the average age of patients was 77. There are presently a number of new nursing homes under construction which will saturate the State for a few years to come, according to Mr. Dalebout. These homes, when completed, will add approximately 500 new beds. These homes are primarily private enterprises. In April 1963, the MAA program supported 1,300 nursing home patients.

HOME HEALTH CARE

According to the 1960 report of the Council on Aging there were very few home health care programs in effect. Since that time a major effort has been made to rectify this situation by the county and city health departments under the direction of the State health department. The various county health departments provide treatment in the home with a request from the doctor. In some areas, the city and county are separate as in Salt Lake where the city has 26 nurses assigned to different districts who make calls under doctor's orders. The county has a separate facility. Other counties and cities operate jointly in their programs.

A special home nursing care program has been established in Weber County. It is a program which, according to Mr. Bill Manning of the State health department, is working out very favorably as a means of caring for those long-term patients not ill enough to go to hospitals. He further stated they hope to extend this program into other areas rapidly inasmuch as it is beneficial both economically and from the patients' standpoint.

Another service which is available in Salt Lake County is the Community Nursing Service. This organization, which is supported by United Fund and pay patients, has a staff of eight nurses who make approximately 1,600 visits per month as directed by doctors. There are similar organizations in other

counties.

Respectfully submitted.

HAROLD BOWMAN, Executive Secretary.

STATEMENT OF THE VERMONT STATE MEDICAL SOCIETY ON H.R. 3920

Mr. Chairman and members of the committee, my name is Roger W. Mann of Jeffersonville, Vt., Secretary of the Vermont State Medical Society. I am a physician in active general practice in northern Vermont. Mr. Getty Page, our executive secretary, and I had hoped to have the opportunity to appear before you, but due to the lack of available time you were unable to fit us into your schedule. We would, however, request that this statement be made a part of the record.

Two years ago it was our pleasure to report to you on our own survey of the health care of the aged in Vermont. Your appreciation of the situation in Vermont then, makes us feel you would be interested to know how Vermont is doing in caring for its aged this year.

We would like to cover two main items:

1. The extent of health care coverage for those 65 years of age and over in Vermont.

2. The MAA program in Vermont.

The compilation which I am presenting is original. The individual researches have been done by such recognized authorities as the Bureau of the Census, New Hampshire-Vermont Blue Cross-Blue Shield, the Health Insurance Institute, the Vermont Department of Social Welfare, and the Vermont Department of Institutions.

I would like to illustrate our findings with a pie graph (see app. A). This is not professional art work, but it tells the story nevertheless.

The total population of Vermont is 389,881. Of this total, 43,667, or 11.2 percent, are age 65 and over. The chart shown in appendix A is about them.

27.4 percent have commercial or private health insurance. This is shown by the dotted line area.

56.3 percent have Blue Cross-Blue Shield. For those with incomes of $2,500 per year single or $4,000 a year couple, this is a service contract: full coverage.

12.6 percent are on old-age assistance which has its own health care program, and in Vermont full hospitalization and nursing home care, with physician's bills paid; 10 percent of this group also have Blue Cross-Blue Shield.

1.3 percent are in State institutions where their health care is provided. The total of these is 97.6 percent, leaving a balance of 2.4 percent, but correcting this for the known duplication in OAA and Blue Cross-Blue Shield, we have 3.7 percent, or only 1,514 persons in Vermont uncovered. This 3.7 percent group includes those persons who are well to do and have neither private health insurance nor Blue Cross-Blue Shield. You may have noticed I have not mentioned anything about the MAA yet-this program will of course more than cover this 3.7 percent group, and we are pleased that it does.

The exact number of people who are eligible for MAA is difficult to ascertain because actual determination is not made until need (both medical and financial) is shown. If we took the income limits alone, 60 percent of our population age 65 and over would qualify.

MAA in Vermont, we are happy to say, is essentially a major hospitalization program. The patient pays $7 per day deductible for up to 2 weeks, with MAA taking care of the rest: the balance of the full hospital cost during the first 2 weeks and the entire hospital bill ad infinitum-even 1 year, or 2 years, however long is necessary-provided there is a need.

The caseloads in MAA are not living up to expectations. The need, as originally anticipated nationally, has not materialized in Vermont; therefore several liberalizations for eligibility have been made since the program was instituted a year ago last July.

We feel that people are made aware of the program because the hospitals and the doctors know about it and, if they feel the patient can qualify, they are encouraged to apply.

The department of social welfare is considering adding drugs. Then it will be quite all inclusive: hospital bill, drugs and doctor visits.

If Vermont can do it, how about the rest of the country; aren't they doing equally as well? 11.2 percent of our population is 65 and over. This ratio is exceeded only by three States. Our per capita income places us in 35th position-so we, statistically, are a poor State with lots of old people; but we are a hardy and independent lot and take pride in taking care of ourselves.

Our commissioner of social welfare made the statement, according to the press, on May 5, 1962, that there was: "No need for King-Anderson bill in Vermont." Our senior Senator, the Honorable George D. Aiken, spoke similarly when in a Claremont, N.H., speech of February 11, 1963, he said:

"Bluntly speaking 'medicare' as proposed by the administration is a political joker.

"It would not provide medical care at all.

"It would not pay any doctor's bills.

"It would not furnish any medicine to keep old people in good health in their homes.

"It would only provide limited benefits in a hospital ward for which the patient would contribute the first $90 of costs, the limited aftercare in a type of nursing home which in New Hampshire and Vermont is practically nonexistent.

"In short, if you are old and need help from this administration, you are going into a hospital ward whether you like it or not and whether you need hospital care or not.

"By means of an additional payroll tax the entire costs of the White House medicare problem-other than that charged to the patient himself-would be paid for by the low-income people of America, the very people the President now professes to want to help.

"Every elderly millionaire in the country would be eligible for equal benefits to be paid for by a tax on earnings of less than $5,200 a year.

"This is Robin Hood in reverse."

In summary then, we feel that if Vermont, which has the fourth highest number of older people per capita, and is one of the lower income per capita States, can adequately take care of its elderly people without any further Federal laws, that the rest of the 50 States should be able to care for their aged also. We feel certain that, with the Kerr-Mills program in Vermont actually begging for recipients, neither the King-Anderson nor any similar compromise bill is necessary.

Thank you very much for the opportunity of including our statement in the record. ROGER W. MANN, M.D.

Appendix A

Health Care Coverage In Vermont for those 65 years of age & over

MAA (Medical Aid for the Aged) is not shown on this chart. Considering only the annual income requirements, 60% of those age 65 and over would be eligible.

TESTIMONY OF THE MEDICAL SOCIETY OF VIRGINIA ON H.R. 3920

The Medical Society of Virginia, with 3,200 members, is the largest and most representative medical society in the State. It is one of the oldest medical societies in the Nation-having been founded in 1820. While it has grown with Virginia and the Nation, its purposes have remained unchanged over the yearsnamely, the promotion of the science and art of medicine, protection of public health, and the betterment of the medical profession.

While the Medical Society of Virginia is essentially a physician's organization, it has established a long and enviable record of public service. It has made its voice heard in the areas of medical service, voluntary health insurance for all age groups, public health and welfare, medical education, mental health, and so on down the line.

As far as services to its members are concerned, it has provided active leadership in matters pertaining to postgraduate education, State and National legislation, public relations, mediation, professional liability and other insurance programs, ethics, etc.

Concern for the health care of our aging population is certainly nothing new for the Medical Society of Virginia. As a matter of act, the society played a leading role in obtaining the enactment of legislation which established Virginia's State-local hospitalization program in 1946. This program is still unique in that it assists the State's medically indigent to obtain hospital and medical care without turning to the Federal Government. The program is a cooperative one-stressing and placing responsibility where it truly belongs-at the local and State levels. The program assists the needy sick of all ages-not just those over 65. Virginia, and the Medical Society of Virginia concurs, believes that the needy young must be helped just as much as the needy aged. Illness and adversity know no special targets. Regardless of the fact that our State-local hospitalization program has operated with little, if any, fanfare or publicity, its splendid record is available for all to see (see attached exhibits).

The Medical Society of Virginia took a strong stand in support of the KerrMills law in 1960 and feels that its faith in that legislation has been more than justified. Virginia has participated in the old-age assistance (OAA) portion of the law since its inception, and now stands ready to implement a program under the medical assistance to the aged (MAA) portion beginning January 1, 1964. The delay in implementing the MAA portion of Kerr-Mills can readily be explained by the fact that Virginia's General Assembly meets every 2 years and it was not possible to enact enabling legislation until the 1962 session. It is to the credit of Virginia's lawmakers that, even in a period of unusually heavy budgetary demands and problems, they made available those State funds necessary for a first-rate program. The State appropriation is based upon an estimated need of $22 million per year.

In 1959, the house of delegates of the Medical Society of Virginia called upon Virginia physicians to continue their policy of providing medical service regardless of ability to pay, and especially in the aged group to recognize the importance of providing services at the lowest possible cost. The house also asked all carriers to develop and bring forth new plans designed especially for those over 65. Members were requested to accept reduced fees under any such special plans offered by Blue Cross-Blue Shield and the commercial companies.

As the result of that request, the Virginia Hospital Service Association (Blue Cross) and Virginia Medical Service Association (Blue Shield) developed special senior-citizens contracts. These contracts, now available at any time during the year to our older citizens, have been found most attractive over 1,000 already issued. It is also good to note that the commercial insurance companies are also writing special contracts for the older age group, and an industrywide over65 plan is in its formative stages. The plan will be similar to those developed in Connecticut and elsewhere.

One of the society's most active committees has been that concerned with the aging and chronically ill. It was through this committee that the society, in 1960, took the lead in organizing the Virginia Joint Council To Improve the Health Care of the Aged. This council welds the Medical Society of Virginia, Virginia Dental Association, Virginia Hospital Association, and Virginia Nursing Home Association into a coordinated unit—working to find the answers to mutual problems.

Virginia physicians are greatly concerned over the conflicting estimates of what a health care program financed through the social security mechanism would cost. The administration has placed first year cost at $1.1 billion. This figure, according to insurance actuaries, is much too low. There are many who predict that the cost would be at least twice that much. They also say that by 1983, the cost will be $5.4 billion-an increase of more than 500 percent.

Should these dire predictions be true, then it would appear that our social security system is in serious danger of being completely swamped.

It is difficult to say just how Virginia's already overburdened taxpayers would stand up under such increased loads. Should King-Anderson legislation be enacted, an additional 15 to 17 million social security tax dollars would be taken from our Virginia taxpayers and mandatorily assigned to a specific area of governmental activity.

In summation then, the Medical Society of Virginia is unalterably opposed to H.R. 3920, and clings strongly to the principle that the finest health care available should be provided those who need help, but no bureaucratic program of unpredictable cost should be established for those who are perfectly able and willing to take care of their needs.

VIRGINIA COUNCIL ON HEALTH AND MEDICAL CARE

THE STATE-LOCAL HOSPITALIZATION PROGRAM

What it is when it developed-why it developed-what it does--who is helpedwho participates in it-administrative problems-why it needs expanding— some facts and figures-why it is important to all Virginians

SLH CONFERENCE

A conference on the State-local hospitalization program will be held on Thursday, October 17, 1963 at the Hotel Roanoke, Roanoke, Va. The meeting will last from 10 a.m. until 3 p.m. Citizens of the Commonwealth are invited and urged to attend this important conference.

WHAT IS THE SLH PROGRAM?

The State-local hospitalization program is a statewide plan to provide inpatient hospital care and treatment for medically indigent residents of Virginia. Funds appropriated by the general assembly are made available to match local money on a 50-50 basis, as long as funds appropriated by the State last.

The SLH program is administered locally under limited State supervision. It is based on a law which permits counties and cities to decide the extent of their participation. It is a local option law. All counties except two, Amelia and Powhatan, and all cities except one, Hopewell, participate in the SLH program. Almost all counties and cities have participated in the program since it started. Each locality determines who is eligible for hospitalization at public expense on the basis of its own definition of "indigency" and "medical indigency." Local responsibility for operating the SLH program rests with the governing body which can designate any person or agency to administer it as their authorizing agent.

The choice of hospitals to be used by a locality is left up to the locality. It negotiates an agreement with hospitals for care on the basis of an all inclusive per diem rate. The law requires that the State department of welfare and institutions give its final approval to these agreements.

No Federal funds are involved in the SLH program.

WHEN WAS THE SLH PROGRAM DEVELOPED ?

The general assembly established the State-local hospitalization program in 1946. This came following a study made by a commission set up by Joint Resolution No. 8 at the special session of the general assembly in 1945. The commission was created "*** to make a thorough study of the facilities now offered by the State of Virginia for the hospitalization of indigent people. It shall give careful consideration to the amounts now being appropriated to the hospitals of the University of Virginia and the Medical College of Virginia for the care of indigent patients, and determine if more efficient service could be rendered by making available to the political subdivisions of the State a sum sufficient to care for their indigent citizens."

WHY DID THE SLH PROGRAM DEVELOP?

Some findings of the legislative commission:

1. There was no coordinated plan in the Commonwealth for the hospitalization of medically indigent persons.

2. With rising hospital costs, persons of modest means were either being denied needed hospitalization or hospitals which accepted these persons as patients were facing serious financial losses with the possibility of their closing. 3. A large number of people needed hospitalization but were financially unable to provide it for themselves.