But, somehow, when it comes to establishing a system and a program to enable the people themselves to pay for their own medical protection in this old age, at no expense to the Government, then the cry of socialism is heard throughout the land and the AMA starts squandering more millions in a frenzied attempt to whip up the old vendetta, against whom?

Against the old, the weary and workworn mothers and fathers, grandparents and aunts and uncles and brothers and sisters of all of us who have become too old to work, too young to die, and whose sole income, for the most part, is the social security system and some pension plans here and there.

The Nation's rallying cry some 150 years ago was:

Millions for defense; but not one cent for tribute.

The new rallying cry seems to be:

Billions for business and other causes, but not one cent for a decent medical system for the old folks, even if they and we pay for the entire cost.

I am confident that the American people very seriously desire a comprehensive health insurance program for their elders.

A survey made last year by the University of Michigan indicated that 70 percent of the American people believe their Government has a responsibility to its senior citizens.

Certainly our retirees and pensioners themselves are in favor of such a program. This I know from the hundreds of letters I have received each month from active and retired members of my union. I am certain that the gentlemen of this committee, likewise, receive such letters.

I would like to read excerpts from some of them.

Let me, first, say that in tone and sense of urgency there is no change in approach this year over last year. Last year, appearing before the Senate Subcommittee on Problems of the Aged and Aging, I reported a mood of fright and despair in most of the letters. Phrases like these abounded:

"To whom do we turn?" "We don't want to go on welfare." "I've always paid my own way."

The letters I receive now are longer, but the problems and the tone and the mood are the same.

Although it is now several months since the Mills-Kerr bill became law, it is operative in 10 States at most. It is not in effect in many key States where we have members, and it applies only where there is "dire emergency need" as defined by State law.

The Kerr-Mills bill has had no observable salutary effect on the health problems of our older members.

These letters come from persons who are IEU pensioners, exfactory workers, and have no other source of income.

In many cases, they have had 15 to 20 years of service.

One of the facts lost sight of too often is that the majority of persons retiring today under union-negotiated pension plans have from 15 to 20 years of service before retirement. These are men and women who lost their jobs in the depression years, went from one job or another until World War II began. They could not accumulate any reserves until their last job started.

I do a lot of talking with the companies I negotiate with. In 1950 the average service of retirees at Westinghouse was 15 years.

In 1955 in General Motors it was slightly over 10 years.

Today, in 1961, the average years of service of people eligible to retire in General Motors is 22 years, which is not sufficient to give them a sizable pension.

Here is a letter from Earl A. Hendrickes of Philadelphia:

Here is an account of my doctor and medical costs from January 1961 to July 17, 1961.

His pension is $34 to $35 and he gets $100 at the most from social security.

Doctors, $26; medicine, $187.70; total, $447.70. Life insurance, $94.92 per year. Blue Cross-Blue Shield, $171.24 per year. Rent, clothing, et cetera, a very great problem.

Now here his doctor and medical bills are over Blue Cross and Blue Shield payments.

He is putting in pretty close to $700 out of a total income of perhaps $1,500.

This is a letter, together with itemized annual statements, from Mrs. Harriet Deckhut, of Queens, N.Y.:

Enclosed find information on my medical expenses.

Trusting this will help in getting medical care for the aged. I recall my husband's experience with a mother confined to bed from 1941 to 1948, and then in a nursing home from 1948 to 1959 at a cost to him and his brother of more than $30,000.

1956: Doctor's bill, $223.55; Blue Cross, $89.80.

1957: Doctor's bills, $271.65; GHI Blue Cross, $90.80.

1958: Doctor's bills, $374; GHI Blue Cross, $90.80.

1959: Doctor's bills, $304.87 (including drugs for first time); GHI Blue Cross, $115.

1960: Doctor's bills, $284.60; GHI Blue Cross, $115.

1961: Doctor's bills (six months), $398 (including drugs); GHI Blue Cross, $187.08.

Mrs. Marnie Liedner, Jamaica, N.Y., has written this to us:

I was retired in 1956. I applied for my social security and am getting $84.40 per month. I had a cataract operation and the doctor charged me $350 for his fee. I had to pay $175 and the other $175 was paid by Blue Shield. After I felt better, I had to work to get the money for the doctor. I worked over my $1,200 and had to pay the money back to social security. So for 7 months I didn't get any checks and it was very hard for me to get along on the little money I was earning. My eye drops and medicine I had to pay from my salary.

Now, this last December I had another operation. I got hemorrhoids from standing. I am a matron in the movies and I stand from 12 to 7. The doctor charged me $300 and I got $90 back from Blue Shield. I had to pay X-rays, $35; and anesthesia, $35. But, thank God, I am feeling fine and working 3 or 4 days a week and now I have the same story. I am going over my social security. She is about 69 or 70 years old.

Here is a situation where a woman, already old enough to retire and collect on social security, was forced to go back to work to pay for doctor bills and then develops new sicknesses because of the new job. Frank Baer, of Philadelphia, has written as follows to us:

I am a man of 71 years of age. My wife and I cannot afford to go to the doctors for treatment we both need. All we can do is suffer on and hope for the best. God grant that you men can see clear to help us in our last years. Walter E. Browne, Tuckerton, N.J., writes:

I wish to go on record against any medical plan bill for the aged that is not financed through social security. The insurance plan passed by the Eisenhower administration is a plan advocated by the insurance companies and the power

American Medical Association and, in effect, would pauperize the aged and become their private pork barrel.

Since my retirement, I tried to keep up my hospitalization, but I had to drop it because I could not pay it and eat too. I receive $117 from social security and $33.73 from the union retirement plan. My taxes on my house have been increased 100 percent in the past year, $220 a year.

I cannot afford doctor's care and I have hypertension and the drugs I must take cost so much that I must discontinue them. My wife must take an expensive drug and we must live on a substandard diet-no pleasure, no clothing, one meal per day. Now, how can I plan to pay $26 per month for the lowest hospitalization plan? I advocate the Kennedy bill's passage by both Houses of Congress as the plan pays for itself and does not require a pauper's oath from self-respecting elder citizens.

These are but a very few of the many letters our union has received, and all tell the same heartrending story. They cry out for swift effective action to relieve pain, suffering, and deprivation.

Opponents of the legislation bewail the high cost for providing medical coverage for those over 65.

But the IUE confronts the same problem whenever we start a new pension plan. We are told there are a number of older persons ready to retire. But it always turns out that the older workers do not comprise a large proportion of the group and when the costs are spread among active employees the expense becomes quite reasonable. The same approach can and should hold true in the matter of health care for the aged. The expense of the program for this group, when prorated among all participants, is not unduly high.

Social security actuaries estimate that coverage for hospital care will come to about 90 percent of the total cost of the King-Anderson bill, and that cost, on a long-range basis, will total about 0.6 percent of payroll.

I understand that has been increased slightly.

Nursing home care, outpatient diagnostic and home health service will amount to about 10 percent of the total cost under the KingAnderson bill.

But the King-Anderson bill, unhappily, provides no surgical coverage and also no dental coverage.

Since 60 percent of men and women over 65 have lost all their teeth, the cost for the dental service should have been within reach.

A study of the New York State Insurance Department of voluntary health insurance and the senior citizen, made in 1957, established that the cost for complete hospital expenses for 120 days and a $300 surgical schedule for the family, where the man and wife are 65 or over, was approximately 40 percent higher than for the average for the other groups.

Considering that the group is a small proportion to the total group, this cost can be absorbed without too much difficulty.

Much is also made about the duration of hospital stay for older persons. I feel that this may also have been exaggerated. A book titled "Ensuring Medical Care for the Aged," by Mortimer Spiegelman, published in 1960, compiled statistics on the average hospital stay for the noninstitutional population. Emphasis is rightly placed on the fact that, among those interviewed on their hospital stay the previous year, 70.4 percent had a stay of less than 8 days, whereas 41.2 percent of the aged stayed less than 8 days.

But when we compare the percentages for those with less than 15 days, we find 88.4 percent of all ages were out of the hospital in less

than 15 days, and 70.9 percent of those 65 and over were out in less than 15 days. The comparison is not too startling.

I have stated that our international union and I, personally, are in favor of the King-Anderson bill. I regret that the bill, because of the current political atmosphere, compromised the overall insurance principles contained in the original Forand bill.

I refer specifically to the deductible features of the current bill. I do not believe that the extra cost for providing complete coverage would be exorbitant.

I regret, moreover, the principle of deductibility is applied to our older citizens, too many of whom cannot afford to pay the extra costs. The $10 deductible for the first 9 days-and I understand it is $20 deductible, or $10 for the first 9 days, whichever is higher-means a definite cost of $90 for each person since the average length of stay for older folks is more than 9 days.

If the man and wife have to be hospitalized during the course of the year, this may mean $180 per year.

The letters I receive indicate that this could well be a calamity for many of our people.

Incidentally, I note also that under outpatient hospital diagnostic services, there is a deductible $20 for each X-ray or test, but, in either event, here is a charge that hurts the older person and goes contrary to our entire philosophy.

I have had extensive experience with these deductibles. We on the IUE negotiated the first such program in the industrial field in 1955, with the General Electric Co. Last year we reviewed our experience. We found that if all the deductibles and coinsurance had been eliminated, we would have had a completely comprehensive program, in and out of the hospital, including surgery-the whole arrangement superior to what our older folks may get in the King-Anderson bill, all for an extra cost of 14 cents per hour per employee, or $25 per

year.

I believe that the extra cost for deductible for such a modest plan. as is here proposed is quite small and will serve, in too many cases, as a deterrent to getting medical care.

The King-Anderson bill is a laudable and sound first step in the direction of full medical care for our older citizens. We of the labor movement do not believe we can truly consider ourselves civilized nor our society mature if we continue, in the future as we have in the past, to render unavailable to our older people the wonderful medical benefits and sicentific advances of which we are so proud, only because our pensioners cannot afford the expense.

In the declining years of their lives, in what should be the golden years, after a lifetime of toil for employers, for themselves, their families, and their country, our senior citizens, our old folks, cannot be forsaken or forgotten. We cannot withhold from them the means for a less painful existence.

The glib, repeated claims of the AMA's professional politicians that no American today suffers for lack of medical care just is not true. Dozens of letters I receive every week attest this.

Experts, who have specialized in this field, and who have no ulterior motive, also state that the AMA claim is not so.

Anyone who has ever known poverty or eked out a wretched livelihood on an inadequate income, anyone who lived through the incredible tragedy of the great depression, can refute, even demolish the AMA claim.

There are a thousand people within a mile radius of this building who do not have enough money for the normal day-to-day means of existence, and who do suffer medically because they can't afford a doctor.

Among them are many older people who could, if this legislation is enacted, get some measure of care which they deserve for their declining years and which civilized sentiment dictates is their due on a Judaeo-Christian society, that prides itself on believing in the brotherhood of man under the Fatherhood of God.

Thank you, Mr. Chairman.

The CHAIRMAN. Mr. Swire, we thank you, sir, for bringing to us this discussion of the views of the organization which you represent. Are there any questions of Mr. Swire?

Mr. CURTIS. Yes.

The CHAIRMAN. Mr. Curtis.

Mr. CURTIS. I notice at the bottom of page 11 you state that you regard this as only a first step in the direction of full medical care for older citizens of the King bill.

In other words, your union would want to actually see a complete coverage in this area; am I correct?

Mr. SWIRE. You are absolutely correct, sir. We believe that the older folks should have complete medical coverage on an insurance basis.

Mr. CURTIS. The next question is: Do you also favor total health insurance for all our people such as in the Wagner-Dingell bill?

Mr. SWIRE. I have talked to many of our people over the last 10 or 15 years on this problem. The rank and file of labor does not believe in a national health bill.

Mr. CURTIS. Has your union taken a position on this?

Mr. SWIRE. It has not been a problem for years and years, sir.
Mr. CURTIS. You do not think there is a social problem here?

Mr. SWIRE. I don't believe, very honestly, that the problem of national health insurance in this country will become a serious problem unless we have a very serious crash.

Mr. CURTIS. I am talking about the social need.

You would not want to extend the health insurance program that you are advocating, complete coverage, under social security insurance to our older people; you would not want to extend that to the disabled beneficiaries of social security?

Mr. SWIRE. Frankly, we might. I am not sure right now because we have not gone into that.

It might arise sometime in the future. We might want to suggest that.

Mr. CURTIS. When this committee goes to consider this bill, this is a radical departure from the system that we have previously had. So, logically we want to look to see where it would lead and get that in the context.

That is the reason I am asking these questions because I think if we start something, just as I think you have ably pointed out, probably the logic will carry us on to the other step.