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to consult with the Hospital Insurance Benefits Advisory Council respecting the determination by the Secretary of eligibility requirements and standards for hospitals and other providers of service, and other provisions with respect to the Hospital Insurance Benefits Advisory Council, would not apply with respect to the Board.

Payments under the bill with respect to railroad people would be made from the Railroad Retirement Account. The bill would make it the duty of the Railroad Retirement Board and of the Secretary to arrange their respective administrative procedures so as to avoid duplication and prevent any individual from being paid for the same health service under both the railroad retirement and social security systems. Maximums prescribed by the bill (90 days of inpatient hospital services (may be increased to 180 days, or decreased to 45 days, by irrevocable election; in the first case à larger deductible would apply and in the second, there would be no deductible), 180 days of skilled nursing home services, and no more than 240 home health visits in a calendar year) would be applicable to services under either or both acts for any benefit period.

The financial interchange provisions of section 5(k) (2) of the Railroad Retirement Act would be amended to provide for their application to the new health insurance programs. These are the provisions under which the railroad retirement system is, in effect, reinsured under the social security system, in the sense that financial adjustments are regularly made between the two systems to place the social security system funds in the same position they would be if service under the Railroad Retirement Act were included in the term "employment” as defined in the Social Security Act and in the Federal Insurance Contributions Act.

The social security tax increases provided by the bill apply only after 1964. The Railroad Retirement Tax Act now provides for automatic tax rate increases on compensation for services after December 31, 1964, related to social security tax increases after 1956. In view of this, the increases required to support the benefits provided for railroad people by this bill would require no changes in the tax act.

The bill would increase the wage base under the social security system from $4,800 to $5,200 a year, both for purposes of taxes and benefit computation, but this presents no problem because the compensation base under the railroad retirement system was recently increased to $450 per month, the equivalent of $5,400 a year.

In the light of the foregoing, the railway employees and their unions are strongly convinced of the need for the program the bill would provide. We believe the program offers the best practical method of providing the aged with protection against the calamities of ill health. We therefore, urge the enactment of H.R. 3920 with the inclusion of title III to cover railroad employees.



Boston, November 18, 1963. Re H.R. 3920. Hon. WILBUR D. MILLS, Chairman, Committee on Ways and Means, U.S. House of Representatives, Washington, D.C.

DEAR SIR: Will you kindly record the Massachusetts Department of Public Welfare in favor of the passage of the Hospital Insurance Act of 1963, H.R. 3920?

We have approximately 585,000 persons over the age of 65 in Massachusetts. During the full year period from October 1, 1962, through September 30, 1963, we granted medical assistance to the aged to an average of 21,543 persons monthly. Approximately 90 percent of these persons received hospital care or nursing home care.

It is our opinion that the passage of H.R. 3920 is essential in order to assure necessary medical care to a large number of the aged who do not qualify for the MAA program under our means test or are reluctant to apply for it. Very truly yours,

ROBERT F. OTT, Commissioner.


Valley Forge, Pa., November 20, 1963.
House Office Building,
Washington, D.C.

DEAR MR. MILLS: We would appreciate your including the following resolution adopted by the American Baptist Convention in its annual session in Philadelphia, Pa., May 25, 1962, as a part of the testimony heard before the House Ways and Means Committee in regard to H.R. 3920.


Medical care for the aged has become a matter of national concern because medical services are both more effective and more expensive. The problem of paying for medical services is of concern to society and thus to the church. The benefits of modern medicine should be available with dignity to all.

Therefore, we urge the following three complementary recommendations to insure adequate medical care to the aged :

(a) Expansion and improvement of voluntary private medical insurance to senior citizens at reasonable cost.

(6) Further implementation of the Kerr-Mills bill.

(c) Passage of legislation providing for medical care to the aged through a financially and actuarially sound Federal system which will enable people to set aside funds during their productive years to take care of need in unproductive years. Thank you for your help and consideration on this matter. Sincerely,

CARL E. METZGER, Special Assistant.



New York, N.Y., November 27, 1963. Mr. LEO H. IRWIN, Chief Counsel, Committee on Ways and Means, Washington, D.C.

DEAR MR. IRWIN: In behalf of the National Council of the Churches of Christ in the U.S.A., I am herewith submitting the testimony on “Hospital and Nursing Care for the Aged" for consideration by the Committee on Ways and Means. Our representative, Mrs. DeLeslie Allen, was to have presented the testimony in person on November 23, 1963. Since we are uncertain as to whether the committee will reschedule public hearings on medical care for the aged, we are filing our written statement, in lieu of a personal appearance, for inclusion in the record of the hearings. Sincerely yours,





My name is Mrs. DeLeslie Allen, of Rochester, N.Y. I am vice chairman of the department of social welfare of the National Council of the Churches of Christ in the United States of America, and a member of the United Presbyterian Church in the United States of America. I also appear before you as a homemaker and a concerned citizen.

The general board of the National Council of Churches first adopted a general position on "the churches' concern for health services" on February 25, 1960. The following year, on February 22, 1961, a more specific position relative to the medical needs of the aged was adopted entitled “The Economics of Medical Care for the Aged.” Copies of these two position statements are attached for inclusion in the record of this hearing.

In the latter general board statement we read:

"To the extent that Christian duty can be discharged by the assumption of individuals, family, and group responsibility and without resort to governmental action, this is to be preferred.

"On the other hand, where needs of people can be met only by united, socially planned action, the Christian will choose such action rather than the neglect of basic human need."

Several studies have pointed out the need for insurance protection for the aged. Nine out of ten people 65 and over will go to the hospital at least once in the future. The typical aged couple will average over four hospital admissions after age 65. One out of every six aged persons will enter a hospital in any given year. Added to this, we know that when an older person goes to the hospital he will, on the average, stay twice as long as a younger person because he is more likely to have serious and long-lasting illnesses. People over 65 are in hospitals, on the average, over 242 times as much as younger people, and their hospital bills are twice as large.

The great need for hospital care imposes an intense strain on the financial resources of older people. Half of the aged who are single have annual incomes of less than $1,000, and half the aged couples receive less than $2,500 a year. Roughly half of the people over 65, moreover, have less than $500 in assets that can readily be turned into cash; over one-third of them have less than $100.

The latest estimate of the Health Insurance Association indicates that 54 to 55 percent of our 17.4 million citizens over age 65 are covered by some form of private health insurance. However, many of the policies they do have provide for small benefits under limited conditions and at high cost.

With regard to the hospital and nursing care needs of our older citizens, the conclusion appears unavoidable that private nonprofit and commercial insurance programs cannot meet the full need alone. Therefore, the National Council of Churches continues to support in principle legislation which will extend the benefits of old-age, survivors, and disability insurance to include adequate health care for the aged. The National Council of Churches also supports the maximum utilization of private nonprofit and commercial hospital and nursing insurance for the aged. To help our older eople meet their heavy medical expenses, a combination of both private and social insurance coverage is needed.

When the United States first established the old-age and survivors insurance program under the Social Security Act of 1935, fear was expressed that the social insurance program would weaken the private and commercial insurance industry. Exactly the opposite happened. It is reported that from 1940 to 1961, life insurance in force grew from $115 billion to $685 billion. No one today seriously suggests that private and commercial insurance alone could provide the basic protection which old-age, survivors, and disability insurance provides even for the poorest family.

The 1961 national council resolution calls attention to two human values that are inseparable from the economics of medical care and we cite them here:

“(1) Quality of care. While high quality medical care has been achieved under a number of different methods of payment, it is unrealistic to think that quality is ever completely separable from the economics of medical care. The national council urges that in the development of prepayment and insurance plans—under both private and public auspices—careful attention be given to arrangements which give maximum encouragement to the highest quality of care and the enhancement of the best relationship between physician and patient.

“(2) Individual dignity and freedom. Government participation in any welfare program does not necessarily involve loss of individual freedom or affront to personal dignity. In some circumstances, indeed, individual freedom is enhanced by the utilization of Government to achieve a social goal, though it is obvious that such enhancement does not come about automatically. As the instrument of government is employed by a free people, they must be ever vigilant to guard their freedoms. In planning and developing any Government insurance program to help older people meet the cost of their medical care, there is a Christian obligation to include provisions for its administration that will adequately safeguard freedom, dignity, and self-respect." Forcing the aged into indigency

Social insurance has provided older people with a measure of economic security. We cannot allow it to be eroded by the increasing costs of illness. Yet this is exactly what is happening. Many older people are being forced into a financially helpless condition by hospital, nursing, and medical bills which have eaten up most of their savings, the equity in their homes, and their credit. In a recent report by the Department of Health, Education, and Welfare we read the following facts. "In the first half of 1961, just about every third person approved for old-age assistance needed it directly or indirectly as a result of health difficulties. Among recipients getting the assistance to supplement OASI benefits-generally those with the greatest economic resources of their own—the proportion obtaining assistance on account of medical needs was a high as 2 in 5.1

Cash assistance from appropriated tax funds for the indigent older person is better than nothing; but direct relief is a poor substitute for private and social insurance protection available as an earned right, before one is reduced to penury. Self-reliance and self-respect

The National Council of Churches supports the principle of prepaid private and social insurance because it safeguards the self-reliance and dignity of the older person. The moral and ethical basis for this preference is clear and quite compelling.

In prepaid hospital and nursing insurance, under both private and social security coverage, each individual contributes to an insurance fund during his working years which gives him a paid-up social insurance coverage or continuing private insurance protection at age 65. In case of illness, these insurance funds are then his by right while he is still financially independent, not after he has been reduced to indigency.

The National Council of Churches commends to the Committee on Ways and Means and to the Congress the appropriate implementation, through the social security system, of this principle of contributory insurance protection for our older citizens.

Attachments: "The Churches' Concern For Health Services,” a pronouncement unanimously adopted by the General Board of the National Council of the Churches of Christ in the U.S.A., February 25, 1960. “The Economics of Medical Care for the Aged," a resolution unanimously adopted by the General Board of the National Council of the Churches of Christ in the U.S.A., February 22, 1961.


A pronouncement unanimously adopted by the General Board of the National

Council of the Churches of Christ in the United States of America February 25, 1960

Churches have a major role in the development of health services. Health and holy are words with a common origin akin to whole, sound, hale and well. Their close relationship in Christian history stems from the life and work of Jesus Christ who "went about all Galilee teaching in their synagogues, preaching the gospel of the kingdom and healing every disease and infirmity among the people.”

Through the centuries, even to this day, Christians have been constrained to show forth the love of God not only by preaching but also by healing. Society has frequently been alerted by the churches to meet health needs. Churches have nurtured a large proportion of the persons engaged in the health professions. Extensive health services have been developed and maintained by churches in this Nation and abroad. Through all their activities in the field of health, churches have aided men more fully to render service to God and their fellows and have expressed the Christian faith in love.

Health is not merely the absence of disease and infirmity, but is a state of physical, mental, social, and spiritual well-being. The churches have a continuing concern for all aspects of health, for the well-being of the whole man and the whole community of men. Therefore, churches are urged to work in the community, the Nation, and the world toward (1) promotion of positive optimum health, (2) prevention of disease and disability, (3) treatment and alleviation of disease, (4) rehabilitation of all persons with disabilities.

1 "Background Facts on the Financing of the Health Care of the Aged,” Special Committee on Aging, U.S. Senate, May 24, 1962, p. 8 (excerpts from the report of the Division of Program Research, Social Security Administration, Department of Health, Education, and Welfare.)


Churches should help their members become aware of health needs. They can promote health by supporting programs which raise standards of living, foster wholesome family relationships, and assist people in developing their capacities. The activities of the churches in pastoral care, Christian education and action, missionary work at home and abroad, social welfare and world service are among many which encourage healthful living in this Nation and abroad. Health edu. cation, usually centered in public health services, voluntary health organizations, and the schools is also a responsibility of church-related health and welfare agencies and should receive attention and support from churches.

The health of individuals is of deep concern, but Christian responsibility also extends to the public health. Prevention of disease and accidents through such measures as control of the environment, immunization, optimal nutrition, and the practice of principles of healthful living is of paramount importance. Maximum prevention requires support of sound and effective public health programs under both voluntary and governmental auspices.

When disease or disability has occurred, early detection, accurate diagnosis, prompt comprehensive medical care of good quality, and concurrent rehabilitative procedures should be available to all people, without regard to race, religion, ethnic background, or economic circumstances.

Adequate support of public services by church members is necessary to insure basic services of sufficient quality and quantity to meet the needs of the whole community. Economic and manpower aspects of modern health services are of such complexity and magnitude that it is incumbent upon all health agencies, both public and voluntary, to recognize that joint efforts and broad community planning are essential.


Mental health

The increase in the incidence of mental idiness in this generation is alarming. Mental and emotional aspects of all health services and problems demand special consideration by voluntary and governmental agencies. Preventive measures, early detection, more effective treatment and rehabilitation should be subjects for expanded programs of research directed by professionally trained personnel.

Religion has contributed significantly to the maintenance and recovery of mental health, especially as the assurance of the love of God and fellow men has been imparted by churches to individuals needing recognition and acceptance in an unsettled world. The relation of religion to mental health should be a subject of continuing study.

The churches' contribution should also include participation in cooperative community planning, furtherance of sound community and church-related programs conducive to mental health, and support of more adequate and extensive treatment facilities, including psychiatric care. Financing of health services

It is now widely recognized that the health of people is an important national resource, and therefore government has increased its responsibility for the maintenance of optimum health. The churches' concept of man, centering upon his creation and redemption by God for a divine purpose, imposes a more fundamental obligation for the furtherance of health, Therefore, the availability and financing of medical care of high quality is of deep concern to the churches.

With the rising cost of medical care, serious or extended illness has imposed economic burdens which are beyond the capacity of many individuals and families to meet from current income. There is need for churches and church members to study the economic aspects of health services. Experimental patterns of health service, such as group health programs under the auspices of labor, management, or other responsible voluntary associations of people, deserve encourage ment. Flexibility on the part of all health professions and the public; willingness to try new methods; cooperative planning, analysis, and evaluation are required to meet the needs of people.

Continued growth of prepayment methods shows promise of insuring high quality of medical service. The churches should encourage the inclusion of mental, dental, nursing, and other health services in programs of prepaid care, and the extension of the amount and kind of care available to retired and other aged persons and to persons living in rural areas. If voluntary prepayment plans cannot accomplish the desired ends, Government should protect the health of the people by making possible the prepayment of health services.

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