They are particularly in need of these latter benefits, due to the prolonged course of the degenerative and malignant diseases to which, at their age, they are patricularly susceptible. They are, however, unable to pay for them either directly or through insurance because the cost of such service or insurance is beyond their means.

MARITAL STATUS

Marital status has a particular bearing on the problem of hospitalization and home care. In view of the prolonged illnesses which strike older persons, they cannot be cared for adequately at home, and the high cost of hospitalization is more than they can afford.

About 75 percent of our patients over 65 years of age were married, but due to various reasons-death of spouse, divorce, or separation10 percent of the males and 52 percent of the females have no spouses

now.

Those patients who have married children are reluctant to live with them because they feel they would be considered a burden, and often children reject old folks.

SOCIOECONOMIC CONDITIONS

A recent study of a large number of our cases who had suffered coronary attacks revealed that 69 percent were over 65 years of age. Only about half of this group studied had savings accounts up to $3,000. Some patients had insurance policies of $1,000, $2,000. Rarely did we find any of them holding policies up to $5,000.

As a rule, garment workers are not large wage earners. Our experience among our patients is that the majority earn between $2,500 to $3,500 a year because of the seasonal nature of the industry. Occasionally in some small local unions, such as cutters and pressers, there are incomes of around $5,000, but this exists in less than 10 percent of the industry.

Social security and union pensions are almost the sole sources of income for retired patients. Due to their low earnings in past years, their social security benefits do not reach the maximums and their union pensions are only $50 to $65 a month. Obviously, this is not enough to provide even the bare essentials of daily living, much less any additional cost for medical care. We have had evidence of their financial difficulties in medical problems by their inability to pay for low cost drugs at the center which are priced on a cost basis.

Only a small number of people manage to carry hospitalization insurance on an individual basis after they have retired from the industry where it had previously been provided on a group insurance plan.

HOSPITALIZATION OF AGED AND RETIRED PATIENTS

In studying our hospitalization problem, we found that 53 percent went to voluntary hospitals, 35 percent went to municipal hospitals, and 6.5 percent went to proprietary hospitals.

The greatest majority of patients who go to voluntary hospitals go into the wards, and usually through our influence, where they are of such interest to the surgical staff that we get them in without any charge.

Many patients are reluctant to go to municipal hospitals because of the charity atmosphere and the means tests. The municipal hospitals in New York City are primarily for the medically indigent, and still the rate here is approximately $28 a day, which is an all inclusive fee for service as well. While rates lower than $28 may be accepted, patients are subjected to financial investigation concerning insurance policies, bank deposits, and real property, as well as any other assets it may appear the patient has even copies of income tax reports are reviewed."

I regret that I cannot subscribe to organized medicine's position in opposing this bill. They most fear that it will lead to so-called socialized medicine and that it will interfere with the promotion of voluntary hospitalization insurance. These and other objections at this moment do not compare with the illness which produces insecurity and misery of the aged who are now in great need of hospitalization insurance. Besides, voluntary hospital insurance is no panacea even if the aged could afford this luxury. Voluntary and commercial insurance contracts often pay only part of the bill. In cases of hospitalized aged, payments may be extremely limited because of prolonged stay in the hospital.

Apparently, the feared so-called socialized medicine is due to the fact that this bill would add another medical program to the numerous Government health programs now in operation. Mr. Flemming's report describes various ways of managing this hospital insurance through the social security program which would allay some of these fears. The need for this care is far more serious than satisfying these fears, particularly when there is no realistic alternative plan backed by a funding arrangement that has been proposed at this time.

The CHAIRMAN. Dr. Price, we thank you, sir, for bringing to us the views you have expressed in your own behalf and that of the Union Health Center. Thank you very much.

Are there any questions?

Mr. ALGER. Mr. Chairman.
The CHAIRMAN. Mr. Alger.

Mr. ALGER. I would like to ask you, Do you know Dr. Asari?
Dr. PRICE. Yes.

Mr. ALGER. He spoke yesterday, testifying for the Medical Society of the State of New York

In New York any person who requires medical care and cannot pay for it, receives that care. This program in terms of medical standards and administrative efficiency and results has been classified as one of the best in the country. Reliable sources show that approximately $100 million a year is spent to provide medical care for the medically indigent.

That is a pretty fine record for New York City.

Dr. PRICE. I would say we have a very good system in New York. As I say, if these people have as much as $300 in the bank between themselves and nothing else to depend upon, this $300 will be taken away from them in those municipal hospitals. They get excellent service there. I will tell you the largest group of our patients, the cancer patients, are being taken care of in most instances in the Bellevue Hospital in New York and given excellent service.

They give that service because they are part of the teaching institution where this material is very important. They are accepted there

and sometimes they are not charged because of the nature of the surgery that has to be performed. But this is not what we want. We want that they be able to have a right to have this given to them, not as a form of charity.

The CHAIRMAN. Thank you, Doctor.

I have a statement that the distinguished Senator from Minnesota, Mr. Humphrey, has asked that we include in the record. The statement he is making is in behalf of the bill. Without objection the statement will appear in the record.

(The prepared statement of Senator Humphrey follows:)

STATEMENT OF SENATOR HUBERT H. HUMPHREY

Mr. Chairman, I appreciate very much this opportunity to present a brief statement on the very urgent problem you are discussing in these hearings. I would like first to pay my respects to Representative Aime Forand, the author of the principal bill before this committee, H.R. 4700, aimed at providing insurance against the costs of hospitalization and other costs for older citizens. His active and intelligent promotion of this vital improvement in our social security laws has already done much good. More and more attention has been focused on the necessity of meeting through practical programs the medical needs of our older people. Insurance companies have taken steps to cover a larger proportion of our older citizens in their private plans. Welcome as these steps are, however, they cannot really meet the problems which the Forand bill and similar bills aim to meet.

Mr. Chairman, I am the author of one of the two bills in this area which have been introduced in the Senate. My distinguished colleague, Senator Wayne Morse, of Oregon, is the author of the other bill, and he has already appeared before you.

My own bill, S. 1511, which I introduced on February 23, differs from H.R. 4700 in that it does not include surgical benefits. It would provide insurance against the costs of hospital and nursing home care. But the principal objective of my bill, and the basic philosophy behind it, is similar to that of the Forand bill. It is to use the wonderful tool of social insurance to provide a basic service to our people which cannot be adequately rendered any other way.

I have not had the time to follow in detail all the testimony which has been presented before this committee during the past 4 days. But I am impressed with two things that I understand have been clearly demonstrated already. First, the opposition to the Forand bill, and presumably to my own, is essentially the same kind of opposition that was voiced against the original Social Security Act and against every extension and improvement made during the 25 years of its existence. Again, the false issue of regimentation is raised. Again, the threat to private insurance is raised. Again, the cry of socialized medicine is raised. Again, the fear of a huge bureaucracy is raised. The answer to all these charges, Mr. Chairman, is found easily in our actual experience. We have brought over 100 million people into our social security program, and our freedom remains intact. We provided for those permanently and totally disabled and the program has worked. We have paid people when they could not find work, and our economic system has not fallen apart.

Let those who decry further improvement tell us whether they were right or wrong in their earlier fears. And let them tell us whether they would now repeal any of the actions they once opposed.

Secondly, Mr. Chairman, I am impressed with the roster of prominent and experienced witnesses who have appeared before you in favor of legislation in this area. And I am impressed with the fact that two former Social Security Administrators-one a Democratic appointee and one a Republican appointee have attested to the administrative feasibility of, as well as the need for, this program.

The record of these hearings, I am informed, is already very rich with documentary evidence as to the unmet medical and hospital needs of our older citizens. I will not burden the record with repetitious material.

The matter before this committee is not merely an economic problem, a cost problem. One way or another, the cost must be and will be met.

Americans are not heartless or insensitive to people's needs. Of course, there are many doctors who provide free service. Of course, there are many free clinics and free hospital rooms for indigent patients. Of course, we cities, counties, States, and Federal Government-will continue to appropriate hundreds of millions of dollars for medical care under our public assistance programs. And, of course, children and grandchildren and other relatives will continue to bear the cost of medical and hospital bills during emergencies. But there will never be reliable statistics about those who would rather suffer, and even die, before asking for help that carries the label of charity or who wait too long before they ask for help. Can we measure the heartache that accompanies the decision to ask a son or daughter to exhaust his or her savings, or go into debt, to pay for a parent's hospital stay or nursing home care?

And while we are discussing the cost of medical care for the elderly, I want to call attention to the tremendous financial burden to local and State governments for providing hospitalization for the aged. I strongly feel that the Federal Government should assist in meeting the costs of such care. Local and State governments are finding it increasingly difficult to finance the programs needed and demanded by their citizens; by helping to relieve them of the heavy costs of hospital care for the aged, a greater portion of their revenues can be channeled into providing for the educational needs of our children. May I respectfully suggest to this committee that it make a study of the costs born by local and State governments for hospital and nursing home care for the elderly.

To me, Mr. Chairman, the issue is primarily that of providing a dignified system of insurance where the benefits are obtained as a matter of right, a right that results from a lifetime of work, and a lifetime of contributions. In creating such a system, we must make up partially for past neglect by blanketing in those who are already qualified for present OASI benefits.

An America headed for a $500 billion economy can provide health care for its aged. The insurance approach to such care represents the right way, the dignified way, the socially desirable way.

I hope you will give us in the Senate a chance soon to put our stamp of approval on favorable action which you will take in this committee and then in the House itself.

I would like to ask that an address which I delivered on May 26, 1959, in New York City before the ninth annual Group Health Institute luncheon be inserted in the hearing record at the conclusion of my statement.

Thank you for this opportunity to testify.

(The address referred to is as follows:)

NEXT STEPS TOWARD HEALTH

Remarks of Senator Hubert H. Humphrey, ninth annual Group Health Institute luncheon, New York City, May 26, 1959

I never cease to wonder at the range of Mrs. Roosevelt's capacity for doing good. You know her wonderful work for the United Nations, for human rights, and for peace. Within the last few weeks she has been in Washington helping to improve the conditions of migrant workers, helping to get the minimum wage raised, helping in the campaign for better housing. Today she is here giving of her time and her immense influence in the cause of health. Wherever there is good to be done, we can be grateful that she is on hand to do it.

And I want to pay tribute also to that patron saint of medical care, Mary Lasker. Without her crusading interest and support and her wonderful work we would not be nearly so far along toward the goal of good health and good medical care for everybody in this country.

That is our goal. I am pleased and honored that you have invited me here to take counsel with you on some of the next steps we must take. I am particularly flattered to be here because in this room are some of the best brains and bravest spirits in the business. The solutions to these problems, when they come, will come from people like you.

In a few days we will mark the 25th anniversary of Franklin Roosevelt's message to Congress laying down the guidelines for what has since become the social security system of the United States.

"Among our objectives," he said in that message, "I place the security of the men, women, and children of the Nation first."

In that sentence F.D.R. summarized one of the great revolutions in American political thinking-one which grew out of the Great Depression. In that sen tence he put the final seal of rejection on the degrading, poor law philosophy which had dominated American public attitudes towards dependency and the problems of dependency.

Of course, there were die-hard dissenters. My good friend, Arthur Schlesinger, Jr., in his great book on "The Age of Roosevelt" records that a distinguished Republican, now ranking minority member of the House Appropriations Committee, greeted the social security system with these words: "Never in the history of the world has any measure been brought in here so insidiously designed as to prevent business recovery, to enslave workers, and to prevent any possibility of the employers providing work for the people."

The spokesman for the Illinois Manufacturers' Association said that social security would undermine our national life "by destroying initiative, discouraging thrift, and stifling individual responsibility."

The spokesman for the Amercan Bar Association labeled it the beginning of a pattern which "sooner or later will bring about the inevitable abandonment of private capitalism."

Yes, my friends, as we try to move on to round out the coverage and the protections of our social security system we can expect the same opposition, the same gloomy alarm, that has greeted every reform and every great forward step in our history.

But the fact remains that we must get on with this unfinished business. The question is not whether we are going to finish it, because we will. The question is how and when.

We need to modernize our unemployment compensation laws. I have sponsored legislation to accomplish this. It is a cause for great disappointment that this has recently been rejected by the House Ways and Means Committee. But we will try again-and soon.

We need to increase the amount of old age benefits, which in many cases are disgracefully low. I have been among the sponsors of legislation to do this, and I regret very much that the increases enacted last year were so meager. Within the next decade our social security benefit standard should be increased not by 10 percent, but by 50 percent or more.

When we enacted the social security system we embarked on a program which would provide not only the material basis for subsistence to those who could not be self-supporting. We embarked on a program which would also preserve their self-respect. Even so long as there is poverty in the United States, let there never be paupers.

In no aspect of welfare is this more true than in health. Our system of economic security should enable people to buy the necessaries of food, housing and clothing. It should enable them to obtain the necessaries of health. Foodclothing, shelter-to these basic needs I add health, the right of every American to adequate health services, regardless of his income.

We have made enormous strides forward in the science of health, both in the prevention and the treatment of illness.

We have made considerable progress in the financing of health services through voluntary health and hospital insurance, and particularly through the union health plans and prepaid group health organizations. Those in this room have been among the leaders in these promising developments.

And yet we cannot honestly say we have in sight a comprehensive solution for the gigantic task of bringing good medical care within the reach of every American.

Those who can afford to buy it individually can get it.

Those who are fortunate enough to belong to unions which have won comprehensive health plans through collective bargaining can get it.

Those who have had the foresight to organize and join prepaid group health associations can get it. But for large segments of our population, medical care is limited to emergencies, and even when the medical emergency is surmounted, it leaves a financial emergency in its wake.

I am not an expert in medical care. It is my job to worry about the practical problems of legislation.

I do not profess to know how we will solve all the difficult and complex problems of bringing good medical care within the reach and within the means of all our people. But we who struggle with legislative practicalities must look to people like you for the design of health programs of general legislative ap