HEALTH SERVICES FOR THE AGED UNDER THE SOCIAL SECURITY INSURANCE SYSTEM THURSDAY, AUGUST 3, 1961 HOUSE OF REPRESENTATIVES, Washington, D.C. The committee met at 10 a.m., pursuant to recess, in the committee room, House Office Building, Hon. Wilbur D. Mills (chairman of the committee) presiding. The CHAIRMAN. The committee will please be in order. Our first witness this morning is our colleague from Arkansas. We are very pleased to have before the committee this morning the Honorable Dale Alford, who represents the Fifth Congressional District of Arkansas, residing at Little Rock. We appreciate having you here and you are recognized. STATEMENT OF HON. DALE ALFORD, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF ARKANSAS Dr. ALFORD. Mr. Chairman and members of the committee, I ask unanimous consent, Mr. Chairman, to revise and extend my remarks. The CHAIRMAN. You have that permission. Dr. ALFORD. Thank you, sir. I am extremely grateful to you for this opportunity of being heard during these singularly important hearings. I have asked for this courtesy because I feel strongly that the bill you are considering is of unusual significance. In my view, H.R. 4222 is a measure cunningly devised for fishing in troubled waters. The bait is humanitarianism; the hook is loss of freedom. May I reemphasize this, Mr. Chairman? The bait is humanitarianism; the hook is loss of freedom. I say this as a physician, whose liberty to practice medicine freely is at stake. I say it also as a citizen elected to this House of Representatives. From both viewpoints, I urge the committee to reject this bill. By now you have heard many representatives of my profession testify to the damage this legislation could inflict upon the world's finest system of medical care. They are the Nation's experts on health, uniquely qualified to speak on matters affecting health. And from what I have read of their testimony, I can only add my fervent "Amen" to the case they have made. I shall therefore talk, not as a doctor, but as a Member of Congress deeply concerned with many of the bill's other aspects. 76123-61-pt. 3——21 To begin with, we do not need it. Last year the 86th Congress voted the Mills-Kerr law into effect. Its implementation has been remarkable, and its potential for helping those of the aged who need help is unlimited. On this count alone H.R. 4222 is unnecessary. But there are other reasons of which the committee is well aware. There are existing welfare programs; there are unremunerated efforts of responsible men and women, working together within their communities to help solve the problems of the aged; and there is the magnificent record of the insurance and prepayment plans, which now protect 132 million Americans, cover more than half the aged, and provide an effective, expanding method of cushioning the costs of ill ness. Surveys also show that the majority of our older people are selfsustaining financially, and that their health is generally good for years. Why then, does H.R. 4222 propose a compulsory national health plan for those receiving retirement benefits under ŎASDI? To me, the answer seems plain: This proposal was designed to set precedents-not to help people. Its sole purpose is to introduce the large foot of the Federal Government into the door of freely practiced medicine. I cannot believe, Mr. Chairman, that a bill of such suspiciously limited benefits and such avowedly modest ambitions is seriously proposed as the be-all, end-all solution to financing health care for the aged. Those who support it admit as much, for in rare moments of candor they point out the measure's inadequacies and add: "This is just a beginning." We are all aware that a philosophical battle rages in the United States between those who wish to cede more and more territory to the Federal Government, and those who believe we have already yielded more ground than we should. I suggest that the debate over social security medicine for the aged is simply a single skirmish in that continuing battle. But I predict that this skirmish will become the rallying point at which the American people will pause to fight the matter out, for there is a growing realization that further retreat would be the prelude to disaster. This is a generous nation-perhaps the most generous in the world history. Its people will dig deep into their pockets to help their neighbors. They are ready with the helping hand when it is needed, and easy-going when honest mistakes are made. But when they are riled, they are the toughest people on earth, and I think they are now beginning to get riled at the waste of their tax dollars. The distinguished chairman of this committee is properly recognized as an outstanding authority on fiscal matters. I cannot claim a fraction of his knowledge or experience in this field. But I submit that there is a limit to the amount of money the taxpayer can and will pay, and that we are approaching that limit right now. We have already bequeathed a mountainous stack of IO U's to our children and grandchildren, and it is doubtful if they will appreciate the inheritance. Yet H.R. 4222 proposes that we run up an even larger tab and send the bill to future generations. This measure would simply raise social security taxes, ask young working people and their descendants to pay them in perpetuity, and earmark the money for the help of millions. of older people who do not need help. It is one thing to help a neighbor in need, Mr. Chairman. It is another thing to ask a young worker to help everybody 65 or older simply because he has retired and receives benefits under social security. The people who will bear the brunt of this tax increase are already making the buffalo scream. They have children to feed and clothe and house. They have doctor bills and insurance premiums and mortgages and college education to pay for. They have taxes to pay-or else. All any member of this committee needs to do is watch the struggle of his younger constituents the next time he returns to his district. He will quickly observe that few young couples get very far ahead of the game. Why should they be asked, then, to pay the hospital bill for a man who may, for all this measure has to say about it, be a coupon-clipping millionaire living the life of Riley? Do I overtsate the case? Consider, Mr. Chairman, a single provision of the bill. H.R. 4222 provides that a person over 65, still at work, would be entitled to coverage for health purposes. Not having retired, this person is presumably as able to pay his own medical bills as he was at 50, or 40, or 30. Does it make sense to hand him unsolicited health services at the expense of a younger worker? I suggest that it does not. And I suggest that the committee consider carefully the justice of increasing social security taxes by 17 percent in order to provide medical benefits for millions of the aged who are able and willing to pay their own way. I say the tax would be increased by 17 percent. I should amend that statement. The tax would be increased by 17 percent for the time being. For it would go up as surely as day follows night as the program increased benefits, expanded coverage, and embraced an everenlarging number of older people. In conclusion, Mr. Chairman, I am unwilling to believe that the traditional virtues of self-reliance, initiative, independence, and thrift have disappeared from the American scene. Those virtues helped. build this country, and they die hard. But die they will if the Federal Government sees its function as the ultimate provision of a welfare state extending from cradle to grave. If our native virtues disappear, Mr. Chairman, there will be little left of our Nation worth preserving, and we shall fall easy prey to enemies from within or without. History is filled with examples, but I should like to quote only one. These are the words of William Shirer, in his book entitled "The Rise and Fall of the Third Reich": Bismarck put through between 1883 and 1889 a program for social security far beyond anything known in other countries. It included compulsory insurance for workers against old age, sickness, accident, and incapacity, and though organized by the state it was financed by employers and employees. It cannot be said that it stopped the rise of the Social Democrats or the trade unions, but it did have a profound effect on the working class in that it gradually made them value security over political freedom and caused them to see in the state, however conservative, a benefactor and protector. Hitler took full advantage of this state of mind. In this, as in other matters, he learned much from Bismarck. "I studied Bismarck's socialist legislation," Hitler remarks in "Mein Kampf," "in its intention, struggle, and success." Let us hope, Mr. Chairman, that we in America never set security over political freedom. And let us always remember that the Federal Government is the creature of the people, and that the people are not, and never must become, the creatures of the Federal Government. I thank the committee for granting me this opportunity to appear. Mr. Chairman, may I add if I may have the time just for a moment, I had the opportunity of seeing briefly copies of various testimony. I am concerned over individuals who will use unfair tactics. I think that this measure should be discussed upon its philosophical and legislative merits. I do not think that we should indulge in the use of cliches and terms that would smear one particular group of people. I think that anyone that will just take out after a profession is using an unfair tactic. I think that we should discuss this measure on its own merits and to those who come after me I would beg of them to discuss the merits of this measure, rather than to take out after any particular group of individuals. I may say that I am a friend of working people, as the chairman well knows, in my own district and State and I am deeply concerned that we will find a young worker in Little Rock, Ark., for example, let us say a mechanic, paying the bill, the health bill, if you please, of a coupon-clipping retired millionaire living on the shores of Florida. I think there are very deep issues at stake here, and I think that we should look into them studiously and be concerned with the merits of the case and not indulge in smearing each other. The use of smear tactics should have no place in this committee hearing. I thank the chairman for his indulgence in permitting me to add this statement. The CHAIRMAN. We thank you, Dr. Alford, for bringing this testimony to the committee. I know that you are, or that you were at least-I do not know whether you have forgotten how to do it by now or not at one point before you entered the political arena, recognized throughout the State of Arkansas as being one of our very finest surgeons. We appreciate all the more having you here. Dr. ALFORD. I thank the chairman for his kindness. The CHAIRMAN. Any questions? Thank you, sir. Dr. ALFORD. Thank you, sir. The CHAIRMAN. The next witness today is the Honorable Elmer J. Holland from the State of Pennsylvania. We appreciate your taking the time to come before the committee today. STATEMENT OF HON. ELMER J. HOLLAND, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF PENNSYLVANIA Mr. HOLLAND. Mr. Chairman, I would like your serious consideration of the administration's program for medical care of our aged, the King-Anderson bill now before your committee, and I ask, in behalf of the thousands of pensioners residing in my congressional district and Allegheny County, your committee to report this bill out so we may vote upon it during the present session. Although the committee is not studying legislation which I introduced this session that provides greater benefits for our elder citizens, I shall be glad to see the King-Anderson bill passed-and I will vote for it-as help in this field for our pensioners is long overdue. We have heard, for the past years, that the Forand bill, which my bill duplicates, "provided socialized medicine," that "the personal physician-patient contact was eliminated," "that such a plan was against our way of life." In fact, the propaganda published against this legislation made it appear that those who favored it were to be considered almost un-American. No such charge can be made against the King-Anderson bill-for fees charged by physicians or surgeons are not covered in this legislation. And, as President Kennedy said in his official message to Congress on this legislation, "There would be no supervision or control over the manner in which medical services are provided by any hospital." It seems strange, then, that we still hear the cry of "Socialized medicine," for this charge is deliberately false. The King-Anderson bill covers the cost-excluding the first 9 days for inpatient hospital services. It covers the cost of skilled nursing home services up to 180 days. It provides outpatient hospital diagnostic services over and above $20 per year. It provides community nurse services and related home health services. It costs the employer and employee each one-quarter of 1 percent more each year. The personal physician-patient relationship is not changed here, for we all know that in order to enter a hospital for care, one must be under the personal attention of a physician or a surgeon. Early this session, I sent a questionnaire to those on my mailing list who are pensioners. The response was excellent, and I should like to give this committee a short résumé of the results of this personal survey. Question Answer Would you prefer to have medical and hospital Yes (95 percent). insurance under social security? Do you have any kind of medical and hospital insurance now? Average payments for medical care since going on pension, on a yearly basis. Have you done without medical care because you did not have the money? Yes (50 percent). Hospital, $236; doctors, $377; medicine, $299; total, $912. Yes (41 percent). Although many who answered made personal comments, for the most part, the following gives you an idea of what was written: Cost of health insurance is high at a time when only relatively meager funds are available. Limitations on the coverage available to those retired are severe. A married man, 72, said: I was forced to drop hospital and medical care under Blue Cross and Blue A married man, 78, wrote about the cost and limited scope of protection: In 1952, the Blue Cross cost was $1.50 monthly and covered 3 weeks' hospitalization plus 90 days at half price. Now they exclude the 90-day clause and increased monthly payments to $3.80 with only 3 weeks hospitalization. |