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Opponents claim that the 65-plus insurance plans are adequate. How can that be when many millions cannot afford to pay the premiums? Opponents object to the additional social security taxes to be paid by workers and businessmen. Our corporations have had the highest profit year in history and our workers have given enthusiastic support to the bill before you. Opponents object that the Federal Government will be involved with hospitals. This is a specious argument, for the Federal Government is very much involved in hospitals through the Veterans' Administration and its hospital building program.

Above all, opponents object to this bill as being a step toward socialized medicine. Every time a reform is contemplated, the word "socialism” has been raised as a symbol to make us shy away from reform. We have many such reforms which were denounced in the past as socialistic from workmen's compensation to social security, but which even conservatives, with an occasional exception, would not abolish today.

May I again urge your support of the King-Anderson bill. Its passage will bring us into the family of Western European democracies where such type of medical care has been standard practice for years.

BUILDING SERVICE EMPLOYEES' INTERNATIONAL UNION,

Washington, D.C., December 26, 1963. MR. LEO R. IRWIN, Chief Counsel, House Ways and Means Committee, U.S. House of Representatives, Washington, D.C.

DEAR MR. IRWIN: In accordance with your suggestion that we submit written rather than oral testimony in support of the proposals for medical care for the aged as part of the social security system, I am enclosing herewith 10 copies of our statement. This is submitted on behalf of the 300,000 members of this union for the consideration of the committee and inclusion in the record. Sincerely,

DAVID SULLIVAN, General President.

STATEMENT BY DAVID SULLIVAN, GENERAL PRESIDENT, BUILDING SERVICE EM

PLOYEES' INTERNATIONAL UNION, AFL-CIO, IN SUPPORT OF H.R. 3920 TO THE HOUSE WAYS AND MEANS COMMITTEE We welcome and appreciate this opportunity to submit a statement on behalf of medical care for the aged as part of the U.S. social security system.

Our views in this field start with the assumption that we should not expect our social insurance system to protect each individual against all possible emergencies. But we do believe that this insurance system can protect most people against many grave emergencies. The lengthy illness that can befall the aged citizen is one such emergency. We believe that all citizens who have made their contribution of work and citizenship to our society should be protected against such disaster on the basis of right, not need.

High medical costs keep many aged citizens from getting the medical care and attention they need, and accordingly they suffer more seriously or for longer periods with various illnesses, or even go to an earlier grave because of the lack of proper medical attention. It seems to us that three methods are open to us for protecting the aged citizen against these high medical costs.

One method that has been proposed, and is being pushed by commercial insurance companies, is the use of hospitalization, surgical care, catastrophic illness, and other types of health insurance sold through the private carriers. It seems to us that no serious argument need be presented here against this method of taking care of the needy aged, since they simply are not able to afford insurance. Despite the great growth in private health insurance for the elderly in the last few years—and it should be noted that this growth has been stimulated by the fact that the Congress has been considering medical care for the aged as part of the social security system—there are still large segments of the aged and aging population without adequate insurance against the hazards of illness. We feel certain, also, that many of the retired people who do carry private health insurance at the present time are not adequately protected by that insurance and are, in fact, protected against only some of the health hazards that they face.

The second method that is open to us is through the continued use of the dolelike system envisioned by the Kerr-Mills program. It seems to us that the report recently issued by the Subcommittee on Health of the Elderly-a subcommittee of the Special Committee on Aging of the U.S. Senate offers complete proof that the Kerr-Mills Act is clearly an inadequate approach to the great national problem that we face. As the committee report indicated, after 3 years of Kerr-Mills it is still not a national program and there is no reason to expect that it will become one in the foreseeable future.

The third possibility that is open to us in some variation of health insurance attached to the social security system. We firmly support this proposal as it is incorporated in H.R. 3920.

The basic reason why we need some kind of health insurance for the aged is simply the humane reason that we must provide care for every citizen who needs it. No doubt there are very few opponents to the medical care proposal who would feel that we should not take adequate care of the aged, or who would feel, for example, that we should let them starve or die sooner than necessary simply because they cannot afford food and doctors. We are united as Americans in a humane society which recognizes the right of every individual to protection and aid from the society as a whole. It has been argued in the past that the mechanism of the market would adequately distribute all goods and services, but during the past two or three decades we have, as a nation, come to recognize the fact that our economic system will not properly function by itself if permitted to rush along in a chaotic world unattended.

The argument is not about whether the aged should have adequate health services but rather about how should we care for them, and as related to the present proposal, specifically how should we pay for medical care for the aged.

Our union believes that the experience of the United States with the social security principle shows that it is effective and adequate in producing a method of orderly savings by which working men and women during their productive years can help contribute to their needs in their later years. Of those who opposed the social security system when it was first considered in the 1930's, there are few who would oppose it today, few who would not admit that it has served a tremendously useful and important role in the orderly distribution of goods and services in our society.

The social security mechanism can be applied to help assure care for the aged, and in that application will make an orderly, useful contribution to the distribution of hospitalization and other health services to our citizens.

While the basic argument on behalf of this bill is the argument for humane conduct, there are other considerations of great significance, which must be mentioned briefly; first, most of our aged have extremely low incomes. Three out of every five elderly citizens have incomes under $20 a week. The total incomes of people over 65 are, for the majority at least, too low to permit them to adequately finance medical care. As a result, many of them are forced to rely upon aid from the county or some other governmental body, or to rely upon children and other relatives. Most tragically, many of those elderly who are in need and unable to pay for it probably do not receive adequate care and very few of them have an opportunity to secure any preventive medical care. Older people are less able to pay for medical care at a time when they are most likely to need it.

A second consideration is that medical costs have been rising and are continuing to rise. As a result of wonderful medical research which has been carried out during the last half century by various kinds of scientists, including doctors, our concepts of medical treatment and hospitalization have been tremendously altered. Health care has become much more effective, but it also has become more expensive. The neighborhood general practitioner who was a friend as well as a medical man is largely a thing of the past, and the relatively inexpensive though unquestionably less adequate medical care that was available to the older generation a century ago is largely unavailable today. This is one of the great reasons why there is pressure for some kind of prepayment of medical care for elderly people today.

Another factor in our day is the fact that continuing unemployment, and the increasing difficulty of people to secure employment when they lose jobs in their later years, has made it more difficult for many of the elderly to prepare for retirement. The negotiation of pension plans by labor unions and the improvement of the Federal social system has been helping to assure elderly people of some kind of support in their postretirement years but, in general, the amounts available through pensions and social security are not adequate to pay more than routine living costs and certainly are not adequate to provide for proper medical care in the vast majority of cases.

These considerations, coupled with the fact that public welfare programs are overtaxed through the high level of unemployment, mean that local government agencies cannot be expected to provide for the growing need for medical care of an elderly population whose life expectancy continues to rise.

We support the social security approach to paying for medical care for the aged for many reasons, including that it will be the most effective, that it will aid the largest number of persons, and that it will offer benefits coming to citi zens as a matter of right, not of need. We are unalterably opposed to the means. test approach to this problem which is incorporated in the Kerr-Mills bill.

We think it important that each person should make a contribution to his own postretirement security and good health. When he needs the aid that a health insurance program can bring, it must come to him as a matter of right, or as a right which he has earned and to whose growth he has contributed. Only such a program is concomitant with the growth and strengthening of human dignity.

The testimony of many distinguished leaders in the field of politics, medicine, and social legislation could be quoted in support of the present proposals

and no doubt will be in the course of these hearings. During the past years adequate testimony has been prepared and disseminated to show clearly the need for a program of medical care for the aged as a part of social security system.

Perhaps the most important statement that has been issued on the subjectimportant because of the wide range of views represented by the group that issued the statement-is that made by the White House Conference on the Aging, which was held in January 1961 during the Eisenhower administration. I would like to close this testimony with a brief paragraph from the policy statement issued by the Conference:

“Establishment of a program of health benefits financed in the same way as OASDI cash benefits, would give to the aged the assurance that the costs of essential health care will be met when their working years are over. The mechanism of contributory social insurance, under which contributions are made by workers during their working years will then provide health care to protect them in retirement.

"Such legislation would help to ease the problems of hospitals, public assistance programs, and private philanthropy and would relieve voluntary insurance programs of the burden of carrying this high risk group."

Thank you for permitting us to submit this statement.

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INTERNATIONAL ASSOCIATION OF MACHINISTS,

Washington, D.C., January 31, 1964.
Mr. LEO H. IRWIN,
Chief Counsel, House Ways and Means Committee,
House Office Building,
Washington, D.O.

DEAR MR. IRWIN: As a physician (1) for over 30 years, as medical director of Eastman Kodak Co., (2) as medical consultant of the International Association of Machinists for the past 10 years, and (3) as chairman of the American Medical Association Committee on Medical Care for Industrial Workers for 8 years during the 1950's, I wish to register with you my conviction that the most logical, economical and efficient way to provide certain hospital and medical care benefits for those past 65 is through social security.

During my years of supervising and counseling with workers and their families, it became unmistakably clear that many older workers did not always have the timely medical care they needed. The reasons for this situation are largely financial. Many older folks, especially those retired who have raised families and had hard luck because of unusual illness, have not been able to accumulate savings. After retirement when income diminishes and sickness increases, the expense of medical care has to be avoided, often leading to chronic and disabling illnesses.

Older industrial workers in need of help for medical problems are reluctant to seek welfare assistance when they haven't the money to pay their way. They put off needed care and learn to live with ailments that could have been helped by proper attention. It seems logical therefore that through a system of small payroll deductions during their working years they should be assured of medical attention when it is needed in their later years.

It is this group of older people that practicing doctors do not take account of in their opposition to further social security coverage. These older folks are not patients because they can't afford to see the doctor. The King-Anderson bill will take care of them in large part. Some of them are cared for now under the Kerr-Mills bill, but too many will not submit to the investigations necessary to prove eligibility for welfare assistance through Kerr-Mills benefits, and it is not the most economical way to do it. Is it just to deny this employed group who legally come under social security for retirement pensions, the opportunity to pay by social security deductions in their younger years for hospital and medical care needed in the later years? It is the American tradition that workers help themselves insofar as possible. Social security has proven its value as a way of putting aside periodically something for pension payments. Why can it not be extended to cover medical needs of later years? It fits the prepayment principle so much approved.

The American Medical Association has stated its position in a booklet re cently issued, "A New Concept of Aging.” Their conclusions about the aging seem superficial, ambiguous, and incomplete. This is a direct quotation, for example: “Today old age catches no one except perhaps the lion tamer or the soldier—by surprise. In this country, with its resources, wealth, and standard of living—there are few excuses for being financially unprepared on the threshold of later years other than laziness or blind refusal to look at facts." These words quoted directly from the report seem to be considering an entirely different world—where poverty from unemployment and automation, illness and death of the breadwinner, and other sociologic and economic problems of the labor force are unknown. This does not fit with my observation and experience.

Perhaps the gaps are too great; perhaps organized medicine will never understand the problems facing that part of the public not receiving needed medical care. Perhaps the decisions should be made without them.

I hope that your committee, entrusted with the responsibility of bringing to Congress such pressing human needs as described in the amply documented testimony now before you, will agree to approve the King-Anderson bill for further debate and action in the House of Representatives. Respectfully yours,

WILLIAM A. SAWYER, M.D.

NEW YORK CITY BUILDING SERVICE JOINT COUNCIL,

New York, N.Y., December 3, 1963. Mr. LEO H. IRWIN, Chief Counsel, Committee on Ways and Means, House of Representatives, Washington, D.C.

DEAR MR. IRWIN : I have the privilege of writing you on behalf of New York City Building Service Joint Council, which represents nearly 100,000 building service employees in Greater New York and which is affiliated with the Building Service Employees International Union, AFL-CIO, with a membership in the United States and Canada of approximately 300,000, for the purpose of submitting a statement in connection with proposed legislation that would provide medical care for the aged linked with the social security system.

We in the building service industry feel very strongly on the subject of medical care for the aged linked with the social security system because our members are primarily men and women in the older age brackets (our average age for many years has been between 55 and 60 years). While our members enjoy comparatively excellent wages and working conditions today (our wage rates extend from approximately $72 per week for workers employed in unskilled jobs to well over $150 per week and more for superintendents and resident managers in first-class buildings), they have little to fall back upon in the way of savings and retirement income after they cease working. Accordingly they, like so many other Americans, have an urgent need for some kind of protection to ease the impact of medical expenses if and when they become ill, or when a member of their family becomes ill.

I feel that our industry represents one which exemplifies the tremendous need for coverage such as would be provided under medical care for the aged through social security, since our members work with their hands, and have no skills that could be applied in a limited manner after they retire and when they are at an advanced age where their physical capabilities are more limited.

We are well aware of the arguments that have been advanced by those who oppose medical care for the aged linked with social security, including the contention that such legislation would discriminate against those persons who are not covered by social security; also that such a system would not permit people to have "free choice" of doctors and institutions in which they might have to stay if and when they become ill.

By virtue of the fact that so many Americans would be covered under medical care for the aged legislation, and that a relative small minority would not have such coverage because they do not come under the Federal Security Act, we feel that such protection is most desirable, in fact vital to the security and well-being of our members and their families. As for "free choice" of doctors and institutions, there is no doubt in our minds but that most people would have a sufficiently wide choice to afford them every opportunity of securing the best medical assistance available, as well as institutional accommodations that would serve their every need.

During the more than quarter of a century that it has been on the statutes, the Social Security Act has more than proved itself as one of this Nation's most worthwhile and unique pieces of legislation. Indeed, it is cited throughout the world as the kind of legislation that has made our Nation famous as an exponent of the democratic way of life. The fact that so many of our fellow citizens today enjoy a more comfortable retirement as a result of their social security retirement benefits, plus the fact that the actuarial soundness of the act is an established reality are excellent pieces of evidence to support the value of the social security system. Moreover, the fact that working people have an opportunity to contribute toward their retirement income during their working life, when their strength and earnings are highest, is additional evidence to support the soundness of the pay-as-you-go principle embodied in the proposed medical care for the aged legislation.

The people who oppose medical care for the aged often use the phrase "welfare state” in criticizing this proposed measure. Indeed, our Nation exists in seeing to it that they can enjoy peace of mind and adequate health protection in their old age is a problem which we cannot afford to ignore.

On behalf of New York Building Service Council No. 11 and its 100,000 members and their families I respectfully submit that our Nation desperately needs medical care for the aged linked with the social security system; and I furthermore respectfully urge that the Committee on Ways and Means take action to expedite the enactment by Congress of medical care for the aged at the earliest possible time. Sincerely yours,

THOMAS G. YOUNG, Vice President.

CONGRESS OF THE UNITED STATES,

HOUSE OF REPRESENTATIVES,

Washington, D.C., November 22, 1963. Re Medicare legislation. Hon. WILBUR D. MILLS, Chairman, Committee on Ways and Means, House of Representatives, Washington, D.C.

DEAR MR. CHAIRMAN: Enclosed is a letter I received from Mr. F. S. Griffin, Augusta, Ga., who desires to file his written statement in lieu of a personal appearance for the careful consideration of the committee.

It is my understanding that his written statement will be included in the printed record of the hearings. Submitted herewith are three copies of his statement. If additional information is needed, please let me know. Sincerely,

ROBERT G. STEPHENS, Jr.

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