ries. ovide a psychological lift to the beneficiaries, who by the complexities of medicare; and maybe also oviders. Some providers would oppose it, of course. nany physicians would oppose it.

other benefits. It might facilitate the use of genich are already dominant in part B, so you have If the two parts were merged, it would make it ave a certain proportion coming from general revate to see this proportion ever exceed 50 percent. a third might be appropriate, not the 75 percent ith part B or the 5 percent-or whatever it iserhaps a third for the combined program would immediate deficit problem.

ger of part A and B, while it does not make medig HMO, does have some of the characteristics in ans would be a little more tied in with the institutotally separate as they are now. Even the DRG n it indirectly impacts on physicians as the quote en shows, does not touch them directly.

to me a little inconsistent for the same administraushing the HMO—not just this administration, but for the past 10 or 15 years-or the idea of tying hysician reimbursement more closely together to ction and encourage a total separation of the two as aration into parts A and B tends to do.

hank you. Mr. Chairman, I would like to just read for those members of the committee who will read Advisory Council on Social Security's statement renbination, and it goes like this.

part A and B would potentially contribute to imMary understanding, simplify the more effective adnd improve monitoring of the utilization of health Potential problems to be evaluated would include fierations for combining benefits with distinct funding omplexities of merging different reimbursement sysrt A and B."

a summation of what you just said, so I do apprecients.

st want to thank you, Mrs. Somers, for again remindittee, as you did in your testimony, of the intent of know sometimes you have to get back to the basics. id, in reforming medicare, we must be very sure that stroy, but rather protect and strengthen its original ding medical care to the elderly and disabled. So I you all for your testimony.

Do. Thank you, Mr. Smith. Do any members of the ny suggestion about encouraging assignment among have heard quite a bit about that this morning, and I ng if anyone had any ideas they would like to put time in that regard.

RS. Nothing definitive, but one of the problems with that were referred to earlier is that apparently what

t.

asked is: "Do you or do you not accept assignment?" Now since Figures cited-50 or 53 percent-do not refer to individual docbut refer to claims, a doctor can claim that he takes assignt and yet perhaps have only 1 percent of his claims on assignam all in favor of publicizing. It seems to me that that is the the program owes the public. If doctors are permitted not to assignment, medicare certainly owes it to the public to say h ones do and which don't. But some sort of arbitrary, but reable, formula would have to be devised to define a doctor who pts assignment. Perhaps it should be at least 75 or 80 percent e time. Something of that sort would certainly be more meanul in terms of public information.

r. RINALDO. I think that is a good suggestion and I want to ment on this entire area. I feel so strongly about assignment just a few days ago I wrote to Mrs. Heckler, the new Secretary he Department of Health and Human Services, asking her to rove this information available to medicare beneficiaries about sicians in their communities who accept assignment. I think it ld be the policy of Health and Human Services and I am going ntinue to push for that policy to be implemented in the proper ion.

are the very old. It

*them.

RINALDO. Many Me ght to modify me and other items of t State program to dressing this to the mment on it. Do you there is any desir

ou also mentioned, Mrs. Somers, quite a bit in your testimony t increased life expectancy. Are you advocating in any ner, shape or form, raising the age of eligibility for medicare to espond with increasing life expectancy? Or do you feel, for exle, that there should be a two-tiered age of eligibility, one for entive care, one for acute care? Because you mentioned all of e things in an interrelated fashion, and I would like to have position cleared up in my mind.

A

SOMERS. Yes, abso Average. The reimb ed out. Also, it is est entulous, that is, r zes nor teeth.

rs. SOMERS. No, I do not advocate raising the age of eligibility nedicare. I would like to see it dropped, if possible. I know that ot realistic, now, but eventually I would like to.

w you can imagine mens, as well as mer ng is such a pe we are pursuing a d Davis mentioned th new studies to see the field of preventive kingh technolog

hat I did support quite strongly, was raising the age of eligibilFor social security. I think these are two very different things. yet they are related in that the longer we keep on working the more inducements we have to keep on working, the more ontinue paying taxes.

a $50 pair of eyeg le continuation of th

the area that acco Niblion-dollar nk everything sto

am well over 65. I am still working. I am still paying taxes. But very glad that I have my medicare, and so, I am sure, is my loyer! I fear there may be some change now in employer attis toward older workers with the new shift in who has the priy responsibility. That is very unfortunate. Because some older le may lose jobs for no other reason except that their employer not want to be the payer of first responsibility, rather than icare.

des. The previou set of the list conte ademy of Science to be acaded a

ow, I will say, as we phase in new services, such as preventive ices, or long-term care, as a temporary easement of the cost lem, I think it is justifiable to start with, say those over 75, or 70, or over 80, whatever. These are actuarial computations would have to be figured out. Obviously the people who need sing home care most, the people who are being reduced to ury in order to get on medicaid-in those States where they

old. It certainly seems to me justifiable to start

[any Members of Congress feel very strongly that dify medicare to cover eyeglasses, prescription cems of that nature. For instance, New Jersey has gram to aid the elderly in prescription drugs. I am is to the panel generally for whoever would like . Do you think, since you mentioned this in some any desirability of trying to do this at the Federal

Yes, absolutely. But I do not think it can be blane reimbursement list will have to be carefully it is estimated that one-half of the people over 65 hat is, no teeth at all. Ten percent have neither h.

imagine what that contributes to gastrointestinal 1 as mental health problems. This whole prevench a penny-wise, pound-foolish approach. I also suing a double standard in this respect.

tioned this morning that HCFA is going to fund a es to see what is cost effective and health effective reventive services. Why do they not do that in the hnology? The same administration, which worries of eyeglasses or a $25 visit to the podiatrist, opion of the Center for Health Technology Assessthat accounts for such a large proportion of medion-dollar costs.

thing should be assessed, but there have already e previous Surgeon General, Dr. Julius Richmond, Institute of Medicine, which is part of the NationSciences, a report on preventive services which ded in national health insurance as well as medi

I in the IOM study. We sent that to the Surgeon ago. The only thing that survived from it was the accine that was referred to. Everything else was igreventive service has been studied. It is no more medical technology. The annual physical, 15 or 20 considered very good. Now, I was one of the first d it was not cost effective or health effective, but periodic schedules that are being followed today. What should it be? What in your opinion should it

. It should vary according to age. An infant in the e obviously needs to be seen more than once a year e basis.

. I am talking about primarily adults and senior citi

. I think it varies every 5 years for a healthy young every year for the old. One easy-to-remember schedvo preventive visits for healthy adults in their twene every 5 years), three in their thirties; four in their their fifties (every 2 years) and every year after 65.

the particular procedures should vary. They are not the same nen and women. They are not the same depending on your octional background. They are not the same depending on your All of those things have been carefully studied. We are not ing with a clean slate. One has the impression that there is a foot-dragging here.

r. RINALDO. I want to thank you very much. I think the testi-
y of this panel has been very constructive. As you know, by
of summary, we in Congress, in my view, are going to have to
ove some medicare legislation in the next few years, possibly
arly as the next year or two. And we have to do our best to
tain benefits in the face of health care inflation that is pro-
d to remain at double digit rates. The Congressional Budget
ce puts it at 13.8 percent through 1995.

is obvious we will need revenues. We may not be able to
and benefits as much as we would like, and we have got to get a
Hle on health costs. I think that has been dramatically pointed
at this hearing.
am going to push for more hearings by this committee and I
t to state to all of the people who could not testify today that I
d appreciate it if they would like to testify at some future
ing, to please write to the Select Committee on Aging and we
do everything possible in an effort to have your name placed
list for one of our future hearings.

want to once again thank all of the panelists. I think you have
e up with some excellent proposed solutions, and maybe one of
e days we will see them put into effect.

e hearing of the Select Committee on Aging is now adjourned. Whereupon at 12:37 p.m., the hearing was adjourned.]