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This legislation I am introducing today is likewise designed to meet priority needs of the elderly at the lowest possible cost. It too builds upon the expertise, experience and mechanisms of the Medicare program. And it provides an important and meaningful role for providers of health care--the doctors, hospitals and insurers.

Passage of this legislation will reduce the cost of national health insurance legislation by billions of dollars. Costs under the Long-Ribicoff bill would be reduced by as much as $4 billion if this legislation is enacted.

The

The Medicare program in 1973 paid out $9.5 billion. additional costs of this program will be approximately $3 billion in induced federal costs.

In his

These extra costs should be met by general revenues. health message to Congress, the President indicated that the $6 billion federal cost of the federal part of his program could be financed out of general revenues with no additional taxes. New induced federal costs of this proposal can likewise be met by general revenues.

As congressional debate on national health insurance progresses, I hope the concepts embodied in this Comprehensive Medicare Reform Act of 1974 will be considered.

By lowering the price-tag for initial health care, older persons will be encouraged to seek the basic medical check-ups needed to diagnose and stop an illness before it becomes critical.

Older Americans who have worked their entire lives deserve a measure of security. This legislation will provide them with the assurance that their health needs will be provided for.

Appendix 3

STATEMENT SUBMITTED BY THE AMERICAN SPEECH AND HEARING ASSOCIATION

At the outset, the American Speech and Hearing Association (ASHA) wants to express, on behalf of its close to 18,000 members and the many thousands of communicatively handicapped Americans they serve, its appreciation to the Committee for providing this platform, so that organizations and individuals concerned about the health and welfare of America's elderly can attempt to focus national attention on the special needs of this very special population. Our intention in this statement is to comment on but one of the many needs of the communicatively handicapped elderly which have been overlooked in past health-care plans, and continue to be overlooked in S. 2970 and other current proposals for national health-insurance legislation.

This Committee has previously heard delineated the issues which still contribute to our inability to assure reasonably priced quality rehabilitation issues which have concerned the

services to the elderly hearing-impaired1/

Congress for at least a decade. But never before have these issues been so thoroughly and tirelessly researched, so well documented, so clearly drawn. And never before has the voice of the hearing-handicapped elderly consumer been heard quite so strongly as it is being heard now through the agency of such consumer-interest spokesmen as Ralph Nader's Retired Professional Action Group, the Minnesota Public Interest Research Group, the Public Interest Group in Michigan, and public-interest journalists in such large metro

1/ "Hearing Loss, Hearing Aids, and the Elderly," Hearings before the Subcommittee on Consumer Interests of the Elderly of the Special Committee on Aging, U.S. Senate, 90th Cong., 2nd Sess., July 18 and 19, 1968.

2/ "Prices of Hearing Aids," Senate Report No. 2216, 87th Cong., 2nd Sess., October 1, 1962.

3/ Public Citizen's Retired Professional Action Group, Paying Through the Ear, Public Citizen, Inc., Washington, D. C. (1973).

4/ "MPIRG Report," Hearing Aids and the Hearing Aid Industry in Minnesota, November 13, 1972.

5/ "A PIRGIM Report," You Know I Can't Hear You When the Cash Register's Running: The Hearing Aid Industry in Michigan, Public Interest Research Group in Michigan, Lansing, Michigan, December, 1973.

politan areas as Minneapolis-St. Paul, Detroit, and Baltimore.

Had consumer influence been brought to bear earlier on the problems discussed here today, perhaps legislative committees of the Congress would have been moved to follow up with meaningful legislative proposals the impressive initiative this special congressional panel took in July of 1968; perhaps, too, the pro-consumer recommendations of the 1962 Kefauver Subcommittee (on Antitrust and Monopoly, Senate Judiciary Committee) would not have been transformed from what then seemed a consumers' shield into a sword wielded against America's hard-of-hearing public.7/

The critical central issue of these and the earlier congressional hearings has not changed. It is our fervent hope, however, that congressional regard for that central issue will change in the direction of meaningful, creative legislation, as a consequence of the new ingredient of consumer outrage at the marketplace treatment of hearing-impaired older Americans.

The critical issue which obviously pervades these hearings and the reports of those conducted in 1968 and 1962 is that the hearing-aid delivery system in the United States represents and fosters a clear and continuing conflict of hearing-aid-industry interest of significant proportions.

6/ See, e.g., Minneapolis Star, November 13, 14, 1972; Minneapolis Tribune, November 14, 1972; Detroit Free Press, February 25, 26, 1973; Baltimore Sun, May 13, 1973

1/ A major Kefauver panel recommendation was for establishment of hearing-aid dealer licensing requirements by states as a means of controlling untoward dealer sales practices. According to a recent issue of the Hearing Aid Journal, the industry's monthly news magazine, "a veritable avalanche of opposition" to the concept came from industry members. In the meantime, however, the primary focus of state dealer-licensure legislation has changed from consumer protection to industry protection. "Most of the dealers operating in the 14 unlicensed states are now clamoring for the passage of a good protective licensing act." (Milton Bolstein, "Licensing...And How It Has Changed," Hearing Aid Journal, July 1973, p. 3.) One industry spokesman goes so far as to label licensing for hearing-aid dealers as "the key to... survival." (W. Hugh Conaughty, "The Licensing Effort Never Ends," ibid., p.

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Our

The economies of the industry and its retail practitioners depend exclusively on sales volume the more sales made, the more fiscally successful the retailer, the greater the industry's profits. ASHA is assuredly not opposed to profit or to the full and fair operation of the free enterprise system. But it does have profound reservations about any system which pits the financial interest of a seller against the health and economic interests of a buyer and then permits the seller the choice of alternatives. reservations in this regard are heightened by the fact that unless hearingaid dealers qualify as audiologists or physicians specializing in diseases of the ear, they are simply unable to satisfactorily evaluate the integrity of the auditory (hearing) system, to locate the anatomical location of an auditory problem, or to assume responsibility for the rehabilitation of the hearing impaired. The percentage of dealers so qualified is so infinitesimal as to defy calculation.

The solution to this conflict-of-interest situation is as obvious today as it was when last this Committee held hearings on hearing aids and the elderly, or when the Kefauver Subcommittee earlier undertook its inquiry into the pricing practices of the hearing-aid industry. If this and earlier congressional efforts as well as recent consumer-group initiatives are to mean more to the elderly hearing-impaired than ineffectual gestures, however well-intended, hearing-aid salesmen must be precluded by law and appropriate administrative regulations from selling a hearing aid without first obtaining an order, written by a physician specializing in diseases of the ear or by an audiologist, to provide a specific aid to a specific customer whose hearing has been evaluated by the prescribing professional. Unless such regulation at national and

state levels occurs, we shall continue to have a situation in which untrained non-professional personnel diagnose complex health problems, prescribe

prosthetic devices, and accept payment for providing a device which the seller cannot assure is appropriate to the buyer's health need or needed at all. Unless the Committee calls for such regulation in its final report on these hearings, we believe it will have failed to meet effectively the objective it set for itself more than five years ago: ...to help older Americans

i.e.,

those most vulnerable to deafness and near-deafness

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to save themselves from the isolation, demoralization, and hazards that occur when hearing

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For decades, the sale of eyeglasses to the visually handicapped has been possible, under law, only after prior examination and prescription by a physician specializing in diseases of the eye or an optometrist. ASHA believes that the hearing-handicapped people of this country should be accorded equal protection of law; that they, too, should be assured the expert advice of an appropriately qualified health professional prior to their purchase of a health appliance. In the instance of the hearing handicapped, the appropriately qualified health professional is an audiologist or a physician specializing in diseases of the ear.

9/

ASHA is a national scientific and professional society of speech pathology and audiology practitioners, 2103 of whom, as of the start of fiscal 1974, have been certified as clinically competent in the area of audiology. hundred and fifty-four (554) additional individuals were on the continuum of professional preparation, having fulfilled their master's degree requirement

Five

8/ Hearings before the Subcommittee on Consumer Interests of the Elderly, op. cit., p. 1.

9/ Edward Bruder, "Official ASHA Counts: July 1, 1973" (unpublished report), August 13, 1973, p. 7.

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