Obrázky stránek
PDF
ePub

cent are covered. The insurers are also extending their coverage to include nursing home care. Figures from the Health Insurance Association of America indicate that 10.3 million persons 65 and over were protected in 1962 by some form of private health insurance. This figure has increased tremendously in the last few years as I am sure the committee realizes. At the same time, we are told by the Social Security Administration that 14 percent of the aged are receiving old-age assistance benefits and are therefore eligible to obtain Government help in meeting health care costs. In other words, at least three-fourths of the Nation's aged have available a means of meeting health care costs without including those who receive aid under the MAA, or Kerr-Mills program. Private insurance coverage companies are expanding their coverage to include nursing home care, and at the end of 1962 more than half of the Blue Cross plans provided nursing home coverage in their benefits.

13. The aid to those financially unable to meet not only health costs, but the costs of everyday living is a joint responsibility of National, State, and local governments and administration of these programs is best done at the State and local level.

The American Nursing Home Association has supported much in the way of legislation which we consider to be to the benefit of our many senior citizens. In opposing or supporting any legislation in this area, we have carefully studied the considerations before assuming a position. So we come here today not without a serious question as to the necessity of this additional program and not without serious question as to the orthodoxy of housing such a program in the framework of social security.

It is our contention that there is now an avenue which is open through which we can take immediate and special action to provide adequate health care for our aged who are in need. This avenue is the present MAA and OAA programs.

It is our position that the real need lies in the development of strong and sincere leadership from the Department of Health, Education, and Welfare to promote the implementation and liberalization of MAA systems and to improve the payments for services in OAA cases.

We feel strongly that this leadership is necessary in many areas of the Nation. Roughly half of our nursing home patients receive some sort of public assistance. In many States the programs are working well, but in some they lag. Health, Education, and Welfare is in a strong position, with its vast network of personnel and resources to provide strong and valuable leadership in these weaker areas. There is, unfortunately, a feeling rampant throughout our field that Health, Education, and Welfare would like to see Kerr-Mills fail of adequacy in order to create an outcry for legislation of this type.

In summary, we support H.R. 11865 and oppose any amendment which is foreign to the intent of this legislation and which could abate the changes of speedy passage of it.

Thank you, Mr. Chairman, for the opportunity of presenting our

statement.

Senator BENNETT. Thank you very much, Mr. Beaumont. We appreciate your coming here, and we appreciate your patience in waiting for us this afternoon.

Mr. BEAUMONT. If there is any additional information which we can furnish the committee we would be happy to do so.

Senator BENNETT. Thank you.

(At the request of the chairman, the following are made a part of the record :)

STATEMENT OF THE AMERICAN NURSES' ASSOCIATION ON H.R. 11865, August 10, 1964

The American Nurses' Association is the professional organization of registered nurses in 54 constituent State and territorial associations. We are one of the professional groups deeply concerned with providing health care for the American people and are the largest single group of professional persons giving that care. The American Nurses' Association has supported the provisions of the Social Security Act and extensions and improvements of the system since its adoption. We support the amendments to the act passed this year by the House of Representatives.

In 1958, the highest policymaking body of the association, its house of delegates, voted to support the principle of extending the social security program to include health insurance for recipients of old age, survivors, and disability insurance. The house of delegates reaffirmed this position in 1960 and in 1962. We therefore welcome the opportunity to give our views on further extending the act to include health insurance for the aged.

Our primary reason for support is stated succinctly in the following resolution adopted in 1958 and reaffirmed at the two subsequent conventions:

"Whereas necessary health services should be available to all people in this country without regard to their ability to purchase; and

"Whereas prepayment through insurance has become a major and an effective method of financing health services; and

"Whereas certain groups in our population, particularly the disabled, retired, and aged, are neither eligible nor able to avail themselves of voluntary health insurance: Therefore be it

"Resolved, That the American Nurses' Association support the extension and improvement of the contributory social insurance to include health insurance for beneficiaries of old-age, survivors, and disability insurance; and be it further "Resolved, That nursing services, including nursing care in the home, be included as a benefit of any prepaid health insurance program."

The association further believes that using the social security mechanism as a means of solving the problem of financing health care for the aged is more dignified and appealing to the people of this country than an approach through public assistance programs.

In taking this position in support of the extension of social security to include health insurance coverage, the association indicated its concern for the health needs of millions of Americans who are faced with the problem of financing health care at a time when income is lowest and potential disability at its highest.

Because of their own economic situation, nurses identify with those facing retirement on a limited income. In 1963, the average weekly salary of general duty staff nurses in non-Federal general hospitals was $86.50 per week. The salary range was $55 to $100. This group of nurses comprises over 60 percent of those in practice.1 Private duty nurses, who are independent contractors, are the next largest group. During January 1962, they earned a median monthly salary of $320. The median number of days worked during the month was 18. These nurses have no paid sick leave, no retirement program other than social security for which they pay the entire tax, no paid vacation leave or other benefits commonly available to employed workers.2 The third largest group of prac ticing nurses are employed in physicians' and dentists' offices. Their median monthly salary in July 1962, when ANA last surveyed their employment conditions, was $360. Only 20 percent reported hospitalization coverage and 5 percent retirement plans other than social security. According to law, office nurses are covered by the Social Security Act.'

These three groups comprise over 80 percent of all practicing nurses. On retirement they will be faced with the problem of maintaining a decent standard

1 "Facts About Nursing." American Nurses' Association, 1964 ed., p. 138.

2 Ibid., p. 148.

3 Ibid., p. 175.

of living and securing needed health services. On their present salaries it is impossible to save any substantial amount toward retirement, nor will they, on present salaries, be eligible to receive the maximum retirement income under social security.

In previous testimony before the House Ways and Means Committee, we made several suggestions regarding the provisions of nursing services and the role of professional nursing in establishing policies and executing them in a skilled nursing facility and a home health agency. The major continuing service furnished by these facilities is nursing. Nursing care should be given by or under the supervision of a registered professional nurse and policymaking bodies of the institution should include registered professional nurses.

We have been concerned with the care available in many nursing homes in this country where there is minimal medical and professional nursing service. We believe payments from the social security fund should not be used to support and perpetuate substandard care. We further believe that if skilled nursing facilities are to be eligible to participate in the proposed program they should meet requirements for accreditation set by a multidisciplinary committee or commission. Such a multi-disciplinary accrediting body does not now exist. Efforts to establish a division for accrediting inpatient facilities other than hospitals under the Joint Commission on the Accreditation of Hospitals have not been successful to date. However, several associations, including the American Nurses' Association, continue to explore ways of implementing this multidisciplinary approach.

The American Nurses' Association has supported the Kerr-Mills Act (medical assistance for the aged) by encouraging its constituent State nurses' associations to support necessary enabling legislation to activate the program. On principle the association does not approve of the means test and it questions how much freedom of choice recipients of MAA actually have. Recent studies of the program appear to indicate it has limited value. A few of the more wealthy States have comprehensive programs and receive most of the Federal funds allocated under MAA. In the past, these same States have had fairly liberal public assistance medical care programs, indicating not only ability to finance a program but also a greater than average concern for the less fortunate of their citizens. It would appear, therefore, that the success of MAA is dependent on the resources of an individual State and its commitment to proposals contained in the law.* For all these reasons, the American Nurses' Association supports proposals to extend the social security system to include health insurance for recipients of OASDI, and we urge the committee to give favorable consideration to the principle of financing health care through the Social Security Act.

Senator GEORGE D. AIKEN,
Washington, D.C.

VERMONT NURSING HOME ASSOCIATION,

March 23, 1964.

DEAR SENATOR AIKEN: At a meeting of the Vermont Nursing Home Association, March 12, 1964, the membership resolved that "the Vermont Nursing Home Association is opposed to H.R. 3920 or any other legislation which provides for medical care of the aged under the social security system without regard to the financial needs of the patient."

We are writing to you to express the feelings of the association which represents the better nursing homes throughout the State and a large percentage of the total nursing home bed capacity. We feel there are many reasons why this bill is unrealistic:

The bill seeks to provide medical benefits to all the aged regardless of means and the problem rests only with a minority who require assistance. The bill is unrealistic in that it is hospital oriented and out of focus with the actual health care picture today. It would force aged persons to enter a hospital before they could qualify for nursing home care when many require only nursing home care and not more costly hospital service. The bill fails to meet actual costs of care, providing only for payment of what the Secretary of HEW prescribes as reasonable. The financial condition of Amerca's population age 65 and over has improved tremendously in the last few years and the prospects ahead are even

Medical assistance for the aged-the Kerr-Mills program, 1960-63, Subcommittee on Health of the Elderly, Special Committee on Aging, U.S. Senate.

brighter. Private and voluntary health insurance is constantly expanding coverage of the over-65 age group.

We hope that you will vote against the passage of this bill and we believe that the real need is for improvements in the Old Age Assistance Act and the Medical Assistance Act program to meet the problems of those who truly cannot afford the cost of major medical expenses.

Sincerely yours,

Hon. HARRY F. BYRD,

RAYMOND GOBELL, President.

NEW YORK STATE NURSING HOME ASSOCIATION, INC.,
Syracuse, N.Y., August 10, 1964.

New Senate Office Building,

Washington, D.C.

DEAR SENATOR BYRD: The New York State Nursing Home Association wishes to record its support for H.R. 11865. We also wish to register our opposition to amendment 1163 (Senator Javits' amendment) to H.R. 11865.

Very truly yours,

FREDERICK C. PFISTERER, President.

OKLAHOMA STATE NURSING HOME ASSOCIATION, INC.,
Oklahoma City, Okla., August 10, 1964.

Hon. HARRY F. BYRD,

U.S. Senator, Committee on Finance,

New Senate Office Building, Washington, D.C.

DEAR SIR: We have just studied Senator Javits' amendment No. 1163 to H.R. 11865.

As you may know, our Oklahoma State Nursing Home Association and the American Nursing Home Association have already gone on record in support of H.R. 11865. We cannot, however, support amendment No. 1163.

We, therefore, respectfully request that you do all within your power to defeat amendment No. 1163 to H.R. 11865.

Mr. William E. Beaumont, Jr., president of American Nursing Home Association, is scheduled to testify before your Senate Finance Committee on Friday, August 14, in opposition to the amendment proposed by Senator Javits. He will support H.R. 11865. His statement will further explain our position. Thank you in advance for your consideration of this request.

Respectfully yours,

ED WALKER, President. Senator BENNETT. Dr. Buhler of the College of American Pathologists.

Dr. Buhler, will you identify the gentleman who is with you. STATEMENT OF DR. VICTOR B. BUHLER, PRESIDENT, COLLEGE OF AMERICAN PATHOLOGISTS; ACCOMPANIED BY DR. OSCAR B. HUNTER, JR., MEMBER OF THE BOARD OF GOVERNORS

Dr. BUHLER. Mr. Chairman, I am Dr. Victor B. Buhler of Kansas City, Mo., president of the College of American Pathologists. I am accompanied by Dr. Oscar B. Hunter, Jr., of Washington, D.C., a member of the board of governors and committee on national legislation of the college.

The College of American Pathologists is a professional society representing over 4,000 doctors of medicine practicing the medical specialty of pathology in hospitals, medical schools, and private offices throughout the country. I appear before you today representing these physicians in opposition to the amendments to H.R. 11865 now before you for consideration which seek to finance certain health benefits for the aged through the social security mechanism.

First, I would like to emphasize that pathologists are doctors of medicine. After an individual graduates from medical school he must spend at least 5 additional years in intensive training in order that he may be certified to practice the medical specialty of pathology. Mr. Chairman, despite the disclaimer in the various amendments before you that

Nothing in this title shall be construed to authorize any Federal officer or employee to exercise any supervision or control over the practice of medicine or the manner in which medical services are provided * *

The practice of laboratory medicine and the manner in which such medical services are provided would be specifically regulated were these amendments to be adopted.

The services of over 6,000 doctors of medicine practicing pathology are specifically included under the provisions of these amendments which define the medical practice of pathology as an inpatient hospital service. As physicians engaged in the practice of this specialty, we disagree with and resist the implied classification of the art and science of medicine as practiced by us as a "hospital service."

Make no mistake about it, tens of thousands of medical doctors' services are specifically controlled and regulated by the proposed legislation due to the inclusion of the medical specialties of pathology, radiology, physiatry, and anesthesiology as a "hospital service" under the provisions of these proposals.

Laboratory medicine is just that-medicine. It requires the services of a highly trained medical doctor. Although many pathologists carry on their medical practice as directors of hospital laboratories, this situation does not alter the fact that these physicians are practicing medicine and that their practice would be controlled, supervised, and regulated were these amendments to be enacted into law.

In addition to those pathologists practicing in hospitals and other institutions, a substantial number of the pathologists in this country maintain private offices where they conduct the practice of laboratory medicine as a service to the other medical practioners in private practice and their patients in the communities which they serve. The enactment of this legislation would result in paying for certain laboratory services were they to be provided by the hospital and not to pay for identical services were they to be performed in the private offices of a pathologist.

What about the cost of pathology examinations? Those aged recipients of benefits under these proposed amendments would have great incentive to seek the shelter of hospital and institutional care for diagnostic examinations which could be provided more inexpensively in private physicians' laboratories. Pathology services provided as hospital outpatient services, in general, must reflect, in addition to the professional services involved, various hospital administrative and overhead charges which are more costly to the patient.

When diagnostic services are provided as hospital services-where the primary reason for hospitalization is a diagnostic workup the cost differential becomes greater because to the cost of pathology serv ices must be added room, board, nursing care, and hospital administration costs which are completely unnecessary for most pathology examinations. Consequently, we feel this bill would not only be destructive of good medical care but costly both to the taxpayers and to the patient.

« PředchozíPokračovat »