UNITED CHURCH OF CHRIST COUNCIL FOR CHRISTIAN SOCIAL ACTION, Hon. WILBUR D. MILLS, Chairman, Ways and Means Committee, DEAR MR. MILLS: The Council for Christian Social Action of the United Church of Christ would like to file with your Committee on Ways and Means a copy of the statement on medical care for the aging, adopted by the council in June 1960. This is the most recent action taken by our council on this subject. We trust that the material is still relevant and we hope it will be helpful to your committee in considering legislation on this subject. Thank you for this opportunity to file a copy of our statement. Cordially yours, RAY GIBBONS, Director. STATEMENT ON MEDICAL CARE FOR THE AGING, ADOPTED BY THE COUNCIL FOR CHRISTIAN SOCIAL ACTION OF THE UNITED CHURCH OF CHRIST, JUNE 15, 1960 Whereas nearly every person who reaches the retirement age of 65 can anticipate many more years of life; and Whereas statistical studies have shown that retired persons now have a median income of less than $1,000 anually, an amount which is inadequate to meet present human needs; and Whereas experience has indicated that the health needs of most aging persons cannot be met adequately on the restricted income usually received after retirement; and Whereas there is widespread recognition of the need for careful study and support of proposals for meeting existing deficiencies in health insurance, so that those with limited means may be protected against the insecurity and anxiety of ill health; be it Resolved, That the Council for Christian Social Action of the United Church of Christ favors legislation designed to provide insurance against the costs of hospital, nursing home, medical and surgical services for all retired and disabled persons, and urges favorable consideration of such legislation by State legislatures and the Congress of the United States. We would encourage the purchase of voluntary private health insurance by those who have the means to do so. But we must not lose sight of the inadequacy of these programs to serve many of the neediest cases, and we should recognize the responsibility of all citizens in our industrialized society to share in meeting the health needs of those whose limited resources cannot be expected to pay for adequate insurance. We believe the costs of medical service to these persons should be met in the most equitable manner possible, either through the social security system or through a program of general taxation, so that no aging person shall ever lack proper care because of economic inability or be subjected to indignity in order to qualify for it. We look to the time when health insurance programs will provide not only for the costs of hospital, nursing home, medical and surgical care, as suggested in legislation now before the 86th Congress, but also pay for preventive care which can be given at much less expense in a patient's home. We urge church members to give careful consideration to this subject and to express their convictions to their respective legislators. Hon. WILBUR D. MILLS, UNITARIAN UNIVERSALIST FELLOWSHIP FOR SOCIAL JUSTICE, Washington, D.C., January 28, 1964. Chairman, House Committee on Ways and Means, New House Office Building, Washington, D.C. DEAR MR. MILLS: I would like to record the views of the Unitarian Universalist Fellowship for Social Justice on the legislation now before your committee regarding medical care for the aged. The Fellowship for Social Justice, at its annual meeting, May 14, 1963, adopted the following resolution: Whereas meeting the health needs of our older population constitutes one of the most pressing social problems in this country; and Whereas medical and hospital costs continue to mount so that serious illness for the retired person often wipes out his life's savings or places great burdens on his children; and Whereas the program of health care for the aged under the Kerr-Mills law is inadequate because it is limited to the indigent; and Whereas the need is for a program that will treat the older person with dignity rather than requiring him to become penniless to qualify: Therefore be it Resolved, That the Unitarian Universalist Fellowship for Social Justice voice its conviction that medical care for the aged should be established and financed through the social security system. In implementation of this resolution, we are writing to ask your support and that of your colleagues on the Committee on Ways and Means for the Hospital Insurance Act as described in H.R. 3920, otherwise known as the King-Anderson bill. We believe this bill will go far toward providing hospitalization insurance and other benefits to those in our country who are most in need of medical care and least able to afford it. The aged, those 65 and older, spend two to three times as many days in the hospital as younger persons. Furthermore, more than half of our citizens over 65 have incomes of less than $1,000 per year. While the Kerr-Mills bill has been of assistance in those States where the legislatures have chosen to cooperate with the Federal program, it falls short in two respects. First, it is not helping nearly enough people. In the 3 years since its adoption, the program has been implemented by only 28 of the 50 States and 4 territories; and second, it has the defect that it requires recipients to be medically indigent aged. They must, therefore, be subjected to a means test. In at least 12 States with the program, relatives of aged applicants are subject to financial investigations. These means tests either prohibit or discourage many aged citizens from securing hospital care. We support the King-Anderson bill because we believe it will provide, in a fair and dignified manner, for many of the hospital, nursing home, and diagnostic needs of our aged citizens. We believe that our elderly people should not be left to the mercy of means tests or be deprived of living essentials in order to pay hospital expenses. The fairest, most efficient method of financing is through the social security system. The increase proposed in social security taxes is not excessive. It is for these reasons that we urge early committee action in favor of the Hospital Insurance Act, H.R. 3920. Very truly yours, ROBERT EDWARDS JONES, HEALTH CARE FOR THE AGED Adopted by the 47th Biennial General Assembly, Chicago, Ill., November 1963, by Union of American Hebrew Congregations, New York, N.Y. Treatment of the aged is a test by which to judge the moral character of a society. "Thou shalt rise up before the hoary head and honor the face of the old man" (Leviticus 19:32) is a commandment with renewed significance. In a time of rapidly increasing longevity and rising medical costs, our society cannot ignore the plight of millions of elderly citizens who cannot meet the expenses of serious or protracted illness. The requirement to demonstrate inability to pay before receiving medical care will limit the number of people receiving aid and will infringe upon their dignity. Medical care for the aged is a right to which all citizens are entitled by virtue of living in an enlightened society. We urge the enactment of legislation which will provide adequate medical care for the aged, whether within the framework of the social security system, or other nonprofit systems of low-cost coverage. HEALTH CARE FOR THE AGED (Adopted June 1962 by Central Conference of American Rabbis, New York, N.Y.) We hail the efforts of the Kennedy administration to provide medical care for the aged within the framework of the social security system. It is our contention that the Nation is strengthened when we make it possible for those who have helped to create America's economic and social wealth to receive adequate medical care after their earning power has decreased. Our support does not mean that we consider the King-Anderson bill the complete solution to the problem of medical care for the aged. But we regard it as the establishment of a beachhead in the continuing struggle to preserve the health and dignity of the aged. STATEMENT BY CLARK W. BLACKBURN, GENERAL DIRECTOR, FAMILY SERVICE ASSOCIATION OF AMERICA, SUPPORTING THE EXTENSION OF HEALTH BENEFITS TO THE AGED UNDER SOCIAL SECURITY The Family Service Association of America, 52 years old this year, is a federation of over 300 local family service agencies throughout the country, largely supported by local united funds and community chests. Staffed by approximately 2,800 professional social workers, these agencies serve over 1 million people in troubled families each year with counseling and related social services. This frequently involves counseling with respect to family relationships, as, for example, between husband and wife, parents and children, or several generations in a family group. It may also involve a direct service, such as providing temporary homemakers or foster care, or consultation may be given about where to turn for a particular type of specialized help. Increasingly, in recent years family service agencies have been approached by people from all walks of life and in all income groups for help in dealing with the many problems facing older members of the family group. In 1961, the Family Service Association of America established a special project on aging to help member agencies meet this growing demand on the part of families for help in meeting needs of older relatives. This demand will increase because the aging population of our country will continue to expand as the advances of medical science lengthen the average life span, and as the older person's problems of adjustment to his environment become increasingly more complex. As a result of their experience in working with these family groups, our member agencies report family after family where the burden of meeting health care needs is causing financial and emotional stress on many older people and their adult middle-aged children an other relatives. These same difficulties, moreover, affect not only families served by us professionally, but also affect the families of family service board and staff members and people known to them personally. This combined evidence reveals that the present methods of financing health care for the aging through public assistance, private insurance, voluntary philanthropy, and family resources are not sufficient to meet the needs of our rapidly growing aging population. Since the combined current programs are clearly not adequate, we wish to report to your committee on the health care needs of the aging, and the resultant problems confronting families today as they are reflected in the work of our member agencies. An example typical of many families known to family service demonstrates some of the problems which face older people with health care needs. Mr. and Mrs. A, both over 65, a middle-class couple who have raised three children, have always been financially independent and self-sufficient. Since Mr. A's retirement, they have maintained themselves modestly on his limited pension, social security benefits, and small savings built up through his working years. On this limited income, however, they cannot afford adequate private hospitalization insurance. On the other hand, their financial capacity disqualifies them for any public assistance program for the medically indigent, and the A's, in fact, would make great sacrifice to avoid turning to public assistance. Concerned for the future welfare of their children and grandchildren, Mr. and Mrs. A also wish to avoid becoming dependent upon them. The A's children, now parents themselves, are approaching middle age, and have the typical problems of middle-generation families under pressure to make ends meet as tney finance the education of their own children and plan for their own retirement. Faced with the health needs typical of older persons, however, Mr. and Mrs. A are apprehensive about the future. Hospitalization could well mean exhaustion of their savings, and they fear making expenditures which might push them to the brink of dependency. Since they cannot face becoming dependent on their children or on public welfare, people like Mr. and Mrs. A often postpone seeking medical care until a chronic condition results, or a crisis precipitates emergency hospital care. A varying resultant chain of events stems from fear of the high cost of hospital and allied medical expenses. Many old people do not receive timely, proper, or sufficient health care. Their families often extend themselves to the breaking point, both financially and emotionally, in attempting to provide care and services to substitute for those not available because of their cost. When old people postpone seeking medical care through fear of heavy expenses, physicians often find that conditions which could have been prevented or cured are brought to their attention too late for medical science to help. In the meantime, both the older persons and their families have suffered unnecessary physical and emotional stress, and the resultant physical deterioration makes the years ahead even more difficult. In other instances a physician is consulted and recommends hospital or nursing home care. People like the A's may try to arrange makeshift plans at home because of the fears of the financial burdens of hospital or nursing home care. This not only contradicts the doctor's recommendation, but also places severe strain and stress on the family relationships. The A's middle-aged children may attempt to serve as substitute nurses and homemakers for their parents, which reduces their ability to assume responsibilities and duties which they owe to their children and employers. The strains which result from attempts to provide substitute care within the family budget is frequently the precipitating cause which brings families to our family service agencies for help. How much better it would be if the physician's recommendation for hospital or nursing home care could be followed without concern about meeting the financial cost. This would be possible if a system of prepaid social insurance were established. In some instances physicians may recommend that an older person be treated at home provided certain professional services, such as physiotherapy and nursing care, can be made available on an intermittent basis. When it is impossible to finance these home health services, obviously the patient is deprived of the medically recommended treatment. A patient should receive the kind of care which his physician recommends as the best medical treatment. The choice of care should be based on medical rather than financial criteria. Thus we see that if there were a more adequate way to finance hospital, nursing home care, and home health care, people like the A's would not put off seeking medical treatment until it is past due, and they could be cared for in a more efficient and medically recommended way. We would not only insure more timely and more adequate health care for the aging members of our families, but we would at the same time help remove the anxieties and tensions from the middle generation which currently bears the burden of caring for many of our older people. We see that the present gap between health needs of the aged and the provisions now available to meet them has an unfortunate impact on family relationships. We find it difficult to understand the thinking which holds that socially organized measures like social security tend to discourage or minimize family ties and solidarity. Our experience runs directly counter to this. Our observation is that family ties are weakened when burdens placed on the family relationships exact too heavy a toll. Present-day older people are just as resentful of being dependent on the generosity of their children as their children are torn by the conflicting needs of young and old. This does not mean, in our view, that families care less about their older members or feel less responsibility for their well-being than they did in former times. On the contrary, it is our observation that these family difficulties arise from the fact that families are struggling-often beyond their capacity—to make up to older people for the failures of our rapidly changing social structure to take their needs adequately into account. When we do not provide a good social base and adequate social measures for our expanding aging population, it is the family that must make up the deficiency, and family relationships are sometimes subject to considerable strain in the process. 27-166-64-pt. 5-9 One of the most successful methods of preventing need in old age has proved to be the system of social insurance through which people can pay in their working years to more adequately cover their needs in retirement. This system which has served so admirably to provide cash income in retirement should now be extended to the field of health benefits. This would not only help appreciably to solve the economic problem involved in financing health services in the high risk-lower income years, but would do so in a way that would strengthen family ties. In the same way that the social security income of older people has served to relieve many of the tensions that formerly grew out of financial dependency on their children, so, too, a clear entitlement to health benefits would open up the way to better living arrangements and family relationships for older persons. The fact that no future illness of the older person threatens family solvency frees the family for its traditional role as the source of mutual respect, affection, and moral support that it alone can give its members. THE POSITION OF THE BOARD OF DIRECTORS OF THE FAMILY SERVICE ASSOCIATION OF AMERICA IN THE EXTENSION OF HEALTH BENEFITS TO THE AGED UNDER SOCIAL SECURITY The Family Service Association of American is governed by a board of directors of over 50 persons from all parts of the United States, most of whom have served for many years with local family service agencies in their own communities. On May 11, 1961, the board of directors of the association voted to endorse the principle that "medical care for the aging be financed under or provided by the social insurance system," and I so testified before the House Ways and Means Committee on August 1, 1961. On February 16, 1962, the Executive Committee of the Board of the Family Service Association of America voted to clarify its position with regard to proposals for health care for the aging, since it wished to make clear its opposition to means or income tests in health care proposals using the contributory social insurance principles which we support. Therefore, the statement of policy was revised to provide: "an endorsement of the principle that medical care for the aging be financed under the social insurance system with benefits as a matter of earned right." On March 12, 1962, I wrote Chairman Wilbur Mills to that effect. This clarifying action of the executive committee was subsequently endorsed at the next meeting of the board of directors of the association on May 10, 1962. On November 20, 1963, the Family Service Association of America joined with other national organizations in a statement supporting the extension of benefits to the aged under social security which was presented on their behalf by Miss Elizabeth Wickenden, who appeared before you. The statement was signed by James L. Turrentine, Stamford, Conn., FSAA president 1961-63; Roy E. Morgan, Wilkes-Barre, Pa., FSAA president 1963-64, and by myself as general director of the association. As a result of the needs reflected in the work of family service agencies as discussed above, we continue to urge the Ways and Means Committee to take early and positive action to provide more adequately for the health needs for our aged population. STATEMENT REGARDING H.R. 3920, HOSPITAL INSURANCE ACT OF 1963 (OTHERWISE KNOWN AS THE ANDERSON-KING BILL) BY NATIONAL FEDERATION OF SETTLEMENTS AND NEIGHBORHOOD CENTERS, NEW YORK, N.Y. The National Federation of Settlements and Neighborhood Centers is composed of 264 affiliates operating 356 neighborhood centers in 88 cities and 31 States and the District of Columbia. The National Federation of Settlements and Neighborhood Centers supports H.R. 3920, Hospital Insurance Act of 1963, on the basis of the resolution adopted at its delegates' annual business meeting in Boston, June 1960, as follows: "The National Federation of Settlements and Neighborhood Centers believes that communities must assure to all their citizens full access to the best possible preventive, treatment, and rehabilitative services known to modern health sciences. It therefore supports a comprehensive program of health insurance through the social security system with supplementary programs for nonparticipants in the social security system with no means test." |