and in numerous instances contribute to the costs of maternity, eye conservation, care of tuberculars, and so on. During the calendar year 1960 the total disbursements for all health benefits and services was over $23 million.

I mention these facts to show that we have come a long way from the days of the old sweatshop. Through collective bargaining the health of the average garment worker has materially improved. We have raised his standard of living, laid the foundation for better medical care, and provided some financial assistance when he is disabled. Despite the success of our programs, however, much remains to be done, much more than any single union in cooperation with the employers of its members can hope to accomplish.

There are certain limitatitons on what the union funds can do for its members in the prevention and treatment of illness.

In the first place, as a result of the position taken by organized medical groups in most areas, our health centers outside New York City can provide only diagnostic services. They cannot treat any ailments which they discover and the members are required to rely on their own resources to pay for medical treatment. The sharp increases over recent years in the cost of medical services make this financial burden too heavy for many persons who must therefore neglect their health until it deteriorates to such a point as to become an emergency.

Secondly, the resources of our health and welfare funds usually do not permit the provision of any health and medical benefits or use of the health centers to the families of our members. Yet the burden of paying for needed medical care for families frequently must be shouldered by our members.

Finally, because employer contributions to our health and welfare funds are based on payrolls, retired members of our union are not eligible for any of the health and medical benefits enumerated above except for use of the health centers. And, as pointed out above, there are limitations on what our health centers can furnish. Our retired workers, who are usually most in need of medical care, are thus not eligible for the types of benefits based on employment-disability benefits, hospitalization, and surgical benefits, and so on.

Therefore, we are faced with a situation where those who need medical care the most, the elderly, are least able to afford it because they are no longer receiving wages or the fringe benefits which are tied to employment. Our experience demonstrates that this problem cannot be dealt with in terms of individuals or even in terms of relatively large groups. Pooled protection, carried out in accordance with the principles of sound social insurance, is the way to provide the needed medical facilities and services during old age. The cost of such protection should be spread out among each individual's productive years and among the working population as a whole. It is of basic importance to keep the degrading means test out of any medical care program. The social security system, which has worked so effectively and efficiently is providing old age, dependents, survivors, and disability benefits, in the vehicle for the most constructive and inexpensive overall solution to this problem.

The Anderson-King bill (S. 909, H.R. 4222) provides the framework for a Sound and constructive program of health benefits for the aged. While the deductible feature of this bill, which requires heavy initial payments from the aged citizens themselves for early medical care, is unwise, the bill does offer a basis for providing our senior citizens with the benefits which modern medicine can offer.

TESTIMONY OF JOHN CLARK, PRESIDENT, INTERNATIONAL UNION OF MINE, MILL & SMELTER WORKERS

The International Union of Mine, Mill & Smelter Workers, which I represent, wishes to endorse and urge the enactment of H.R. 4222, the Health Insurance Benefits Act of 1961.

There has been a great deal of excellent general testimony in support of this bill at these hearings and, rather than adding to the weight of this material, I believe my union can be most helpful to the committee in outlining the special importance of this legislation in meeting the needs of our membership.

Our members are employed in the mining, milling, smelting, refining, and fabrication of nonferrous metals. Along with the general occupational health and safety hazards faced in greater or lesser degree by all industrial production workers, the workers in nonferrous metals are exposed to silica dust, metallic poisoning, such as lead and cadmium poisoning, and other poisons, fumes, and chemical irritants. Exposure to silica dust, of course, leads to the disease of

silicosis. In testimony last month before a Select Subcommittee of the House Committee on Education and Labor on the Federal noncoal mine inspection bill (H.R. 5435, Representative James O'Hara), we presented considerable evidence to point to a menacing increase in the dimensions of the industrial disease problem, particularly silicosis and diseases associated with exposures to radon gas. Associated with silicosis is a predispositon to tuberculosis, and an abnormally high rate of cardiac dieases among advanced silicotics. In underground mining, where exposure to damp conditions and sudden temperature changes occurs, arthritic and rheumatic diseases frequently result. In the mills, exposure to silica dust is prevalent, as in underground mining.

A study by Dr. W. C. Hueper of the National Cancer Institute, "A Quest Into the Environmental Causes of Cancer of the Lung," has revealed unusually high rates of death from lung cancer in counties where copper smelters are located. The same survey, citing lung cancer death rates for seven industrial groups in Ohio, in which nonferrous metals showed the highest rate, observed that nonferrous workers "often have contact with dust, fumes, and vapors of some carcinogenic metals, such as chromium and nickel, or with arsenicals which are impurities in many nonferrous metals-copper, zinc, and silver."

Finally, the very high rates of disabling injuries, especially in underground metal mining, leave a disproportionately high number of men from our industry in need of varying degrees of care. This, in brief outline, highlights the major health problems, and resulting health care needs, that may be found among retirees from the nonferrous metals industry in considerably greater degree than among the rest of the retired population.

The members of my union, on the average, receive higher earnings than most other categories of industrial workers, and are close to the highest average industry earnings reported by the Bureau of Labor Statistics. Yet, like most industrial workers, our members reach retirement age with very limited, if any, accumulated savings. Their retirement income derives from social security payments and industrial pensions which typically average about $55 per month. The typical worker retiring in the next few years from the nonferrous metals industry will have had average social security taxable earnings at not much over the $4,200 limit in effect until 1959, and for such a worker at 65, with a wife the same age, the monthly social security retirement benefit will generally not be over $174 per month, and, in many cases, less. Together with the industrial pension, the total income of a typical retired couple comes to less than $230 a monthabout $2,760 per year. Many of those already retired, especially those who retired some years ago, receive less than this amount because social security benefits and industrial pensions were both lower at time of retirement.

The typical nonferrous worker is not entitled to medical or hospital benefits that are almost universally paid for by the employer during his active years. There are few exceptions to this rule; one major producer will reimburse a retired couple's medical and hospital expenses up to a total lifetime maximum of $1,000, after which its responsibility ceases. Another major producer, which has a contributory hospital and medical plan, permits retirees to remain in the plan with increased premiums and diminished coverage. Two smaller firms offer limited medical and/or hospital benefits. The great majority of retired workers in the industry have no industrial coverage of any kind, and most of those with coverage are covered inadequately.

In the great majority of cases of nonaccidental work-connected disability, workmen's compensation is denied. Rigid eligibility requirements, covering long residence in the State where the claim is filed and tests of degree of disability disbar most of the disabled silicotics. Similarly, tuberculosis, lung cancer, heart disease, arthritic and rheumatic diseases are either noncompensable or proof that the disability is work connected is difficult to establish. Most of those disabled by accidents, if they have been able to win compensation, have exhausted their compensation benefits by age 65.

Retired persons, in the circumstances I have gone to some length to describe, simply do not have the resources to pay for hospital and nursing-home care, and frequently expensive therapy that is required by many accidentally disabled, or by those with the industrial diseases I have enumerated. Their current incomes are barely sufficient to permit a very modest, and necessarily carefully managed, scale of living. Most retirees have no industrial hospital coverage, and the minority who do are not adequately covered to meet the needs of their retire ment years.

Modest though their incomes are, the stark and tragic fact is that virtually all retirees from the nonferrous industry will be excluded from the limited

benefits available, or to be available in the next few years, in half or less of the States under the medical assistance to the aged program, established in 1960 under Public Law 86-778. A staff report to the Special Senate Committee on Aging, "State Action To Implement Medical Programs for the Aged" says the vast majority of States estimate that, on the basis of eligibility criteria only, between 30 and 45 percent of the aged population in their States would qualify for MAA. On page 50 of this report, a table appears showing financial eligibility criteria thus far established by 15 States. These range from a maximum income for a single person of $1,000 to $1,800 per year and for couples from $1,560 to $3,000 per year. The maximums for single persons are $1,500 or less in 12 of these States, and for couples are $2,500 or less in 11 of these States. One State disbars couples, regardless of income, if there are adult children.

Only one of the nonferrous metal mining States has established maximum income eligibility standards thus far. This is Utah, where the maximum for single persons is $1,200 and for couples $2,040. The only retirees from our industry who would be eligible in Utah under these standards would be a handful of oldtimers retired years ago at much lower than present pension levels.

The disappointingly low eligibility standards in Utah and in States where fabricating and refining operations are carried on, are of concern to my union, but even this is of largely academic interest in nearly all of the principal nonferrous mining States, where it would appear from the report cited above, chances that the States will adopt any program at all in the foreseeable future are slim. Such important nonferrous metals mining States as Arizona, Montana, Nevada, New Mexico, Idaho, and Colorado have not yet adopted programs.

I appreciate this opportunity to lay the views of my union on this important legislation before this committee. There exists a need among retired workers in this industry for the services which this bill would provide. The vast majority of these retirees lack any other means of financing them. We therefore urge enactment of this legislation at this session.

BERNALILLO COUNTY MACHINISTS NONPARTISAN POLITICAL LEAGUE,

Albuquerque, N. Mex., July 31, 1961.

A STATEMENT IN SUPPORT OF THE HEALTH INSURANCE BENEFITS ACT OF 1961, H.R. 4222

Hon. WILBUR D. MILLS,

Committee on Ways and Means,

House of Representatives, Washington, D.C.:

The Bernalillo County Machinists Nonpartisan Political League, representing some 2,000 machinists families in Albuquerque, N. Mex., has gone on record favoring the enactment of H.R. 4222, the Health Insurance Benefits Act of 1961. In New Mexico the Kerr-Mills bill is not in effect because the 1961 legislature failed to appropriate the necessary funds. No action can be taken until 1963 at the next legislative session. In the meantime our senior citizens are without adequate medical care. The insurance industry has given inadequate service in this area, and we do not feel that there should have to be a profit made on human misery.

We therefore ask that H.R. 4222, the King bill, receive favorable consideration by the Committee on Ways and Means, and that this statement be entered in the record of the hearings on H.R. 4222 the Health Insurance Benefits Act of 1961. Respectfully,

JAMES J. WEBER, Chairman, Bernalillo County Machinists Nonpartisan Political League.

STATEMENT OF THOS L. PITTS, SECRETARY-TREASURER, CALIFORNIA LABOR FEDERATION, AFL-CIO

The most recent convention of the California Labor Federation, AFL-CIO took place in Sacramento, August 15-19, 1960. Some 2.000 delegates, representing the 1.3 million AFL-CIO members in this State, unanimously adopted a statement of policy on social security matters, part of which endorsed the concept of prepaid health care for our senior citizens through the social security mechanism. Although attention focused on the Forand bill in 1960, whereas the Anderson-King

bill is at present the principal embodiment of such proposals, the issues and the statistics relating to the problem have not been altered materially.

As the most recent expression of direct rank-and-file sentiment on the part of the entire body of organized labor in California, the most pertinent portions of statement of policy are called to the committee's attention:

"The abysmal void facing our 16 million senior citizens as a result of the conclusive failure of voluntary programs to meet their compelling health care needs can only be filled through the enactment of a Forand-type program of prepaid health care under the social security system with financing provided through a payroll tax shared equally by employers and employees.

"The ranks of America's 16 million citizens over 65 years of age are being swelled by another million every 3 years. The circumstances under which most of them are striving to maintain their health is one of the most dismal and shameful aspects of American life today.

"Only one out of five of our senior citizens is employed in any manner. The total income for 80 percent of this group falls below $1,000 annually, while another 20 percent receive less than $2,000. These income totals include the aver age OASDI retirement benefit of $73 per month in effect at the beginning of this year. The pathetic inadequacy of these income levels is highlighted by the State division of industrial welfare's determination that $2,647 minimally was required by a single workingwoman to maintain an adequate standard of living as of March 1960.

"Since medical care requirements for this group are abnormally high, the rise in medical care costs since 1947-49 at about twice the rate of increase for all other items in the Consumer Price Index has had an especially severe impact. It contributed substantially to Secretary of Health, Education, and Welfare Flemming's conclusion last year that three out of four elderly persons were utterly unable to meet the costs of serious illness.

"To contend with these costs, only about 40 percent of the aged have health insurance of any type. For the great majority of those covered, the unusually high premiums charged by commercial carriers provide benefits far inferior to those available to younger persons.

"In addition to confirming these statistics as to income levels of our senior citizens, Senator McNamara's Subcommittee on Problems of the Aged and Aging made the following pertinent findings this year:

"(1) Increased longevity has brought with it a dramatic shift of chronic ailments in the Nation's health profile. These chronic diseases, which typify the elderly, differ from acute illnesses in that they develop at first without any easily detectables symptoms, are long lasting, and usually result in disability after effects.

"(2) The over-65 group has two to three times as much chronic illness as the rest of the population. They require a greater and steadier use of drugs and medicines.

"(3) Long-term chronic conditions require special services, such as early diagnosis, preventive treatment, medical-social services, sustained rehabilitative and semicustodial care.

"(4) When acute illness strikes, the aged are disabled longer and require more medical attention. Between 1953 and 1958, their per capita health expenditures rose 74 percent compared to only 42 percent for all age groups. This left the hospital, drug, and medical costs of our senior citizens 120 percent higher than the average.

"The only arrangement available to the elderly, other than those on public assistance rolls, for dealing with their health problems has been the voluntary group or individual health insurance programs of commercial carriers. As a result, older workers have been, by and large, relegated upon retirement to the category of spent resources, to fish for themselves in a sea infested with profithungry sharks who offer extremely limited health coverage at inordinate costs. "It must be recognized that the development of these voluntary programs has been largely on a dog-eat-dog basis whereby private carriers have catered primarily to our more selfish animal instincts by fragmenting the community into experience-rated groups. They have offered higher benefits at lower costs to some through the device of terminating coverage for older workers upon their retirement. The choice in such a situation is almost invariably governed by selfish considerations. Profit-conscious employers in union-negotiated programs are only too willing to go along with such an arrangement. The consequence is that the high-cost older workers are then experience-rated separately on the basis of the high risk they represent to private carriers.

"Organized labor has played a significant role in the development of voluntary health insurance plans in the hope that they would do the job. The degree of their inadequacy, however, was demonstrated conclusively in a 1958 survey of 211 collective bargaining agreements by the Division of Labor Statistics and Research. This agency found that union-negotiated health plans provided continued coverage upon retirement, generally with reduced benefits, for only 7.4 percent of the 854,000 California workers included in the study. For some additional workers, limited conversion rights were available.

"Unlike the medical associations and the insurance companies, labor has recognized the failure of these voluntary programs and has lent every effort to the development of an alternative approach through the use of the social security mechanism in achieving a system of prepaid health insurance.

"As to the amount of the medical expenses defrayed, a Federal study of pensioners found that only 14 percent of the couples and 9 percent of the single persons who incurred such costs in 1957 drew any private insurance benefits whatsoever. Under such circumstances, preventive care and treatment of seemingly minor ailments go out the window. Thus, in addressing itself to the seriousness of the health problems of the aged in its April 16, 1960, issue, Business Week editorialized:

"For far too many of these, long life has meant shrunken incomes, increased sickness, loneliness, and the shame of being a candidate for a handout from society * * *. The issue, then, is not whether there is a problem but rather how to meet the problem

"Indeed, after studying Flemming's able report, and the arguments on all sides of this issue, we are forced to conclude that the voluntary approach simply will not do the job. The problem basically is that the aged are high-cost, high-risk, low-income customers. Their health needs can be met only by themselves when they are young or by other younger people who are still working. The only way to handle their health problem, therefore, is to spread the risks and costs widely, and that can best be done through the social security system to which employers and employees contribute regularly.'

"This precisely outlines the approach long adhered to by organized labor as it has spearheaded the campaign for enactment of a health care program under the social security system as embodied in the Forand bill and other Forand-type proposals.

"In the provision of health care benefits for the aged, organized labor stands for a comprehensive, balanced program geared to the special health needs of the aged. Such a program would include the following elements in its benefits structure:

"(1) Complete inpatient and outpatient medical care.

“(2) Full coverage of hospital costs.

"(3) Emphasis on prevention of illness and on early diagnosis and treatment. "(4) Treatment and rehabilitation in skilled nursing homes and under supervised programs for home nursing care, including the provision of homemakers' services, physical and occupational therapy, medical-social services, and dietary counseling.

"(5) Coverage of prescription drugs.

"(6) Stimulation of research and expansion of demonstration programs for community health services.

"Together with the provision of supplemental benefits for retired persons in need of health care services who are not covered by social security, these constitute in broad terms the essential elements of the kind of program necessary to meet the needs of our senior citizens under a program financed through the social security mechanism.

"In terms of such a comprehensive approach, it is apparent that the Forand bill, vigorously supported by organized labor, is itself a compromise with the actual needs of the aged. The Forand bill does not pretend to solve the whole problem of medical care for the aged. Designed to guard against total disaster, it would pay in full for 60 days of hospital care for persons eligible for OASDI benefits (including dependent children of widows), meet the cost of combined nursing home and hospital care up to 120 days a year, and certain surgical expenses. The measure includes standard safeguards as to quality of care, negotiation of rates, and the freedom of cooperating institutions from Government interference. Program costs would be financed by an additional one-quarter of 1 percent social security tax on employers and employees, and a three-eighths percent tax increase on self-employed persons."