Hon. WILBUR MILLS, THE NEW YORK SCHOOL OF Chairman, House Ways and Means Committee. DEAR MR. MILLS: My name is Eveline M. Burns and I am professor of social work at the New York School of Social Work of Columbia University. I am a past president of the national conference on social welfare and the author of many books and articles in the field of social security. I have frequently appeared as a witness before your committee on behalf of various organizations with which I am connected and would have wished to testify at the current hearings but as I am unable to do so I am sending this written statement with the request that it be printed in the hearings. I am strongly in favor of the King bill and hope that your committee will report it favorably. Although the bill does not go as far as I would have wished, notably in that it provides only for limited forms of health benefits, it is a vital first step toward meeting the problem of medical care in old age. Your committee ha-, received ample testimony in this and earlier hearings regarding the extensive medical care needs of the aged, their relatively low incomes, and the lintited extent to which the problem can be met by any conceivable extension of private, voluntary insurance. Many witnesses have also shown that the Kerr-Mills program, while a useful supplementary measure, cannot possibly meet the major problem or be the basic answer. This is because the limited fiscal capacities of the States will not permit them to provide all types of care or to set income limits high enough to benefit the great majority of aged persons who are above the public assistance level, and partly because the very principle on which the program rests; namely, the needs test basis, is anathema to most of our people. I would therefore like to confine my comments to another aspect of the proposal and to express the hope that your committee will not allow yourselves to be swayed by slogans and misleading emotionally charged assertions. In particular, I believe that the medical profession has done a great disservice to the country by disseminating the idea that H.R. 4222 would introduce a system of socialized medicine and that socialized medicine is a bad thing. Neither assertion has any validity. First, the essence of socialized medicine is that the Government accepts responsibility for insuring adequate health care for all its citizens. This means not merely removing from all individuals the financial barriers to the receipt of needed care (as is done in a health insurance system) but also assuring that needed services and facilities are in fact available and are of acceptable quality. No such wide-ranging responsibility as this is provided for, or implied, in the King bill. All it would do is to make available to all persons covered by the Social Security Act, a method of paying for certain limited types of health care in old age, which, through Blue Cross and similar schemes has already proved its efficacy and its acceptability to the suppliers of such care. It is a method of distributing the costs of care, and as such, has no bearing on the purely medical relationships between patient and physician, indeed, apart from diagnostic outpatient services and the limited types of medical care from hospital medical staffs that have for years been paid for through such schemes as Blue Cross, the King bill does not provide for medical care. But second, and more important, what is so terrifying about socialized medicine? For over 100 years this country has had socialized education and we all seem to accept it as normal, proper, and good. No more than in socialized education would socialized medicine prevent those who want to use private, nongovernmental services from doing so. Nor would any individual medical an be forced to practice under the public program, any more than any teacher is forced to teach in a public school. There is no evidence, during the 13 years n which Great Britain has operated a truly socialized medical program, that here has been any improper intervention between doctor and patient on purely medical or professional relationships. No claim has been substantiated that Inder such a socialized health service, matters of professional concern to the hysician have been arbitrarily determined by laymen: indeed, some students of the British system believe that, if anything, too much power has been placed n the hands of the medical profession. Every poll of doctors in Britain has shown an overwhelming majority approving of the National Health Service and it is significant that a reason frequently given was that for the first time 76123 0-61-pt. 4--15 a doctor can prescribe the treatment appropriate for his patient without having to consider whether or not his patient can pay for it. What then does the American Medical Association object to and of what are they afraid? What is wrong about a medical system that is able to consider the medical needs of the country as a whole and to take steps to deal with shortages of facilities and personnel, either in total or as between areas? Do our doctors want to perpetuate the present shortage and maldistribution of both in this country? What is wrong with a system that, while aiming at high standards of care, nonetheless exerts some oversight in the interests of consumers to see that the costs of such care are not wastefully high or that drugs are not unnecessarily costly? Has our medical profession no concern that unnecessary costs be eliminated or that the most effective use be made of all available medical resources? One can only assume that our medical men are too busy to read the many available studies of the operation of such a socialized medical program as the British. Otherwise, they would surely have been impressed and excited by the astounding progress that has been made in all medical services in Great Britain since that country adopted socialized medicine. One hesitates to adopt the alternative explanation of organized medicine's phobia about socialized medicine; namely, that the profession is interested solely in maximizing the incomes of its individual members, in opposing any interference with their customary ways of doing business (their word, not mine) and refuses to admit that there is a public interest in any service rendered by a profession. Yet in the last resort, the question of the extent and quality of medical care that should be available to the people and the reasonableness of its costs, is one for the people and not for the profession to decide. I can perhaps sum up my testimony by stating, first, that the bill under discussion is not socialized medicine, and second, that this is perhaps its major weakness. Nothing short of socialized medicine will enable us to grapple effectively with the vast array of problems that beset our present arrangements for the provision, the organization, and the financing of medical care. Yours faithfully, EVELINE M. BURNS, Professor of Social Work. STATEMENT BY ALVIN T. PRESTWOOD, COMMISSIONER, ALABAMA STATE Department OF PENSIONS AND SECURITY I am Alvin T. Prestwood, commissioner, Alabama State Department of Pensions and Security. This agency administers the public assistance programs (except MAA) authorized by the Federal Social Security Act, as amended. I speak for the Governor, who is chairman of the State board, for some 1,000 employees of this agency, and in behalf of approximately 261,000 aged people in this State. many of whom would benefit from the enactment of the Health Insurance Benefits Act of 1961 (H.R. 4222). This department long as subscribed to the basic principle that a contributory social insurance program is the best means of protecting individuals and their families against loss of income due to retirement, disability, unemployment and death of the family wage earner and against health costs. We have been pleased over the years that, under the leadership of your committee, the Congress has taken action to extend and improve the insurance phases of the Social Security Act. The raising of the minimum benefit, the changes in the requirements for benefits, and the liberalization of the retirement test already enacted this year (Public Law 87-64) are the most recent examples. We are particularly pleased that you are giving consideration to legislation designed to provide health insurance for the aged under the social security system. The medical care needs of the increasing aged population have been so well documented so many times that I will not detail them. Suffice it to say that with more people living longer than ever before there is a higher incidence of chronic diseases and disability. This means that there is an obvious need for protection against the consistently increasing costs of catastrophic illness and prolonged hospitalization. We recognize that the problem is large and complex. Its solution will require, among other things, the full use of individual and family resources, voluntary health insurance, social security, and public assistance. The legislation which you are considering will add the contributory social security plan. This, together with vendor-payment, medical-care pro grams for the low-income aged authorized by Public Law 86-778 enacted last year, would make for a better balanced program. That there is need for both types of programs is illustrated in the facts presented below. This pending legislation would be of immediate benefit to many persons in Alabama 65 years of age or over now as well as to countless thousands of such individuals in the years to come. Of about 261,000 persons in Alabama 65 years of age and over approximately 133,300 receive OASDI benefits. Included in this number are about one-fourth of our nearly 100,000 old-age-assistance recipients. If the major medical care needs of these beneficiaries are met through social security taxes and payments, the vendor-payment, medical-care program for old-age-assistance recipients could be improved and made more adequate. It was not until the more favorable formulas for Federal participation in the cost of medical care for the aged were enacted last year that Alabama established any vendor-payment, medical-care program for old-age-assistance recipients. At present we provide only for nursing care in licensed nursing homes, begun in October 1960, and for hospitalization for acute illness or major injury, begun on April 1, 1961. Due to inadequate State funds, arbitrary limits have been placed on both programs. For example, the Department can pay no more than $125 a month for the nursing care item in a licensed skilled nursing home and no more than $110 in a licensed nursing home. Similarly, a limit of 10 days' hospitalization in any one fiscal year has been imposed in addition to the restriction to acute illness and major injury. In June 1961, vendor payments were made totaling nearly $201,500 in behalf of 1,951 old-age recipients for nursing care and about $122,600 in behalf of 836 such recipients for hospital care. We hope to liberalize the hospitalization program. If the health care needs of one-fourth of the recipients were met through social security and if State funds requested are appropriated, we expect to be able to do so. Sufficient State funds, however, are not anticipated to make it possible to provide a comprehensive or adequate medical care program for oldage-assistance recipients or to obtain the maximum available Federal funds. The Department does not have legal authority to establish a program of medical assistance to the low-income aged not receiving old-age assistance. Bills are pending in the Alabama Legislature authorizing the Department of Pensions and Security to establish such a program and to appropriate State funds to enable the agency to initiate a quite limited program. The potential number of persons who might be eligible for such a program would be greatly reduced if H.R. 4222 were enacted by the Congress. Various groups have gone on record in support of contributory social insurance as a desirable method to provide health care protection in retirement. Notably among them are the American Public Welfare Association and the 1961 White House Conference on Aging. The State and county departments of pensions and security are active members of the APWA and support wholeheartedly the following which is one of its 1961 Federal objectives: "Health costs of old-age, survivors, and disability insurance beneficiaries should be financed through the OASDI program. The health costs of aged, surviving, and disabled individuals and their dependents who are not insured OASDI beneficiaries should be met through an effective governmental program. Arrangements for achieving this objective should take into account the priority needs of the groups to be served; availability of facilities, personnel, and services; and protection and encouragement of high quality of care, including the organization of health and related services to effect the most appropriate utilization of services and facilities.” The 1961 White House Conference on Aging devoted major attention to the need of adequate health services to be available to all aged persons irrespective of their ability to pay. The section-income maintenance-to which this matter was assigned concluded that "the problem of financing an adequate level of high quality care for the aged is so large and so complex that it will require for solution the utilization of voluntary health insurance, of individual and family effort and resources, and the resources and instrumentalities of the local, State and Federal Governments." The majority recommended that: **** to assure adequate health care for the aged with certainty and dignity there should be established a basic program for financing health care for the aged within the framework of the old-age, survivors, and disability insurance system." I join many other individuals and organizations throughout the country in urging that you give favorable consideration to the principles and plans for financing health care for the aged contained in H.R. 4222. Representative WILBUR D. MILLS, Committee on Ways and Means, House of Representatives, Washington, D.C.: BOSTON, MASS., August 17, 1961. After careful consideration of the King-Anderson bill, I am glad to express my approval of it which. if the safeguards incorporated in it are adhered to, should be of great aid in the case of the health of our aged citizens. Hon. WILBUR D. MILLS, DEAR MR. CHAIRMAN: It is my understanding that your hearing records on the health-care-for-the-aging bills will be open until August 18. I would like. therefore, to submit this letter and an enclosure for your record. (Attached petitions have been placed in the files of the Committee on Ways and Means.) As you can see, the petition bears the names of 2,100 citizens of New Jersey who are emphatically for a plan that will extend the social security system to this new area of protection for our aged and aging citizens. The names have been submitted by Mrs. Lillian Allan, corresponding secretary of the Hudson County Branch of the National Federation for Social Security, which has already forwarded 6,000 other signatures on petitions to your committee. Few issues have caused a more heartfelt reaction among citizens of the United States, including many citizens who would not immediately benefit from the proposed social security plan. It is significant, I think, that your committee should receive petitions bearing the names of more than 8,000 persons who believe that the social security approach offers the Nation the most equitable and effective method of meeting a growing national need. As one who has long supported the social security principle, I am heartened by this evidence of keen concern by citizens of my home State. With best regards. Sincerely, HARRISON A. WILLIAMS, Jr. AMALGAMATED Meat CUTTERS AND Hon. WILBUR MILLS, Chairman, Committee on Ways and Means, U.S. House of Representatives, Washington, D.C. DEAR MR. MILLS: On behalf of the 375,000 members of the Amalgamated Meat Cutters and Butcher Workmen of North America (AFL-CIO), we would like to urge committee approval for H.R. 4222, the bill to provide medical aid for the aged under social security. Our union firmly believes that this bill is among the most important and most needed pieces of social legislation Congress has considered in recent years. We are disturbed at the use of name calling and innuendos which the opponents of H.R. 4222, especially the American Medical Association, have undertaken. Our study of the bill indicates no way whatsoever in which the Federal Government could dictate or even influence either the choice of doctor or any of the medical practices. We find it difficult to understand how the American Medical Association could honestly object to a social insurance scheme which would allow doctors and medical institutions to provides services to more older citizens and would assure that these doctors and medical institutions would be paid for these services. Clearly, the statistics presented to the committee during the hearings demonstrate the tremendous need for social insurance of this type. When three out of five senior citizens have an income of less than $1,000 a year, it is simply ridiculous to argue that they can afford medical services without social insurance. Further, it is outlandish to suggest, as the American Medical Association and its allies have, that providing for one's medical needs in old age through insurance which is to be paid while one is working is socialistic or somehow un-American. We are quite aware of the fact that AMA does not feel this way when it attempts to gain congressional support for H.R. 10, which it claims would allow doctors and other self-employed persons to prepare for their retirement. Year after year, workers retire from long and productive employment with only a modicum of protection against medical bills. A serious illness of their own or their wives eats into the pension and savings to such a degree that they are left poverty-stricken. Is this what the AMA wants? Enactment of legislation such as H.R. 4222 is long overdue. We hope that the committee will quickly approve it. DEAR MR. CHAIRMAN: The American Federation of State, County, and Municipal Employees, which represents 220,000 State and local government employees in the United States, in the Commonwealth of Puerto Rico and a number of employees of the Canal Zone government, is gratified that your committee is holding hearings on H.R. 4222, the President's health insurance proposal, beginning July 24, 1961. Because of the very limited time available for the hearings, Mr. Nelson Cruikshank, Director of the Department of Social Security of the AFL-CIO, who is testifying in support of H.R. 4222 will also speak of our international union and other affiliated unions of the AFL-CIO in support of this bill. Therefore, in lieu of giving additional testimony in a personal appearance, I would ask that you make this letter a part of the record of the hearings on H.R. 4222. Since the early 1940's, the American Federation of State, County, and Municipal Employees has worked steadily to obtain coverage under the OASDI system for members of existing retirement systems in State and local government services. The 1950 amendments to the Social Security Act made possible, for the first time, OASDI coverage for State and local government employees who were not covered by State or local retirement systems. Finally, in 1954, coverage was made available to members of State and local retirement systems who voted by referendum to accept such coverage. Today, of the 6.1 million State and local government employees, 3.9 million have OASDI coverage. There are thousands of retired State and local government employees who are receiving pitifully inadequate retirement benefits, either from State or local retirement systems, from the Federal OASDI system, or from a combination of such plans. These persons may not receive medical benefits unless they are so poor that they can pass rigorous means tests and unless they live in a State which is not financially impoverished and has taken action to provide additional funds to match Federal grants under the Kerr-Mills bill. Rising medical costs are a growing threat to these aged retired, most of whom cannot afford the high cost of commercial insurance protection or the increasing rates under Blue Cross-Blue Shield plans. Public welfare programs are overtaxed by growing loads. Medical allowances are pathetically small. The President's proposal would permit most working people to contribute during their years of employment for protection when they become age 65. It would assure payments for medical care and as a result safeguard the peace of mind and dignity of the aged. Only by the use of the OASDI insurance system will working people be enabled to contribute during their working life toward their health expenses after retirement. The President's proposal to provide health benefits for the aged through social security would assist private welfare agencies, hospitals, and nursing homes to do a better job; it would take a great burden from State public assistance agencies, thus permitting them to do a more adequate job for those who need public assistance and cannot qualify under social security. |