Herman Gardens, we studied the wants of close to 1,000 older persons, possibly more. Was it health? Was it something else that caused them worry? We found out. It was a multiplicity of problems. With a social worker, Lois Pettit, I participated in in dept studies of older persons living in hotels, in rooming houses, in private homes. Stories on all of these subjects, including a story on a public health clinic at Herman Gardens, are available.

We found out.

What to do next?

The Well-Being Project with a highly skilled social worker and a registered nurse with public health training, working as a team, without rigid controls at the neighborhood level was the answer. We did not want these teams to make intricate detailed reports. Either you give service or get reports.

The program is not one hundred per cent perfect. As these workers become better established in their communities the time spent on aggressive visitation in their neighbor hoods decreased. These are highly dedicated workers. In another type of service one might recommend bringing in a new team-always with the intent of putting on the muscle to visit more people in their homes. But when you deal with old people change is a factor you can do without.

If not too many social scientists get involved, the Well-Being. Project, not easily defined because it deals with human beings in the best method to cope with human beings, offers a formula, or a principle, if you will, that should be duplicated on a broader scale throughout the Detroit area and applied in every community throughout the country.

While I am on the subject of aging I would like to take this opportunity to make a couple of other points.

On the question of insurance I have had a devilish time trying to figure out how to get the protection through Medicare and two private insurance policies for my own eighty-five-year-old mother-in-law. My wife nags me because she says as an expert I should have all the answers. I have developed a fair understanding of what I am doing. I have appealed to other experts, such as Bill Fitch in Washington, and they in turn indicate that the problem is so involved they don't have all the answers. God pity the old person who does not have someone helping him.

Recently, at a hospital in Detroit I overheard an older person tell the snippy clerk dressed in a nurse's uniform at the desk, "The hell with all this stuff. So, I'll pay my bill and let it go at that."

Most doctors and most hospitals don't give a damn how the patient makes out with respect to his own pocketbook. All they are concerned with is the responsibility incumbent upon them. The doctor treats. The hospital wants payment for its services. How the patient is reimbursed is the patient's business. And I'm afraid that nine out of ten older persons do not have the knowledge to pierce through all of the red tape to get what he or she is entitled to.

All laws such as Medicare should be simplified. And doctors, hospitals and nursing homes that do not subscribe to the system in full, including the task of processing the claims of their patients, should be stricken from the approved list.

All of this in addition to the requirements concerned with high standards of

care.

The government should take into consideration the need for keeping older persons except those chonically ill-in their own homes. My mother-in-law and I fight like cats and dogs. But she is a part of our family life. She takes part in taking care of her great grandchildren. She has duties and chores. And as much as she gripes at age 85 she also laughs and gets great satisfaction out of being part of life. Furthermore, she is never told that she may be taken to a nursing home. She has a home.

I regret that I could not participate in your hearing in person. I was informed that your meager expense allowance permits coverage for only one person per project. I have had close to forty years in newspaper. work, first in Chicago and then Detroit. I was with the Detroit Free Press for 26 years-for about the last 15 as a reporter in the social sciences covering mental health, the aging and the handicapped-and I left there about Feb. 1.

One of the reasons is that I came to the conclusion the "big," monopolistic press is not interested in doing a real job of serving people. The communications field is dominated by the motives of big business. I felt I could build up a weekly newspaper to the point of economic and professional status so that the real pur

pose of a newspaper could be preserved: to give top quality news to its readers and serve its community. When that goal is reached I can then, again, become a spokesman for those who cannot speak for themselves on a wider basis. For the time being it was not economically possible for me to be there-although my heart is entirely with what you are doing.

Maybe, sometime, the rules can be changed to the extent that you can have the privilege of hearing from persons who may have something to offer, whether they are on a payroll or not and whether they can afford to pay their expenses to appear or not.

I am completely dedicated to the spirit of the Well-Being Project. It has a purpose. To me, keeping people from the despicable prospect of being victims of a nursing home is enough.

Sincerely yours,

83-481 0-67-pt. 1—21

WARREN STROMBERG.

APPENDIX 3

A REPORT TO THE PRESIDENT ON MEDICAL CARE PRICES BY THE DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE FEBRUARY 1967

Last August, you asked me to study the reasons behind the rapid rise in the price of medical care and to offer recommendations for moderating the rise. In response to your request, I am transmitting herewith a Report on Medical Care Prices. The Report was prepared by Assistant Secretary William Gorham of this Department with the assistance and advice of the Department of Labor and the Council of Economic Advisers.

Medical prices have been rising for many years at a rate substantially in excess of the rise in the general price level. Like other prices, medical care prices accelerated in 1966. The Bureau of Labor Statistics Index of Medical Care Prices rose 6.6 per cent in 1966. Hospital room rates rose even more precipitously.

The Report attributes these price rises to the pressure of the rising demand for medical services, the relatively slow growth in the supply of physicians, rising wage costs in hospitals without commensurate increases in productivity, and the increasing complexity of medical care provided to the patient.

The Report holds out little hope for an early end to medical price
increases. Growing population and rising incomes, as well as the
public commitment to assure adequate medical care for all citizens,
will continue to put upward pressure on medical prices.

Nevertheless, steps can be taken to moderate the rise in medical prices by using medical resources more efficiently. To this end, the Report recommends:

1. The establishment of a National Center for Health
Services Research and Development to discover and
disseminate new ways of delivering health care
efficiently.

2.

The encouragement of the group practice of medicine.

3.

Strong Federal support for State and area-wide planning
for the efficient use of health resources.

319

4.

5.

6.

7.

Re-examination of the reimbursement formulas under Medicare and Medicaid in an effort to design formulas which increase the incentives to health institutions to operate efficiently.

The appointment of a Presidential commission to review
Federal programs of support for health institutions with
an eye to the efficient distribution of such institutions.
Training and use of physician assistants and other innova-
tions in medical education and the efficient use of medical
manpower.

A study of frequently prescribed drugs to determine the
relative therapeutic value of brand name products and
other drugs with the same generic name.

Implementing these recommendations will demand the concerted efforts of the medical community, the insurance industry, State, local, and Federal officials, and concerned public groups.