

"NETTIE AND CHARLES MALLES,

"Miami, Fla."

"I would like to set down what hospital bills I have had since October 1961, when I was in the Victoria Hospital here in Miami for 12 days for a prostate and bladder operation, which cost me $900. In May of 1962, my daughter was in the hospital for a hysterectomy for 7 weeks and the bill was $4,055.62. I am forced to pay $50 a month to liquidate the bill.

"Now my wife is ill and must have hospitalization and because my savings have been depleted, we are waiting and waiting and hoping that she won't have to go-but what will happen when she does? Do I have to plead poverty to be eligible for the Kerr-Mills bill and have my house attached for which I saved and slaved many years to be able to own? My social security income is $146.20.

"With medicare, it is like insurance for which I paid for so many years and feel I am entitled to as the right of a citizen who paid taxes and educated my sons to go to the Army and help our country. Now they have their own families. I wouldn't go to them for help as it would make it harder for them and their children. So if we had medicare, my wife would not hesitate and be taken care of and perhaps in that way we all could be prevented from many ills by having peace of mind.

From Kentucky

"HARRY KURZWEIL, Miami, Fla.”

The following case was brought to our attention by Mr. Hub Cope who is the Amalgamated Clothing Workers of America (AFL-CIO) business agent at the Merritt Clothing Co. plants in Mayfield, Ky., and Martin, Tenn.

Mr. A. C. Weatherford, of Wingo, Ky., had much sickness when he was about 50 years old. At that time he lost just about everything that he owned except a pair of mules. He has a wife and four children, and by the time he reached 65 years he had been forced to spend all his money for medicine and doctor bills. In February 1963, both Mr. and Mrs. Weatherford had to be hospitalized at the same time and the bill came to $327.

In September 1963, Mrs. Weatherford was admitted to a hospital for major surgery. She spent 20 days at the hospital and the bill was $950. Mr. Weatherford paid $600 and then borrowed the remaining $350.

Mr. Weatherford has no money left. The only income he has is his old-age pension. What is he supposed to do from now on? Incidentally, the State of Kentucky has the Kerr-Mills law, but it did not apply to Mr. Weatherford's

case.

From Connecticut

"As one of the 'elderly,' as a widow, living on social security, I felt I must write to you. I have three daughters, who my husband and I were able to give a college education to by working endless hours in a small store-and by saving pennies bit by bit. We also saved to be able to be independent as we grew older. One of our daughters has four children, one daughter has gone back to work to be able to send her college-age children to school, and one daughter is alone, and is working to support herself and her son. My husband and I carry hospital insurance-but he had a heart attack which forced him to give up work and which kept him in the hospital for 6 weeks-with the need for round-the-clock nursing care at $75 a day, and physicians' bills and medicines that cost over $2 a day. Our savings dwindled. Then came a disabling stroke, which again meant long hospitalization and nursing care and physicians' fees and medicines and payment for rehabilitation service. With good medical care we were able to prolong my husband's life, so he could take pleasure in his family, but my husband is now gone, and $8,700 of our savings. My children, who have so many needs of their own-now must help me meet the necessities of everyday living. Every bit of my life's effort seems wasted, if I have to ask help of my children and if I become ill now-must I ask them to assume an even greater burden? I would have been so willing to pay for necessary medical coverage through a social secu

rity prepayment plan. Every parent wishes to pay his own way. Every parent wants to be able to be giving-not taking-we want to be independent, even if we are ill and old. We need the coverage that the medicare bill provides.

From Arkansas

"Mrs. M. RAWITCH, Fairfield, Conn."

"My father, George Dougan, is 79 years old. Over the past 18 months he developed serious stomach trouble. A series of tests had to be taken, showing a bad tissue inflammation. He lives in Morrilton, Ark., and receives $60 per month from social security. Because of his stomach trouble, he had to spend 6 days in the Morrilton Hospital a year ago. The bill came to $325. Since he was unable to get insurance for himself and his wife, we children pitched in to pay for his hospital bill. Shortly after he left the hospital, he began to develop a heart condition. He had to be put on special drugs that cost $5.65 for 12 tablets. He has to buy a 12-tablet supply twice a month. Two weeks ago he had a heart attack. Because there was no money available, he was not hospitalized. The doctor who comes to see him charges $6 for a home visit. My father's wife, Ellen, age 74, has diabetes. She has been in and out of the hospital for the past couple of years. Her last hospital bill came to $250 for 3 days. She has a heart condition, also, and is taking medication amounting to nearly $12 a month. In addition, she has to take diabetes capsules for which she pays $8 a month.

"LILLIAN TRAMELL, Little Rock, Ark.”

F. WHAT ARE THE HEALTH CARE PROBLEMS AND COSTS OF SENIOR CITIZENS LIVING IN RURAL AREAS

Congressman Curtis, of Missouri, during the course of these hearings, has made a number of inquiries about the health care needs of the rural population. The Department of Agriculture Marketing Service made a study in 1956 of farm family consumption patterns. While this data is 7 years old, the trend shows that in general the older farmer and the farm family is and has been less well off in these matters than urban individuals and families. The important fact to remember is that these are farm families still working their farms themselves. The hardest hit group are the still older farmer or widow who can't work any more. All experience demonstrates that the unfavorable situation of the rural family has worsened since 1956.

Some of the findings are:

Oldest farm families (heads over age 65) spent a higher proportion of net family income (1.6 percent) for medical items than did the youngest (under age 35) farm families (7.9 percent).

Per capita medical expenditures for the oldest group of farm families (over age 65) were consistently higher ($92 per year) as compared with all families under 65 ($59).

Average cost of hospitalization when reported was nearly twice as great for older families than for the young families.

People living in rural areas have less insurance than people living in urban areas. In predominantly rural States (60 percent or more live in rural areas), half the people had hospital insurance. In the urban States (less than 20 percent live in rural areas), three-fourths of the people of all ages had insurance.

Only 37 percent of the older families in the rural areas reported private health insurance. When some member of these farm families with heads over 65 also worked off the farm, the percentage having some insurance went up to 40 percent. Of the farm families receiving only farm income, only 29 percent had private insurance of any type on any of the family members.

In the larger older farm families, the level of insurance protection is very low. Where there are four or more persons in the family with head over 65, half as much was spent on health insurance as in all families with heads over age 65. On every index of economic status, the farm family with head over 65 is in poorer condition than the farm family with a head of family under 65. In a composite index of economic conditions, the oldest farm families were concentrated in the lowest economic group. Six out of ten farm operators 65 or over were in this category as contrasted to 1 out of 3 of farm operators under age 35, and 4 out of 10 farm operators of all ages.

There were 559,000 farm families with heads over 65 which had farm sales of less than $1,200 a year, and only 58,000 farm families with heads over 65 with sales of over $1,200 a year.

Hospital expenses were about the same for the high-income family with a head over 65 as the lowest group. Only 31 percent, however, of the low-income group had any insurance of any type on any members of the family, as contrasted with 49 percent of the high-income group.

On the basis of cash income, which is one index of a farm family's economic position, only about one-fifth of the families with head over 65 and with incomes of less than $1,000 reported medical insurance expenses during the previous year. Compare this figure with about half of all the older families with incomes of $4,000 or more.

The average older farm family with income of less than $1,000 spent 20 percent of net cash income for medical expenses.

The average older farm family is composed of 3.8 persons as contrasted with a little less than 3 persons for the urban family.

Farm families spent less on medical expenses than urban families on a perperson basis. Where the head of the farm is 65 or over, they spent $90 per year per person. In the city where the head is over 65, they spent $101.

Only 37 percent of farm families with heads over 65 had health insurance as contrasted with 41 percent of the urban families with heads over 65.

G. WHAT IS THE IMPACT OF HEALTH CARE OF THE AGED ON STATE AND LOCAL TAXES ?

What would be the impact on local and State taxes of the passage of a program of hospital insurance for the aged through social security? This has been one of the least explored areas throughout the hearings.

State taxes rose $1.5 billion last year (1963). Several States are now considering new tax increases including sales taxes on foods and medicines. Last year sales taxes produced more money (51⁄2 billion) for the States than any other type of taxes.

A good portion of the $22.1 billion in State taxes raised through imports on sales, income, gasoline, business, and property, etc., went to support general hospitals, clinics, homes for the aged, nursing homes, mental hospitals, and public welfare. All of these programs would be directly or indirectly affected by a program of health care for the aged through social security.

State and local government spending has doubled in the last 10 years and the number of employees has tripled.

Local government relies heavily on property taxes and in some areas on sales taxes or rebates from State taxes. The biggest expenditures of county governments are usually for schools, welfare, and hospitals. The latter two would be affected. The biggest financial problems for city governments are schools, libraries, and public improvement projects and sometimes emergency hospitals. Only the latter would be affected.

How are seniors involved? Many seniors own their own homes (property taxes); have fixed or declining incomes for essential items (sales taxes); and have little savings or cash assets. Though only about 20 percent of the aging have been paying income taxes, most seniors pay heavy sales and/or property taxes.

Older people are faced with increasing sales and property taxes, which fall disproportionately heavily on retired people. Organizations of seniors have been working for lower levels of property and sales taxes in States, including Michigan, Georgia, Florida, Alabama, and Pennsylvania.

Because of the pressures of increased property taxes, older people are often among the "no" voters on State and local bond issues, thus often helping to prevent State and local governments from carrying out their responsibilities. Passage of a hospital insurance for the aged through social security programs can greatly ease county welfare budgets, State welfare budgets, city and county hospital budgets, and State mental hospitals (aged mental patients can be treated in general hospitals under H.R. 3920). These are financed at present; primarily through State and local sales taxes and Federal subsidies.

One out of three new old age assistance recipients enter the rolls because of large or prolonged illness. Nine out of ten of these do not leave the rolls when the illness is over. Medicare, a program of health insurance through social security for the aged, would reduce the number of people who have to go on old age assistance as well as Kerr-Mills.

Passage of health insurance through social security would also have an impact on the Federal budget. Not only would it relieve the strain on public assistance rolls, it would reduce the number of people on public assistance and MAA and the amount of money spent per person through these programs. Medicare would reduce some of the cost paid by the Veterans' Administration. Older veterans tell us that if they were able to receive the more limited benefits of medicare at their local hospitals, they would forego Veterans' Administration comprehensive medical hospital treatment for which the Federal Government pays the full cost. One of the reasons is they prefer to remain in their own communities and have their own, personal doctors treat them.

Medicare might also have some small influence on some other Federal programs such as Indian hospitals and some of the programs of the Public Health Service. A limited amount of Federal, State and local tax moneys is also currently used to pay for visiting nurse services through either local health departments, county hospitals or welfare departments.

H. WHAT IS PRIVATE INSURANCE DOING TO MEET THESE PROBLEMS, AND WHAT CAN IT DO?

When Congressman Forand first introduced his medicare plan in 1957 there were no senior or plus-65 plans. During the past 72 years more than 700 types of policies have been issued. There are currently about 80 different companies issuing "senior-type" policies.

The principal insurance industry witness before this committee stated that 60 percent of the aged are protected by insurance. Evidence was presented which discredited this assertion. Indeed, the statement was quite misleading.

Only about 50 percent of the aged have any kind of health insurance plan. Most of the remaining 50 percent need and want insurance protection but feel they cannot afford it or can't get it.

Only about one-third of the aged have comprehensive insurance coverage according to the Senate Committee on Aging study. Only two-fifths of the insured aged have hospital insurance which will cover three-fourths of the hospital bill. The seniors pay more than younger people and receive less benefit. All private health insurance covers less than 15 percent of all medical care costs for people 65 and over according to HEW studies.

Seventy percent of those over 65 with chronic conditions curtailing major activities do not have any type of health insurance.

Sixty-eight percent of the people over age 75 do not have any type of health insurance.

One-third of persons with less than $2,000 income annually have insurance. Most of the aged who are covered only have hospital insurance. For most, hospital insurance is all they can afford.

Most senior citizen insurance prices have been going up and will continue to do so. Hospital insurance costs have surpassed the cost of hospital care as the fastest rising item in the cost of living according to the Department of Labor. The average private insurance company (other than Blue Cross) is now pro viding comprehensive health insurance protection which costs between $220 and $300 a year per person at current prices.

According to a spokesman for the nonprofit Blue Cross plans, "Insuring everyone over 65 is a losing business that must be subsidized somehow" (Washington Post, Aug. 11, 1963).

Of the 80 companies issuing plus-65 policies, only Continental Casualty reports making a profit.

Connecticut-65 backed by 32 insurance companies, promoted by a saturation public relations campaign, and endorsed by the Governor, paid out $555,000 more than it collected. They sold only 183,000 policies-25 to 30 percent of these were paid for by the children. In the fall of 1963 Connecticut-65 asked for a 20-percent