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The CHAIRMAN. I am extremely pleased today to have Dr. Louis Sullivan appear before us. As Secretary of the Department of Health and Human Services, Dr. Sullivan has come face to face with the difficult decisions confronting this Nation. In his role as Secretary, he has brought genuine compassion for, and commitment to, the most vulnerable of Americans. Today's hearing will focus on the health of vulnerable Americans and the health of the Federal commitment towards them.

Dr. Sullivan, it is indeed a pleasure to have you before this committee. Please proceed in any manner that you may desire. STATEMENT OF LOUIS W. SULLIVAN, M.D., SECRETARY OF

HEALTH AND HUMAN SERVICES Secretary SULLIVAN. Thank you very much, Mr. Chairman, Mr. Rinaldo, members of the committee. It is a great pleasure to appear before you today because the work of this panel is indeed critical. It's critical in improving the quality of life for all Americans. So I look forward to our dialogue with you today, and please know that my door is always open to you.

As a physician, medical administrator and educator, I have devoted my entire professional life to expanding access to our health care system. I know firsthand that there is room for improvement in health care delivery in our country,

I know that the members of this committee have a particular concern in addressing the problems of those older citizens who must bear the terrible burden of poverty and illness. I want you to know that President Bush and I both share this concern. We must work to assure that our parents and our grandparents who gave us the gift of life, live a life of dignity themselves.

Far too many of our citizens have neither public nor private health insurance. An unacceptable number of these citizens are our children. At the same time, we must also confront the implications of an aging society for our health and long-term care system. Our elderly population is growing faster than any other group in society. We must also be prepared to meet their needs. Finally, we must meet these two complex challenges while remaining committed to bringing the staggering cost of our Nation's health care system under control.

I know that the task ahead is a difficult one. I take note that selected Members of this body, under the leadership of Senator Rockefeller, have just last week completed a similar task. I would like to take this opportunity to commend the Senator and the other commission members for their commitment to achieving a better health system for all Americans. The work of the Pepper Commission is one contribution to the public debate over desirable health policy goals for the 1990s.

As you are aware, President Bush announced in his State of the Union Address that has appointed me to lead a Domestic Policy Council review of recommendations of several health studies, including the Pepper Commission and the Advisory Council on Social Security. Several private sector efforts are also underway. In addition, last year I appointed a task force chaired by HHS Únder Sec

I retary Constance Horner, which also is working on this issue.

However, I want to add an important note of caution. We are all wiser after the repeal of the Medicare catastrophic law. The lesson to be learned is that good intentions can have unintended consequences, particularly if they carry a high price tag. We do not want another catastrophic outcome on our hands, and my concern is that the almost $100 million price tag on the Pepper Commission proposals involving public and private dollars could result in just that.

As I conduct the domestic policy council review of the Nation's health care financing system, I look forward to working with the members of this committee and with others who are devoted to improving the health of our Nation, to make the American people aware of the significance of this issue, and their stake in it.

I would like to focus my remarks today on my Department's deep commitment to addressing the concerns of the vulnerable elderly, and specifically, improving their access to our health care system. Fortunately, because of a vibrant economy and many of the social service programs under the roof of the Department of Health and Human Services most older Americans no longer are faced with the harsh dilemma of whether they will be able to pay the rent, the doctor, or the food bill. In fact, today most older people are in good health, maintaining active lifestyles, and contributing to all aspects of our society. But we must not forget those who have not yet shared in our Nation's prosperity, particularly our vulnerable older citizens.

President Bush and I are firmly committed to maintaining and indeed to strengthening the critical fabric of service delivery to our older citizens. Let there be no doubt about this in anyone's mind. Accessibility and affordability of health care are issues of particular concern to older Americans who are minorities. The statistics and my own personal experience as a physician in Georgia bear out this fact. That is why one of my major priorities as Secretary is to improve minority health care.

I have initiated action in several areas to begin to address this concern. Assistant Secretary for Health, Dr. James Mason, and the Director of the Office of Minority Health, Dr. William Robinson, are currently developing a plan to address the disparity in minority health status, which in part focuses on local intervention. This effort will involve a broad spectrum of organizations and institutions, and will target health problems faced by minority populations.

The problems of the minority elderly is also a major focus of the Administration on Aging, led by Dr. Joyce Berry. The Administration on Aging has created 11 national aging resource centers. Six of these centers assist State agencies on aging in developing community based long-term care systems for the vulnerable and chronically ill elderly. Five other centers assist the States to meet the needs of the rural elderly, the minority elderly, persons suffering from elder abuse, residents of nursing homes, and to develop health promotion programs for the aging.

The Administration on Aging is also working in joint endeavors with other divisions within the Department of Health and Human Services, including the Social Security Administration, the Public Health Service, the Health Resources and Services Administration, and the National Institute on Aging to facilitate services and research directed to the health needs of vulnerable persons.

Health service delivery to the minority elderly suffers from a lack of professionals to serve them. I have intimate knowledge of this problem since my entire professional life has been dedicated to improving the health of minority populations through the training of minority physicians and other health workers. Increasing the number of minority health professionals is a major objective of our department, and I want to point out that the administration's budget contains a new initiative in this area.

To further assist in the effort to improve the health of older minority Americans, the Department of Health and Human Services is awarding $600,000 in grants to 10 historically black colleges and universities to develop and implement health promotion programs aimed at improving the health of minority older citizens.

Another important aspect of our efforts to address the health problems of the vulnerable elderly falls in the area of research and research training. Independence of older persons is compromised by a range of biomedical, behavioral, and social factors that adversely affect health and increase the demand on services.

Increased emphasis must be placed on a continuum of studies, from understanding basic aging processes, to conquering later life diseases, as well as understanding the elements of prevention and apply the approaches to rehabilitation of dependent older persons. Training of a new generation of health researchers must at the same time accompany the studies being carried out in those areas. In addition to the major role of the National Institute on Aging at NIH and other components at NIH, the Centers for Disease Control and many other programs within the Department contribute in a significant and coordinated way to these efforts.

An example of the important research underway is the work the National Institute on Aging is conducting to prevent hip fractures, which each year affect 200,000 Americans over the age of 65. Research is also being conducted on how increasing safety factors can reduce accidents among older people.

As I mentioned in my opening remarks, 50 years ago our country began a concerted effort to protect our older citizens from financial insecurity. The cornerstone of that effort was the creation of the Social Security Program.

For me and for this administration, nothing is more important than the proper management and protection of the Social Security Trust Funds. Social Security is certainly not broken and does not need fixing, either by undermining the financial condition of the trust funds or by making ill-advised changes in the structure of the Social Security Administration. I remain firmly opposed to separating the Social Security Administration from the Department of Health and Human Services. Such a proposal would not make sense from a management perspective, nor, more importantly, from the standpoint of our beneficiaries and particularly the vulnerable elderly.

Today, I have described a social service delivery system under the roof of the Department of Health and Human Services that works and that recognizes the interconnected medical and social needs of the elderly. The vulnerable elderly do not need to be

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forced to deal with another bureaucracy when they can currently go to their local Social Security Office and have one-stop shopping access to information regarding a myriad of service delivery programs administered by the Department of Health and Human Services, including Medicare.

Those who want to make the Social Security Administration separate from the Department of Health and Human Services have never explained in concrete terms how creating a new bureaucracy would better protect the retirement security of Americans. Seniors, and especially the vulnerable elderly, need dependable service, not another layer of administrative red tape. Social Security Commissioner Gwendolyn King and I are delivering on our promise to improve the Social Security Administration's service to our Nation's seniors. It's certainly not the time to disrupt our efforts by tampering with the structure of the Social Security Administration.

To give you an idea of our deep commitment to improving service delivery to the vulnerable elderly, I want to mention a major Social Security Administration initiative, our Supplemental Security Income Outreach Program. The Social Security Administration has launched a major effort to bring SSI to all of those who are eligible through an extensive outreach program. In this effort, the Social Security Administration has the assistance of the Administration on Aging, and the network of State and area agencies on aging. By reaching into the communities where vulnerable senior citizens reside, the Social Security Administration is assisting those who are eligible to apply for benefits. Once these individuals are reached, the Social Security Administration assists in linking them with other programs such as Medicaid and food stamps.

While government has a leading role in addressing the problem of the vulnerable elderly, it cannot accomplish its goals alone. So I am committed to strengthening the relationship between our agency and the community organizations such as business associations, churches, and synagogues, and civil organizations which have direct access and contact with these vulnerable citizens. These mediating institutions are vital in reaching out to the most vulnerable among us. A good example is the Meals on Wheels Program, which involves volunteers delivering meals to seniors in their homes.

Although my focus today has been on the vulnerable elderly, we must recognize that seniors themselves are beacons in the volunteer spirit. Over 40 percent of older Americans volunteer to help their fellow citizens. Many, in fact, serve those at the other end of the age spectrum, helping out in the Head Start Program, in schools, and in recreation centers. Their wisdom and their skills are invaluable and are a major resource in any society. That is why maintaining their independence in our communities is so very important.

In closing, I want to assure the members of this committee that I am committed to serving as an advocate for the concerns of the vulnerable elderly. I extend my hand to work with you as we lend a helping hand to this group of Americans.

That completes my statement, Mr. Chairman. I would be pleased to respond to questions.

The CHAIRMAN. Thank you, Dr. Sullivan.

What we are going to do now is proceed with the 5-minute rule. Each Member will have 5 minutes to ask questions. I will start, and after we have completed the 5 minutes, we will come back again and use additional time.

The one question that I have is in regard to the Pepper Commission. You state on page 3 that “my concern is that the $66 billion price tag on the Pepper Commission proposals” is of great concern

to you.

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You have also, and are now, conducting the domestic policy review of the Nation's health care financing system. Have your studies led you to believe that the "$66 billion price tag” is way out of line? What is your recommendation in regard to that cost?

Secretary SULLIVAN. Well, Mr. Chairman, our review is still underway so that we don't have specific dollar figures to propose. My testimony really draws attention to the fact that the recommendations of the Pepper Commission would cost $66 billion, that is Federal dollars to which we would add private sector dollars.

This is a very expensive program, and we need to be sure to develop a program that not only is effective in delivering services, but also one that is mindful of costs. While we are very committed to providing access to health services for all of our citizens, we want to be sure that we get the best investment.

And the reason we stress that, is the fact that the United States, as you know, is number one in our per capita expenditures for health care. We spend more than $2,200 per capita, each year, on health care for our citizens.

The number two Nation, Canada, spends about $1,400 on its citizens. New Zealand and Britain actually spend less than a thousand dollars per capita.

When you look at the status of our health compared with those nations, we are no better, and in many ways they do better than we, lower infant mortality rates, longer life expectancy.

So what we are concerned about, and part of our overall review, is to try to learn more about what are the differences between what we do here and what other nations do. And I am sure that a part of that will encompass preventive services in health promotion activities.

So we clearly have a responsibility that we have to meet, and it's going to cost some figure. But we have to be aware of the fact that simply dollars alone are not necessarily going to provide us with the best health because if that were the case, we should be the healthiest Nation in the world now, which we are not.

The CHAIRMAN. Do we not know for sure what the cost would be to bring a national health plan to this Nation?

Secretary SULLIVAN. No. We still are awaiting the results, not only of the Steelman Commission, but our own task force, as well as consultations with others in the private sector.

The CHAIRMAN. Sure. But we do know that the elderly population is paying more now than it did before.

Secretary SULLIVAN. Oh, yes.

The CHAIRMAN. We also know that the cost of medicine is increasing tremendously almost on a daily basis. And we also know, based on studies, that if we do not do something about it soon, it is going to get completely out of control.

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