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Cooperation has been marked among Texas doctors who significantly are accepting Blue Shield payments under the Kerr-Mills Act as payment in full although these payments are substantially below their customary fees. Blue Cross has kept its guarantee that it would administer the program for less than 3 percent of the total premium, a remarkable accomplishment.

The provision of nursing home benefits under the Kerr-Mills program has been most successful, too. The Texas State Department of Public Welfare is administering this portion of the program directly.

Very recently in Texas the Texas 65 plan was made available to aged Texans by a group of leading insurance companies, providing low-cost health insurance. The Blue Cross-Blue Shield Senior Texas Service offers medical and surgical, hospital and nursing home services at a very reasonable premium. More than 100,000 persons over the age of 65 in Texas have availed themselves of this Blue Cross-Blue Shield coverage. During the initial months' enrolling period for the Texas 65 plan this year, more than 50,000 elderly persons enrolled. These and other voluntary prepayment health insurance plans are offering more than ade quate health care for the aged in Texas at a cost they can afford.

We believe that ony a small group of aged Texans not on the old-age assistance rolls find themselves unable to pay for necessary hospital and medical services. The Texas Legislature has authorized that a constitutional amendment be submitted to Texas voters which, when approved, will make possible medical and hospital benefits, under a vendor payment mechanism, for this group.

For these reasons, the Texas Academy of General Practice opposes H.R. 3920 We believe this legislation is neither wanted nor needed in Texas.

AMERICAN ACADEMY OF GENERAL PRACTICE,

ALAMO CHAPTER,

San Antonio, Tex., November 27, 1963. Hon. WILBUR MILLS, Chairman, House Ways and Means Committee, House Office Building, Washington, D.C.

DEAR SIR: The Alamo Academy of General Practice, an association of family physicians, wishes to express its appreciation for the thorough study and consideration that the House Ways and Means Committee has devoted to the medical care of the aged citizens of our Nation.

We share the committee's concern for the needy aged of our country, who in recent years have lost much of their savings, the value of their insurance, and security for their old age as inflation has taken its cruel toll. We are encouraged, however, in the progress that has been made, and will continue to be made under the principles of individual responsibility, family responsibility, charity, and government help to those who need help.

The role of government help to the needy through the voluntary health mechanism as manifested by Texas adoption of the Kerr-Mills program has been very satisfactory in action and experience.

The role of voluntary health insurance in Texas, and its easy availability to the aged, has been and is increasingly becoming the choice of most of our elderly people. More than 70 percent of them now have such policies. Recently, further incentive to voluntary health insurance has been offered by the new Texas 65 plans offered by the combination of private insurance companies.

The present medical programs for the elderly Texans have evidently achieved a large part of their success because of the preservation of the doctor-patient relationship which has preserved the good will of the patients and the willing cooperation of the physicians.

The Alamo Academy of General Practice also wishes to express its strong opposition to the King-Anderson bill. We believe that it would produce inferior medical care for all of the aged, needy or not. We do not believe it would work to preserve the good will of the patients, nor the cooperation of the physicians. We believe that its basic concept of the abolition of individual responsibility at age 65 is morally wrong and fiscally irresponsible.

We would appreciate it if you would seriously consider our opinions and enter this letter into your records as a statement of the policy of the Alamo Academy of General Practice. Yours very truly,

TED JOHNSON, M.D., President.

TARRANT COUNTY ACADEMY OF GENERAL PRACTICE,

Fort Worth, Tex., November 25, 1963. Hon. WILBUR MILLS, Chairman, House Ways and Means Committee, Washington, D.C.

HONORABLE SIR: According to information received by the Tarrant County Academy of General Practice, hearings are now in process concerning Federal aid to medical care.

I should like to call your attention to a previous survey submitted to your committee by Dr. James Brooks, who, at that time, was chairman of the Tarrant County Medical Society Legislative Committee. This report was done in an unbiased manner and shows the lack of critical need for aid to the elderly. This report was submitted in 1961.

The Tarrant County Academy of General Practice would like for you to know that we support the testimony given by Dr. Albert Ritt, president of the American Academy of General Practice. It is requested that this be made a part of the minutes of the committee hearings. Respectfully,

R. E. CHAPMAN, M.D., Secretary, Tarrant County Academy of General Practice.

TENNESSEE STATE DENTAL ASSOCIATION,

Nashville, Tenn., November 23, 1963. Hon. WILBUR MILLS, Chairman, House Ways and Means Committee, U.S. House of Representatives, Washington, D.C.

DEAR CONGRESSMAN MILLS: The Tennessee State Dental Association notes with a great interést the hearings now being held by the House Ways and Means Committee on medical care for the aged.

Our association respects the views of those who propose this legislation but we do not concur in their conclusion. We realize a problem does exist but believe that other solutions are available, other than financing through social security. If the trend continues, our social security tax will become equal to our income tax.

The Tennessee State Dental Association would like to be entered on the record as opposing medicare as not in the best interest of our citizens. Your careful consideration of this bill will be appreciated. With all good wishes, I am, Sincerely,

EWING J. THREET, D.D.S., Chairman, Council on Legislation, Tennessee State Dental Association.

STATEMENT OF THE TEXAS DENTAL ASSOCIATION ON H.R. 3922

(By Byron N. Coward, D.D.S.) I am Byron N. Coward. I live in Corpus Christi, Tex., where I am engaged in the private practice of dentistry.

I want to thank the committee for the privilege of presenting testimony as president of the Texas Dental Association.

Texas is very proud of its present effective program for the medical care of the needy aged. When the Texas Legislature voted in 1961 to implement the first portion of the Kerr-Mills bill, the health professions of Texas gave full cooperation in developing a most effective program of medical care for the recipients of old-age assistance. A major factor in the success of the Texas program has been the very effective administration of the plan by Blue Cross-Blue Shield together with the full cooperation of the health professions.

The special program of low-cost health insurance for the Texas aged that was introduced by a group of leading insurance companies in Texas has proved to be a great success. This Texas 65 plan was made possible by the last session of the Texas Legislature. The plan makes health insurance available to all citizens over age 65 with no health questions or examinations required. This voluntary action by 57 insurance companies, in providing health insurance for all persons over age 65, very clearly demonstrates the willingness of private enterprise to cooperate in solving the health problems of the aged without Government control and supervision. The Texas 65 Plan concluded its initial enrollment period on October 31, 1963, with 50,000 citizens enrolled. The enrollees ranged in age from 65 to 103. It is now possible for all Texas citizens to have this insurance when they reach age 65.

The Texas Dental Association with its 3,800 members is on record as opposed to the King-Anderson bill. We feel that better health service can and will be provided to our needy aged citizens through the provisions of the present Kerr-Mills legislation.

The present benefits to old-age assistance recipients in Texas under the present comprehensive program has cost the taxpayers $22 million in the first year of operation. The King-Anderson proposal would cost the people of Texas an estimated $69 million in new taxes the first year and at the same time provide less benefits to our needy aged.

We can see no logical reason for providing medical care at Government expense to any of our citizens where there is not a demonstrated need for such assistance. Recipients of social security benefits should provide for their own medical expenses as they do other living costs. Such provision is readily available through medical insurance available from private insurance companies such as the Texas 65 insurance plan, and at a cost they can afford to pay.

We are alarmed at the trend of the Federal Government to assume a greater role in providing health services for the American people at taxpayers expense. Our present time-honored system of free enterprise, without Government subsidy or control, has given our people the best health service in the world at a price they can well afford to pay when they budget their health care in a carefully prepared insurance program'available to all Americans.

In summary, gentlemen, we are firmly convinced that our needy aged in Texas can have the health insurance program that they need through the means that are now available and that no need exists for the King-Anderson proposal.

The dentists of Texas receive practically no benefits under the present Kerr-Mills legislation, yet they are continuing to provide dental care to the needy aged on the same basis of treatment with little or no compensation that has been our custom since dentistry, became a profession.

Thank you so much for this privilege of introducing this testimony.

THE GEORGIA NURSING HOME ASSOCIATION, INC.,

November 12, 1963. Hon. WILBUR D. MILLS, Chairman, Committee on Ways and Means, House of Representatives, Washington, D.C.

DEAR MR. MILLS : It is our understanding that the Committee on Ways and Means of the House of Representatives will begin public hearings on proposed legislation for medical care for the aged on November 18, 1963.

And since it is impractical for this association to send a representative to testify before the committee, we desire that this letter be introduced and placed in the record as a statement of the position of the Georgia Nursing Home Association, Inc., with respect to the administration's compulsory health insurance program to be financed through the social security system.

This association has gone on record repeatedly as being unalterably opposed to the provisions of the proposed King-Anderson bill for the following reasons:

We feel that the provisions of the Kerr-Mills bill are adequate to provide the same type of assistance proposed by the King-Anderson bill for the medically indigent old-aged citizen through programs administered by the individual States, and that implementation medical assistance to aged section by the States will provide the relief needed by aged persons who can qualify.

We further believe State participation and administration of the program are essentially necessary to prevent abuse and misuse of tax moneys by persons who are eligible for social security benefits and at the same time possess adequate financial means through savings, personal income, or private health insurance to care for themselves.

We are opposed to the many hidden and implied aspects of the King-Anderson bill which point to Federal paternalism or socialism, and would deny individual citizens the right to treatment by medical or dental practitioners of their choice.

And such an action would result in a situation as now exists in Great Britain and would adversely affect the practice of medicine and allied health care professions as well as the welfare of the patients.

Our nursing homes are now regulated by the laws of the individual States under uniform criteria which has resulted from Federal requirements imposed by provisions of the Kerr-Mills bill, and the passage of the King-Anderson bill would result in new and in many instances, meaningless and impractical regulations that would eventually destroy privately owned nursing homes, which represent an approximate $7 billion segment of the national economic product.

We further believe that uniform implementation of all of the major provisions of the Kerr-Mills bill and realistic revision of same as applicable, would provide a means of resolving the problem affecting our medically indigent older citizens (those who are otherwise ineligible as financially indigent citizens) without additional and confusing Federal legislation.

We are opposed to any Federal legislation which seeks to usurp the rights of our individual States to regulate and control private enterprise within its boundaries on the grounds that the problems of one section of the country widely differ from the problems confronting other sections. We also believe each State is capable of insuring adequacy of necessary health care services to its citizens, and that private enterprise cannot successfully serve two masters simultaneously and survive. We trust this makes our position clear. Sincerely,

Mrs. NADINE BENDER, President.

STATEMENT OF EDWARD F. CONNELLY, COUNSEL, MASSACHUSETTS FEDERATION OF

NURSING HOMES, INC., BOSTON, Mass., ON H.R. 3920 My name is Edward F. Connelly of the law firm of Lynch & Connelly, Boston, Mass. I appear as counsel for the Massachusetts Federation of Nursing Homes, Inc., in opposition to H.R. 3920, the so-called medicare proposal. The federation has a membership of some 300 nursing homes.

My comments will be confined to the measure as it relates to nursing homes. Some reference will be made to the Massachusetts medical aid to the aged law, enacted November 23, 1960, effective retroactively on October 1, 1960, to implement the provisions of the Federal Kerr-Mills law.

The measure we center on here offers meager protection to the elderly who need nursing home care. It is doubtful that there are many who know how truly minscule is this protection under this measure. It is only proper that the facts should be widely disseminated so that no one will be misled.

Let me state them as simply as I can against the context of Massachusetts data.

The proposed measure provides some coverage for needed nursing home care. Such a facility-called a skilled nursing home is defined as one affiliated or under common control with a hospital

There are about 740 licensed nursing homes in Massachusetts. Only 10 at most are so affiliated. Nothing in this measure or in the benefits to the elderly would encourage this affiliation. Assuming people had substantial rights under this measure, the measure itself effectively nullifies any practical opportunity for people to exercise such rights for nursing home care.

This brings up an interesting question. What are the rights to nursing home care?

A covered individual would be entitled to 180 days of such care in a benefit period. A benefit period begins with the first day in a hospital or nursing home and ends when the individual has not been in either facility for 90 days.

The person over 65 who must remain in a nursing home for the remainder of his life thus would receive but 180 days of protection during his life, however long it may be.

In Massachusetts there are about 23,000 patients in nursing homes. The average age is 80. Over 90 percent are over 65. About 65 to 70 percent are now public aided under the medical care to the aged law. Their average length of stay is about a year and one-half. Their illnesses run the gamut of human ailments for which acute hospital facilities are either not required or cannot be helpful.

The combination of age and physical disabilities make it impractical for most cases to care for themselves or to be cared for by relatives. We would wish it otherwise but wishing cannot make it so.

Of what practical avail would it be to say that for a short period-no longer than one-half a year—they would be under one system, and thereafter they would pay their own way or go on to another system of public aid? This measure suffers from the twin disabilities of making it impossible to find a nursing home which would be acceptable for governmental payments, and of limiting benefits to the point where there would be no practical value anyway from a social point of view.

The point is quite frequently made that this medicare proposal would save people “from taking the pauper's oath.” What ever the validity of such an argument it loses its force when it merely postpones the day of reckoning for all, those who are truly in need of nursing home care.

In the light of these circumstances we ask ourselves what is to be gained and what is to be lost by this proposal as it relates to the payment of nursing home benefits? It is true that there are a relatively few over 65 who need nursing home care for a brief period. It is also true that there are some with resources who would be able to use such resources for other purposes.

In the main, however, the proposed measure skirts the edges of the problem of the nursing care needs of people and would merely create practical difficulties since two systems of public aid would have to be continued to meet the realities of this problem.

The measure itself shows a great doubt in the mind of its framers about the wisdom of the Federal Government entering this field of providing benefits to people as a matter of right and not on the basis of need. With the severely limited benefit rights and restrictions on what may be considered skilled nursing homes, the measure cautiously allows the Secretary to expand what will be considered approved nursing homes if he “finds that such action will not create (or increase) any actuarial imbalance in the Federal hospital insurance fund.” We do not condemn this concern. We merely underscore it as something which points up the questionability of this manner of Federal participation in recognized needs of our people in the area of nursing home care.

I can speak somewhat familiarly with the Massachusetts coverage of these needs under its medical aid to the aged law, one of the first to be adopted to implement the Federal Kerr-Mills law. I don't think it necessary for me to detail its provision, which I am sure your staff has already done with competency. It is sufficient to say that no State provides greater protection than does Massachusetts.

Briefly, every area of medical, dental, or other similar need is provided for under our law. Our system picks up the cost of such care when it becomes a burden for the individuals to meet such cost with available income or resources. Medical care costs must be met by the individual only when it can be met by income above $150 per month if single, $225 per month if married, and by liquid assets in excess of $2,000 if single and $3,000 if married.

The individual's home is free from being burdened, and no liens apply even after death. All such benefits are unlimited in time.

This system as it has operated since October 1, 1960, reaches into areas where individuals would not be entitled to old-age assistance,

For instance, for the fiscal year ending June 30, 1963, acute hospital care was made available to individuals not entitled to old-age assistance at an average case load of 1,223 persons per month providing a yearly total of 212,526 days of such hospital care at a cost of $4,908,211.

During this fiscal year 1963 some $45,127,814 was expended for medical aid to the aged of which some $27,852,491 was for nursing home care. During the same year some $12,774,154 was expended for medical assistance chargeable to the old-age assistance system.

These figures, when analyzed, show that medical aid is coming to people in Massachusetts who are “on their own" and generally able to pay their own way without subsistence from old-age assistance. We merely say here that local programs can and do work.

We can sum up very simply:

(1) The nursing home provisions and benefits under this measure are so limited and constricted that they have little practical value in relation to the true need to be met.

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