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SPECIAL COMMITTEE ON AGING

HARRISON A. WILLIAMS, JR., New Jersey, Chairman GEORGE A, SMATHERS, Florida

EVERETT MCKINLEY DIRKSEN, Illinois WAYNE MORSE, Oregon

FRANK CARLSON, Kansas ALAN BIBLE, Nevada

WINSTON L. PROUTY, Vermont FRANK CHURCH, Idaho

HIRAM L. FONG, Hawaii JENNINGS RANDOLPH, West Virginia JACK MILLER, Iowa EDMUND S. MUSKIE, Maine

THRUSTON B. MORTON, Kentucky
EDWARD V. LONG, Missouri

CLIFFORD P. HANSEN, Wyoming
FRANK E. MOSS, Utah
EDWARD M. KENNEDY, Massachusetts
RALPH YARBOROUGH, Texas
STEPHEN M. YOUNG, Ohio
WALTER F. MONDALE, Minnesota

WILLIAM E. ORIOL, Staff Director
JOHN GUY MILLER, Minority Staff Director

SUBCOMMITTEE ON HEALTH OF THE ELDERLY

GEORGE A. SMATHERS, Florida, Chairman WAYNE MORSE, Oregon

EVERETT MCKINLEY DIRKSEN, Illinois EDMUND S. MUSKIE, Maine

FRANK CARUSON, Kansas EDWARD V. LONG, Missouri

HIRAM L. FONG, Hawaii
FRANK E. MOSS, Utah

THRUSTON B. MORTON, Kentucky
RALPH YARBOROUGH, Texas
HARRISON A. WILLIAMS, JR., New Jersey
EDWARD M. KENNEDY, Massachusetts
WALTER F. MONDALE, Minnesota

Part 1–Washington, D.C.
Part 2—New York, N.Y.
(Additional hearings anticipated but not scheduled at the time of this printing.)

II

CONTENTS

Page

1

126

COMMUNICATIONS

Cervantes, A. J., mayor, St. Louis, Mo.: Letter to Hon. George A. Smathers,

chairman, Subcommittee on Health of the Elderly, dated June 13, 1967--
Danforth, William H., vice chancellor for medical affairs, Washington Uni-

versity, St. Louis, Mo.: Letter to Alfonso J. Cervantes, mayor---

110

132
Kern, Father Clement, Most Holy Trinity Rectory, Detroit, Mich. : Letter

to Hon. George A. Smathers, chairman, Subcommittee on Health of the Page
Elderly, dated June 17, 1967-

158
Slattery, Rev. Robert P., director, the Cardinal Ritter Institute, St. Louis,
Mo.: Letter to Alfonso J. Cervantes, mayor--

135
Zibit, Samuel, executive director, Jewish Center for Aged, St. Louis, Mo.:
Letter to Mayor Alfonso J. Cervantes ---

134

114

83

98

Appendix 1–Additional material from witnesses :

Item 1. Information from representatives of Department of Health,

Education, and Welfare --..

Item 2. Exhibits related to Mr. William R. Hutton's tes ony-

Item 3. Reports submitted by Dr. Rodney M. Coe----

Item 4. Material supplied by Dr. Milton I. Roemer.

Item 5. Material supplied by Dr. George James.

Appendix 2—Letters and statements from individuals and organizations :

Bachrach, Samuel, M.D., Age Center of Worcester (Mass.) Area, Inc-

Barker, C. T., Dover General Hospital, Inc.--

Birren, James E., University of Southern California.

Larson, William R., Ph. D., University of Southern California.

Densen, Paul M., Health Services Administration, New York, Y.Y.

Furstenburg, Frank F., M.D., Sinai Hospital of Baltimore, Inc.--

Goldman, Ralph, M.D., University of California, Los Angeles.

Harris, Raymond, M.D., Center for the Study of Aging, Albany, N.Y.

Hudson, Milton W., Morgan Guaranty Trust Co. of New York.

Koretz, Sidney--

Mosher, David R., Florida Nursing Home Association ---

Muller, Charlotte, Ph. D., Public Health Association of New York City-

Mushkin, Dr. Selma J., the George Washington University-.

Plaza, Rhoda W., the Providence District Nursing Association.

Koch, Russell, American Optometric Association -

Haney, Richard L., Colorado Optometric Association---

White House Conference Report on the Senior Citizen and Optometry-

Steinberg, Franz U., M.D., Jewish Hospital of St. Louis, Mo.-

Yerby, Alonzo S., M.D., Harvard University School of Public Health -

Williamson, Kenneth, American Hospital Association --

Stromberg, Warren, Anchor Bay Beacon, New Baltimore, Mich.

Appendix 3-A report to the President on Medical Prices by the Depart-

ment of Health, Education, and Welfare, dated February 1987--

COSTS AND DELIVERY OF HEALTH SERVICES

TO OLDER AMERICANS

THURSDAY, JUNE 22, 1967

U.S. SENATE,
SUBCOMMITTEE ON HEALTH OF THE ELDERLY
OF THE SPECIAL COMMITTEE ON AGING,

Washington, D.C. The subcommittee met at 8:45 a.m., pursuant to call, in room 1318, Senate Office Building, Senator George A. Smathers (chairman), presiding.

Present: Senators Smathers and Moss.

Committee staff members prusent: William E. Oriol, staff director; John Guy Miller, minority staff director; J. William Norman, professional staff member; Dr. Austin B. Chinn, consultant; and Patricia G. Slinkard, chief clerk.

OPENING STATEMENT BY SENATOR GEORGE A. SMATHERS, CHAIR

MAN, SUBCOMMITTEE ON HEALTH OF THE ELDERLY

use.

Senator SMATHERS. The meeting will come to order at this bright and early hour. Of course, Senator Moss and I have been working for an hour or two already today.

As we begin today's testimony—the first to be taken at several hearings on the subject of costs and delivery of health services to older Americans I would like to say that even with medicare paying a major part of their bills, many older Americans find that health services are still too costly, or too remote, or too forbidding for them to

The elderly are the major victims of the gap that exists between the kind of health care American medicine can provide and that which is available. The prevalence among the elderly of a high chronic disease incidence, drastically reduced income, frequent lack of transportation to services, and a fatalism that equates each passing year with worsening health, is clear evidence that a callousness exists in our society in regard to health problems of the elderly.

I think, too, that there is a great gap between what we say we want in the way of health services for all Americans and what we actually have. Perhaps this gap is due to selfishness or unawareness. I prefer to think it is the latter-though I might be wrong in light of the statement made by the new president of the American Medical Association at its annual convention on Monday. He seemed to oppose any Government health program on the grounds that such programs are socialistic. I think every responsible citizen-if he chooses to be discerning-can make finer distinctions than that. We all recall when social security itself was called socialistic.

1

The subcommittee will investigate our progress, or lack of it, toward several of President Johnson's health goals outlined in his January address on older Americans; and we will also ask many questions.

I am quite pleased that we are beginning our questioning only a week before the first of the National Conferences on Medical Costs. Our deliberations should help assure that the problems of the elderly receive adequate attention at the conference. More than that, I believe that the subcommittee and the conferees will benefit from exchanges of opinion and information.

In this introductory hearing, we can hope to sound only a few themes and gather only a small part of the information we need. But we are happy to say we have received wholehearted cooperation from the Department of Health, Education, and Welfare and from distinguished witnesses with much to tell us.

I would also like to say that, as former chairman of the Committee on Aging, I am pleased indeed to be able now to continue one part of the work of that committee, as the new chairman of our Subcommittee on Health of the Elderly. The new chairman, Senator Harrison Williams, has been both energetic and encouraging in showing his interest in the work of this subcommittee, and I appreciate his cordial leadership.

I particularly appreciate the presence of the distinguished junior Senator from Utah, Senator Ted Moss, who has long demonstrated his interest in the problems of the elderly.

Senator Williams.

STATEMENT OF SENATOR HARRISON A. WILLIAMS, JR., CHAIRMAN,

SPECIAL COMMITTEE ON AGING

Senator WILLIAMS. Mr. Chairman, I want to take just a minute or two to comment on the timeliness and importance of the study you are initiating today.

It it quite apparent, I think, that in the wake of medicare we in this Nation are finally willing to reexamine our health resources and to determine whether widespread reorganization of health services is required.

And I might add that medicare's first birthday, now almost upon us, is as good a time as any to admit that health services for many older Americans today are minimal, marginal, and miles away.

Congress and the public can feel proud about the good done by medicare, but if anything medicare's record should make us wonder how we got along without it for so long.

Latest statistics show that 4 million persons had inpatient hospital services under medicare during its first year, and hospitals received $2.4 billion for those services.

Home health services went into action and served more than 200,000 people.

And, under medicaid, 25 million bills have been paid.

We can take comfort from that record, but a nagging question persists: How many individuals thus helped by medicare would have gone without hospital treatment if such programs had not existed ?

And further, what services are still unavailable or too costly because we have not yet really mobilized medicine to help many of our elderly and others who need it the most?

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