Appendix A Communications Received by the Committee Expressing an Interest in the Subject of National Health Insurance (301) U.S. SENATE, COMMITTEE ON APPROPRIATIONS, Washington, D.C., May 13, 1974. Hon. RUSSELL B. LONG, Chairman, Senate Finance Committee, Washington, D.C. DEAR RUSSELL: This letter is to express my thoughts on the importance of including adequate coverage for mental illness in any of the National Health Insurance Bills which your Committee is considering. I wanted to provide you with my views on this matter, because I have been quite closely involved for some time now with officials at the National Association for Mental Health, mainly due to my State of North Dakota having taken the lead all over the country in the establishment of Community Mental Health Centers. These Community Centers have proven to be very helpful to many people with mental illness by providing treatment in or near their own communities without having to travel long distances and suffer the separation from their families. Before the establishment of these Community Mental Health Centes, the patient population of North Dakota's State Hospital, located at Jamestown, was nearly 2,000. I am advised now that it is only around 500, mainly cause of the availability of mental health care at these regional centers. If National Health Insurance becomes the primary method of financing health care and if such a program does not adequately provide for continued support of Community Mental Health Centers, I believe we stand to lose perhaps the most important advance in a century in the whole area of mental health. As I indicated earlier in my letter, these Community Centers are providing a viable alternative to State Hospital care. I hope very much that in your deliberations on this very complex legislation, that coverage can be provided for unlimited outpatient and partial inpatient services offered by Community Mental Health Centers. I am advised that mental illness can be insured at reasonable rates. I am sure you have the results of several studies which have been made on this type of insurance. Thank you again for this opportunity to provide you with my thoughts on this very important matter. With warm personal regards, MILTON R. YOUNG. Hon. RUSSELL B. LONG, UNITED STATES SENATE, OFFICE OF THE MAJORITY LEADER, Chairman, Senate Finance Committee, U.S. Senate. DEAR MR. CHAIRMAN: I am enclosing a copy of a letter I have recently received from Mr. Stephen McCrea of Great Falls, Montana. I am calling Mr. McCrea's letter to your attention for the Committee's consideration in its study of health insurance proposals. With best personal wishes, I am Sincerely yours, MIKE MANSFIELD, JUNE 22, 1974. DEAR SENATOR: I would like to thank you for the interest you have shown in my problem. I am happy to be able to tell you my situation has improved considerably since I last wrote. A couple of months after that the State Division of Vocational Rehabilitation was able to find me a job and the Social Security Office notified me I was eligible for disability benefits within a weeks span of each other. I'm sorry to say I can't say much for Social Security's finding me eligible for benefits when I had found a job, after years of going without either. Social Security did gave me a years back benefits, but I didn't qualify for the customary trial work period since I was already working when they ruled in my favor. My medical situation is fairly stable at the moment and things seem to be turning out alright, as I am now working for the federal government at Malmstrom Air Force Base, although not as an engineer where my training lies. It appears that their group health insurance should cover a large portion of my intraveneous feedings, special diets, and the like, although I am not really certain as I have just became eligible to sign up. In the meantime the county has taken care of my medical costs and should help in the future, depending on how high my costs go. As I understand it we are to have an arrangement where I would pay so much depending on my salary and they would take care of anything over that. This would still keep my hands tied as far as choosing what I would want to do goes. For one thing I would be tied to one county because I couldn't move to another place and have such a system transferred with me, My experience may show that the present system can work, but I think a national health insurance system would give it more consistency without a lot of the present confusion. I'd like to part on one note. Medicine and the treatment of patients has to be left in the hands of doctors and the medical profession; without bureaucrats telling doctors how they can treat patients, no matter who is paying the bill. I really think it is to the detriment of the patient for others to be telling the doctor how he can or cannot treat a patient in conjunction with national health insurance. Sincerely yours, STEPHEN MCCREA. U.S. SENATE, Washington, D.C., July 26, 1974. Hon. RUSSELL LONG, Chairman, Senate Finance Committee, DEAR MR. CHAIRMAN: I call to your attention the enclosed testimony of my constituent, Dr. Maynard Shapiro, which was delivered before the Ways and Means Committee in conjunction with national health insurance. I would appreciate having this fine statement made a part of the record. Thank you for your assistance. Sincerely, ERNEST F. HOLLINGS. TESTIMONY OF DR. MAYNARD I. SHAPIRO, ON BEHALF OF NATIONAL EASTER SEAL SOCIETY FOR CRIPPLED CHILDREN AND ADULTS INTRODUCTION Mr. Chairman, my name is Dr. Maynard I. Shapiro. I am testifying today on behalf of the National Easter Seal Society for Crippled Children and Adults (the "Society"), as a member of its Professional Advisory Council. I am an active practicing physician and am Director of the Department of Physical Medicine and Rehabilitation and Vice President for Academic Affairs at Jackson Park Hospital in Chicago. I am past President of the American Academy of Family Physicians, and a member of the HEW Medical Assistance Advisory Council. My biographical data is attached to this testimony. HEALTH CARE PROVIDED BY THE SOCIETY The Society is one of the major national voluntary organizations providing health care in this country. In 1973, approximately $30 million was expended for health services through programs of the 52 state and territorial societies. The Society provides comprehensive rehabilitation services, essentially on an outpatient basis, and its affiliates own and operate approximately 314 rehabili tation facilities throughout the country in which these services are provided The Society has also been very active in recent years in providing prev ative services, particularly for children. While the rehabilitation programs the Society include vocational training and education, this testimony today is directed to comprehensive physical and mental restorative services, and preventiv care. My testimony today will describe these two elements of the health care stem as covered by the Society's programs, and their human and economic signif ance Further discussion in some detail will focus on the weakness of current Mecare law and the three bills before the Committee insofar as support for c prehensive outpatient rehabilitation is concerned, and describe the impact of the bills before you on rehabilitation and prevention programs. I should like to take a moment first to describe the types of disabling conditions of patients of our rehabilitation facilities in order to give you a sense of the nature of the problems our rehabilitation and prevention programs deal with. Generally, we are treating the chronically ill and the severely disabled-namely, those with a catastrophic illness or condition. Neither the outpatient rehabilitation program nor the preventive care program of the Society are unusual compared to other facilities in the patient mix they serve. Our patients are fairly evenly divided between those with orthopetic disabilities, neurological and neuromuscular disabilities such as spinal cord injuries (resulting in quadrapalegia and parapalegia), communication disabilities such as speech and hearing disorders, and a general category of diseases from heart, stroke, respiratory diseases, blindness and a large number with multiple disabilities. These disabilities may be (1) congenital, (2) as a result of an accident, or (3) disease-related. Most of the cases treated by programs of the Society are cases of severe disability. In terms of age, many of those served are 15 years of age or under. Approximately 80,000 or 35% of the 230,000 disabled served fall into this age group. COMPREHENSIVE MEDICAL REHABILITATION Medical rehabilitation is a process applied to such disabled individuals to reduce their disability and optimally restore their mental and physical function. It is first and foremost an outcome-oriented program--one oriented toward achieving specific progress for the patient toward improved function, and the prevention of deterioration. The process must also be comprehensive since the elements of any disability are diverse. Patients with spinal cord injuries have substantial psychological problems which must be dealt with. They also have social adjustment problems. The service elements of rehabilitation are multiple, therefore, involving numerous professionals in a coordinated team approach to achieving rehabilitation for the patient. For each patient a plan of rehabilitation is prescribed by a physician, and the earlier this plan is developed, the better. The participants in the professional team responsible for developing and carrying out the plan are physicians and nurses specializing in rehabilitation medicine, physical, occupational, speech and other professional therapists, psychologists, social workers, rehabilitation counselors, prosthetists, and orthotists. Generally speaking, a comprehensive rehabilitation program should provide reimbursement for the following types of services: medical diagnosis and treatment including medical supervision of the delivery of services; rehabilitation nursing services; physical, occupational and speech therapies; audiology (for hearing problems); vision therapy; other medically necessary therapies (prescribed by a physician), such as inhalation therapy for those with severe respiratory ailments (emphysema, black lung, etc.); psychological services; medical social services; prosthetic and orthotic devices and related services for those needing artificial limbs, and replacement devices or supports such as braces, etc. The team of professionals and the provision of these services is coordinated by the physician in charge of the case. While patients may not need all elements of such a program, and while facilities, in particular outpatient ones, may not provide all elements of such a program, the key point is to reimburse for the full range of services. In this way, a continuum of services from various providers may be organized under a plan prescribed and supervised by a physician. Without provision in the law for such a comprehensive approach, rehabilitation of individuals with severe disabilities and chronic illness, such as most of |