Health facilities, hospitals, and nursing homes The traditional and vital role of church-related hospitals and other health services must be maintained and strengthened. It is especially incumbent upon the churches to seek out and help communities which cannot provide adequate health services, and to give sufficient financial support to church-related programs, including hospitals and nursing homes, to enable them to pioneer in meeting health needs. Church members should also support hospitals and services which are not church related. Churches should insist upon the establishment and observance of high standards of care in all health facilities, especially in those which are church related. In all phases of their operations church-related facilities should reflect the Christian view of the dignity and eternal worth of every person, and the spiritual ministry should be developed as effectively as physical and mental health services. Trained chaplaincy services should be a part of the professional team in hospitals and other institutions of healing. Health careers Careers in the health field provide outstanding opportunities for dedicated Christian service. Christian motivation can increase substantially the effectiveness of health workers. Recruitment of qualified health workers should command the attention of the churches. Church-related schools and colleges have particular responsibility for both recruitment and training. The need is not alone for doctors and nurses, but also for many types of paramedical personnel, including dieticians, physical and occupational therapists, and attendants and aids in general and mental hospitals. Some church-related hospitals are major training institutions for health workers, especially for physicians, nurses, technicians, and social workers, as well as theological students and chaplains. Their teaching facilities and methods should periodically be evaluated by persons with professional competence and responsibility. Training programs are needed, but they should not be financed as part of the cost of medical care. Other sources of financing must be made avail able, both within and outside the churches. Volunteer services Volunteers, both professional and lay, contribute significantly to health services. Physicians particularly have provided medical services for the economically underprivileged. Acute shortages of health workers, including nurses, have made lay volunteers essential for the current operation of many health facilities and the provision of significant personal services to patients. In general and mental hospitals, nursing homes, and other facilities for the chronically ill and the aged, volunteers have made unique contributions. Volunteer home visitors and home helpers are also assuming increasing importance with the national growth in the number of older persons and the development of home care services for the chronically ill. The need for volunteer service is great and offers Christians unparalleled opportunities to witness for Christ with deeds of love and mercy. Local churches should assume a significant portion of the responsibility for recruitment, transportation, training, and sustained organization of volunteer services. International health services International health and wholesome international relationships have been advanced by generations of Christian health workers. The need continues with appropriate adjustments in organization and methods as changes occur throughout the world. The work of the mission boards is now supplemented by relief and rehabilitation services rendered through denominational and ecumenical agencies on the national and world levels. Health work, pioneered by Christian missions, has in recent decades been extended by other world agencies, including technical units of the United Nations and of national governments. Both churchrelated and other international health programs are worthy of strong support from the churches and their members. Christians should be encouraged and trained to participate directly in voluntary and public programs. Important potentialities for Christian service by churches and church-related agencies may be found in the provision of technical training and Christian experience in connection with the education in this country of students from other nations. Because world economic and scientific developments profoundly affect the health of millions of people, Christians should be increasingly concerned for pro grams of mutual aid both governmental and voluntary. Increasing concern of the churches should also be expressed in relation to such problems as rapid population increases and developments in nuclear science which affect human health. Health problems at home and abroad offer abundant opportunity for churches and church members to show forth the continuation of the acts of God as supremely revealed in the love and compassion of Jesus Christ. 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 United States of America, February 22, 1961 The good news of God's redeeming love and saving power, declared in the teaching of Jesus Christ was proclaimed in His concern for suffering and His ministry of healing. From the beginning, Jesus went directly to the sick and suffering. To all who came or were brought to him, he expressed his loving concern for the health of body, mind, and spirit. This divine concern has received repeated emphasis in Christian life and teaching. The Apostle Paul wrote that the strong should bear the burdens of the weak. Through the generations Christians have turned to the victims of disease with increasing concern and at the same time have sought resources which might bring healing power to the sick. Consciously or unconsciously sharing God's purpose that mankind should have health, a ministry of healing has become an inherent aspect of a civilized and humane society. As new health needs have appeared, new resources have been discovered for meeting them. In our day, as the number of aged persons has increased, there are among them many men and women who require financial assistance if they are to have physical and mental health and that spiritual health which may be dependent thereon. On their behalf today, ways should be sought and found to further the will of God once so clearly made manifest by Jesus Christ that men and women should be enabled to enjoy health.1 For the Christian, means are as important as are ends; but no more so. In our endeavor to achieve Christian ends we must choose those methods best calculated to develop and maintain Christian character and relationships. No method is better suited to do this than sharing the unpredictable incidence of the cost of medical care through the various mechanisms of mutual aid that have been developed. The most widely accepted of these is the mechanism of insurance both private and public. 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. Therefore, we should seek to bring the blessings of modern medical care within reach of all by nongovernmental action to the extent that such methods can accomplish this. But we should not fail to support governmental action in circumstances where other methods are clearly inadequate or impossible. On the average, American families spend nearly $300 a year for health purposes. Most of this money is spent to secure hospital and physician services, medicines, and prosthetic and other appliances after illness has already become The General Board of the National Council has already made clear its concern for the provisions of adequate standards of health care for all and for the cooperation of both private and public agencies in their maintenance as follows: (1) "Christians should work for a situation wherein all have access at least to a minimum standard of living. Such minimum should be sufficient to permit care of the health of all and for suitable protection of the weaker members of society, such as *** the aged." (Pronouncement on Basic Christian Principles and Assumptions for Economic Life, adopted Sept. 15, 1954.) (2) "The churches' concept of man *** 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. * cannot accomplish the desired ends, Government should by making possible the prepayment of health service." Concern for Health Services, Feb. 25, 1960.) If voluntary prepayment plans protect the health of the people (Pronouncement on the Churches' serious. Comparatively little of it is spent for the maintenance of optimum health. This contributes substantially to demands on hospital facilities and to a lower level of general health and well-being than could be had by a wiser and more orderly expenditure of the same amount of money for preventive care. The rapidly rising cost of modern medical care puts it beyond the ability of most retired persons and low-income families to purchase such care on an emergency fee-for-service basis. A very wide variety of nongovernmental efforts have been and are being made to meet this problem of medical economics. They range from indemnity health insurance provided by commercial insurance companies to prepayment, group practice health plans providing comprehensive, including preventive, care for nearly all the health needs of their subscribers through teams of physicians which include specialists and general practitioners. The voluntary sharing among groups of people of the risks and hazards of illness, and the voluntary pooling of some of their funds to meet the cost of care for any in their group who may need it is indeed a Christian approach to this problem, whether this method is utilized by churches, labor unions, industrial managements, fraternal organizations, cooperatives, community groups, or by subscribers for health insurance. The National Council of Churches commends it and urges its widest possible application. It is noteworthy, however, that the cost of health care and consequently of health insurance is rising so rapidly as to make it difficult for the average family to afford adequate coverage for its comprehensive health needs. While some 73 percent of the American people have some form of health insurance, nonetheless, only 25 percent of the total private medical expenditures are paid from such insurance. About 4 million Americans who are today obtaining comprehensive medical care from group practice or other direct service health care prepayment plans pay for it by monthly subscription premiums amounting to less per year than the average $300 per family annual expenditure. It appears that one method of making the best of modern medical care available to more and more people lies in a rapid growth and expansion of voluntary health plans of this character. There are, however, certain groups in the population for whom even their ordinary medical needs cannot be met by voluntary prepayment plans; namely, low-income families and most people 65 years of age or older. Eighty percent of persons with family income of $5,000 or more have some form of health insurance, but only 33 percent of those with family income under $3,000. Only 35 percent of persons 65 or more years of age have any health insurance. Voluntary health plans are unable to offer coverage for even a fraction of health care needs at charges either of these groups can possibly afford. Eighty percent of people 65 years of age or older have annual incomes of less than $2,000; about 60 percent, incomes less than $1,000. At least 7.6 million older people have liquid assets of less than $500. Yet 77 percent of people 65 years of age and older have chronic ailments, and the percentage increases to 83 percent for those 75 and older. The group 65 and older now require, for less than optimum health care, more than twice as much hospitalization per person as is needed by the rest of the population, and they spend on the average twice as much for health care as does the population as a whole. Full advantage should be taken of recent amendment to title I of the Social Security Act which offers Federal funds to improve State medical care programs for aged persons on public assistance rolls and also provides matching funds for States desiring to aid medically needy older people not now on relief rolls but able to pass a means test as a condition of eligibility. This program offers the States opportunity to provide help for older persons at the bottom of the economic scale. However, it does not offer aged persons of moderate means and many of low income any solution to their problem. About three out of every four policyholders in voluntary group prepayment plans are completely excluded from coverage upon retirement, and studies indieate that less than 5 percent can convert to individual policies without reduction in benefits. The voluntary prepayment plans, necessarily based upon experience rating, discriminate against high-risk groups and are not geared to the problems of chronic illness characteristic of old age. Policies commercially written for older people are not only beyond the means of most, but they are not based upon a philosophy of preventive medicine and optimum health, nor do they include provisions for diagnosis, followup, and restorative medicine. As previously noted, the general board has stated, "If voluntary prepayment plans cannot accomplish the desired ends, Government should protect the health of people by making possible the prepayment of health services." This is precisely what the social security system would be able to provide efficiently through the mechanisms of old-age, survivors' and disability insurance. Therefore, the National Council of Churches supports in principle legislation which will extend the benefits of old-age, survivors' and disability insurance to include adequate health care for retired aged persons.2 There are human values that are inseparable from the economics of medical care. Two call for special consideration: (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 plansunder 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 of 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. The counsel, cooperation, and active participation of the medical profession and other health workers in both planning and execution of a government health program are essential. The values to be realized from an improved level of health for America's older citizens are so great that we are confident that cooperation will be forthcoming from all who in our day are custodians of the almost miraculous capacity to maintain the health and cure the diseases of their fellow human beings. In the light of the above concerns the general board authorizes representatives of the National Council to testify at public hearings along the lines herein indicated. Hon. WILBUR D. MILLS, THE LUTHERAN CHURCH-MISSOURI SYNOD, Chairman, Ways and Means Committee, DEAR MR. MILLS: We have studied "Medical Assistance for the Aged-The Kerr-Mills Program, 1960–63," the report by the Subcommittee on Health of the Elderly to the Special Committee on Aging of the U.S. Senate. Our church department of social welfare begs to submit the following opinions for your consideration: 1. The Kerr-Mills approach to medical assistance for the aged is a complete and serious failure. It should be abandoned as quickly as possible. 2. We believe in the enactment of a social security financed program of health insurance. 3. We do not believe that the purchase of voluntary health insurance by the Federal Government or by the States is a practical one unless it could be made uniform and placed in immediate and simultaneous operation. We believe it would be more complicated and more expensive. The mechanism already established in the social security program, we feel, ought to be employed. Very respectfully yours, H. F. WIND. 2 In its "Pronouncement on the Churches Concern for Public Assistance," adopted June 4. 1958, the General Board stated: "The National Council of Churches affirms that the use of social insurance as exemplified by old-age, survivors' and disability insurance is to be preferred to economic dependence upon the public assistance programs." WOMAN'S DIVISION OF CHRISTIAN SERVICE OF THE Hon. WILBUR D. MILLS, House Office Building, Washington, D.C. DEAR MR. MILLS: On behalf of the Woman's Division of Christian Service of the Methodist Church, I wish to give encouragement to the passage of the bill on nursing and hospital care for the aging. The Woman's Division of Christian Service is the duly elected policymaking body of organized Methodist women. We are unable to present testimony at the hearings which begin Monday, November 18, 1963, but would be happy to have the attached statement placed in the congressional record. Sincerely yours, THERESSA HOOVER, Executive Secretary. NURSING AND HOSPITAL CARE FOR THE AGING The Woman's Division of Christian Service of the Board of Missions of the Methodist Church with headquarters at 475 Riverside Drive, New York, N.Y., is the duly elected policymaking body of organized Methodist women. Policies are recommended to the 36,000 organized local societies and guilds with a combined membership of approximately 2 million. Mrs. J. Fount Tillman, of Lewisburg, Tenn., is currently the national president. Through many of its agencies the woman's division offers direct services to the older citizen including health care, services to the homebound, and opportunities for participation in the total life of church and community. The division has been consistent in its support of legislation for the protection and enrichment of life for all citizens. Concern for the family is rooted in our history and finds continuing growth in present programs with children, youth, and adults. If a society is to be a healthy society it must have healthy families. In this age of increased life expectancy three-generation families are common even as four-generation families are not unusual. Thus it is that some Americans on the eve of their own retirement will increasingly have even older relatives still alive who may be potential dependents. National statistics would indicate that as persons in our culture continue to live longer the greater effect will be found among women. Some of these will enjoy both good health and adequate incomes; but, concern for the general welfare of all people demands that the Nation provide protection for that part of the population not so privileged. The problem of chronic illness and need for institutional care is more acute in the over-65 group which is the economically declining period of life for most Americans. Therefore, we urge that the Federal Government provide health protection for older people, using the contributory machinery of the social security system for insurance covering hospital bills and other high-cost medical services. Those older people who have never been eligible for social security coverage should have corresponding benefits from general tax revenues. We feel there should be no means test for those receiving such benefits. The woman's division has alerted its constituency to some of the issues involved in efforts to secure adequate nursing and health care services for the aging. An appeal has been made for study of the issues and an expression of concern to congressional leaders. This would precede and follow personal and group efforts to adequately serve the needs of older citizens in church and community. |