DEPARTMENT OF SOCIAL WELFARE, NATIONAL COUNCIL OF THE CHURCHES OF CHRIST IN THE U.S.A., Hon. WILBUR D. MILLS, Chairman, Committee on Ways and Means, House of Representatives, Washington, D.C. DEAR MR. MILLS: In behalf of the National Council of the Churches of Christ in the U.S.A. I am pleased to send this letter for consideration by the Committee on Ways and Means and for inclusion in the printed record of the hearings on the President's health insurance proposal, H.R. 4222. The economics of medical care for the aged were studied over a 3-year period by two departments of the National Council of Churches; considered by 376 members of the governing committees of these departments and by the executive board of a division with authority over 8 departments. On February 22, 1961, a proposed resolution, which had been adopted at regular meetings of each department and the executive board without dissent or abstention, was presented to the general board of the council by one of the medical doctors who had participated in its formulation. The resolution was adopted by the general board without dissent or obstention. In attendance at this meeting of the board were 105 voting members who were the elected representatives of 23 member denominations. This resolution on "The Economics of Medical Care for the Aged" noted that voluntary prepayment health plans should be encouraged, but also stated that these plans are unable to offer coverage for even a fraction of health care needs at charges that most people 65 years of age and older can possibly afford. The resolution also pointed out that the voluntary plans “necessarily based upon experience rating, discriminate against high-risk groups and are not geared to the problems of chronic illness characteristic of old age." The resolution continued: "If voluntary prepayment plans cannot accomplish the desired ends, Government should protect the health of people by making possible the prepayment of health services. This is precisely what the social security system would be able to provide efficiently through the mechanisms of oldage, survivors, and disability insurance. Therefore, the National Council of Churches supports in principle legislation which will extend the benefits of oldage, survivors, and disability insurance to include adequate health care for retired aged persons." This action was taken unanimously by a representative assembly officially constituted by the member denominations. I need hardly point out that the council's official action does not reflect the views of its entire constituency, even as the acts of Congress do not reflect the views of all citizens. However, I trust the committee will give due consideration to the action of the eminent elected representatives of the churches. It was taken after thorough and objective study with no personal or organizational interest other than the welfare of the Nation's retired citizens. Sincerely yours, WILLIAM J. VILLAUME, Hon. WILBUR D. MILLS, GENERAL BOARD OF CHRISTIAN SOCIAL CONCERNS Chairman, House Ways and Means Committee, OF THE METHODIST CHURCH, DEAR CONGRESSMAN MILLS: This letter is in regard to the numerous bills which are before your committee dealing with the problems and needs of the aging and the aged. We request that this letter be made a part of the record of the public hearings. The General Board of Christian Social Concerns is an agency of the Methodist Church. I am Roger Burgess, associate general secretary, and am responsible for the division of temperance and general welfare. The location and general offices of this board, and my office, is given on this letterhead. The Methodist Church from its very beginning has been interested in the physical and material welfare of our citizens as well as in their moral and spiritual welfare. The social creed of the Methodist Church as reaffirmed in its general conference of 1960 states specifically: "We stand for security for old age, for insurance against sickness and injury to the worker, and for increased protection against those preventable conditions which produce want." We support wholeheartedly the action of the Congress which moves to accom plish these ends. We are not concerned with the conflict of interest between the several groups which, each in their own way, would seek to accomplish these purposes. So long as there is one person hungry; so long as there is one aged person in need; so long as there is one sick person unable to secure adequate hospitalization or nursing care; so long as there is one person who faces in terror a bleak and uncared for future-for just that long we say, "Enough has not been done." We do not suggest which bill, or provision of a bill, will accomplish these purposes, but we do suggest that with the increased millions of aging and aged, no less than heroic measures are required, and such heroic measures the Methodist Church will support. We also request that we be notified when public hearings will be held so that å representative of this board may attend those hearings. Sincerely yours, ROGER BURGESS, Associate General Secretary. COMMENTS ON THE KING-ANDERSON BILL, BY EMERSON O. MIDYETT I had originally planned to come to Washington to appear personally at these hearings, but I found that I just could not afford to after all. Therefore, I have prepared this statement regarding the King-Anderson bill in the hope that it will set forth my views and convictions on this matter. It is submitted to you, the members of the Ways and Means Committee, with my sincere appreciation. As a retired individual, 76 years old, I have been active for many years working toward the resolution of the problems of the aged, none of which is more serious than their inability to pay for high medical costs such as hospital and nursing home care. I have been a member of a senior center for many years. I am also chairman, Reduced Transportation Fares for Senior Citizens in San Francisco, and a member of the Catholic Committee on the Aging, Archdiocese of San Francisco. Last year, I attended the Governor's Conference on Aging and the White House Conference on Aging. Since my return from the White House Conference on Aging last January, I have been besieged with letters, telephone calls, and personal calls by many hundreds of the seniors or aged in San Francisco and other parts of northern California. These people are all deeply concerned and greatly worried about problems of medical and hospital care which have arisen through no fault of the aging group. Most of those who communicated with me felt that upon retiring from work or immediately prior to their retirement that they had, to the best of their ability, tried to assure themselves of some degree of security and protection against medical care costs. Several were people in their seventies and eighties who reported that their savings had been eroded by increasing costs, especially of medical care. Most said they had once carried hospital insurance but their policies had been canceled upon retirement. Those permitted to carry their policies into retirement found their benefits materially reduced and premiums increased to such an extent they were unable to continue to carry them. The policies later offered to this group by the insurance interests are so limited that usually they cover 20 to 25 percent of the actual cost of hospital care in California. The premiums remain at an absurdly high figure for persons with extremely limited incomes, a situation hard to understand since the protection is low in comparison with the costs. In the last year or so, I have attended numerous conferences, committee meetings, and discussions on the needs of the aging and in all of these, the participants are doctors, insurance company representatives, members of charitable organizations, employers, and officials of welfare departments. Seldom are there present, except for a token representation, those most deeply concerned, the senior citizens themselves. This seems to me to be a case of study and examination of the patient without the patient being present. These conferences have resulted in mountains of material containing studies. recommendations, statistics, and reports, particularly on medical care of the aged. All of this represents a vast amount of activity, but so far, in my opinion, there has been very little action. One thing which I learned at these conferences, including the White House Conference on Aging, was that several of these groups of purportedly interested in the aging are more interested in furthering their own interests than in making a real effort to help the senior or aged. Everyone knows that organized medicine is opposed to the King-Anderson bill as it was 2 years ago to the Forand bill. It is rather hard to understand the fierce opposition of the AMA and their allies to the social security approach to financing health care for the aging. It is particularly difficult in view of their many claims of real interest and concern for the welfare and well-being of the aged. The fact that several members of the medical profession have disavowed the policy of the AMA is certainly evidence that not all doctors consider the KingAnderson bill as socialized medicine nor fear control of the way in which doctors practice. There is nothing in the King-Anderson bill that suggests control of the doctor or hospital, more than is now exercised by health and hospital authorities at the present time to insure certain standards to protect both the hospital and the doctor. If it were not for some of the desperate propaganda and tactics of the AMA, there probably would be many, many other physicians willing to speak out in favor of the King-Anderson bill. They know that they have been misinformed about the bill, and I think are about ready to express themselves despite the AMA's stand. The purpose of the King-Anderson bill is to secure a pay-as-you-earn approach to insure that upon retirement there will be protection against medical care costs and that the benefits will be available as a matter of right and not upon a debasing, degrading means test to secure such protection. Means tests tend to lower morale and pride and I'm sure that the Members of Congress have no desire to reduce the aged population to a group of paupers. However, in most instances, this is what happens at the present time when the aged need assistance to pay for hospital and nursing home care. No one of any age or profession has offered a single reasonable argument against the intent of the King-Anderson bill which is to protect our society against the burden of an aged and medical indigent population by requiring individuals to save during their working years for the inevitable health expenses of their old age. Does the AMA object to these efforts to protect individuals and society from medical indigency in old age? Is it content to see a large and growing segment of our population treated as medical indigents? Do the insurance companies object to such efforts? If they do not object, why consistently fight them, yet fail to offer workable alternatives. Instead of a complete plan, they have supported the Kerr-Mills bill, which is nothing more than another kind of public aid. These groups have attacked the King-Anderson bill with many of the arguments they used to oppose the Forand bill. The arguments of costs, utilization, control of physicians, lack of complete coverage for all the aged, its compulsory provisions, and that only those who need help should receive it. Well, I'd like to conclude by giving my views on some of these arguments and their merits. The argument of the costs of the program proposed under the King-Anderson bill have been questioned, but the cost of the administrative work through the Social security system for paying for the benefits in the bill would be very small compared to any program administered at the State level with the duplication of effort plus all of the local and county costs which many States would have. It would also be far less than if insurance companies were to handle it. The argument offered on the utilization, or demands that the aged would make, is another interesting one. Certainly, there would be some increase in the aged entering hospitals or nursing homes. The reason is clear enough. We would have a way to pay for such care. Something that we do not have now in the great majority of instances. However, the argument has been offered in a way that suggests that each doctor's office and hospitals will be flooded by the older people demanding to be hospitalized and/or have surgery. This argument does an injustice to the mentality of older people. It shows a fundamental lack of respect for him as an individual. Control of physicians is another theme of the opponents of the King-Anderson bill. The bill is simply a way to pay for services and not to provide the benefits it contains. It is no different than private insurance plans, as far as this is concerned. Another argument offered is that it is a compulsory plan. None of us like the word "compulsion." But, I wonder how many of the 11 million persons now drawing social security benefits would be doing so had they not been required to contribute as they earned. How many of this 11 million would now be a burden on the relief rolls of the States had not compulsory payroll deductions provided retirement protection under the Social Security Act. Then, it is said that the King-Anderson bill will control the physicians and hospital and other groups who are included. The bill is a way of paying for services, not providing them. This is an interesting objection which the opponents to this bil lraise. If they really believe it, then they are actually saying that private insurance companies, public aid programs, and others who help pay for medical expenses control the hospital and doctor. This is unlikely, but this is what this argument seems to be saying. In recent television debates on this bill, the AMA spokesman keeps referring to their position: namely, that only the aged person who is in need should receive these benefits. And, always, he upholds the virtues of such an extra welfare system that was created by the Kerr-Mills bill. I sincerely hope that the Members of Congress will examine carefully what has happened under this bill. Most of the States that have passed legislation for its implementation have enacted very limited plans. It does not provide anywhere near the same protection that the King-Anderson bill would provide. Instead, it will lead to more bureaucracy and redtape for the aged persons seeking aid. I believe that President Kennedy, through Representative King and Senator Anderson, has presented Congress with the type of program that the vast majority of aged or seniors desire. We do not want charity, nor do I believe the aged of the future will want it. The King-Anderson bill would go a long way in restoring our dignity, our independence, and remove from our minds the fear that now is upon us when we are sick. The seniors today require a program that will enable them to live with a feeling of security and pride to dispel the sense of being outcast and forgotten by society. There is a tremendous block of voter strength in the aged, near aged, and 50- to 60-year-old group who are worrying about their retirement years. This strength can be used to great advantage to our society and unless a real start is made now toward solutions to the problems of the aged, there is great danger that these groups may become victims of promoters who seek to control and use them for their own financial and political gain so that their voting strength may be used to bring measures that are unsound, unworkable, and of such a nature that the entire economy could be jeopardized. The King-Anderson bill would be one of the steps to prevent this since it will give the aged the basic protection they need in paying for their health care, create a solvent system and be administered in a manner which will recognize our true value as individuals. I earnestly urge you to support the King-Anderson bill. STATEMENT OF JOHN F. PLETZ, JEFFERSON CITY, Mo. FINANCING COMMUNITY HEALTH SERVICES FOR THE INDIGENT AGED IN MISSOURI Most persons with whom I have discussed this subject will generally agree with the following principle: The individual should pay for his own medical care; if unable to do so, his family and relatives should pay or help pay for it; if they are unable, the local community should do so; if this is not possible the State should do so; and if this is not possible, the Federal Government should participate. This principle is included in the final report of the task force on health and medical care of the Missouri committee for the 1961 White House Conference on Aging, and it has been stated in numerous other places. Where the sparks begin to fly, where the statistics are gathered by the bushel, and then used more or less "selectively," where reason appears to go out the window and emotion becomes the dominant force, is when a person begins to be definite and specific as to when the next step up the above ladder is necessary, and how it shall be taken. It is my intent in this paper-based on more than 25 years' experience in the field of public assistance in Missouri-to point out those facts which I believe must be taken into account by anyone who is trying to make a judgment as to whether more or less Government action is needed, in order to provide speedy and adequate medical care for those aged Missouri citizens who need it but are unable to pay for it themselves. The following statistics appear to me to be so basic that they must be taken as the foundation upon which the remainder of my discussion rests: 1. The 1960 census shows that today there are 503,400 persons 65 and over in Missouri, compared with 405,000 in 1950 and only 113,000 in 1900. Expressed in another way, 1 out of every 8 Missourians today is a person 65 or older, compared with only 1 out of 25 in 1900. Only one State, Iowa, has a larger proportion of older people than Missouri. By 1975 it is estimated that Missouri will have 600,000 persons over 65. 2. As of December 1960, about 308,000 aged beneficiaries received retirement benefits under the Federal old-age and survivors insurance law. The average monthly benefit was about $72. About 6 out of every 10 aged Missourians are now receiving these retirement payments. 3. As of January 1961, about 114,000 aged persons in Missouri received oldage assistance payments under the Federal-State assistance plan. The average monthly payment was almost $60. 4. In spite of the termendous increase each year in the number of persons over aged 65 in Missouri, the old-age assistance rolls have declined from a high of 133,732 in June 1954 to 113,977 in January 1961. This is a net decrease of 19,755 in about 61⁄2 years time. The major reason for this steady decline in the assistance rolls is the steady increase in the number of retired persons who are eligible for social security benefits, and are eligible for more adequate amounts. 5. The above figures mean that in Missouri about 8 out of 10 persons 65 years of age and over receive income from social insurance or old-age assistance or both. 6. The 1950 census figures showed that in the United States, 12.1 percent of all families (one in eight) had an annual income of less than $1,000. The same figures showed that 19.1 percent of all families in Missouri (one in five) had an annual income of less than $1,000. Whether the 1960 census will show any change in these proportions is not yet known. 7. Missouri ranks 21st in average per capita income, but ranks 42d in per capita State tax collections. 8. The aged spend at least twice as many days per capita in general hospitals as the population as a whole. 9. As of November 1959, the Missouri Division of Employment Security estimated that 103,000 persons 65 and over in Missouri have some employment. This figure cannot be taken as representing those with earnings sufficient to provide all their needs, including medical care, since there are an unknown number who are working only part time, including some receiving OASI benefits. Against this background of verifiable facts, let us examine the application of our basic principle to Missouri. I will assume that our analysis is directed toward those citizens of Missouri who are 65 years of age or older and who are not employed, since this is the group from which our problem would come. A. The retired person over 65 Surely there would be universal agreement that whenever he is able to do so. the aged person should pay for his own medical care. The primary sources of payment considered here would be health insurance, retirement income, savings, and other liquid assets. There are, of course, a number of the aged in Missouri who are able to do this; how many is not known, and would be a most difficult figure to obtain or even to estimate. That there are sizable numbers who would probably not be able to pay a large medical bill can be more readily established. 1. Voluntary health insurance.-There has been a tremendous increase in the number of persons of all ages covered by the Blue Cross-Blue Shield plans, by commercial insurance, or by both. Again, we would all agree that this is an excellent trend, and one to be fully encouraged. This is another indication of the widespread interest in the individual paying for his own medical care, and in using a prepayment system of doing so. However, in some quarters this fact has been interpreted as meaning that most, if not all, of the retired aged will have such coverage within the next 5 or 10 years. That this is not a valid interpretation has been rather definitely proved by a report recently published by the U.S. Public Health Service. In 1959, the T.S. national health survey conducted a study of approximately 19,000 households containing 62,000 persons, making this by far the most authoritative study in recent years. Among many revealing findings, the following seem to be most applicable to this discussion: |