Nor is this the only reason we believe a modification of the requirements under Mills-Kerr is in order. Local control of programs generally results in improved efficiency and a more economical operation. For instance, in Florida we have had an experience in health services for the needy sick which we believe graphically illustrates the economy effected by the application of this important principle in the administration of tax-supported health care.

Hospital care has been provided through Federal, State, and county matching funds for aged public-assistance recipients at an average cost of $2 per eligible recipient per month, which is among the lowest costs for similar State programs in the United States.

Drugs have been provided for these same recipients through a State and Federal fund only at a cost of over $5 per eligible recipient per month, which is among the highest costs for similar State programs in the United States.

We believe county financial participation in the costs and practicing physician responsibility in the administration of tax-supported health services are fundamental requirements for efficient and economical operation.

The King bill, H.R. 4222, now under consideration by the Committee on Ways and Means, would not permit application of this fundamental principle for the economical administration of tax-supported health services. Indeed, it would not provide at all for many of the needy sick and would be an invitation for the excessive use of hospital and nursing home care at taxpayers' expense by many who could provide for themselves.

Mr. KING. Does that complete your statement, Doctor Hampton? Dr. HAMPTON. Yes, sir.

Mr. KING. The committee wishes to thank you.

Are there any questions?

Since there are no questions, the committee wishes to thank you again, Doctor.

Mr. Nagle.

STATEMENT OF JOHN F. NAGLE, ON BEHALF OF THE NATIONAL FEDERATION OF THE BLIND

Mr. NAGLE. Mr. Chairman and members of the committee, my name is John F. Nagle. I am the representative of the National Federation of the Blind in Washington. My address is 1908 Q Street NW., Washington 9, D.C.

To be seriously ill at any age is a calamity for the individual; it is a calamity for his family as well. And this is particularly so when the individual is past the age of retirement.

Wearied and worn by a lifetime of fruitful labor-with a few dollars saved to eke out his meager social security income-perhaps with a home that represents years of scraping and scrimping-and with children and grandchildren who will live a better life than he did because of his efforts-all are endangered when this person must go to the hospital.

Savings which took nearly a half century of work to accumulate disappear as the bills pour in-for doctors and surgeons, for hospitals, nurses, drugs, and medicines. A home so proudly owned "free and clear" of mortgages may again have to be encumbered to meet the

crushing costs of urgently needed medical care-to pay for a repaired body, for restored health.

But not only are the resources of the aged sick subject to claim for his illness; the resources of his children too may be levied upon, either as the result of affectionate concern and voluntary sacrifice or as the result of legally enforceable obligation. Then these resources, intended perhaps as a downpayment on a home or a college education for the young, are buried beneath the avalanche of medical bills for the old.

What of those aged unfortunates who have no savings to use, no home to mortgage, no children to call upon? Of course, there is always public assistance there is always charity-after a lifetime of proud self-sufficiency, of determined independence-yes, there is always public assistance or private charity-with their inquiries and questionings, their probings and investigations that tear a man's privacy to shreds, that change him from a man into a statistic in a caseload.

We of the National Federation of the Blind believe in social insurance as a means whereby men, joined together in vast numbers, may, as they work, provide from their earnings for future contingencies for retirement income when they are no longer thought to be productive because of advancing years and the Congress, too, has recognized the value of the socal insurance method by enactment into law of the retirement provisions of the Social Security Act; for disability insurance income when, by reason of disease or accident, men are forced from the normal channels of the Nation's economic life because they are thought to be no longer productive-and again, Congress recognized the value of the social insurance method by the enactment into law of the disability insurance provisions of the Social Security Act.

We of the National Federation of the Blind approve and endorse the social insurance method of meeting the health costs of those no longer able to pay their way from their own earnings because they are considered too old or too disabled.

We commend for your favorable action H.R. 4222.

We believe that the distinguished Cngressman from California, Cecil R. King, who introduced this bill, and the administration which supports it, are offering a sensible and economically sound solution to the daily tragedy of illness in old age, compounded by financial disaster.

I would like to say here that we who are blind have much reason to be grateful to Mr. King. As Congressman he has consistently been a stanch supporter and ardent advocate of legislative proposals which would give blind people a greater opportunity to function fully, though blind, in our sight-oriented society. We believe that Mr. King's espousal of the health care needs of America's older citizens is in complete accord with the finest standards of democratic representation-representation which gives a voice to the unmet needs of the inarticulate many who are too often neglected and forgotten.

But, Mr. Chairman, just as those who are retired and must live on the limited income of social security have need that their costs for health care be paid for during their working years, so, too, is it necessary that the health care needs of those who must live on a limited

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income because they are disabled, are beneficiaries of the disability insurance program, be met by the same concept of social insurance enacted into law.

Is not the limited income problem of the disabled beneficiary just the same as that of the retired person? The amount of his payment is the same as the amount of the old-age benefits for which he would be eligible if he were already 65.

Then, if for no other reason than this, do not the same arguments justify the inclusion of the disabled beneficiary within the scope of the bill you are now considering?

It is said that older people in general have need for more medical care and less ability to pay for this care than is the case of younger persons.

Is it not equally true that disabled persons, with verified, medically determined disabilities, in general have need for more medical care than retired persons who, though advanced in years, may still be robust and well?

It is said that aged people go to the hospital more often than younger people and stay longer.

Is it not equally true that persons whose disabilities are chronic are constantly in need of medical attention?

Gentlemen, section 223 of the Social Security Act defines "disability" as the inability to engage in any substantial, gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or to be of long continued and indefinite duration.

In the fall of 1959, a subcommittee of this committee on the administration of the social security laws made a thorough study of the disability insurance program.

I believe that this study established beyond all doubt that only the most severely impaired are able to qualify for entitlement to disability benefit payments. Case after case cited in the public hearings indicated that the definition of disability is interpreted and applied very, very restrictively.

To say that the overwhelming majority of disability beneficiaries are in need of continuing medical care is, I think, an understatement; to say differently is to ignore the rigid interpretation of the term "disability" and the jealously guarded application of the term.

What must these people do if they have need for hospitalization or home nursing care?

They are beneficiaries of a social insurance program to which they have made financial contributions, but for their health care needs they must turn to public or private charity.

Applicants for disability insurance benefits who establish their eligibility are entitled to cash payments by right because they have paid in advance, during their working years, for these cash payments. They should also be entitled to health care of right because they have paid in advance for it-when they were physically fit and working and earning as contributing members of the Nation's labor force.

We of the National Federation of the Blind are peculiarly informed as to the need and desirability of including disability beneficiaries in the provisions of H.R. 4222.

In the Social Security Amendments of 1960, the 50-year-age eligibility requirement for entitlement to disability insurance benefits was removed. As a result, a number of blind persons, recipients of blind aid, were able to apply for and to receive disability insurance benefits. This change was cause for satisfaction to these people. They were entitled to benefit payments by right and in accordance with law; their payments were in an amount determined in accordance with law. Their satisfaction, however, was short lived when they found that if their disability payments exceeded their established need, in accordance with public assistance standards, they would lose their entitlement to medical care provided under public assistance; and they would gain no comparable medical care entitlement as disability insurance beneficiaries. Their only recourse for such care general relief or private charity. So the disabled person, rescued from the means test of public assistance, by action of the 86th Congress, at last able to claim benefits from a program to which he had contributed during his working life-must turn to the local welfare doctor when he is sick, must go to the charity ward for hospitalization.

Gentlemen, the rescue was not a rescue after all.

In summary, Mr. Chairman, members of the committee, we of the National Federation of the Blind endorse H.R. 4222. We believe that the concept of social insurance should be incorporated into the provisions of title 2 of the Social Security Act so that those who are engaged in covered employment may be able to provide when they are young, or working, for their health care needs when they are old and are living on the limited income of retirement payments.

We also believe that the concept of social insurance should be incorporated into the provisions of title II of the Social Security Act so that those who are in covered employment may be able to provide when they are healthy and physically fit, are earning their living, for their health care needs when they are disabled and living on the limited income of disability insurance payments.

Health care for the aged and the disabled should be available as a right to those who work under social security because they have paid for it when they were able to work.

To be entitled to benefits by right of advance payment for themthis is the dignified, self-sufficient way-this is the only way-to meet the health care needs of America's aged and disabled citizens.

I thank you for the opportunity to present the views of my organization to this committee.

Mr. KING. I want to compliment you on your statement, Mr. Nagle. I will overlook the kind things you said about me. You have done

a good job.

Are there any questions?

Mr. ULLMAN. Mr. Chairman, I want to say we agree with the kind words that you had to say about our acting chairman.

I also want to compliment you, and particularly your eloquence in pointing up the basic fallacy of the welfare approach where you point out and I quote "their inquiries and questionings, their probings and investigations that tear a man's privacy to shreds, that change him from a man into a statistic in a caseload." I think that points out very eloquently the basic problem of old age and the basic need of

this type of insurance that will take him away from those investigations and allow him to hold his head high in his old age.

Thank you.

Mr. NAGLE. Thank you, gentlemen.

Mr. KING. Mr. Dikovics.

STATEMENT OF LESLIE J. DIKOVICS, ASSISTANT CONTROLLER OF WALTER KIDDE & CO., INC., BELLEVILLE, N.J., ON BEHALF OF MEMBER STATE CHAMBERS OF THE COUNCIL OF STATE CHAMBERS OF COMMERCE

Mr. DIKOVICS. Mr. Chairman and members of the committee, my name is Leslie J. Dikovics. I am the assistant controller of Walter Kidde & Co., Inc. of Belleville, N.J. I am a member of the Social Security Committee of the Council of State Chambers of Commerce, and I appear before you on behalf of the 31 State and regional chambers of commerce which are listed at the end of my statement.

The organizations for whom I speak are vigorously opposed to the creation of a new federally controlled program for health care benefits in conjunction with the OASDI program. Consistent with our position, we oppose the enactment of H.R. 4222 or any similar proposal for old-age health care where control is vested in the Federal Government.

Let me emphasize, at this point, that the organizations on whose behalf I am speaking today believe that adequate health care should be available to all the aged. This is a sound and desirable goal which we believe is accepted by everyone. Thus it seems to us that the differences in viewpoint revolve about the best method or methods of attaining that generally accepted goal.

We believe that the Congress in 1960 provided the best public means to supplement private efforts toward that end when it enacted the Kerr-Mills bill, H.R. 12580. On the other hand, we are more than ever convinced that a drastic modification of the social security system is neither necessary nor desirable to assure reasonable health care protection for the aged.

The American system of voluntary health insurance has done and is doing much to reduce the health care cost problem for millions of our aged citizens. According to a January 1960 national health survey, 46 percent of the 16.3 million aged, or 7.3 million persons, are covered by private hospitalization insurance. Other sources indicate this coverage is even broader. And this coverage will continue

to grow.

Other forces are also at work. Current health care protection is extended to 2.3 million aged persons under State old age assistance programs. About 1.5 million aged persons are entitled to health care protection under other programs, or do not want health care protection. In this category are included veterans, medical practitioners, member of religious groups, the well-to-do, and so forth. And much commendable activity is taking place to cover with protection the great majority of the remaining aged population under the FederalState assistance program for the medically indigent aged-the KerrMills program. We will detail this later in our statement.