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problem. It is the cause of a large part of the supplementation of OASI benefits and of the rising costs of public assistance, despite the declining numbers of old-age assistance recipients. It will become increasingly important with the growth in numbers of the aged *** The question the Nation faces is merely the question of the best way to meet these costs *** We believe that, for the long run, the most rational method is by way of insurance, and that the most feasible method of making sure that everyone shall be insured is to utilize the machinery of compulsory premium payment through OASI.

Congressman Forand's bill which this year bears the identification H.R. 4700, is notable because it will not only provide insurance against the costs of hospital and surgical services, but takes cognizance of the growing need for nursing home care. With the lengthening span of human life, we shall need more of this special type of service for the aged.

Congressman Forand's bill will finance the extra cost, with respect to employees and employers, by gradual increases for both under the Federal Insurance Contributions Act to a maximum after December 31, 1968, of 434 percent. This, even though it is an addition to other taxes under the F.I.C.A. to finance the provisions of the Social Security Act, is a small price to pay for removing the dread specter of fear and worry from the last years of our older citizens who are in need of medical care but are unable to pay for it from their social security checks.

As long as legislation to provide such insurance is certain to be enacted in the near future, in response to public demand and social needs, I believe that our best course is to make the beginning, now, so that our program will be adjusted to the increasing percentage of the aged in our population.

The CHAIRMAN. Thank you, Mr. Lane, for coming to us and giving us the benefit of your views on this subject.

Mr. LANE. Thank you, Mr. Chairman.

The CHAIRMAN. We will now hear from our colleague, Hon. John B. Bennett from the State of Michigan. We are happy to welcome you, Mr. Bennett.

Mr. BENNETT. Thank you, Mr. Chairman.

STATEMENT OF REPRESENTATIVE JOHN B. BENNETT, OF MICHIGAN

Mr. BENNETT. It is my sincere belief favorable consideration should be given at an early date to provide medical and hospital care in our social security system. It is very apparent our numerous retired people find it impossible to pay for the cost of medical care associated with hospitalization on the meager pensions now available to them. My proposal is that the cost of hospital care and surgical services should be provided in the hospital up to 60 days for people eligible for social security benefits. Then, if further care in a nursing home is indicated by the physician, additional costs up to 120 days of combined hospital and nursing home care is provided. It incorporates an income test, used in many private plans, by limiting this protection to those people whose total family income, including social security benefits, does not exceed $2,400 a year. The method of confining payments to those hospital services where cost schedules have already been tested by Blue Cross plans, also preserves the professional independence of doctors. We must take this forward step to provide a form

of insurance protection for those people on social security whose income is so limited they cannot afford to pay the premiums for this kind of prepaid care. I am convinced our older people are not getting their share of the modern but increasingly costly miracles of medical care, which high cost is felt more acutely by older people because their illnesses are usually of longer duration.

It is well known that the wider application of preventive measures which we are getting today will lead to less infirmity in older years in the future. This is one of the reasons why I am not persuaded by the argument sometimes presented that my proposal would lead eventually to excessive medical costs. I also believe the doctors of this country are competent enough, and honest enough, to insure against any abuse of this provision.

Good evidence indicates that it is not through negligence that many older people are without medical care protection. It simply is not available to them at a price they can pay. My plan with its $2,400 income ceiling is designed specifically to meet the medical care needs of people with a low retirement income who would otherwise be selfsufficient. In this way we will not only preserve individual selfrespect, but will also be helping hospitals to meet the mounting costs of providing the best kind of medical care for people who cannot now afford it.

I also propose a more liberal definition of permanent and total disability for social security benefits and a modification of the present stringent length of service requirements. I believe such modifications should apply to the benefits payable to people 50 and over and also to the "disability freeze" which applies to workers at any age. The definition of disability in the law is strict and it is even more strictly administered. My proposal is to modify the present law by stating a person must be unable to "engage in a substantial gainful activity which is the same as or similar to the occupation or employment last performed by him on a regular basis before the onset of such impairment." This terminology is closer to what Congress really intended in passing the 1956 amendments and will insure administration of the act in a way that will give the American worker real protection against crippling injury or disease. Then, too, I propose the period be reduced to 15 out of the last 30 quarters of coverage for an individual to qualify for disability. Such revision will take care of some of the tragic cases of middle-age workers who are incapacitated in the early years of their coverage under this system.

We must keep our social security system up to date because we believe in the inherent dignity and worth of each individual. The above described changes are required in our present social security program. It is my sincere hope the Members of this Congress will enact such changes into law.

The CHAIRMAN. Thank you, Mr. Bennett, for coming to us and giving us the benefit of your views on this subject.

Mr. BENNETT. Thank you, Mr. Chairman.

The CHAIRMAN. We will now hear from our colleague, the Honorable A. S. J. Carnahan, from the State of Missouri. We are happy to welcome you, Mr. Carnahan.

Mr. CARNAHAN. Thank you, Mr. Chairman.

STATEMENT OF REPRESENTATIVE A. S. J. CARNAHAN, OF MISSOURI

Mr. CARNAHAN. Mr. Chairman, and members of the committee, I appreciate the opportunity to appear before you. Each of us in Congress has had an opportunity to observe the extraordinary interest and concern that has been evoked by H.R. 4700, introduced by the Honorable Aime J. Forand, which is designed to ease the problems of the old-age and survivors insurance beneficiaries in regard to certain medical costs. I believe I speak in behalf of a large number of my constituents when I say that this bill deserves favorable action by this committee and this Congress. The problem of how to pay increasing medical costs is a frighteningly serious one for all of us, but especially for those who are forced to live on meager, fixed retirement incomes. We in Missouri have particular cause for concern, because our population of elderly persons is even higher than the national average. Figures from the Census Bureau show that in 1960 the number of persons 65 years old and more will reach 10.6 percent of our total State population. This is almost 2 percentage points higher than that for the United States as a whole.

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Throughout the country, however, the number of elderly persons who need this legislation is growing at an extremely rapid rate. problem of adequate medical care for these people cannot, therefore, be regarded as a local or regional one. Everywhere it has reached serious enough proportions to warrant the attention of each Member of Congress. It is clear that we must have an answer to it, and we must find it soon.

As I have indicated earlier, I believe the best answer lies in passage of the bill the committee is now considering. It has one basic advantage which no other public or private proposal has offered: It would enable persons to pay for the cost of the insurance at a time when they were employed and could afford it. After retirement they would be free of the burden of monthly premium payments which inevitably are a serious drain on small pension incomes.

The method of payment for the medical insurance program under the Forand bill is well conceived. It makes uses of existing social security machinery, and makes it easy and painless for each person under the social security system to qualify for benefits. According to reliable estimates, the initial costs of the program, which would amount to about $1 billion annually, would be covered adequately by increasing the social security tax by a very small percentage. Each employer and employee would pay about three-eights of 1 percent of payroll on earnings up to $4,800 each year. The self-employed would pay nine-sixteenths of 1 percent. This seems to me a very reasonable price to pay for the benefits which would be gained.

The medical coverage offered under the Forand bill would not be comprehensive. But it would have certain basic advantages over the insurance that is available to older citizens under existing plans. Most important, every person entitled to old-age and survivors insurance benefits would be eligible, which means that no one could be arbitrarily denied insurance coverage. In addition, the benefits which would be provided are ones which the elderly are most likely to need. The cost of surgery, which today often is far beyond their means would be covered. Expensive hospital and nursing home care would also come

under the program, with much more complete benefits than are now generally available to the aging.

Under the proposed system, the old-age and survivors insurance beneficiary would have certain other important assurances: There would be no lifetime limits on the total costs that would be covered; there would be no exclusion of preexisting conditions.

Each of us who is at all familiar with the problems of older people knows that there is an overwhelming humanitarian basis for this legislation. The need for it can be demonstrated through facts and figures, as well as through personal experience or knowledge. The recent study by the Department of Health, Education, and Welfare, conducted at the request of this committee, gives an objective picture of the plight of the elderly in obtaining and paying for medical services. An examination of the income figures of this age group and the costs of medical care which are needed by them points up the existing dilemma.

If we want a healthy and vigorous population, and I trust we do, then I see no alternative than to take proper and adequate measures to make this goal reality. I believe, therefore, that this Congress must give favorable consideration to H.R. 4700.

The CHAIRMAN. Thank you, Mr. Carnahan, for coming to us and giving us your views on the subject.

Mr. CARNAHAN. Thank you, Mr. Chairman.

The CHAIRMAN. We will now hear from our colleague, the Honorable Isidore Dollinger, from the State of New York. We are happy to welcome you, Mr. Dollinger.

Mr. DOLLINGER. Thank you, Mr. Chairman.

STATEMENT OF REPRESENTATIVE ISIDORE DOLLINGER, OF NEW YORK

Mr. DOLLINGER. Mr. Chairman and members of the Committee on Ways and Means, you have before you for consideration the Forand bill to amend the Social Security Act and the internal revenue code so as to provide insurance against the costs of hospital, nursing home, and surgical service for persons eligible for old-age and survivors insurance benefits, and for other purposes. I introduced a similar bill on March 4, 1959, as I wished to emphasize my strong support of this legislation.

There is an overwhelming need for the benefits provided by the bill. Such benefits would be allowed as part of our established social security system and would be financed under that system. The contributions to be made by employees and employers would insure the necessary help when illness and disability are suffered in later years by those entitled to old-age and survivors insurance benefits.

Today there are more than 14 million persons in the United States who are over 65 years old. As of March 1959 more than 12 million persons were receiving social security payments, the majority of whom are entirely dependent upon such social security benefits for their existence; they have no other income or assets. All living costs are at a new high-including medical, nursing, and hospital care. Many thousands of our older persons are suffering great pain and discomfort, jeopardizing their lives, because they cannot afford doctors' bills,

medicines, or hospital or nursing care. Present social security benefits are still grossly inadequate to meet the barest necessities; our older citizens have nothing left with which to pay for the high expenses of illness or medical aid.

It is incredible that, in our Nation of plenty, countless older persons are denied the medical aid and attention they so desperately need. I have received many letters describing pitiful circumstances and great hardships being suffered by older people in my district; petitions bearing the names of many thousands have been sent me attesting to their inability to procure necessary medical help and to the great need for the legislation before you.

I believe that your committee has before it evidence to show that many outstanding organizations strongly endorse health benefits under the old-age, survivors, and disability insurance program; also evidence that health services for the aged are grossly inadequate throughout the Nation. As a result of the studies of the situation which have been made, it is obvious that such a health program cannot be provided satisfactorily in any way other than that provided by the bill before you; the Federal Government must take the necessary action. It would be unconscionable and cruel of us to continue to ignore the tragic plight of our older persons who find it impossible to provide for themselves the insurance to cover the high cost of illness and care. They should be given this opportunity under our social security program.

I know that your committee will show the proper concern for our older persons and that you will take favorable action on the bill before you.

The CHAIRMAN. Thank you, Mr. Dollinger, for coming to us and giving us your views on this subject.

Mr. DOLLINGER. Thank you, Mr. Chairman.

The CHAIRMAN. Our next witness is our colleague from Wisconsin, Hon. Clement J. Zablocki.

Mr. Zablocki, we appreciate very much your being before the committee.

STATEMENT OF HON. CLEMENT J. ZABLOCKI, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF WISCONSIN

Mr. ZABLOCKI. Thank you, Mr. Chairman.

I deeply appreciate this opportunity to appear before your committee, to present my views on legislation proposing to provide health benefits to the aged.

Some time ago, on March 17, 1959, to be exact, the Common Council of the City of Milwaukee, Wis., adopted a resolution expressing its position on H.R. 4700.

Last week I received a telegram from Mr. Stanley J. Witkowski, city clerk of Milwaukee, asking me the present the common council's position to your committee. I am happy to do so, and I would like to ask for permission to have Mr. Witkowski's telegram, and the text of the common council's resilution, included in the record of the hearings.

The CHAIRMAN. Without objection, that will be included.

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