Federal employees have a special problem so far as income tax is concerned, and it is a situation which should be remedied. The annuity of a Federal employee at present is subject to the full rate of income tax after he has received in annuity payments an amount equal to the amount deducted from his salary during his Federal service. In effect this is discriminatory because it places a penalty on the contributory type of retirement system. Two facts should be borne in mind about the Federal employee retirement system. The first is that the employees during the 38 years in which the system has been in operation have paid into the retirement fund in the form of deductions from their salaries approximately $1 billion more than total disbursements from the fund. During the first 8 years the Government made no contributions, and during the next 7 years employee contributions were nearly 50 percent greater than payments into the fund by the Government. Thus Federal employees have really paid their way so far as annuities are concerned. Secondly, the civilian retirement system is contributory unlike that provided for the military service. Of equal impact on the planning of the Federal Government should be the projected increase of the number of persons in the upper age groups in relation to the total population. The investigations made by students of population changes have so far indicated that the population age 65 and over will become an increasing proportion of total population. As a result, the burden of adequately caring for older persons imposes as great an obligation on the Federal Government as on any State or local government or on a private employer. Certainly the obligation of the Federal Government as an employer is greater than that of any other employer, for it can and must provide the leadership that cannot be exerted as effectively by a State or local government or by private enterprise. The number of persons in the United States who are aged 65 years and over has increased nearly five times since 1900, although total population has doubled. In 1900 the proportion of men and women 65 years of age and over in the total population was 1 in 25. Today it is less than 1 in 12. The Bureau of the Census has estimated that by 1975 it will be slightly more than 1 in 10. From the standpoint of impending retirement, the Federal Civil Service may well concern itself with the age group of 50 years and over. At age 50 a relatively small group of employees in hazardous occupations may retire, and at 55, employees having had 30 years of service may retire on a reduced annuity, or at age 60 they may go out on full annuity. Thus for planning purposes, age 50 and over has meaning. In the total population, the age 50 and over group is nearly 20 percent of the employed portion of the civilian labor force. In total Federal employment, it is 27 percent, which would seem to indicate that Federal employees do not hasten into retirement. This is evidence that every employee who would be eligible would not necessarily retire if the law were amended to permit retirement after 30 years of service regardless of age. The fact that the number of persons in these upper age groupings has increased so materially poses a challenge to the Federal Government, not only as it relates to such programs as old-age and survivors insurance and old-age assistance, but to the Federal Government as an employer. The challenge is to continue the employment of those persons who choose to remain on the job when they are physically capable of employment. It would indeed be most unfitting for the Federal Government to join those private employers who refuse to hire a prospective employee past age 45 or even after 35. The Federal Government has supplied leadership to the extent that age limits for hiring were abolished by Public Law 112, 84th Congress. That action, however, is but the basis in law for Federal policy. Much more than the enactment of a law is needed. Appointing officers and administrators in the Federal civil service must translate that law into action and make it a force for the good of those Federal employees who need employment and wish to continue it when past 65. There have been sufficient indications in the comments of Federal workers who have had considerable service that in many quarters administrative officers are not abiding by this policy. It is a difficult situation to identify for the purpose of lodging a complaint. As in so many other instances of violation of the principles of good personnel management, the technique is subtle. There is the seemingly solicitous "suggestion" that the employee would do well to retire. After a time the pressure may become intensified, and in some instances the situation has all the semblance of persecution. This situation should be dealt with positively and unequivocally by the Federal Government. It can be done only by spelling out, so that no one can misunderstand, the meaning of the policy of utilizing the older worker for the contribution he can make from his fund of experience and knowledge acquired over the years. There is often an employment problem within the period preceding retirement and it may be extremely difficult to resolve. It is not confined to a supervisor or an employer trying to force an employee into retirement. It may consist of a desperate need for a job. Too often the person who is past 50 or 55 is thought of as no longer in need of employment as the younger individual may be. Persons in such age groupings have obligations, and at times they are greater and more exacting than those persons who are younger. This need of employment may be acutely affected by the person who normally would be within a few years of retirement losing his job. This is almost invariably a tragic occurrence, because the individual may lack the opportunity for reemployment. Ofttimes loss of a job at this time of life may result from displacement because of technological advances. Retraining is of course the remedy, but it may have its difficulties or it may offer no practical solution because of current conditions of the labor market. Then there is ever the chances for reemployment of a person past 45, 50, or 55, regardless of experience, training or individual capabiliites. The recognition and review of these circumstances which confront the older worker seem to point to this basic fact: the problem of aiding the aging and the aged may be divided in its underlying conditions into two important time periods the period preceding what has come to be accepted as the normal time for retirement, and the period following retirement. Each poses a different set of problems, and this fact should be taken into account in the analysis of conditions relating to aid for the aging and aged. The objective should be not only that of aiding the individual who has retired. It should include the development and implementation of policies which will benefit the person who is nearing retirement. First, such assistance must emphasize the advantages of employing or retaining the older worker. Beyond that point, there is also the need for taking such measures as will assist the employee who is nearing the normal retirement age to continue his maximum earning power. To render this assistance, an employer-and the Federal Government is the largest employer-could help the older worker most by recognizing the value of his experience. That experience may be put to more advantageous use by reassignment, if the employee is willing, to a position in which knowledge of past methods or policies may be extremely valuable. It must be recognized that there are instances wherein knowledge of what has happened or what has failed may not be desired by those in authority. However, this is but one of the handicaps which a realistic and sincere program of aiding the older worker must strive to eliminate. While the aging population may benefit from preretirement planning, planned recreation, or housing facilities specially designed for them, the contribution which these and other beneficial programs may make to their welfare is limited by the amount of income which is available. The extent to which older persons are in need of more nearly adequate income indicates the desirability of Congress reviewing the existing social security program. One important feature which requires reconsideration is the limitation on the amount of earnings by a person eligible for old age and survivors insurance payments. The present requirement that benefits must be forfeited if the individual is receiving as much as $1,200 a year is unrealistic in the light of the present-day purchasing value of the dollar. This amount should be increased, for its effect is to penalize the person whose social security is small. Raising the exemption could hardly be inflationary, for it would provide additional purchasing power for the very necessary staples, medical service, and the like. A major need of the aging population is broader provision for medical, hospital, and surgical care. Medical care is of paramount importance to the older person who is still employed or has retired. In many cases, older workers who continue to work are still covered by their group health insurance, under many insurance plans, but the worker's right to benefit may be reduced or canceled when he retires. If there is to be any provision for medical care and hospitalization for the aging which even approaches adequacy, it will of necessity be made available as a result of Federal legislation. This is true of providing such facilities for all employed persons, whether in the public service or in private industry. It appears urgent that some start be made in the Government underwriting the cost of medical care for persons of advancing age. This need also highlights the desirability of including at least partial benefits for retirees in the health insurance plan proposed for Federal employees. Analysis of the needs of older persons plainly indicates that the most urgent are adequate income, housing, and medical care. So basic are these to living in minimum comfort that, unless they are first supplied and to a reasonable degree, efforts to aid these persons in other respects have little or no practical utility. It seems imperative, therefore, to plan any remedial program around these main objectives. It should also be recognized that such a program will require substantial financing by Government. Unless that financing is to be forthcoming, the program, no matter how worthwhile, will be futile. We are grateful to you, Mr. Chairman, for making it possible to express our views on this matter. AMERICAN DIABETES ASSOCIATION, INC., New York, N.Y., August 5, 1959. Hon. PAT MCNAMARA, DEAR SENATOR MCNAMARA: This is in reference to your letter of July 20 in which you kindly invited our organization to submit a statement to your Subcommittee on the Problems of the Aged and the Aging. As suggested in your communication, we have been in touch with Mr. Sidney Spector, staff director, and as a result of several discussions with him we are submitting herewith the statement. On behalf of Dr. Francis D. W. Lukens, president of our association, and for myself, I wish to express our regret that it was not possible to arrange at this time to present testimony. We sincerely hope that the information contained in our statement, which is primarily a description of our activities, will be of value to your committee. As you will note in the last page of the statement, we are sending you copies of some of our material as we thought you might be interested in knowing the extent of our program, especially in the areas of professional, patient, and public education. These items are being sent to you under separate cover via parcel post, special delivery. At this time, on behalf of Dr. Lukens, and indeed our entire organization, we wish to offer our best wishes for the success of your hearings and to express our desire to cooperate with you at all times. Cordially yours, J. RICHARD CONNELLY, Executive Director. STATEMENT OF J. RICHARD CONNELLY, EXECUTIVE DIRECTOR, AMERICAN DIABETES ASSOCIATION The American Diabetes Association was organized and incorporated as a medical organization in 1940. The association is a nonprofit membership organization and the only national organization of its kind serving in the field of diabetes in the United States. The association's membership today numbers about 2,500 physicians and other scientists and includes members from every State in the Union, from Puerto Rico and from 27 foreign countries. The broad objectives of the association, in the language of its constitution and bylaws, are "to further the general welfare through acquisition and dissemination of useful and accurate knowledge and information regarding diabetes mellitus and to undertake in the public interest such activities as will improve the physical welfare of persons having that disorder." To these ends, the association strives (1) To promote among physicians and others the free exchange of knowledge with respect to diabetes mellitus. (2) To improve the standards of treatment. (3) To promote medical research by individuals, hospitals, clinics, universities, and other institutions. (4) To educate the public in the early recognition of the disease and in the importance of medical supervisions of its treatment. (5) To distribute accurate information to the general public by literature, meetings, and other appropriate means. (6) To develop educational methods designed to give diabetic patients a better understanding of their disease. (7) To encourage the formation of subsidary groups which will cooperate actively with the association in its program. The association now has more than 35 boards and committees which are active in virtually every phase of diabetes. To assist the American Diabetes Association in fulfillinfg its objectives, 41 local and State affiliate associations have been established throughout the United States. These affiliates carry out the program of the national organization in the fields of professional, patient, and public education at the local level. Active contact is maintained with more than 900 county and State medical societies which have working committees on diabetes, as well as many national, international, and government agencies and organizations. It has been a member of the National Health Council since 1944 and was one of the charter members of the International Diabetes Federation in 1952. It is estimated that there are more than 2 million diabetics in the United States and almost one-half of that number are unaware that they have the ailment. Approximately 4,750,000 living today are potential diabetics, which means that they will develop the condition sometime during their lives. Almost 65,000 persons become diabetic each year. It is estimated that 4 out of every 5 diabetics are in the 40-and-over age group. The following table represents, generally, the incidence of diabetes by age groups: In carrying out its general purposes, the American Diabetes Association conducts a broad program, primarily educational in nature, and directed to the diabetic patient, to the public, and to the members of the medical profession. Public education and detection Each year during the third week in November, the American Diabetes Association, with the cooperation of its 41 affiliates and county and State medical societies throughout the country, observe Diabetes Week, the annual highlight of a year-round program in education and detection. During this period an intensive nationwide search is made for unknown diabetics and materials for millions of tests designed for mass screening are distributed. This is combined with a broad educational program to acquaint all segments of the community with the important facts and symptoms relating to diabetes through appropriate literature and through the media of newspapers, magazines, radio, and television. Labor, industry, schools, pharmacists, civic organizations, and other groups participate and a special effort is made to reach elderly diabetics. It is suggested that each community set aside 1 day during Diabetes Week to be known as Senior Citizens Day and that the local organization responsible for the diabetes program cooperate with senior citizens' clubs, golden age clubs, welfare departments, homes for the aged, churches, and all other groups within the community. This entire program emphasizes the importance of early detection and adequate control of the conditions. Active participation of public or voluntary groups is sought to develop a communitywide detection drive, especially during Diabetes Week. As indicated in a survey of State and local projects compiled by the staff of the Committee on Labor and Public Welfare, "Studies of the Aged and Aging,” volume X, January 1957, many health departments are cooperating in the conducting of diabetes-detection programs. Pilot studies are conducted from time to time for the purpose of developing and evaluating new mass screening techniques. The most recent of these was held in the fall of 1958 by affiliates of the American Diabetes Association in Atlanta, Michigan, St. Louis, and Dallas. This study resulted in the adoption of a new method for processing the urine testing unit known as the Dreypak. In addition, the association prepared a public exhibit entitled "What Is Diabetes?" which is made available for showing to the general public. This exhibit, 10 copies of which are available, is in constant circulation at health fairs, county and State fairs and expositions, public buildings, on television, and such miscellaneous events as farm and home week programs. Patient education The increase in the number of local lay societies of affiliates has greatly strengthened the association's work in patient education. There can be no substitute for educational work done at firsthand in the community and literally scores of meetings are now held each year by our affiliates. These include lectures, teaching classes, panel discussions, "cooking schools" and a variety of social activities which well lend themselves to educational purposes. The American Diabetes Association also publishes a bimonthly magazine for diabetics and their families, which now has a worldwide circulation of more than 55,000 copies. Arrangements have recently been concluded with the National Braille Press to publish copies of "ADA Forecast" in braille for blind diabetics. The association is cooperating with the American Foundation for the Blind in the preparation of a transcribed "Talking Book" series consisting of transcriptions of 19 outstanding articles from "ADA Forecast." For those diabetics whose complications include blindness, copies of these transcriptions may be borrowed through the 30 regional libraries of the U.S. Library of Congress. Forty-eight articles of special interest from "ADA Forecast" are now available in leaflet form and 200,000 copies of these articles have already been widely distributed. The association has also prepared a 32-page booklet entitled "Facts About Diabetes," especially for the newly detected diabetic and his family and the interested general public. Over 71,000 copies have been distributed. In response to a widely expressed need, the American Diabetes Association has just published "A Cookbook for Diabetics," 176-page compilation of recipes and menus. Available at very low cost ($1) this book is considered to be of special value because diet is still the keystone in the treatment of all diabetics, whether they are controlled by diet alone or by diet along with insulin or the newer oral compounds. The association suggests that all diabetics carry a suitable means of identification and the association publishes diabetes identification cards, which include a place for the diabetic's name, address and phone number, his physician's name, address and phone number, type of insulin and dosage. Professional education The annual meeting of the American Diabetes Association is both the scientific and organizational center of association activities. The scientific sessions of the annual meetings are a clearinghouse for information collected or developed by individual members or invited guests and offer those in attendance an unusual complete summary of current information. There are now among the association's various committees and boards which are devoted to scientific discussion or to the consideration of scientific problems in the field. The association has conducted seven annual 3-day postgraduate courses for physicians which have maintained a consistently high standard. The faculty has included a number of physicians eminent in the field and the series has been attended not only by physicians but by graduate students, medical students, interns, residents, and fellows. The postgraduate courses include basic information on diabetes and its treatment, as well as information on its recent developments. In this area, too, the association feels that the maximum effectiveness of its educational program can only be achieved through active, local cooperation. Affiliates are conducting clinical meetings regularly and many have their own postgraduate seminars, symposia, or regular scientific sessions. In other areas, many county and State medical societies frequently devote all or a part of their scientific sessions to the subject of diabetes. The journal "Diabetes," published by the American Diabetes Association, is in its eighth year of publication and is virtually the only scientific journal in the world devoted exclusively to this ailment. Its circulation has increased steadily and now includes more than 3,600 physicians and other scientists particularly interested in this field of medicine. A number of articles and abstracts have appeared in the journal which relate to the problems inherent in the older diabetic and, particularly, with reference to cardiovascular problems. Of the several degenerative complications of diabetes, those of cardiovascular origin are probably the most significant. The association also publishes a 95-page "Diabetes Guide Book for the Physician," second edition, which is designed to aid the practicing physician in the |