FIGURE 1.-Extent and effect of chronic conditions on over 65 population

84.5%

Either No

Chronic

Condition

Or Without

Serious
Limitation

Of Major
Activity

Unable to Carry on Major Activity 11.7%

Confined To Home 3.8%

SOURCE:

Health Statistics, Series B-No. 36, From the U.S. National Health Survey, "Chronic Conditions Causing Limitation of Activities," United States, July 1959-June 1961, U.S. Department of Health, Education, and Welfare, Table 10, page 19

But "chronic" defines duration and not severity, and includes such nondisabling afflictions as hay fever and varicose veins. While evidence indicates that about four out of five elderly persons (78.7 percent) do have one or more chronic conditions, it also indicates that only about 15 percent of the noninstiutionalized aged are unable to carry on major activity (fig. 1). Less than 4 percent of the aged have such limiting chronic conditions as to be confined to the house."

Physician visits

When the statement is made that the aged visit doctors 36 percent more often than younger people, the 36 percent translates into only 1.8 additional visits per year, or an average of 5 visits per year for the total population compared with an average of 6.8 visits per year for those over 65.8 A statistic of doubtful economic significance to the average aged person is thus ballooned into an impressive figure. The number of times the aged visit doctors, moreover, is not necessarily a test of good or bad health. The fact is that the vast majority of the elderly enjoy reasonably good health, and really poor health is concentrated among a relatively few. The Health Information Foundation survey found that 46 percent of the noninstitutionalized aged consider themselves to be in good health and 44 percent reported some disability but not sufficient to interfere with their physical functioning. Only 10 percent were classified as very sick."

10

While the aged are more susceptible to chronic conditions than the population as a whole, they are less likely to suffer acute illness or to require surgery. Among the aged who are discharged from hospitals each year, less than 40 percent are hospitalized for surgery. In contrast, among all ages discharged, nearly 60 percent undergo surgery. And the population as a whole has a 244-percent greater incidence of infectious and parasitic diseases than the population over 65-a rate of 25.8 for every 100 persons of all ages compared with 7.5 per 100 for the aged (table 1). Persons over 65 also experience a lower incidence of respiratory ailments than younger people. Furthermore, contrary to a general belief, the aged are less likely to suffer accidental injuries than any other age group. The annual accidental injury rate of 19 per 100 aged persons is significantly less than the rate of 25.5 per 100 for the population under 65 (table 2).

TABLE 1.—Annual incidence of acute conditions per 100 persons (1958–59)

Source: U.S. National Health Survey, "Acute Conditions, Incidence, and Associated Disability, United States, July 1958-June 1959," U.S. Public Health Service, Washington, D.C., 1960, p. 11, table 3.

TABLE 2.-Annual accidental injury1 rate per 100 persons (1959–61)

1 Includes only persons with injuries involving 1 or more days of restricted activity or medical attention. Source: Health Statistics, U.S. National Health Survey, Department of Health, Education, and Welfare, Series B-No. 37, table 2, p. 13 (item II-94).

7 Health Statistics, U.S. National Health Survey, "Chronic Conditions Causing Limitation of Activities." July 1959-June 1961, series B-No. 36, table 11, p. 20.

8 Health Statistics, series B-No. 19, "Volume of Physician Visits, United States, July 1957-June 1959," U.S. Department of Health, Education, and Welfare, table 20, p. 29.

"Medical Care Among Those Age 65 and Over," Ethel Shanans, Ph. D., Health Insurance Foundation, Research Series 16, 1960.

10 Health Statistics, "Hospital Discharges and Length of Stay: Short-Stay Hospitals, United States, 1958-60," U.S. Department of Health, Education, and Welfare.

Hospitalization of aged

The aged who enter hospitals will stay, on the average, about twice as long as younger people, about 15 days against 8.4 days for the population as a whole. The average for the aged, however, is pushed up by the minority who remained hospitalized for long periods, some of whom would be as well care for in nursing homes. The U.S. Public Health Service has reported, for example, that 10 percent of the aged account for 39 percent of the total days of hospitalization for this age group." The 10 percent remain hospitalized for 31 days or longer, while the other 90 percent, who account for 62 percent of hospital days, stay considerably less than that. The 10 percent who are long-stay patients also account for about 38 percent of expenditures.

Health Information Foundation studies suggest that factors, only dimly comprehended, may significantly affect the health and economic well-being of the aged. Doctors know that illness can be induced by loneliness and a feeling of rejection. But how much does anyone know of education (or lack of education) as a factor in illness as well as economic status, or even living in a rural rather than an urban atmosphere?

A diligent, honest, objective search for the facts about the economic and physical health of the aged would serve the national interest a great deal more than the unceasing quest for political exploitation of the elderly which has been going on for too many years.

Fiction, fallacy, prejuidce

Those who so avidly desire to reshape the social security system to accommodate a program of politically controlled, federally-operated tax-paid hospitalization for the aged regardless of need stubbornly argue their case from a catalog of fiction and fallacy and prejudice.

Thus, we hear over and over again that the aged are virtually destitute, that half have incomes of less than $1,000 a year, that the average aged couple lives on about $50 a week, that incomes of the aged families are only half as much as younger families." Proponents of this legislation, however, offer no evaluation of this "evidence." Indeed, they dare not because their case collapses on analysis of their statistics.

Income figures examined

Included among those with incomes of less than $1,000 a year, for example, are wage-earners' wives who have no income at all even though the family-income may be $5,000 or $10,000 or $20,000 or more a year. Others included are persons over 65 with small incomes, or perhaps no incomes of their own, who live with cihldren or relatives and receive the basic requirements of food, clothing, shelter, and medical care from those with whom they live. Three out of four persons over 65 are members of families, and thousands of families both old and young have only one breadwinner.13 More than 200,000 persons over 65, for example, have incomes in excess of $20,000 a year, according to the President's Council on Aging. Few of the wives in such high-income families are likely to contribute anything to the income. Consequently, this statistic obviously is weak support for the argument that the aged as a group are practically impoverished. On the strength of this kind of statistic standing alone, it could be said that all the citizens of America, the richest country in the world, are really almost destitute since nearly two-thirds of the entire population has an annual income of less than $1,000 per person.

14

The implication that most of the aged are economically prostrate because the average couple has an income of about $50 a week is also deceiving. The statistic applies only to two-member families and thus fails to account for the fact that of the nearly 13 million persons over 65 who live in families, about 42 percent are members of families with three or more individuals.15 It also ignores the fact that larger families among the aged generally have larger incomes than twomember families. Census reports for 1960, for example, show a $4,122 median

"Hospital Discharges and Length of Stay: Short-Stay Hospitals," United States 1958-60, National Health Survey, U.S. Public Health Service, 1962. 12 "The Older American."

18 Current Population Reports, Consumer Income, series p-60, No. 37, "Income of Families and Persons in United States: 1960," table G, p. 11 and table 23, p. 40.

14 "The Older American."

18 "Income in 1960 of Families With Head 65 Years and Over, by Selected Characteristics for the United States," U.S. Department of Commerce, Bureau of the Census.

income for three-member aged families, $6,100 for four-member families and $5,727 for families with five or more members.16

Demands on income of aged

The emphasis on income as the sole measure of the economic well-being of the aged ignores other important consideration. Income alone is not a valid index of dependency or independency. Fewer family obligations, tax-free income, other tax advantages, less indebtedness, and lower financial requirements all add to the relative prosperity of aged families.

Many of the aged have retired and thus escape transportation, lunches, clothing, and other expenses necessary to employment. Most of them no longer have children to educate, an increasingly costly drain on the budget of younger families. Housing costs are substantially less for the elderly. A recent survey

by the University of Michigan Survey Research Center disclosed that 83 percent of aged families who own their homes have paid off their mortgages and of those still paying on mortgages, only 4 percent owe $5,000 or more. In contrast, only 34 percent of younger homeowners were free of mortgage debt, and of the 66 percent with mortgage debt, 43 percent owe $5,000 or more.'

17

Federal income tax laws, as well as those in a number of States, favor the aged, allowing double personal exemptions, credits for retirement income, taxfree income from social security, the railroad retirement program and veterans' pensions and more liberal allowances for medical expenses. It is possible for a couple, both over 65, to have an income in excess of $6,000 without paying any Federal income tax, depending on the source of the income.18 A younger couple would normally pay nearly $850 on that income. The President's Council on Aging has estimated that these special tax advantages saved older Americans about $775 million in 1963.19

Proponents of the legislation adhere to gross income alone in making economic comparisons between aged and younger families. They repetitively recite such figures as the median income of younger families in 1960 was about $5,900 compared with about $2,900 for aged families, and they often follow with such statements as: "The aged are a low-income group and it is high time to stop juggling figures in an attempt to prove otherwise." 20

Some

However, it is not necessary to juggle figures to demonstrate otherwise. simple calculations will do, using these figures as a place to start rather than a place to end. It would appear to be elemental that a family's financial well being would be effected by the number of people to be taken care of as well as the amount of inescapable obligations. In other words, how much is available to these families per family member? Need the point be labored that more money is required to provide for a family of four than a family of two? Per member income

Federal taxes will not reduce the older family's income in the vast majority of cases, but will reduce the younger family's spendable income. The average older family is composed of 2.34 members, the average younger family 3.97 members. Thus, the after-tax income of the older family in 1960 was $1,240 for each member, only $60 less than the $1,300 after tax, per member income of the younger family (table 3).

16 Current Population Reports, Consumer Income, "Income of Families and Persons in the United States: 1960," series P-60, table D, p. 36. 17 "Survey of Consumer Finances," University of Michigan Survey Research Center,

1960.

18 Tax Provisions Favoring Older Persons," appendix F, "Developments in Aging, 1959 to 1963," report of the Special Committee on Aging, U.S. Senate, pp. 221-224, taken from a 1962 report to the President by the Federal Council on Aging.

19 "The Older American."

20 From "Income Problems of the Aged." a speech by Dorothy McCamman, a member of the staff of the Special Committee on Aging of the U.S. Senate, excerpts as Appendix D of the Committee's 1963 report, "Developments in Aging, 1959 to 1963."

TABLE 3.-Median family incomes, before and after taxes, per family and per family member, by age of family head, 1960

1 Given in P-60, No. 37. Other figures based on calculations by the Department of Economic Research, American Medical Association.

2 Federal income tax and social security tax were only taxes considered. Federal income tax was estimated by subtracting $600 deduction for each dependent ($1,200 for aged head) and standard 10-percent deduction from the median before tax income and applying the appropriate tax rate from Internal Revenue form 1040 to the remaining taxable income.

Sources: Bureau of the Census, current population Reports: Consumer Income, series P-60, No. 37; Bureau of Internal Revenue, form 1040 (item III, 112, table 2).

Advance reports for 21 major cities included in the Department of Labor's 1960-61 "Survey of Consumer Expenditures" offer further evidence that the aged as a group do not live in a financial straitjacket. These reports suggest that people over 65 living in major metropolitan areas may be as well off or better off economically than anyone else living in these sections of the Nation. The average income per person living in households headed by persons 65-74, $2,223, was greater than the average per capita income of all persons, $1,974. The average income per person living in households with head 75 and over was $1,723 which is not much lower than that for all households (table 4).

TABLE 4.-Average money income after taxes, per household and per household member by age of head, 1960, urban (21 cities)

Source: Combination of all observations included in advance reports in 21 cities sampled in 1960 as part of the 1960-61 Consumer Expenditure Survey, Bureau of Labor Statistics. BLS Reports, Nos, 237-1 through 237-21.

We are not suggesting for a moment that none of the aged has any serious financial worries. The fact that more than 2 million of the aged are on old-age assistance rolls and more than 180,000 a month are receiving medical assistance through the Kerr-Mills program is proof enough that a significant number of the population 65 and over do need financial help from some source. Nevertheless, the data currently available strongly contradict the thesis that the vast majority of the aged exists in economic misery without hope of improvement.