Chart of OAA recipients as a percentage of the over-65 population in Delaware Recurrent in all of these surveys and statistics, and consistently recognized by the medical society, is that while most of the elderly population can care for itself, there is a minority which cannot. We have given full support to the implementation in Delaware of the KerrMills Act. In 1961 an advisory group to the welfare department consisting of the welfare council, the State hospital association, the State labor council. AFL-CIO, and ourselves, suggested unanimously that a comprehensive program of medical and hospital care be made available through the Kerr-Mills Act. Delaware had never had such a program, even for OAA recipients. Therefore, the committee further suggested that the program be confined solely to the OAA group until experience could be accumulated and the administrative machinery could be well established. (Let us add, here, that we are not speaking for any of these groups, beyond reporting this decision.) The program is now in operation, and is providing, among other things, hospitalization, outpatient care in the offices of private physicians, dental care, prescription drugs on both inpatient and outpatient bases, and home nursing services. There is no limit on time or cost for any of these services, except, of course, on fees for individual services or, in the case of hospitals, for reimbursable cost formulas. The program is being expanded as experience proves expansion desirable. It is our very sincere hope that in a year or two eligibility can be broadened to include the group of medically indigent. Since the program has been in full operation for less than a year, and since not all services now offered have been underwritten even for that long, it is unfair to draw firm conclusions on the cost. However, it was estimated in 1961 that a full range of health services, far more comprehensive than the proposed H.R. 3920, could be offered the OAA group for about $435,000 per year, Federal and State expenditures combined. Present experience makes this figure appear high, but this may not be a fair conclusion at this point. At any rate, it is obvious that the State can offer truly comprehensive health care through KerrMills to those people who need it for a fairly small fraction of the cost of providing the far more limited King-Anderson package to a great many people who don't need it. On February 28, 1963, Mr. R. J. Myers, chief actuary of the Social Security Administration, gave the American Medical Association information from which the association calculates that enactment of the King-Anderson bill would cost Delawareans $1 million in general revenues in 1965. In addition, the State would pay an estimated $8.8 million in additional social security taxes, or a total of $9.8 million for the first year of operation. To put this in perspective, $9.8 million is very nearly 10 percent of the budget of the State of Delaware. This is a ridiculous amount to spend for a problem of the limited magnitude of partial health care for the State's aged, especially in view of their documented and redocumented ability to do most of the job themselves, as do most citizens. We are unable to understand why a government should tax its citizens under 65, with essential disregard of their ability to pay, to provide limited health services for the over-65 with absolute disregard of their ability to pay. Social security is, of course, a flat percentage tax on a modest wage base, and takes proportionately more money from low-income households than from those with higher incomes. We were sufficiently interested in this question to study the ages of welfare admissions in Delaware's largest privately incorporated general hospital for all of calendar 1962, looking for the concentration by age of inability to pay. In a series of 2,845 patients (100 percent of welfare patients for 1 year), 306 were 65 or over. But 891 patients-nearly 3 times as many-were in the range from birth to 10 years of age. We conclude that there are more young parents who cannot pay their children's bills, much less their own, but would be forced by H.R. 3920 to contribute toward the bills of the elderly, than there are elderly patients who cannot pay their own way. Helmut Schoek, in his book "Financing Medical Care," points out that the aged, as a population group, have nothing in common but the biological characteristic of being old. He says, further, that no nation has ever discovered in its midst an age group per se that was dependent upon the Government for financing of its medical care. It is likely, we feel, that no nation has discovered this need because the need does not exist. We believe that Government can legitimately help those of any age who need help. We do not believe that it is the Government's role to tax the population for the benefit of any biologic age group without regard for the individual's need. All of our experience shows that there is no indication that any age group, specifically including the over-65, is predominantly unable to pay for its health care. If this is true, a program of universal taxation to provide benefits solely on the basis of age is not justified. STATEMENT OF THE IOWA MEDICAL SOCIETY IN OPPOSITION TO H.R. 3920, 88TH CONGRESS Iowa does not now have an obvious need to supplement its programs for providing health care to the near-needy aged. Its legislature this year, at the behest of the Iowa Medical Society and similar groups of public spirited citizens, appropriated money for a Kerr-Mills program so that the numbers of the near needy who haven't previously been helped in securing health care, and the extent of their needs, might be accurately determined. Statistically, the situation is approximately as follows: Iowans 65 or more years of age 1. 1 World War I veterans eligible or about to be eligible for VA care (average age 65.8 years) 1 Well-to-do persons 65 or over (estimate) Iowans over 65 covered by voluntary health insurance (estimate) Total taken care of------ Remainder over 65 not cared for____ 317, 974 30, 000 14, 460 49, 466 30, 000 1 Source: 1960 census. 2 As of Jan. 1, 1962. These are not precise figures in all instances, and they were not all gathered at precisely the same time, but they constitute reasonable approximations. The 1960 census of population (PC (1) 17D) shows that there were 317,974 persons 65 or more years of age in Iowa. That number has doubtless grown somewhat in the succeeding 3 years, but it remains somewhere nearly accurate. The Health Insurance Institute of America estimates that on January 1, 1962, there were 54.7 percent of over-65 Iowans who held health insurance, which indicates that at least 173,934 individuals were caring for themselves by that means. Several other groups are quite fully provided for. There were 14,460 inmates over 65 years of age in Iowa institutions, according to the 1960 census. World War I veterans numbering 49,466 were residents of Iowa when the 1960 census was taken, and their average age at that time was 65.8 years. The total is slightly smaller now, of course, but their average age must be approximately 68.8 years, and by signing an application form they can secure complete health care without cost at Veterans' Administration facilities. Then a considerable number of the elderlyestimated to be as large as the number of OAA recipients-are sufficiently well off so that they can pay their health care bills without difficulty, as they incur them. The remaining 20,114 elderly Iowans, it should be emphasized, have been taken care of quite satisfactorily in the past, at public expense if their own resources were inadequate. Polk County, Iowa, in which Des Moines is located, has a county hospital where the near needy as well as the indigent are provided surgery and medical and hospital services free of charge, and at county, community, and private hospitals throughout the rest of the State, varying numbers of patients are given necessary care free of charge, though they don't all qualify for old-age assistance. All physicians in private practice, of course, are accustomed to cut their charges or to submit no bills for the care of the economically marginal ones of their patients, regardless of age. Like many other States, Iowa operates a public hospital in connection with the State University of Iowa College of Medicine, in Iowa City, and patients are sent there from throughout the State for surgery and/or medical care, either outpatient or inpatient, partially at State expense and partially at the expense of their respective county governments. The administrator of University Hospitals, Iowa City, reports that 15,668 such patients were admitted there between July 1, 1961, and June 30, 1962, and he estimates that at least 50 percent of them were 65 or more years of age. There are no comprehensive records that show how many were relief recipients, in the generally understood meaning of the term, and how many were in the "near-needy" category. Some figures regarding nursing homes in Iowa may help to show the concern that our people are showing for their elderly fellow citizens. Recent authoritative reports indicate that the State is rapidly becoming adequately supplied with such facilities. In 427 existing homes (all but 64 of them proprietary), there are 11,953 beds; 83 of them (41 proprietary and 42 nonprofit), containing 3,915 beds, have been built since 1960, and 60 more of them (39 proprietary and 21 nonprofit), to contain 3,757 additional beds, are now in the planning stage. These institutions provide, or will provide, appreciable amounts of health care to the aged, and in roughly a third of the cases can be expected to subsidize its cost to a considerable extent at the sponsoring church or fraternal organization's expense. THE IOWA KERR-MILLS PROGRAM The Kerr-Mills program which will be started in Iowa on or about December 1, 1963, will certainly provide for any currently unmet needs of the near-needy elderly. 1. The General Assembly of Iowa, last spring, appropriated $1,680,000 as the State's contribution to the program for each of the next 2 years. These sums, together with Federal matching funds, will provide about $4 million per year. In addition, the assembly's interim committee was authorized to release up to $320,000 per year of additional State money, in case the original appropriation proves insufficient. 2. To be eligible for medical aid to the aged, an Iowan may have an income, after deduction of medical expenses, up to $1,500 per year if single, or up to $2,200 per year combined with that of his or her spouse. A single person may have assets up to $2,000, and a couple may have assets up to $3,000, exclusive of a home and an automobile. The 1960 census (PC (1) 17D) showed the median annual income of Iowa families with heads 65 years of age or older to be $2,796. The median annual income for single persons in that age group wasn't clearly stated, but since Iowa ranked 36th among the States as regards incomes of the elderly, the figure can be presumed as not in excess of $1,050 per year, which was the national median for such people. Thus it is apparent that MAA will be available to about half of the elderly people of Iowa who are not already receiving health services under the old-age assistance, aid to the blind, or aid to the disabled programs. It is anticipated that the caseload for MAA will not exceed 1,500 per month. 3. The program will furnish any or all of the following, after the eligible recipient has paid or obliged himself or herself to pay $50 for health care during the current calendar year. Office, clinic, or hospital care rendered by licensed doctors of medicine, osteopaths, chiropractors, podiatrists, dentists, optometrists, and nurses: Hospitalization; nursing home care, limited to 180 days immediately following hospitalization; drugs; laboratory services; and supplies authorized by any of the above named practitioners, within the scope of his or her practice. These include prosthetic appliance of all sorts. 4. The Iowa Medical Society proposed and the 1963 General Assembly of Iowa enthusiastically accepted the idea that during the initial 2 years of MAA, statisties should be collected to provide a basis for converting the program into a State-Federal subsidy for the private health insurance policies of individual MAA-eligible persons. The physicians and the legislators agreed that such an arrangement would best preserve the privacy and dignity of the aid recipients, and would be most nearly consistent with the principles underlying the American free enterprise system. From what has been said in this statement, it should be obvious that Iowathe State with proportionately the greatest number of elderly citizens-has been doing a great deal to assure sufficient health care for all such people, and is about to embark on a program which will certainly remedy any previously existing deficiencies. Further, it should be obvious that the passage of the King-Anderson bill, H.R. 3920, would be altogether superfluous, as far as our State is concerned, quite apart from the fact that it would be enormously burdensome from the standpoint of social security taxation, and wasteful in providing assistance to many people who are economically self-sufficient. C. V. EDWARDS, Sr., M.D., President, Iowa Medical Society. STATEMENT OF THE LOUISIANA STATE MEDICAL SOCIETY IN OPPOSITION TO H.R. 3920 (By George H. Hauser, M.D., president; C. Grenes Cole, M.D., secretarytreaturer; H. Ashton Thomas, M.D., chairman; committee on congressional matters) The Louisiana State Medical Society since its founding in 1903 has been dedicated to bringing the best possible medical care to all citizens of all ages regardless of their financial circumstances. The Louisiana State Medical Society has been equally dedicated to the preservation of the private practice of medicine. The 2,747 members of our society firmly believe that the only way we can continue to provide adequate, high-quality health care for all citizens is by practicing our profession within the framework of the American free enterprise system. We believe that this system has given our people the best medical care available in the world today. Because H.R. 3920 would seriously interfere with the free practice of medicine, and subsequently lower the quality of medical care in the United States, the physicians of Louisiana are opposed to this proposed legislation. People of all ages and all income groups have health and medical problems. Our profession is dedicated to helping people overcome these problems. We fully realize that some of these health problems are of a financial nature. It is not, however, a sound idea, or an American idea, to enact compulsory legislation affecting the lives and incomes of all citizens to assist the relatively few over 65 years of age who need assistance in meeting their health care costs. Our State has made tremendous strides in helping those over 65 years of age, not to mention other age groups, who need help. Because Louisiana has fully implemented the Kerr-Mills law, which was designed to provide assistance for the medically needy aged, we believe there is no call whatsoever for legislation of the type proposed in H.R. 3920. The Kerr-Mills law is working in Louisiana and the needs of those who require help are being met. According to the Louisiana Department of Public Welfare, there are approximately 243,000 persons 65 years of age and older in Louisiana. This represents approximately 7.3 percent of the State's total population. The Public Affairs Research Council of Louisiana, Inc., a nonpartisan, nonpolitical, highly respected governmental research organization estimates the median income of husband and wife families 65 and older was $2,164 in 1959 compared to $4,661 for all such Louisiana families at the present time. When one considers this and the fact that by the time a person has reached 65, his cash needs are considerably less than for those of a younger person (the home is usually paid for, the children are grown, insurance policies are paid up, etc.), our older citizens are not in such bad financial condition as many would have us believe. In fact, most citizens by the time they have reached 65 years of age have accumulated assets far greater than those in younger age groups. In Louisiana, a person over 65 need not be destitute or a pauper to qualify for medical assistance. The provisions for assistance under the Kerr-Mills law are so generous that 126,000 persons, or over half of all over 65, qualify for medical assistance. In simple terms, those over 65 who need help in meeting health care costs in Louisiana have it available to them. A program such as proposed in H.R. 3920 would merely extend help to those who do not need it. |