We are told by some people that H.R. 5191 would cost too much. The Nation is spending $220 billion per year on health costs. This includes all costs, insurance, Blue Cross, Blue Shield, Medicare, Medicaid and other medical services provided. At the start of H.R. 5191 it may cost more, but as the system is reformed through controls, the cost would certainly be much less within a few years than costs under the present system.

Mr. Chairman, speak to the man in the street and you will hear remarks like, "why can't we enjoy the system of health protection that Members of Congress enjoy," or, "If this system is good enough for us, why is it not good enough for Members of Congress?"

I am grateful for your attention and hope with millions of Americans that H.R. 5191, Health Care for All Americans Act will be the law of the land very shortly.

Thank you.

Mr. RANGEL. Thank you, Mr. Serchuk for giving us an enlightening view and, especially, the views of the man in the street. I have heard many proponents of H.R. 5191 compare it with the system of health insurance and we have in the Congress.

Of course, most of us have participating health insurance plans and we get an option of three or four different types of plans, and depending upon what we pay is how much is deductible.

There is some common feeling in the general public that Members of Congress get free medical care, and if that is happening I haven't found it in 10 years; but we do have comprehensive insurance policies that we purchase from regular insurance companies.

Under that bill which you are supporting I think, and I can be corrected by staff, that it does eliminate the profit motivation and more or less puts Government in charge of providing all medical services and would require doctors to be working for the Federal Government on salary, which is not just a question of cost. It is a question of whether or not that type of concept would be able to pass the Congress. You recognize the difficulty of getting support for that type of idea. Mr. SERCHUK. I recognize the difficulty but I do say that it would control the costs by virtue of the fact that only an amount paid in the budget would be paid out. It would be budgeted accordingly, State by State or any other method. So they would not be paying more than was paid in. There would be your control.

Mr. RANGEL. Of course some of the authors of this legislation indicated that it would not mandate that all medical professionals work for the Federal Government and that would allow those who did not want to participate of course to operate their own health facilities outside of Government. I am thinking in terms of the dual standard of care, those who can't afford to go to the private practitioner are locked into the Government system.

Have you given thought to that?

Mr. SERCHUK. It would not mandate that every physician be part of the plan, but at the same time if I have a choice and go to a place that would not cost me anything or going to a doctor who is going to charge me, I am going to that place where it is not going to cost me anything. I think the very system itself will spell out to the doctors who are not part of the plan, "If you want to continue, you will be part of the plan."

I have to realize that the plan in England, although a lot of people say that is no good over there but yet for many, many years nobody

dared run for office over there without saying "I will maintain that plan," so I think it is a darn good plan.

Mr. RANGEL. You can rest assured that this committee has not just refused to look at that plan and it will be considered before we legislate. So let me thank you on behalf of the full committee, and the subcommittee will stand in recess until 10 minutes after 12.

[Whereupon, a brief recess was taken.]

Mr. RANGEL. Our subcommittee will resume hearings and we are waiting to hear from the National Gray Panthers Association, and certainly we have heard from you all over the country.

Elena Herrschaft will be testifying for the chairperson, Committee for Long-Term Care for the Elderly.

Thank you for being with us.

STATEMENT OF ELENA HERRSCHAFT, CONVENOR, DADE COUNTY GRAY PANTHER NETWORK AND CHAIRPERSON OF THE COMMITTEE FOR LONG-TERM CARE FOR THE ELDERLY, APPEARING FOR BRIAN PETERSON, REPRESENTING THE GRAY PANTHERS

MS. HERRSCHAFT. I am not Brian Peterson, I am substituting for him.

Mr. RANGEL. I am glad that you were able to come here.

MS. HERRSCHAFT. I am the convenor of the Gray Panthers of Dade County and I am a social worker by profession.

Mr. RANGEL. We thank you for being with us.

MS. HERRSCHAFT. We have given you a very long and detailed written presentation which we have left with the secretary.

Mr. RANGEL. I have that statement and I want you to know and the Dade County Gray Panthers Network, that that full statement will be placed into the record.

Ms. HERRSCHAFT. I can make it very brief. The Miami Gray Panthers organization supports Congressman Dellums' bill, which is known as the National Health Act, H.R. 2969, which would establish a national health service in the United States. We want an end to privately controlled health care which simply enriches doctors and hospitals and insurance companies, which provide inadequate and costly health care to consumers.

We are especially concerned with the high cost of health care to senior citizens under the present system. In spite of medicare, older Americans must pay 38 percent of their health care from their own resources. The low income elderly people cannot afford the present system. Older Americans are frankly subjected to unnecessary hospitalization and operations because these are paid by medicare.

Greedy physicians, some of them, are making extra fees through providing unnecessary and often harmful treatment to elderly Americans. We would like a system where doctors are salaried and getting paid, and when there is neither a lack of care for those without large incomes or an excess of care for those covered by insurance for Government people.

We would like the extension of neighborhood health centers which will make medical care more accessible to elderly people, low income

people and minorities or a national health care system to make such health care available to all Americans.

Our protest today coincides with the arrival in Miami of the Health Subcommittee of the House of Representatives Ways and Means Committee of the U.S. Congress. We are inside the courthouse giving testimony on behalf of the Dellums bill and urging the subcommittee to recommend the adoption of the national health service bill.

We, here as the Gray Panthers and other citizens, are especially concerned with the nursing homes. It is the most deplorable condition and we owe it to the local press for exposing the situation because the physical aspects of the nursing homes are terrible. The staff is inadequate and untrained, and the nutrition is terrible. These poor wretches who are on medicaid do not get any sort of significant local support for their physical wells being and they are just left there to vegetate. Now, we feel that if we could pay the family additional help under medicaid, that these poor old people could be much happier and better cared for in their own home. As it is no provision is made and they are shipped off and they are lucky enough if there is an available place in the nursing home.

We have been at it for months and months and we have visited nursing homes and we have sent letters to the Governor and letters to the health and rehabilitation service, but nothing has changed very much. We feel very, very much concerned about what is going to happen to these people or the people who come after them.

We strongly recommend that you, through your committee, will see to it that a Federal project be proposed that will help plan for the frail elderly, and that help should be given in the home. That will alleviate a great deal of the deplorable conditions that exist now in Florida, especially in Dade County.

Now, this is the gist of the whole business, you know that. In conclusion, I must tell you why we are for the Dellums bill. One, is because we hope it will be community-based and that it will be right here. We will decide what is good for us and what isn't good for us. It will be community-based.

Two, it will be publicly funded. The public will support it and not some private insurance companies.

Third, it will provide a full amount of prevention and dental and mental health services to all without charge because it will all come from taxation and not drop from heaven. We understand that.

And the fourth suggestion is that it be governed democratically by those who want it to be practiced in this country. We feel that many of the countries in the world, with the exception of the United States and I believe it is South Africa, do not have any kind of provision for such health action. We are the only two. And we are the most affluent country in the world today. We think so anyway.

Therefore, it doesn't seem possible or feasible or logical that a country like the United States should deprive the poor people and the young people. We are not only concerned with the old for a medical comprehensive health program. We heard from Senator Gordon that there is a need for education. If we had such, maybe we wouldn't have so much illness in this country or in this State anyway.

I don't want to repeat what has been said before. Much has been said. We promise you we are going to continue working along the lines of the Dellums bill.

[The prepared statement follows:]

STATEMENT OF ELENA HERRSCHAFT, CONVENOR, DADE COUNTY GRAY PANTHER

NETWORK

The existing system of health care is not meeting the needs of older Americans and should be replaced by a comprehensive National health program, as provided in the Dellums bill. The experience of the Gray Panther organization in working with older people in Miami has demonstrated over and over again the inadequacies of the existing system of health care, inadequacies which would not be remedied by either the Carter or Kennedy health insurance proposals. Older people are being impoverished by the high costs of the present system, but are still not receiving adequate health care.

In 1976, older Americans paid an average of $491 per person out of their own, personal funds and private insurance for health care, compared to only $385 per person for private health care expenditures for persons aged 19 to 64. Older people have only 60 percent of the family income of persons aged 35 to 64, yet they are being forced to pay more of this lower family income for health care costs. Miami, more than anywhere else in the United States, we see the gross disproportion between huge and rapidly growing incomes of physicians, hospitals, insurance companies and drug companies, and the worsening financial situation of older people. We older people are caught in the midst of a terrible inflation which is reducing the value of our savings, our insurance and our private pension plans. We have fewer and fewer resources with which to pay for medical care, but the cost of medical care goes inexorably upward.

Medicare and medicaid are not adequate. There is no way that an older person on a restricted income can pay even 20 percent of a $10,000 hospital bill. Dental costs for older people are rising, yet are not covered in medicare or in Florida's medicaid system.

We have the clear impression that the gap between allowable doctors' fees and the fees actually charged are becoming wider and wider under the medicare and medicaid systems. It also appears that the number of physicians willing to accept direct billing to medicare and medicaid is declining.

Older people in Miami are being bilked by "medigap" insurance policies, which all too often do not cover the real medical financial needs left by the medicare system. Unscrupulous insurance salesmen are even selling several of the same, essentially worthless policies to one individual by preying on fears and ignorance. Older people in Miami are finding health care inaccessible for non-financial reasons as well. There are few health facilities located in the black community, necessitating long bus rides by sick older people to overcrowded outpatient facilities at Jackson Memorial Hospital. Low-income elderly people who cannot find a private physician willing to accept medicare and medicaid as full payment are subject to long waits and cursory treatment at the existing public health facilities. Although health maintenance organizations have been touted as the answer to health care costs, we have heard many stories which indicate that there are problems with many privately operated HMO's in Miami. In some instances, there has been outright fraud when HMO's or clinicas in the Cuban community have promised to pay for hospitalization insurance as part of the total coverage and then failed to purchase this hospitalization insurance. In many cases, local HMO's offer dilatory service by physicians who are less than outstanding in their medical competence and in their rapport with patients. While fee-for-service private medicine drives up costs by unnecessary tests, hospitalization and operations, pre-paid private medicine often saves costs by cutting corners on quality medical care in order to boost the profits of HMO owners. In either case, the medical customer loses.

Miami's hospitals are full of doctors who are growing wealthy by performing unnecessary procedures on dying individuals with medicare coverage. There are numerous incidents of implanting pacemakers or performing heart surgery on individuals whom it is certain will never recover. Instead of allowing dying individuals to understand what is happening to them and to come to accept their end, our system of private medicine turns their last hours into an agony of

hopeless operations so that unscrupulous physicians can wring thousands of dollars more out of their dying bodies. The system of "peer review" which is supposed to prevent such practices is a joke: Doctors are a tight-knit fraternity who have a good thing going for them and who would never rat on a brother unless he became a scandal in the community.

The nursing home situation in Miami is probably the most outrageous aspect of the unmet health care needs of the local elderly. Miami nursing homes have been investigated by a county grand jury which has discovered a systematic pattern of uncleanliness, financial mismanagement and patient neglect in many. The nursing home industry has excellent political connections through unsavory means, and has managed to control the administrative agencies in Florida which are supposed to license and certify them. Nursing home patients are among the most helpless individuals in our society and are also the most abused. A publically-operated system of nursing homes under democratic community control and with adequate funding could overcome the existing abuse of enfeebled older Americans. There is no reason why nursing home workers should not be trained and certified as competent; there is no reason why helpless older people should be exposed to the greed of private nursing home operators. Many people in nursing homes could be rehabilitated by suitable programs which are simply not funded under the existing system.

There is also a need to provide more comprehensive home health care services for the elderly. Many people would never have to enter nursing homes if public programs existed to send around nurses, aides, homemakers and the like. A welldeveloped system of publically operated home health care services could employ many presently unemployed youth, while making the lives of older Americans more secure and enjoyable. The high costs of institutionalization could be avoided for large numbers of people who are consigned to nursing homes under the existing system. With the decline of the family as a source of care for older people, alternative public agencies will have to be devised, and care should be taken to preserve as much autonomy for the older people as possible.

The Gray Panther Organization wishes to avoid simply enriching doctors, hospitals, insurance companies and drug companies further by the passage of a national health insurance bill. Instead, we ask that a democratic, communitycontrolled, national health program be implemented. Such a program could bring health care costs under control, widen access to health care, relocate health care resources geographically to meet the needs of the black community and rural areas, increase the attention paid to preventive medicine, and take measures to reduce occupational and environmental causes of disease and accidents. We want to see the education of health care workers paid by the public, so that the public can widen access to the health professions for women, minorities and older people. We hope that your subcommittee will give serious attention to the Dellums bill.

Mr. RANGEL. Thank you for your eloquent presentation, Mrs. Herrschaft, and I want you to be assured that this committee will be working and continue to work very closely with Claude Pepper. The reason we are in Florida is because he has convinced us that you have had more experience down here in dealing with the problem of the aged. If your organization could submit to our committee abuses that you see in the care of our aged in these nursing homes, without getting yourselves in trouble and acting as though you are investigators, but when you hear from your family and friends that there has been an abuse, I want you to know that this committee stands ready to look into it.

So, I am not encouraging you to knock down nursing home doors, but I am encouraging you to let our committee know where you have seen abuse of our older Americans.

Thank you for your eloquent testimony.

Our next witness is Hugh Westbrook, the Florida State Hospice Organization, Inc.

We will keep the record open for your written testimony.