THE FINANCIAL ABILITY OF OLDER PEOPLE TO MEET HEALTH CARE COSTS It is a generally accepted fact that older people require more health care than younger members of the population. It is also true that many older persons, and their families, encounter substantial difficulties in financing adequate health care. This does not mean, however, that older people, generally, are unable to meet their health care costs because of inadequate incomes or insufficient resources. On the contrary, evidence indicates that the economic situation of older people, generally, is improving rapidly with the growing proportion of individuals over 65 receiving social security old-age pensions and company pensions. Moreover, in recent years there has been a truly phenomenal increase in health insurance coverage of older people. It is estimated that more than 6 million people more than 50 percent of the population over 65-have some form of health insurance coverage. In fact, the coverage of the older population is growing more rapidly than that for any other age group. This is a reflection of the steady expansion of voluntary health insurance, and particularly the broadening of the availability, as well as the improvement in quality of health insurance coverage for older persons. Moreover, in growing numbers, retired individuals and their families continue to receive such coverage as part of their retirement benefits. It is fair to conclude that while older persons require more health care than younger persons-and while there are many among the older population who encounter difficulties in meeting the costs of adequate health care as a group, older persons, with the assistance of health insurance protection now generally available to people over 65, are reasonably well able to meet their health care costs. SHOULD THE HEALTH CARE COSTS OF OLDER PERSONS BE MET THROUGH SOCIAL The proposition that the Social Security Act should be broadened to include health care costs of older persons must be measured against the following considerations: 1. The adoption of the King bill, or any similar measure which would provide health care cost benefits to social security beneficiaries over 65, will still mean that about 4 million older persons not now receiving social security benefits would remain ineligible for health cost benefits. In many respects, these are the individuals now least able to meet the cost of adequate medical care. 2. It is clear, further, that there are a great number of individuals over 65 who are receiving old-age and survivors benefits under social security, who have the income and resources to meet their medical and health care costs. While many present beneficiaries admittedly have need of assistance to meet health costs, it would be wasteful of public resources to subsidize the health costs of all to meet the needs of some. 3. The enactment of social security health cost coverage for one segment of the population-in this case for persons over 65 who are now receiving benefits-would inevitably lead to its expansion and elaboration to the end that there would ultimately be a complete, compulsory health insurance plan. It has been demonstrated on numerous occasions that the cost of such a program would be immense. It should be borne in mind that current social security benefits, under the present financial schedule set forth in the law, will cost 914 percent of cover payroll by 1968. To add to present benefits a comprehensive health insurance program would involve much larger social security costs necessitating a payroll tax far in excess of the present schedule. 4. Obviously, if there were a comprehensive, compulsory health insurance program financed through social security, it would prove the death knell to voluntary health insurance. This relatively new industry which now serves more than 130 million Americans, including nearly half of those over 65, has experienced a phenomenal growth, and it is making a profound contribution toward better health for the American people. The fundamental virtue of voluntary health insurance is that it preserves the freedom of choice, and insures the continuing freedom of the medical profession and of medical services. A degree of Government regimentation and control over all aspects of medical care would be inevitable and necessary under a public, compulsory form of health insurance. 1 THE MORE DESIRABLE ALTERNATIVE We recognize that society has an obligation to help care for those members of the community who have insufficient income or resources to meet minimum needs, and this obviously includes those individuals over 65 who are unable to meet the costs of needed health care. The point of wisdom, it appears to us, is to fashion public programs to meet these specific needs. The Kerr-Mills bill, approved in 1960, sets up a program of public assistance, with Federal participation, to help our senior citizens who need such help to meet the costs of adequate health care. The program is being implemented in 30 States. Beyond doubt, approval by all States will soon be achieved. It deserves a fair trial. Some criticism has been directed against the Kerr-Mills program on the grounds that a means test approach is involved, and that, in order to qualify, recipients for such assistance must prove not only current low incomes, but must also divest themselves of virtually all other resources, generally excepting a home and appurtenances. For example, it is pointed out that the New York law provides that real property not used as a home, nonessential personal property, and insurance in excess of $500 cash value must be utilized toward payment for medical care before a person becomes eligible for assistance. It is possible that thees somewhat restrictive provisions in New York's law and in other laws might profitably be reexamined so as to relax somewhat the eligibility requirements for old-age health care assistance. In our judgment this can be done without materially affecting the main objective of the general program that of providing assistance where health care financial assistance is needed. We recommend that studies be inaugurated toward this end. We are convinced that the larger public purpose will be served by the selective approach to health care for the aged now inaugurated under the Kerr-Mills program, and being implemented by the several States. We urge the Congress, therefore, to reject the King bill or any other measure which would establish a compulsory program of financing health care for the aged under social security. STATEMENT OF MRS. MADELINE K. VITALE, BROOKLYN, N.Y., REPRESENTING THE AMERICAN ASSOCIATION OF DOCTORS' NURSES My name is Madeline K. Vitale, I am a doctor's nurse and employed by Dr. S. J. Cort, 695 Bushwick Avenue, Brooklyn, N.Y. I have been employed by Dr. Cort as his doctor's nurse since 1956. Prior to that I worked for the late Dr. Vincent Anello of the same address. I make this statement in my own behalf and in behalf of the American Association of Doctors' Nurses, a comparatively new association that has as its members some 2,000 or 3,000 of the approximately 165,000 doctors' nurses in the United States. I am president of the New York Society of Doctor's Nurses and am authorized to appear as a spokesman for the American Association of Doctors' Nurses by the authority of the executive director and J.R. Geyman, M.D.; Bernard S. Weiner, M.D.; Winston E. Burdine, M.D.; and Julian Neill, M.D., of the Medical Advisory Board of the American Association of Doctors' Nurses. Perhaps you would be interested in a brief description of the work I have performed for my doctor, as it will demonstrate my knowledge of the relationship of the doctor and his patient. I act as his receptionist, make all appointments, and meeting the patients. I also perform secretarial and bookkeeping duties for him. In addition to these duties, I assist the doctor in many ways, such as preparation for examination, attendance during certain phases of physical examination, assistance in minor survery, and taking of temperature, pulse, blood analysis, EKG, and X-rays and the like. In other words, I am the doctor's girl Friday. From my 18 years of experience in the occupation of doctor's nurse, I have had the opportunity to observe the relationship of the doctor and his patient, and know how much depends upon the confidence the patient has in his own doctor, the doctor of his own choice. I oppose H.R. 4222 because I believe that if enacted this would be the opening wedge into Federal control of medicine, and the time would not be long before the Federal Government would be telling the doctor what he must do, and what he must not do, and would be telling the patient what he must do and which doctor he may choose. Such a situation would, I believe, destroy the relationship between a doctor and patient, which has been successful throughout the years of advancement of medicine and medical care in the United States. I know the long hours my doctor works. I know that he must and is willing to devote a great portion of his time to charity. I know his feelings toward his patients, and his patients' feelings toward my doctor. I sincerely believe that we must be continually on guard to oppose any encroachment upon the freedom of choice of both the doctor and his patient and request that this committee refuse to recommend the enactment into law of H.R. 4222. Hon. WILBUR D. MILLS, Chairman, House Ways and Means Committee, LIFE INSURERS CONFERENCE, DEAR CONGRESSMAN MILLS: The Life Insurers Conference is an association of 91 life and combination life insurance companies engaged in providing life and voluntary health insurance. These companies are domiciled in 24 States and the District of Columbia with a predominance of membership in the South and Southeast. This association is vitally interested in the various proposals dealing with health care for the aged, and strongly urges the House Ways and Means Committee to reject H.R. 4222. Respecting your request that organizations and individuals with a similar interest and position avoid repetitious testimony, we did not attempt to file a lengthy statement nor request time for appearance. We, however, wish to go on record as endorsing the able statement made on July 31, 1961, by Mr. H. Lewis Rietz, who appeared on behalf of the American Life Convention, the Health Insurance Association of America, and the Life Insurance Association of America. Life Insurers Conference has supported the Kerr-Mills bill and continues through its appropriate committees, and by proper means, to encourage the various States to immediately participate in the implementation of that program. We believe that the Kerr-Mills approach is the best program yet offered to take care of the aged people who are actually in need of help in meeting their medical bills. Respectfully yours, CHARLES E. PHILLIPS, President. CONGRESS OF THE UNITED STATES, Hon. WILBUR D. MILLS, Chairman, Committee on Ways and Means, DEAR COLLEAGUE: Enclosed please find a letter addressed to me from my constituent, Mr. Claude Millsap, president of the Juneau Credit Service Co., Inc., expressing opposition to H.R. 4222, a bill to provide for payment for hospital services, skilled nursing home services, and home health services furnished to aged beneficiaries under the old-age, survivors, and disability insurance program. I herewith submit said letter for inclusion in the record in opposition to said bill, in connection with the hearings presently being held thereon. Thanking you, I am, Sincerely, Congressman RALPH J. RIVERS, Washington, D.C. RALPH J. RIVERS, Member of Congress. JUNEAU CREDIT SERVICE CO., INC., DEAR SIR: We oppose this bill on the grounds that mainly it would deny even those limited services to millions of the poor and destitute who can never qualify for social security. A favoring of the rich at the expense of the poor. Please consider this carefully and if you agree, please help defeat the measure. Sincerely yours, CLAUDE MILLSAP, President. BLUE SHIELD MEDICAL-SURGICAL PLAN To the Committee on Ways and Means of the U.S. House of Representatives: The enactment of H.R. 4222, known as the Anderson-King bill, would not solve the problem of health care for a large number of people over 65 who are not covered under social security. It still leaves a large part of the indigent population in the upper age brackets entirely uncovered. Likewise, a goodly per centage of those who are on social security, who would be covered under this bill, already have excellent protection under Blue Shield and other insurance plans and do not need any tax-financed health program. Thus, we believe that such a program would be economically unsound and would cost a great deal of money in proportion to the benefits provided. In Illinois alone, we estimate that over 150,000 people over 65 already belong to our Blue Shield plan and its companion Blue Cross plan, either as retired employees of firms where they have been employed during their working years or as individual direct-pay members. The same is true in other States where other Blue Shield and Blue Cross plans also cover large numbers of people. Here in Illinois we also have a special over 65 Blue Shield program which over 6,000 physicians in the State have signed to support as participating physicians. Under this program these physicians will accept Blue Shield payments as payment in full for services to either 1. An unmarried subscriber whose annual income does not exceed $2,000 and who has a net worth of $15,000 or less. 2. A married subscriber whose annual income, together with that of his spouse, does not exceed $3,000 and who has a net worth of $20,000 or less. Similar "Over 65" plans are offered by Blue Shield plans in other States. Thus, we believe that voluntary Blue Shield medical-surgical plans and also voluntary Blue Cross hospital plans are making a concentrated effort to solve health care problems of the aged on a local basis. We further believe that this problem can be met more economically and at a lower cost on a local voluntary basis or through a program encompassed by the Kerr-Mills legislation passed last year, which has been adopted by many States. We likewise believe that the system of medical practice as developed in the Therefore, we urge you to consider all of these facts carefully, and we believe that it should be preserved. Therefore, we urge you to consider all of these facts carefully, and we believe that you will concur that the Anderson-King bill should not be passed. BOARD OF DIRECTORS, By R. T. EVANS, Executive Director. MINNEAPOLIS, MINN., June 28, 1961. Representative WILBUR D. MILLS, Chairman, House Ways and Means Committee, DEAR SIR: This is to register my firm opposition to Government medicine or the meddling of the bureaucrats in medical practice, as proposed in the King bill (H.R. 4222). I request that you insert my letter in the committee's hearings. Any phase of private enterprise which the Government has meddled in has built up huge bureaus and has wasted billions of dollars of the taxpayers' money. I'd much rather have that tax money to spend as I please toward payment of my own choice of physician and hospital, and then if I did not need them I'd have that money to buy other things I need urgently. This is a republic-not a Socialist state. I'm past retirement age, considerably, but prefer to continue working as long as I am able. Offhand, I can't recall any enterprise which the Government has meddled in that it has not made a mess of it-i.e., agriculture, etc. And the power to tax is the power to destroy. Copies of this letter are being sent to all nine Minnesota Congressmen. Yours truly, (Miss) GOLDIE CREVER. P.S.-I know that the politicians promise that we would have freedom of choice in Government medicine but that is a ruse to get their Socialist schemes passed, then they begin to "put on the screws." Look at the farmers. 76123-61-pt. 4- -34 JULY 6, 1961. Hon. WILBUR D. MILLS, Chairman of the House Ways and Means Committee, DEAR SIR: This letter was written to tell you that I am opposed to the King bill (H.R. 4222). I do not believe that health benefits for the aged should be put under the Social Security Act. Please have this letter inserted in the committee hearings. Thank you for your consideration in this matter. Sincerely yours, DOROTHY H. WEINER. DULUTH, MINN., July 10, 1961. Re the King bill (H.R. 4222). Representative WILBUR D. MILLS, Chairman, Ways and Means Committee, Washington, D.C. DEAR SIR: This is in opposition to the King bill. It would be a calamity to approve this bill which leads to socialized medicine. Very sincerely, Please insert this in the committee's hearings. ARTHUR N. COLLINS, M.D. NEW YORK, N.Y. Re H.R. 4222, health insurance proposal-Health Insurance Benefit Act of 1961. To the HOUSE COMMITTEE ON WAYS AND MEANS, 1. LACKS FAIRNESS IN COVERAGE Extending health insurance benefits only to people on social security is most unfair and discriminatory against the older citizens who never had an opportunity to work for social security units and so do not receive social security benefits. For example, the older retired teachers in New York City have small pensions and no social security benefits because New York City teachers were only included in the social security program in January 1958 so they never had an opportunity to work for social security units. Many prosperous business people and executives are paying in for social security benefits and at 65 would be entitled to health insurance benefits whereas the older people who never were able to earn units would not get any health insurance benefits. Therefore if this Health Insurance Benefit act has any chance of passing (which it should not) the least that should be done is to give minimum social security benefits to all people 70 years or older who never had an opportunity to earn social security units while they were still active. 2. NO NEED FOR LEGISLATION ON HEALTH INSURANCE BENEFIT ACT OF 1961 It is not needed for the measure would only lead to socialized medicine and a socialized welfare state. It is not what the people want. It is what the administration wants for they see it as a vote getter and they believe in socializing our country. We the people do not want it. The administration is so liberal in piling more unemployment relief on able bodied jobless (many of whom could and would find work if the relief were not extended) and giving lavishly to foreign aid yet in this Health Insurance Benefit Act of 1961 it gives no thought to many older citizens who get no social security benefits. It is not humane to say that that group is small. 3. ALTERNATE SUGGESTION (a) Have no legislation on this Health Insurance Benefit Act of 1961. (b) Increase social security benefits $5 a month for all who receive less than $100 a month benefit and let each individual take care of his own health insur ance. |