Patients pay more because M.D.s use tests defensively. Three out of four American physicians are practicing defensive medicine by ordering extra tests for patients as a protection against potential malpractice suits, according to American Medical Association, A.M.A., polls.

Medical bills are rising as a result of the doctors' action. The lesson to be learned from this experience is that some control is needed over the economic processes of the health care industry. Measures are also needed to stimulate an increase in the supply of health services.

Eleven years of experience with medicare has shown that it is largely self-defeating to pay out insurance money to health care providers without demanding quality and efficiency in return.

Blue Cross, Blue Shield is higher, plus 50 cents increase on medicare, July 1, 1977. Those particularly hard hit by inflation include retirees, of whom at least 6 million are still living at or near poverty levels.

There has been $8 to $10 million in medicare fraud. This could have paid for hearing aids, eyeglasses, and teeth for the elderly.

Social security is a social insurance program for workers, their survivors and their dependents. I would like to see the Social Security Administration a separate autonomous agency, completely independent from HEW.

As an ex-State commissioner on aging, I propose that the State of Ohio adopt programs to assist in home health care aid and service for the elderly in their homes. It would be cheaper and better than sending them to a nursing home or institution. So far it has been successful. Money has run out. There are too many senior citizens in nursing homes that should not be there. They should be at home.

I have two statements from the Nationwide Insurance Co. that. shows they are deducting too much. As president of the Queen City Senior Citizens, I have had too many complaints from senior citizens: that Nationwide is deducting too much from medicare. How can we, the senior citizens, live on a 5.9 percent increase from social security? Social security increase will not meet rising inflation rates.

You have two medicare benefit papers there. The one shows the doctor that I paid $8 for an office visit, and the amount was included, That was in November, November 15, 1976.

On the next page, March 30, 1977, the doctor had to go up to $10, but Nationwide only allowed me $8, plus the 80 percent.

Then you come along, I have a spinal X-ray, on the spine. The doctor charged me $18 and Nationwide took off and allowed me $13 and deducted $5. I don't think it's fair.

Thank you very much.

[Attachment to the statement follows:]

SSA HAS INDICATED A CHANGE IN YOUR HEALTH INSURANCE NUMBER. PLEASE FILE FOR FUTURE CLAIMS WITH THE ABOVE NUMBER TO AVOID DELAY. GFOR ACCURACY AND FASTER HANDLING OF YOUR CLAIMS, PLEASE SEND YOUR MEDICAL BILLS AND CLAIM FORMS AS SOON AS YOU CAN AFTER THE MEDICAL SERVICES ARE PROVIDED.

5972933

THIS IS YOUR CHECK

DETACH ON THIS LINE

SERVICES INCURRED IN DIFFERENT CALENDER YEARS ARE PROCESSED ON A
SEPARATE EXPLANATION OF MEDICARE PAYMENTS. ALTHOUGH NO PAYMENT
WAS MADE CN THESE SERVICES, THE ABOVE AMOUNT WAS APPLIED TOWARD
YOUR ANNUAL DEDUCTIBLE. PLEASE CONTINUE TO FILE ALL CLAIMS AS YOU
INCUR COVERED MEDICAL EXPENSES SO THAT WE MAY PROCESS YOUR CLAIMS
AS QUICKLY AS POSSIBLE.

YOU HAVE MET $ 55.00
YOUR DEDUCTIBLE FOR 19.

79

0:00

If payment not Based on the Full Amount Billed

The amount Medicare may pay under law is limited to the lowest of:

(a) Customary Charge ve, the charge made by the Physician o supplier in 50% of his billing during the bave your.

17) Prevailing change .,.,.., the chary mode 289% of the time. by other Physicians or suppliers for similar secirces in the area during the base year

C) The amount permitted under the limits established by the Cost of Living Council

GREATER CINCINNATI SENIOR CITIZENS Club,
Cincinnati, Ohio.

Mr. CHAIRMAN: Medicare Fees up in 1977-19 percent or $124.00 the patient pays in the Hospital his first cost. The patient's first cost in the hospital in 1976 was $104.00. Medical costs in hospitals up about 20% in 1977 and going higher. By Law, the premium increase is limited to 6.4%, the percentage by which Social Security benefits were increased in 1976. Without this limitation, rising costs of Medical insurance program would have required a much higher premium than the $7.70 beginning July 1, 1977. More than two-thirds of the cost of your medical insurance will be paid from general revenues of the Federal Government. My thoughts are the low income worker who makes about $7,500.00 should not have to pay his 5.85 to his employer. Those earning $25,000 should pay more or the low income worker and his employer and the General Revenue Fund should pay each 3rd. Enclosed is a news clipping social security taxes soaring 1974 and 1975. I was State Commissioner on Aging in Ohio and was President of Cincinnati Council of Senior Citizens. In a meeting in 1973 I was asked to be on a Ad-Hoc Committee representing the Hamilton County Senior Citizens. I proposed that the State of Ohio adopt programs to assist in Home-Health care for the elderly, home aid and service and to be treated in the homes. So far it is successful. Money has run out.

Sincerely,

LOUIS YOUNG.

[From the 1977 Field Enterprises, Inc.]
SOCIAL SECURITY TAXES SOARING

(By Sylvia Porter)

If you expect to earn $16,500 or more this year, the Social Security tax you will pay in 1977 will be more than double what you paid in 1972 and 50 per cent above what you paid in 1973.

Your employer, of course, will match that tax, and so his contributions to the Social Security System also have skyrocketed just as much these past few years. In 1977, the Social Security tax, at the unchanged rate of 5.85 per cent for both employe and employer, but on a new high taxable base of $16,500, will come to $965.25. This compares with $468 five years ago, and $631.80 four years ago.

At the same time, the 1977 Social Security tax you pay as a self-employed person earning $16,500 or more will be $1303.25, about double the amount paid by the self-employed in 1972, and 50 per cent more than the $864 paid by the selfemployed in 1973.

Mounting attention is now being paid to the burden Social Security taxes place, particularly on low and middle-income groups. But the implications-and inequities of this burden are still not clearly understood.

While income tax rates have not been increased in this recent period, the total taxes paid by most middle-income employes have risen sharply. The Carter administration's reluctance to go along with hikes in the SS tax must be weighed against this factor. It is an explosive economic-social as well as a political issue. And a rising tax load is a drain on our spending power, no matter what name the tax goes by.

When Social Security taxes reach this lofty level, it's utterly ridiculous to talk of our tax burden only in terms of straight income taxes and the reductions the White House and Congress are now debating.

Social Security contributions are taking an increasingly hefty bite out of individual workers' incomes, and out of business profits, whether a giant corporation or a modest, local venture.

The Social Security tax is also blatantly regressive. The low-income worker pays the same rate-5.85 per cent-as the highest level executive. This means the $7600 worker pays a far bigger proportion of his income in this tax than the $500,000 tycoon, a situation difficult to defend.

While I am acutely aware that my Social Security taxes have been soaring because I earn more than $16,500 a year, I readily confess my conviction that I should pay more than the worker just above or at the poverty level.

Low to middle-income families are now finding this tax a far bigger burden than the federal income tax. A married man with a $7600 income and five children who uses the standard deduction for his 1977 federal income tax will owe no federal income tax, but he will have paid $444.60 to Social Security.