pendent contractors, are the next largest group. During January 1962, they earned a median monthly salary of $320. The median number of days worked during the month was 18. These nurses have no paid sick leave, no retirement program other than social security for which they pay the entire tax, no paid vacation leave, or other benefits commonly available to employed workers. third largest group of practicing nurses are employed in physicians' and dentists' offices. Their median monthly salary in July 1962, when ANA last surveyed their employment conditions, was $360.1 The These three groups comprise over 80 percent of all practicing nurses. On retirement they will be faced with the problem of maintaining a decent standard of living and securing needed health services. On their present salaries it is impossible to save any substantial amount toward retirement nor will they on present salaries be eligible to receive the maximum retirement income under social security. In our testimony of 1961, we made several suggestions regarding the provisions of nursing services and the role of professional nursing in establishing policies and executing them in a skilled nursing facility and a home health agency. The major continuing service furnished by these facilities is nursing. We are gratified that H.R. 3920 specifies that nursing care be given by or under the supervision of a registered professional nurse and that policymaking bodies include registered professional nurses. We have been concerned with the care available in many nursing homes in this country where there is minimal medical and professional nursing service. We believe payments from the social security fund should not be used to support and perpetuate substandard care. In H.R. 3920, section 1703(b), skilled nursing facility services, describes the extent of the services that must be provided and we are in agreement that these would tend to insure a higher quality of care. We further believe that if skilled nursing facilities are to be eligible to participate in the proposed program they should meet requirements for accreditation set by a multidisciplinary committee or commission. Such a multidisciplinary accrediting body does not now exist. Efforts this year to establish a division for accrediting in-patient care facilities other than hospitals under the Joint Commission on the Accreditation of Hospitals were not successful. However, several associations, including the American Nurses' Association, are continuing to explore ways of implementing this multidisciplinary approach. The American Nurses' Association has supported the Kerr-Mills Act (medical assistance for the aged) by encouraging its constituent State nurses' associations to support necessary enabling legislation to activate the program. On principle, the association does not approve of the means test and it questions how much freedom of choice recipients of MAA actually have. Recent studies of the program appear to indicate it has limited value. A few of the more wealthy States have comprehensive programs and receive most of the Federal funds allocated under MAA. In the past, these same States have had fairly liberal public assistance medical care programs, indicating not only ability to finance a program but also a greater than average concern for the less fortunate of their citizens. It would appear, therefore, that the success of MAA is dependent on the resources of an individual State and its commitment to proposals contained in the law.2 For all these reasons, the American Nurses' Association supports proposals to extend the social security system to include health insurance for recipients of OASDI. We approve the proposals contained in H.R. 3920, especially those relating to the provision of nursing services which reflect a major concern of this association. We urge the Committee on Ways and Means to give favorable consideration to this legislation. 1 "Facts About Nursing," American Nurses' Association, 1962-63 edition. Medical assistance for the aged, the Kerr-Mills program, 1960-63, Subcommittee on Health of the Elderly. Special Committee on Aging, U.S. Senate. Mr. LEO H. IRWIN, HEALTH INSURANCE PLAN OF GREATER NEW YORK, Chief Counsel, Committee on Ways and Means, DEAR MR. IRWIN: Please place in the hearings of the Ways and Means Committee on medical care for the aged the following statement from the Health Insurance Plan of Greater New York which is now providing comprehensive medical care for more than 670,000 men, women, and children: "The Health Insurance Plan of Greater New York endorses the administration proposals for insuring the costs of hospital and nursing home care for the aged through the social security system. "On March 6, 1962, the chairman of the board of directors of HIP sent the following telegram to President Kennedy on this subject: 66 ""The board of directors of Health Insurance Plan of Greater New York congratulates you on your message to Congress on the health needs of the Nation. HIP, as an organization based upon prepayment and group practice of medicine, is particularly pleased with your encouragement of group practices. "Your proposals for financing hospital and nursing home care for the aged are fully supported by us. Our experience shows that most of our subscribers who are 65 and retired are unable to continue their insurance. Your program will provide the necessary hospital coverage and thereby enable large numbers of older people to continue their voluntary medicare care insurance.' Sincerely yours, Hon. WILBUR D. MILLS, EDWIN F. DAILY, M.D. GROUP HEALTH COOPERATIVE OF PUGET SOUND, Chairman, Committee on Ways and Means, House of Representatives, Longworth House Office Building, Washington, D.C. DEAR CHAIRMAN MILLS: I received a press release on October 29, stating that your committee will hold hearings for the purpose of receiving testimony on the subject of medical care for the aged. Group Health Cooperative of Puget Sound is a nonprofit organization located in Seattle, Wash., providing comprehensive prepaid medical care for about 67,500 persons. The cooperative has its own hospital, provides its own clinic facilities, and negotiates with the medical staff who spends full time servicing the cooperative members and a limited number of private patients. People are accepted for coverage up to age 60. Group Health Cooperative of Puget Sound is owned and basically operated by the members through an elected board of 11 representatives. This board voted in favor of medical care for the aged through the expansion of the social security program. Anyone familiar with the facts that have accumulated recognizes that something must be done in this field to meet the ever-increasing need and costs of necessary medical care for our elderly population. We do not take members over age 60, but if they belong to the program before age 60, they remain in the program for life. However, some of our members over age 65 are not able to pay for the protection against degenerative diseases that are very prominent in this age group. At present, 11 percent of our people are age 60 or over, and we find that on an average they use a minimum of 12 times as much medical service at twice the cost of those under age 60. As new medical procedures and techniques are developed in caring for the aged, the cost of medical care increases, and probably at a greater rate than the cost of living. 27-166-64-pt. 5- -7 In studying our own hospital admissions, we find that for the male population there are 54.2 admissions per 1,000 males covered up to the age of 45, with an average stay in the hospital of 3.83 days. However, for the male over age 65, we find that the admission rate is 222.5 admissions per 1,000, and an average stay in the hospital is 9.59 days. The female pattern, although somewhat different, follows the same general trend: 112 admissions per 1,000 females, with an average stay of 4.47 days for females under the age of 45, and increasing to 146 admissions per 1,000 with an average stay of 8.82 days for females 65 years of age and over. Not only do the aged use more hospital days, but they also have special problems, such as inability to travel back and forth to the doctor's office, which necessitates more home calls, care in a nursing home, and, of course, the tremendous social problems that exist. In reviewing the insurance policies that are generally available today for the people 65 years of age and over, we find that they are largely for hospital protection, and the usual policy covers about one-third of the cost of the hospital stay. We find that many of the older people who have the money may carry several such policies in order to protect themselves. This gives a false figure on the number of older people who are covered through prepayment and insurance, since statistics are based on number of policies issued. A study done in Michigan shows that 16 percent of the general population have double coverage. Our board believes that the only sound method is to ask the worker while he is employed to put aside certain funds to assist in his medical care costs after age 65. Medical care generally is by far the greatest single cost that falls upon these people, and at a time when the majority of them are less able to bear such costs. This is entirely a different problem than the population as a whole, particularly under age 65, who today can buy reasonably comprehensive prepaid coverage and insurance to protect them against their medical needs. I supply this information from our experience, and hope that it may be of value to the committee. Sincerely yours, J. A. KAHL, M.D., Director. STATEMENTS ON MEDICAL CARE FOR THE AGED MADE BY ARTHUR S. EHRMANN IN BEHALF OF THE FRATERNAL ORDER OF EAGLES BEFORE HOUSE WAYS AND MEANS COMMITTEE Members of the committee, it is indeed a privilege for me to be able to appear before you today as a representative of the Fraternal Order of Eagles, an organization made up of almost a million Americans and Canadians who have, through the years, clearly demonstrated their concern for human welfare and social security. The work of the Eagles for adequate social security for all of our citizens is well known. For more than a quarter centry the Eagles have campaigned for mothers' pensions, workmen's compensation, old-age security, and other methods of improving the general health and welfare of our Nation and its citizens. At the 1962 international convention of the Fraternal Order of Eagles held in Pittsburgh, Pa., the order passed a resolution in support of the King-Anderson bill for medical insurance for older men and women under social security. The resolution stated that it was in keeping with the ideals and beliefs of the Fraternal Order of Eagles "that our older citizens should have adequate preventive medicine, surgical and medical care adapted to the conditions of their years under the provisions of the Social Security Act." The resolution was reinacted at the 1963 Eagles convention held in Chicago last August. Speaking on behalf of the Eagles, this bill is seen as a logical and much needed extension of the provisions of social security for the aged. Since the passage of the first social security bill in 1936, benefits under this act have continued to grow in scope and depth. More people today are eligible for larger pensions under social security than ever before. Benefits have been increased, age limits lowered, and provision made for the permanently disabled. All of these measures have received the support of the Fraternal Order of Eagles. The members of our fraternity now believe that another step is needed, the important step of providing adequate medical and hospitalization care for our older men and women. We do not consider this a "giveaway" program or the first step down the road to socialism. It is another form of public insurance for the protection of the people of the United States. The social security program is not a giveaway program. It is self-insurance, paid for by the same people who benefit from it at a time in their lives when they most need those benefits and the protection offered through them. It is at the age 65 and over that people most need medical insurance and at the same time find it difficult to obtain. Hospital and doctor's bills tend to increase as that old bugaboo, age, creeps up on us. When a man reaches the age of 65 and retires from his place of employment, group insurance policies which he has held through his company are often terminated. At the same time, he finds it difficult, almost impossible, to obtain a private policy offering adequate medical insurance at a price he can afford to pay. The King-Anderson bill offers a workable solution to this major American problem. The social security approach to the solution of this problem has the support, not only of the Fraternal Order of Eagles and other organizations concerned with the betterment of man, but also of a majority of American citizens themselves, as shown through independent nationwide polls. The program, as stated through the King-Anderson bill, would cover nearly 100 percent of our over-65 citizens at a cost of not more than $17.16 per person per year. The cost of the program to the average-paid worker would be $12 per year. Where, I ask you, could a person receive adequate health protection through an individual policy for $12 a year? The social security mechanism can handle the aged's hospital insurance needs at reasonable rates because of the number of people in the system and because the system is efficiently run. Administrative costs run at about 3 percent of every dollar handled, an unusually low amount. The plan would be self-financing and self-supporting. One of the arguments opponents use against the King-Anderson bill, is that under this plan, more older people will be using the hospitals more often. On this point I must agree. Older men and women who need treatment but have been reluctant to dip into their meager savings because they are afraid there won't be any left for tomorrow, will get the treatment they need. Older folks who are unwilling to burden their children with the bills for their illnesses and diseases will get the treatment they need. Older people who are too proud to ask for charity will get the treatment they need. In fact, all those older people who have been suffering needlessly because of the high cost of treatment will get the care they need. These people will also get the peace of mind they need to make their later years a truly "golden age." By insuring the elderly against the financial ravages of serious illness, we remove the haunting fear that they will suddenly be turned from self-sufficient citizens into applicants for alms. In short, we add a sense of security, a measure of dignity, and a new dimension of happiness to their retirement years. Members of the committee, thank you for this opportunity to present the views and opinions of the Fraternal Order of Eagles in this matter. From the hundreds of diverse reports and opinions you are receiving here, there is certain to come a national health program deserving of the support and backing of all our citizens. Life, liberty, and the pursuit of happiness all are made more meaningful by good health. And in America, the Government, as well as the people themselves, care about the happiness and well-being of their fellow men. Hon. WILBUR MILLS, SOUTHERN CALIFORNIA PHYSICIANS COMMITTEE FOR House Ways and Means Committee, Los Angeles, Calif. DEAR CONGRESSMAN MILLS: This testimony is offered for publication in the committee hearing H.R. 3920. The material herein submitted was offered to the Southern California Physicians Committee by the caseworker who did the research. The Southern California Physicians Committee will identify the caseworker if her name and agency are requested. The research was conducted with the knowledge and approval of the caseworker's supervisor. Yours very truly, HELEN MISHELL Survey of applications for public assistance handled by one intake worker in western section of Los Angeles which includes Beverly Hills, Bel Air, Santa Monica, Venice, Brentwood, West Hollywood, and West Los Angeles. This area has a greater incidence of personal wealth than other areas of Los Angeles. Standard of living is better and residents represent a greater portion of the so-called privileged element of society. Many applicants in this area are parents of successful sons or successfully married daughters who apply for assistance because they feel it their due as long-time contributors to the well-being of the community. Survey includes all applications taken from July 1, 1962, to July 1963. This intake worker handled applications for aid for needy children, general relief, old age security and aid for needy disabled (ATD) during this time. All of the OAS and ATD cases are included in survey. One general relief application which was made by a client old enough for old age security, but with inadequate residence is included. The results clearly refute the AMA's statement regarding the number of aged who have medical insurance, and points up the large percentage of cases whose requirements for aid stems from the cost of ill health. Hon. WILBUR MILLS, SOUTHERN CALIFORNIA PHYSICIANS COMMITTEE FOR House Ways and Means Committee, Washington, D.C. Los Angeles, Calif. DEAR CONGRESSMAN MILLS: This testimony is offered for publication to the committee hearing H.R. 3920. Very truly yours, HELEN MISHELL The appalling tragedy which has befallen us terminated our circulation of this statement. Many other physicians had planned to add their signatures to let you know that they also believe it to be true. We hope, most earnestly, that a decision of your committee to permit the full House of Representatives to discuss and vote on this matter will be a reaffirmation of our belief in law and order, and our trust in representative government. H. M. NOVEMBER 25, 1963. SOUTHERN CALIFORNIA PHYSICIANS FOR ELDER CARE THROUGH SOCIAL SECURITY We physicians hereby reaffirm our belief in the need for immediate enactment of legislation to provide hospital insurance for the aged through social security. We are convinced that the social security system will provide the most economical as well as the most practical method of financing and administering the provisions of hospital benefits desperately needed by aged people. Neither private insurance, as evidenced by the constantly increasing premium requirements of the Connecticut plan, nor the Kerr-Mills implementation after |