STATEMENT IN SUPPORT OF MEDICAL CARE BENEFITS FOR THE AGED UNDER SOCIAL SECURITY, BY THE NATIONAL COUNCIL OF JEWISH WOMEN, INC., NEW YORK, N.Y.

A major concern of the National Council of Jewish Women in the past decade has been with the problems of America's growing numbers of senior citizens. We have been serving the elderly through some 200 varied service projects across the Nation. Discussions with the elderly and a survey of medical costs among members of council golden age recreation centers have pointed up the prevalent fear of illness among older people and particularly their anxiety about meeting large medical bills in case of serious illness.

The basic position of this organization is expressed in our national resolution “to work for a social security program which will provide social insurance as the basic method for financing the costs of medical care for the aged and disabled." This current statement of our view was adopted at council's national convention in 1963 by the elected delegates of our 329 affiliated local units from coast to coast. This resolution is the natural climax of the history of long support by the National Council of Jewish Women of the principle of social security which began with a resolution adopted in 1935 to "work for a social security program which will provide financial protection for all employees and self-employed during unemployment, sickness, disability, and old age." Our reasoning is indicated in a statement adopted by the delegates to our national convention in Pittsburgh in 1961 pointing up that "only a small percentage of Americans are able to save enough during their working lives to sustain the cost of protracted or catastrophic illness in old age."

We still view a program of medical care financed through social security, as we did in May 1962, when the National Council of Jewish Women's executive committee stated: "Far from being an infringement of freedom, it enables the individual to preserve his dignity ***. Unlike plans through which the Government appropriates public funds to pay for medical care for people who can't afford it, a social insurance plan keeps the Government out of the medical field by enabling each individual to provide for himself."

The National Council of Jewish Women urges the House Ways and Means Committee to report favorably, without delay, a measure to provide insurance benefits under social security to help Americans meet the costs of major illness in their later years.

STATEMENT BY THE NATIONAL JEWISH WELFARE BOARD IN SUPPORT OF THE EXTENSION OF HEALTH BENEFITS TO THE AGED UNDER SOCIAL SECURITY

At its 1962 biennial convention, the National Jewish Welfare Board voted the following resolution:

"Be it resolved, That the National Jewish Welfare Board urge the strengthening of the social security system in such manner as to include health care benefits on the basis of earned rights acquired through contributions to the social insurance fund."

The National Jewish Welfare Board is the parent body of 477 Jewish community centers, their branches and camps, whose membership totals more than 700,000. It also serves as the agency of the Jewish community in this country recognized by the Government to deal with religious, morale, and welfare problems of Jewish personnel in the Armed Forces and in Veterans' Administration hospitals. The National Jewish Welfare Board's relationship with Jewish community centers, who provide extensive programs for our senior citizens, provides it with a special competence for identifying the needs and problems of the aging and for helping to provide solutions to these problems.

An inquiry made by our organization's public affairs committee, chaired by Rabbi Morris Lieberman, of Baltimore, Md., among Jewish community centers and camps serving older adults, revealed widespread concern about adequate health care for the aged and unanimous support of the effort to provide for their medical care under social security.

As is known from many sources, there are 17,500,000 individuals in the United States who are 65 years of age and older. In 1967, the figure will be 20 million. In 1972, the total will increase to 23 million. Nine out of ten people over 65 are or will be hospitalized; 2 of 3 people will be hospitalized two or more times. Older people use about five times as much hospital care as younger people.

In 1946, the average daily cost for hospital care was $9. Today it is $32. The average hospital stay for a person over 65 is 15 days.

Most people over 65 have hardly enough money to support themselves-their average income is $1,300 a year. Few have savings adequate to cover an extended illness. A 1961 survey showed more than half having liquid assets of less than $500.

The question arises, "Can private insurance cover these health bills?" The answer is "No." Because older people are sick more often and for longer periods than young people, private insurance coverage is either too expensive or too limited to meet their needs. Dr. Arthur Flemming, president of the University of Oregon, and Chairman of the National Committee on Health Care of the Aged, states:

"Too many of the aged are unable to afford health insurance or are considered too poor a risk. In fact, the number carrying some form of health insurance is just over half of the aged population. In most cases they carry hospital insurance. In many instances it falls far short of meeting the costs of illnesses."

The National Jewish Welfare Board believes that the present Kerr-Mills bill is inadequate to meet the health needs of the aged. Today, only 28 States have implemented the Kerr-Mills bill. In most of these States the program is meager. This program has built into it à humiliating poverty test. In many States, savings must be exhausted and children must undergo a similar test to get help for their parents. Under the program only the very poorest are protected. Savings or income above minimum make one ineligible. Those eligible for KerrMills medical assistance which is provided by the States, though financed through Federal appropriation, have no choice in many States as to hospital and doctor. We believe that medical care through social security contributions will insure a good quality of health services. We believe the law will insure the use of standard facilities and that it will guarantee free choice of hospital and doctor. We believe that benefits will be uniform throughout the Nation and that the program can be carried ou at no cost to the Federal budget.

The National Jewish Welfare Board therefore supports H.R. 3920 as introduced by Representative Cecil R. King.

ALABAMA LEAGUE OF AGING CITIZENS, INC.,
Montgomery, Ala., October 29, 1963.

Hon. LEO IRWIN,

Chief Counsel, House Ways and Means Committee,
House Office Building, Washington, D.C.

GENTLEMEN: In behalf of the Alabama League of Aging Citizens, Inc., and senior citizens legislative committee of the Alabama pensions and senior organizations, we urge a favorable consideration of the King-Anderson bill, House bill 3920, to amend the Social Security Act to provide insurance for the cost of hospital, nursing home, and surgical services for persons eligible for old-age and survivors benefits.

We believe that the problems of medicare for the aged of America, must be approached fundamentally on a self-help basis, not through the demoralizing means test involved in public assistance.

The approach should be one that is consistent with the American concept of earning security through work. The problem is not in the aging; it is in the social segregation of the aged into a class. A group potentially with misidentification and misdirection. We have put the entire burden of adjustment on the persons who turn 65. We like to remind the committee, that the United States has survived the greatest hardships under this democratic form of government. We are most charitable and hospitable nation in the world and yet since its beginning we have been blind to the fact that society, too, must make adjustments. Our approach to the problem of medicare has been psychologically harsh, politically hazardous, and economically immature. Yet with our trillions of dollars economy, we have not made the cultural accommodation necessary for the aged segment of our American society.

Secondly, by what standards do we measure culture? According to the White House Conference on Aging, "it is customary to evaluate a nation by the magnitude of its scientific contributions or the quality of its artistic achievements." However, the true standards by which to gage a culture is the extent to which reverence, compassion, and justice are to be found in the daily lives of a whole people, not only individuals.

The test of a people is how it behaves toward the aged. It is easy to love children. Even Stalin, Hitler, and Mussolini made a point of being fond of children. But the affection and care for the old, the incurable, the helpless, are the true gold mines of a great culture.

In our own days, a new type of fear has evolved in the hearts of millions of aged citizens; the fear of high cost of medical care. In the spirit of the Biblical principle that reverence for the old takes precedence over reverence for God, we are compelled to confess that a nation should be ready to sell, if necessary, the gold and silver treasures at Fort Knox and the sacred objects from its houses of worship in order to help one sick man.

Is there anything as holy, as urgent, as noble, as the effort of the Congress and the whole Nation to provide health care for the needy old people?

This is one of the great Biblical insights: The needs of suffering humanity are a matter of personal as well as public responsibility. The Representatives of the people of these United States are held responsible for the neglect of the dignity of human life, if they have failed to provide properly for those in need. The sages of old, realized that it was not enough to trust to individual benevolence, and that care for the sick was a responsibility of the whole tribe.

It is in accord with these traditions that all major senior citizens and religious organizations of the Nation have endeavored to establish and provide medicare without any form of socialism, basic health insurance for the aged through the contributory social security system which would be the key to a threefold solution:

(1) Basic health insurance protection afforded almost all older people through social security.

(2) Supplementary protection through private insurance.

(3) With the main burden of health costs met by social security, it would become possible in all States to set up a good medical assistance program under Kerr-Mills to meet any remaining needs.

Also providing the assurance that no fees or services performed by any physician at either home or office, would be involved, covered or affected in any way by this act.

Whether this is socialized medicine or not, depends only upon the source of the definition. Certainly, it is social legislation of a most sweeping nature, nor is it coincidental that the program would be part of social security. It is in place there, logically enough, because it would deal with old people already eligible for social security benefits.

And since this means a heavy drain on social security funds, the administration would raise the payroll tax. The American old people are not anxious to see the Federal Government grow larger and larger every day, taking on more and more responsibility, extending its influence into more and more fields. But the American people, nevertheless, are certain that there are some problems which only the Federal Government has the fiscal power to solve. Health care through social security could be one of them.

The King-Anderson bill, H.R. 3920, will take a leading part in reducing our yearly mortality rate of about 700,000 among persons aged 65 and over. Please make every approach that should be explored by Congress which might offer a remedy to the present situation, where large numbers of senile patients are sent to hospitals for the mentally ill to die, because of the lack of a suitable program and facilities for treatment of the aged.

It has been the league's position that all people over the age of 55 should as a matter of right receive equal consideration and opportunity. It is an obligation of a democratic government to make certain the specter of fear which hovers over the housetops of our Nation's senior citizens be removed.

It is our sincere belief that the King-Anderson bill, now pending in the House Ways and Means Committee, will benefit the people of Alabama as follows: (1) It will benefit the 167,000 retired workers and their dependents receiving social security, and 77,000 persons and children of deceased workers.

(2) It will benefit 37,000 Alabamians in the 65-and-over bracket, who are neither pensioners nor OASDI recipients.

(3) Social security medical care would reduce the load of Alabama's present program under the Kerr-Mills Act and release funds to enable Alabama to expand services for the groups.

(4) It will protect doctors who have spent years in study, and have given services and time in meeting community needs-half the time without the assurance of adequate compensation for their services.

(5) It will help 25,000 social security pensioners, who are included on the State old-age pension rolls, to receive health care without pauper oath.

(6) It will help the hospitals and nursing homes in Alabama, which have spent millions of dollars in equipment, and cannot risk the nonpaying patients. (7) It will help the Nation and State industry with more hospital and nursing homes built in the Nation and the State of Alabama.

(8) Above all, it will help the individual senior citizens to once again regain self-respect and dignity.

In the name of democracy and humanity, we urge that the American people and Congress should give the King-Anderson health program the most careful consideration. It would be highly irresponsible to reject the program out of hand, without providing an adequate workable health program for all American senior citizens.

This bill, regardless of expenditure, will not be a liability to the country. It will be an investment for the best future interest of our Nation. Nor can those who so oppose a liberal national hospitalization and medical plan seriously argue that this bill is a step in the wrong direction.

In conclusion, I have one one life, and it's short enough, and I will give it for my country's security. I have no time to waste in things that are unAmerican and unhumanitarian. Thank you.

Sincerely yours,

RUBIN MORRIS HANAN,

President. NOVEMBER 14, 1963.

Hon. JOHN E. FOGARTY,
Member of Congress,

House of Representatives.

DEAR SIR: Enclosed you will find my testimony that has been submitted to the Ways and Means Committee. If you feel that it would be any assistance to getting bill H.R. 3920 through the House by having this testimony inserted in the Congressional Journal.

Thanking you in advance, with respect, I am,

P.S.-Please excuse bad spelling and writing.

LEO IRWIN,

JOHN F. KINDER, North Kingstown, R.I.

NORTH KINGSTON, R.I., November 12, 1963.

Chief Counsel, House Ways and Means Committee,
House Office Building, Washington, D.C.

MR. CHAIRMAN AND MEMBERS OF THE COMMITTEE: It is a privilege to write my testimony to you on behalf of bill H.R. 3920, hospital insurance through social security.

I believe in the past 4 years or more, through number of hearings by members of congressional committees, it has been brought out the need for this program to help the aged to get the medical care that they need. Also that the best way to do it is through social security. I shall not take up your time to repeat what organizations and individual citizens have proven to be a must. I have seen the records of the committee hearings and know that you have too.

I have been very active in this field for I am one of the aged. I am 74 years of age and I receive as much as you can get through the social security pension. which is $127 per month. It is not enough to cover living expenses, let alone medical care.

Let me say that members in both political parties should be very much interested, because their followers will be affected by whatever is done with this program, and if it does not come out the way people want it to, I am sure that in the next few months to come you will hear about it from the voters in their home districts.

Now may we look at who supports this bill, H.R. 3920?

Labor, thousands of organizations and individuals by writing letters to their Congressmen, have had two public relations polls and come out 100 percent for the bill H.R. 3920. I think you will find these statements true.

The group that opposes this bill the most is the American Medical Association. They oppose individual contributions through payroll deductions as a fringe benefit to take care of medical needs in old age, and ask employers to do the Now who can see anything wrong with this? Congress appropriates

same.

millions of dollars every year to put out in grants to hospitals for building additions and research. The individual home States also give contributions for the very same things. The AMA does not oppose these funds because they benefit directly or indirectly, but they continue to raise the cost of medical care.

In this State of Rhode Island alone, it costs $29 per day for 1 day's room and board. This is the minimum cost; and this is only one-half of the cost for the day. You pay for anything you may get extra, even one pill. The whole day's cost is about $60. Now how can anyone living on a pension of $127 per month, pay this much for hospital care?

As for the Kerr-Mills bill, it is only a welfare program. Why should the aged citizens, that have been forced into retirement have to accept welfare? They deserve independence, dignity, and respect that they have earned over the years. I hope that the committee will approve bill H.R. 3920 and send it to the House for approval also.

Yours sincerely,

JOHN F. KINDER,

Vice President, Legislation and Publicity, Rhode Island State Council of Senior Citizens.

STATEMENT ON H.R. 3920, THE KING-ANDERSON BILL AND HEALTH CARE FOR THE AGED BY COMMUNITY COUNCIL OF GREATER NEW YORK

The Community Council of Greater New York is the planning and coordinating body in the health and welfare fields for over 1,000 official and voluntary agencies, including the 3 sectarian federations of New York City. (App. C.)

CONTENTS

A. Income and medical expenditures of older people in New York City.

B. Inadequacy of the alternatives to the social insurance approach.

C. Policy statement on health care of the aged.

D. Recommendations concerning H.R. 3920.

Appendix A. Older people in New York City: Facts and yardsticks.

Appendix B. Endorsements of the community council's policy statement.

Appendix C. Corporate members and board of directors of the Community Council of Greater New York.

SECTION A: INCOME AND MEDICAL EXPENDITURES OF OLDER PEOPLE IN NEW YORK CITY (SUMMARY OF APPENDIX A)

The plight of the aged

The 1960 census indicated that there were 813.827 people 65 years and older in New York City. We estimate that this age group may total 11⁄2 million by 1970. About 21 percent of those 65 and over had no money income in 1959 and an additional 49 percent had income of less than $2,000.

In 1960, the cost of hospital and related institutional care for New York City's aged was $222 million. This means almost one-third the total cost for all such care was incurred by only 10.5 percent of the population.

New York City's aged use almost three times as many patient days in general hospitals as the younger age group and 27 percent of all ward service in general hospitals.

As overwhelming as these data are, they do not convey the full significance of the problem. Two vulnerable sectors of the aging population warrant special mention the "older" aged group, that is, those 75 years and over, and the single person, particularly women, living alone.

The aged, 75 and over

Of special significance in relation to need for health services is the size of the group 75 years and older, almost 230,000 people in 1960. This group will increase at a propotionately faster rate, probably totalling 330,000 in New York City by 1970.

A

While there is no precise documentation available regarding the cost of the medical care they need, we know that expenditures for medical care by the group 75 years and older is double that of the group 65 to 74 years of age. survey of budgets and spending patterns for a sample of New York City families in 1960 by age of head of family was undertaken by the U.S. Department of Labor. Bureau of Labor Statistics. ("Some Facts Relating to the Economic Status of the Aging.") This showed an average 1960 expenditure of $342 for medical care for families headed by persons 65 to 74 years, not in institutions, compared to $686 for families with heads 75 years and older, not in institutions.