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In the spring of 1963, about 12,430 elderly residents of the city who were beneficiaries of old-age, survivors, and disability insurance were receiving supplementary public assistance under old-age assistance.

These insurance beneficiaries constituted almost 40 percent of the department of welfare's total OAA caseload.

Most older people live on fixed incomes, with little opportunity to earn, although more than a fifth were in the labor force in 1960. Of the total of 188,452 older persons in the labor force, 14,600 were unemployed.

About 71 percent of the employed men were working full time; only 56 percent of the women in jobs were employed full time.

HEALTH STATUS AND INSTITUTIONAL CARE

National and local studies indicate that most older people are functioning well, physically and mentally. However, older people are particularly vulnerable to catastrophic illness, and four-fifths have one or more chronic conditions. Recent studies of community need across the country show that most of the chronically ill aged live in their own homes and receive either no health services or totally inadequate care."

In New York City, public agencies are making vigorous efforts to upgrade medical care for the indigent, and for elderly residents of public housing projects. For the much larger group of marginal income aged, health care remains sparse and spotty, despite numerous new pilot projects." Within present-day knowledge, much physical and mental illness and crippling disability could be prevented through early diagnosis, treatment, and rehabilitative service. Moreover, the provision of home health services could enable many elderly now institutionalized to live in the community or to avoid prolonged hospital stays.

Analyses of general hosptials show that from 20 to 30 percent of the extended stay patients have been retained because of social rather than medical reasons.

Similarly, studies of nursing homes, homes for the aged and mental hospitals indicate that many do not require institutional care and could live at home if community resources were available to meet their medical and social needs.

Older people comprising 10.5 percent of New York City's total population use almost three times as many patient days in general hospitals and 30 to 40 percent more physicians' services than the younger population. They also use 27 percent of all ward service in general care hospitals.

In New York City, at least 8,000 older people are in general hospitals on any given day and, in addition, at least 37,000 are in long-term institutions. Almost half of the latter (17,000) are in State mental hospitals.

In addition to our major consideration-the welfare and dignity of the individual—there are compelling economic reasons for expanding services to preserve health and prevent needless institutionalization.

The cost of hospital and related institutional care for the aging is high. In 1960, it was $222 million, almost one-third of the total for all such care, for only 10.5 percent of the population."

Moreover, by 1970 New York City will require 15,000 new long-term institutional beds for the aged at a cost of about $180 million for construction only.

APPENDIX B

ENDORSEMENTS OF THE COMMUNITY COUNCIL'S POLICY STATEMENT ON HEALTH CARE OF THE AGED

Schools of social work (2) :

Fordham University School of Social Service.

Hunter School of Social Work.

Homes (10):

Beth Abraham Home.

Bronx Home for Sons & Daughters of Moses.

Evangelical Home for the Aged.

First United Lemberger Home for the Aged.
Hebrew Convalescent Home.

"Facilities for Long-Term Treatment and Care," American Hospital Association-Public Health Service, February 1963. U.S. Department of Health, Education, and Welfare.

Interim report: "Preventive Home Care and Health Maintenance Programs," Subcommittee on Health, Citizens' Committee on Aging, March 1963.

Klarman, Herbert E. "Background, Issues, and Policies in Health Services for the Aged in New York City," Interdepartmental Health Council, March 1962.

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Gouverneur Ambulatory Care Unit Social Service Division.
Grand Central Hospital.

Hebrew Home & Hospital for Chronic Sick.

Home & Hospital of the Daughters of Israel.
Jamaica Hospital, Social Service Department.
Mount Sinai Hospital Women's Auxiliary Board.
New York Eye & Ear Infirmary.

New York Infirmary, Social Service Department.
Queens Hospital Center, Social Service Department.
St. John's Queens Hospital.

St. Mary's Hospital, Social Service Department.
Recreation centers (13):

Brooklyn War Memorial Recreation Center.
Bronxdale Community Center.

East Harlem Day Center for Older People.

East Side House Settlement, Mill Brook Center.

East Tremont YM-YWHA.

Forest Neighborhood House.

Golden Age Club of the Jewish Center of Kew Garden Hills.

Howard Houses Golden Age Club.

Hudson Guild.

Owen F. Dolen Park, Golden Age Center.

Red Hook Day Center.

The Salvation Army Senior Citizens' Club.

YM & YWHA of Williamsburg, Senior Adult Division.

Neighborhood councils and civic associations (8):

Brownsville Neighborhood Health & Welfare Council.

Coney Island Community Council.

East Harlem Council for Community Planning, Committee on Aging.
Kingsview Community Association.

Kissena Flushing Homeowners Association.

Red Hook Neighborhood Council.

Sheepshead Bay Civic & Community Council.
Wavecrest Civic Association.

Other (22):

Alpha Kappa Alpha Sorority.

Bronx County Society for Mental Health.

Central Bureau for the Jewish Aged.

Childville, Inc.

Church of All Nations, Board of Directors.

Clinical Services of the William Alanson White Institute of Psychiatry,

Psychoanalysis, and Psychology.

Italian Welfare League.

Jewish Community Services of Long Island.

Jewish Family Service.

Musicians Aid Society.

National Association of Social Workers, New York City Chapter.

National Council of Jewish Women, New York Section.

New York Clinic for Mental Health.

New York Hotel Trades Council, AFL-CIO.

New York State Psychological Association.

Optometric Center of New York.

The Salvation Army, Social Welfare Department.

Self-help of Emigres from Central Europe, Inc.

Sidney Hillman Health Center.

Society of St. Vincent De Paul.

Tolstoy Foundation Inc.

United Help, Inc.

APPENDIX C

CORPORATE MEMBERS OF THE COMMUNITY COUNCIL OF GREATER NEW YORK

American Red Cross in Greater New York.

Brooklyn Bureau of Social Service and Children's Aid Society.

Brooklyn Tuberculosis and Health Association, Inc.

Catholic Charities, Diocese of Brooklyn.

Catholic Charities of the Archdiocese of New York.

Children's Aid Society.

Citizens' Housing and Planning Council of New York, Inc.
City of New York.

Commerce and Industry Association of New York, Inc.
Community Service Society of New York.

Federation of Jewish Philanthropies of New York.

Federation of Protestant Welfare Agencies, Inc.

The Greater New York Fund, Inc.

Hospital Council of Greater New York, Inc.
New York Academy of Medicine.

New York Chamber of Commerce.

New York City Central Labor Council AFL-CIO.

New York Tuberculosis and Health Association, Inc.
United Hospital Fund of New York.

United Neighborhood Houses of New York, Inc.

Urban League of Greater New York, Inc.

Visiting Nurse Association of Brooklyn.

Visiting Nurse Service of New York.

Community Council of Greater New York

OFFICERS

Mrs. Harold D. Harvey, Daniel P. Higgins, Jr., and Edwin Rosenberg, vice presidents.

John T. Burnell, treasurer.

Harold F. McNiece, secretary.

Arnold S. Askin

Mrs. Rodman W. Austin

Mrs. Leonard H. Bernheim

Mrs. Leonard Block
Joseph C. Brennan

Rev. Albert B. Buchanan
John T. Collins

Frederick I. Daniels

J. Clarence Davies, Jr.
Edgar Debany

James Felt

Mrs. Albert Francke, Jr.

Mrs. Randolph Guggenheimer

BOARD OF DIRECTORS

Very Rev. Msgr. Edward D. Head
Daniel P. Higgins, Jr.

Mrs. Paul T. Kammerer, Jr.

Marcus D. Kogel, M.D.

Rt. Rev. Msgr. Francis J. Mugavero

Mrs. Richardson Pratt

Mrs. Henry T. Randall

Caspar W. Rittenberg

Mrs. Robert C. Rome

Mrs. Irwin H. Rosenberg
T. J. Ross

Juan Sanchez

Howard A. Seitz

Martin F. Shea

David Sher

Rush Taggart

Rev. M. Moran Weston
Ex officio:

Hon. Herman Badillo

Hon. William F. R. Ballard

Hon. James R. Dumpson

Mrs. Marion L. Foster

Hon. Calvin E. Gross

Hon. George James, M.D.

Hon. Anna M. Kross

Hon. Milton Mollen

Hon. Marvin E. Perkins, M.D.
Hon. Arthur J. Rogers

Hon. Ray E. Trussel, M.D.

Executive Director: James W. Fogarty

Public Health Committee:

Chairman: Walter J. Lear, M.D.
Executive secretary: Naomi M.
Weiss

Citizens' Committee on Aging:

Chairman: Judge Matthew J. Troy.
Executive secretary: Irma Minges

Senator HARTKE. Thank you, ma'am, for a very fine statement. That concludes the list of witnesses to be heard this morning, and the committee will adjourn until 10 o'clock tomorrow morning.

(Whereupon, at 12:30 p.m., the committee adjourned, to reconvene at 10 a.m., Tuesday, August 11, 1964.)

SOCIAL SECURITY; MEDICAL CARE FOR THE AGED

AMENDMENTS

TUESDAY, AUGUST 11, 1964

U.S. SENATE, COMMITTEE ON FINANCE, Washington, D.C.

The committeė met, pursuant to recess, at 10 a.m., in room 2221, New Senate Office Building, Senator Harry Flood Byrd (chairman) presiding.

Present: Senators Byrd (presiding), Smathers, Douglas, Gore, Talmadge, McCarthy, Ribicoff, Carlson, Bennett, and Dirksen.

Also present: Elizabeth B. Springer, chief clerk; and Fred Arner and Helen Livingston of the Education and Public Welfare Division, Legislative Reference Service, Library of Congress.

The CHAIRMAN. The Chair wants to apologize for the fact that there are not more Senators here but we have a vote in the Senate at 11:15 and I think we had better start now.

The first witness is Mr. Karl Schlotterbeck of the U.S. Chamber of Commerce.

Take a seat and proceed, sir.

STATEMENT OF KARL SCHLOTTERBECK, MANAGER, ECONOMIC SECURITY DEPARTMENT OF THE CHAMBER OF COMMERCE OF THE UNITED STATES

Mr. SCHLOTTERBECK. Mr. Chairman, my name is Karl Schlotterbeck. I am manager of the Economic Security Department of the Chamber of Commerce of the United States. I am testifying on behalf of the national chamber.

I want to emphasize that the national chamber endorses the basic principles of social security. Those principles, which have been enunciated repeatedly by both the House Ways and Means Committee and this committee of the Senate, are:

1. Social security cash benefits should be wholly financed by equal taxes on employees and employers, taxes on self-employed, and interest on the trust funds.

2. The benefits should serve as a floor of protection so that the vast majority of elderly beneficiaries would not have to seek additional help through public assistance.

3. Benefits should be wage-related, with some weighing in favor of those at the low end of the benefit scale.

4. Benefits are a partial replacement of income loss, wage loss, due to retirement or from permanent and total disability, or from premature death of the family breadwinner.

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5. Benefits should be paid in cash so this will preserve for each beneficiary his freedom of choice.

And finally, social security benefits should be paid without a needs

test.

Now, turning to the bill passed by the House (H.R. 11865), there are four provisions in the House bill which we regard as of major importance.

First and foremost is the provision for additional financial support to the social security disability benefits program. The national chamber endorses this provision.

Another major provision in the bill is a 5-percent across-the-board increase in social security cash benefits. We recognize, of course, that Congress will decide whether there must be some increase in benefits to preserve benefits as a "floor of protection."

In arriving at this decision we would again urge you to look at those people whose benefits are minimal or slightly larger. Many of these are widows of advanced age with very modest incomes and also less likely to be able to afford health insurance. I might mention. Mr. Chairman, that the national chamber in 1958 and again in 1961 urged the Congress to raise the minimum benefit. We believed it might not be adequate to serve as a floor of protection.

Another major proposal in the House bill is to increase the em ployee, employer and self-employed tax rates and also to increase the taxable wage base.

We recommend that whatever cost increases are finally approved by Congress should be financed wholly by an increase in the tax rate. Turning now to the various medicare proposals, we have analyzed them carefully, and have concluded that:

1. Medicare is not needed.

2. There is an inherent disadvantage in medicare.

3. There are inherent advantages in social security protection provided as benefits in cash.

Now, I would like to take up why we believe medicare is not needed. We have brought together in this table figures showing the health care protection of the elderly through private and public programs in 1952 and compared them with 1962, and then we have projected these figures to 1970.

The estimates below show that 15.4 million persons, approximately 90 percent of the elderly in 1962, had health care protection through one or another of these four broad programs as compared with only 4.5 million or 35 percent of the 1952 elderly population.

The figures also show that in 1962 less than 2 million elderly were without health care protection under these plans as compared with 8.5 million of the 1952 elderly population.

Looking forward to 1970, the projections indicate that virtually the entire elderly population will have protection against health care costs through private voluntary arrangements or through one or another of these three major public programs.

We had a similar transition experience between 1940 and 1960 in providing health care protection for those under 65, a much larger part of our total population. And, no one today seriously contends we need a Federal compulsory program for those under 65.

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