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Hill-Burton under that application, and of course medicare as the other leverage for Federal attention.

Mr. CARBRAY. Now, we feel that a similar comprehensive study should be made of doctors' fees; for during the past 2 years the press, and other news media, have reported many instances of excessive fees, and almost unbelievable increases in doctors' income since the advent of medicare and Medi-Cal.

Numerous samplings this year, during 1968, indicate hospital charges are averaging nearly $100 daily. This would indicate the upward trend continues.

RECOMMENDATIONS

The current deductibles in the medicare program are in reality an economic roadblock to health services for millions of elderly in the low-income bracket and we feel they should be eliminated.

Compounding this injustice in California is the fact—and I might say that this is also true in many other States-I think 34 other Statesthat recipients of State old age assistance suffer a reduction in their State assistance checks in an amount comparable to the increase in Social Security benefits as the result of vetoes by the Governor in 1967 and 1968 of legislation which would have eliminated this injustice.

Prior testimony before this committee by officers of the National Council of Senior Citizens calls for appropriate amendments to the medicare program which would remove such deterrents to health services to the needy. The Los Angeles County Federation of Labor concurs in these amendments. In many instances the billing procedures of hospitals and doctors are suspect due to failure to provide a duplicate itemized bill for services rendered to the medicare patient.

In the absence of such proof of services rendered, how can the carrier, or the Secretary of Health, Education, and Welfare, combat the abuses that are alleged?

May I suggest uniform billing standards as a means of combating such abuses? And it would seem to me that this would also help the program of the peers committee that Dr. Todd made reference to in this State.

I might supplement this with one thought that I just learned of yesterday that, in some instances, I am informed that some hospitals and some doctors likewise, have a code method of making bills-I haven't seen one, I heard of it yesterday-which even though a copy is given to the recipient of medicare, he doesn't really know what it

means.

And it would seem to me that it is very simple for a physician or for a hospital to present that patient-that recipient of the medicare— with the type of statement that would properly reflect the type of service that has been rendered to him.

I think this would be a constructive way of obviously, in my opinion at least, of eliminating some of the possibilities of skullduggery on the part of those who are unethical.

And again I want to say, I know it is a minority, not a majority, of the profession that we can say this about.

Thank you, Mr. Chairman.

Senator WILLIAMS. We appreciate your appearance very much.

(Subsequent to the hearing, Senator Williams asked the following questions in a letter to Mr. Carbray :)

1. You called for a comprehensive study in detail of both hospital costs and charges and additional legislation if necessary to assure disclosure of all records. May we have additional discussion of subjects that would be considered in such a comprehensive study, and suggestions for major provisions of the legislation you mentioned?

2. Do you have any additional information on the "code method of making bills" mentioned in your testimony?

3. What in your opinion will be the effects of the newly-announced 10 percent increase in deductibles and coinsurance for Medicare?

(The following reply was received:)

Dear Senator WILLIAMS:

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NOVEMBER 18, 1968.

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(1) I am sure you agree with me that in the absence of complete and detailed records of hospital and nursing home operations a wholly comprehensive study of service and related costs is not possible. My reference to the need for legislative amendments is based on the refusal of hospitals, nursing homes and doctors to make such records available. I feel it is necessary that legislation be enacted which (a) requires the keeping of detailed records or services rendered, and related costs. (b) Make such records available on request for inspection by, an authorized representative of, the appropriate Federal Agency, the appropriate State Agency, and/or the authorized carrier. These requirements should be a condition of Certification by the Department of Health, Education and Welfare; for all hospitals and nursing homes wishing to participate in the Medicare Program. Similar conditions should apply to the Medicaid Program.

(2) I have no additional information on the "Code Method" of billing by doctors; but I shall continue to pursue this.

(3) The pending 10 percent increase in deductibles and coinsurance will only compound the prevailing hardship resulting from inadequate finances for the deductibles. I have had numerous protests from seniors accompanied by requests for an explanation.

Note: The recent hearing here resulting from the expose of abuses of the MediCal Program by Attorney General, Thomas Lynch, lends support for the previously expressed idea that the Medicaid Program should be federalized. Personal best wishes. Sincerely,

JAMES CARBRAY, Executive Board Member.

Mr. CARBRAY. Now, I would like to have Mr. Hartley and Mr. Davidson for just about a couple of minutes-each of them has one specific thing they want to relate which relates to some of the testimony in my statement.

STATEMENT OF ROBERT HARTLEY, FOR SENIOR CITIZENS ACTIVITIES COMMITTEE

Mr. HARTLEY. I have been asked to make a statement of charges as I have noticed in the past few months in my family from the hospital. For a 3-day period in one of our Los Angeles County hospitals, a charge of $342 for 3 days' services. That doesn't include the physician's charges. That is paid elsewhere.

On a second visit within the past 3 months, an 8-day stay-and I will explain it this way-when I checked out I asked the attendant what the charges were for the full 8 days.

She told me that it was only made out for 6 days.

I said, "May I have the charges that you have on your book here?”

Six-hundred-and-thirty-some-odd dollars for 6 days. And that doesn't include a physician's charges.

Now, over and above this second charge, an anesthesiologist charge of $90 for his services for the operation.

An assistant doctor-surgeon-his charge was $60.

In the past, I will say 4 years-5 years, I will make it--I was in the hospital in the Middle West. The charges that came through on my Blue Cross statement, as the hospital charge per day, was about $35 per day.

The charges as produced by the present hospital visit means a very substantial increase, and if we are not covered by prepaid medical care, the senior citizen who is on a static income-he is on a pension in social security-it is impossible for him to absorb these increases.

LEGISLATIVE ASSISTANCE ASKED

We of the senior citizens and of the labor unions are vitally interested in those people in our organizations that are suffering from the increased costs that they cannot cover. We would like to see some legislation in the form that would give them assistance that would alleviate some of the abuses that they are subjected to when they have to have medical care.

I thank you, gentlemen.

Senator WILLIAMS. Thank you, sir.

Mr. CARBRAY. Mr. Davidson.

Senator RANDOLPH. So as to save time, I want to comment on the gentleman-your associate-who spoke of the hospital charge.

The figure you gave for another area of the country was $30 a day. How long ago was it-I want to make sure?

Mr. HARTLEY. That was about 5 years ago.

for

Senator RANDOLPH. Five years ago. And the figure you gave was

Mr. HARTLEY. Kansas City, Mo.

Senator RANDOLPH. And the figure you gave for Los Angeles-8 days-although charged for 6 days, but running it out on 8 days would make it about $80 a day; is that right? You said six-hundred-andsome-dollars?

Mr. HARTLEY. But that was for 6 days, only. The remaining 2 days was not on the bill.

Senator WILLIAMS. Well now, who paid all of this money?
Mr. HARTLEY. A prepaid medical plan pays for this.

Mr. CARBRAY. A supplement to

Mr. ORIOL. A Supplement to medicare?

Senator WILLIAMS. What is medicare right now?

Mr. CARBRAY. They pay 80 percent.

Senator WILLIAMS. They pay 80 percent? And your

Mr. CARBRAY. Eighty percent for the physician.

Mr. HARTLEY. Eighty percent for the hospital.

Senator WILLIAMS. Eighty percent for the hospital? And the balance was paid by the plan that you got into?

Mr. HARTLEY. That is correct. That is correct.

Senator RANDOLPH. Mr. Chairman, I am trying to determine what the cost was per day.

Mr. HARTLEY. The cost was over $100.

Senator RANDOLPH. I see it now. The 6- and 8-day figure-I wasn't clear.

In other words, $30, 5 years ago in Kansas City; $100 in Los Angeles County.

Mr. HARTLEY. $110, to be exact.

Senator RANDOLPH. $110?

Mr. HARTLEY. Approximately $110 on the first hospital visit$342.

On the second hospital visit-for 6 days-630-some dollars. Now, there is a variation there, but it still runs approximately $110 per day.

Senator WILLIAMS. Why did they take 8 days and reduce it to 6 days?

Mr. HARTLEY. They didn't. Due to the fact that I am covered by a prepaid plan, I could get a release from that hospital and they didn't have their bills made up, because I didn't have to pay it. My carrier would take care of that.

But the office girl related to me that for a 6-day period, there was a charge of 600-some-odd dollars.

Senator RANDOLPH. Mr. Chairman, I find no witness from the hospital profession as such; is that correct?

Mr. ORIOL. There is nothing today.

Senator WILLIAMS. I would say go ahead and do it. I will say, if you have to return to the hospital, I wouldn't go to that hospital.

Mr. HARTLEY. That's beside the point. If those charges are proper in this area, then you are going to have to go to some hospital.

I will say this of this hospital: It is a very lovely hospital and the service is excellent. I am not griping, I might say, about what has to be paid here. Medicare and the prepaid plan pays it.

Senator WILLIAMS. You are doing a service, and I wanted to develop that you didn't pay it, because you were under medicare and also under your insurance program.

So it is a service for you to come here and talk to us.

Senator RANDOLPH. Don't misunderstand me on this point, and I don't want to lay a finger on anyone, but there is a tendency where you are not paying, or the chairman is not paying it—you are speaking about a nebulous group that pays something-and then you sock it to them, because you can't put your finger on you, or you, or you, and I think it is very important that this be developed.

Senator WILLIAMS. Well, I will say this: I know in the State where I live, the Blue Cross rates go up and up and up, and this is part of it, and you know who is in the forefront of the opposition-the AFLCIO.

Mr. HARTLEY. I have had very good service in this hospital, and I would object to anything like that-the prices of this.

The problem I am objecting to is the raises that cannot be met by the people in my age group, people who cannot affordSenator WILLIAMS. That's right.

Mr. HARTLEY. Prepaid medical plans.

Senator RANDOLPH. Mr. Chairman, again I want to stop talking about this I want it broken down so as to be definitive-the hospital

charged this. There may have been some services that I want to know about, do you understand?

Mr. HARTLEY. I do.

Senator RANDOLPH. Not just bed and board.

Mr. HARTLEY. Bed, board, and food.

Senator WILLIAMS. Many X-rays, and other

Mr. HARTLEY. Well, the equipment that they use-laboratory

tests

Senator WILLIAMS. Oh, I mean in your case.

Mr. HARTLEY. Oh, in this case-no X-rays on this particular visit. Senator WILLIAMS. What is your name, sir?

Mr. DAVIDSON. Louis Davidson.

STATEMENT OF LOUIS DAVIDSON, FOR THE SENIOR CITIZENS ACTIVITIES COMMITTEE, LOS ANGELES FEDERATION OF LABOR, AFL-CIO

Mr. DAVIDSON. I would like to make a preface.

Because we have complaints does not mean that the senior citizens and their unions underestimate the importance of medicare. I think there is nobody that more appreciates medicare and all its functions, even with its difficulties, as much as the senior citizens do.

However, I would like to make a couple of points which will serve to substantiate what the previous speaker spoke of-and many of the other complaints.

People living on a standard like mine-income, say, about $200 a month-because of the deductibles and because of the additional costs for doctors are, in a certain way, prevented from utilizing medicare benefits.

And I will substantiate by saying this: I have recently almost entirely lost my hearing. A certain very important and very good doctor, in his profession, was recommended to me.

He examined me in his clinic, and he helped me a great deal. He somewhat restored my hearing.

His charge was $25 for the examination, for which medicare does not pay, and $40 for the service, which also has to be paid by me because the first $50 of treatment is not paid by medicare, and has to be paid by me. That's $50 deductible.

The recommendation of the doctor was to operate. He thought-and he is a very good doctor-that he could put my hearing in good condition.

After I left his office I went to make an appointment for the recommended operation. The charge was to be $650 for the operation and $50 for his assistant-which came to $700.

Incidentally, a friend of mine was operated on by the same doctor in 1959, and was charged $250. If I had arranged for the operation, I would have been required to pay the 20 percent plus the $50 deductible. I would have had to pay $100 for admission to the hospital-which means several hundred dollars.

People in my income bracket couldn't afford that kind of money, and therefore I had to give it up.

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