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was asked is: "Do you or do you not accept assignment?" Now since the figures cited—50 or 53 percent-do not refer to individual doctors, but refer to claims, a doctor can claim that he takes assignment and yet perhaps have only 1 percent of his claims on assignment.

I am all in favor of publicizing. It seems to me that that is the least the program owes the public. If doctors are permitted not to take assignment, medicare certainly owes it to the public to say which ones do and which don't. But some sort of arbitrary, but reasonable, formula would have to be devised to define a doctor who accepts assignment. Perhaps it should be at least 75 or 80 percent of the time. Something of that sort would certainly be more meaningful in terms of public information.

Mr. RINALDO. I think that is a good suggestion and I want to comment on this entire area. I feel so strongly about assignment that just a few days ago I wrote to Mrs. Heckler, the new Secretary of the Department of Health and Human Services, asking her to improve this information available to medicare beneficiaries about physicians in their communities who accept assignment. I think it should be the policy of Health and Human Services and I am going to continue to push for that policy to be implemented in the proper fashion.

You also mentioned, Mrs. Somers, quite a bit in your testimony about increased life expectancy. Are you advocating in any manner, shape or form, raising the age of eligibility for medicare to correspond with increasing life expectancy? Or do you feel, for example, that there should be a two-tiered age of eligibility, one for preventive care, one for acute care? Because you mentioned all of those things in an interrelated fashion, and I would like to have your position cleared up in my mind.

Mrs. SOMERS. No, I do not advocate raising the age of eligibility for medicare. I would like to see it dropped, if possible. I know that is not realistic, now, but eventually I would like to.

What I did support quite strongly, was raising the age of eligibility for social security. I think these are two very different things. And yet they are related in that the longer we keep on working and the more inducements we have to keep on working, the more we continue paying taxes.

I am well over 65. I am still working. I am still paying taxes. But I am very glad that I have my medicare, and so, I am sure, is my employer! I fear there may be some change now in employer attitudes toward older workers with the new shift in who has the primary responsibility. That is very unfortunate. Because some older people may lose jobs for no other reason except that their employer does not want to be the payer of first responsibility, rather than medicare.

Now, I will say, as we phase in new services, such as preventive services, or long-term care, as a temporary easement of the cost problem, I think it is justifiable to start with, say those over 75, or over 70, or over 80, whatever. These are actuarial computations that would have to be figured out. Obviously the people who need nursing home care most, the people who are being reduced to penury in order to get on medicaid-in those States where they

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can-are the very old. It certainly seems to me justifiable to start with them.

Mr. RINALDO. Many Members of Congress feel very strongly that we ought to modify medicare to cover eyeglasses, prescription drugs and other items of that nature. For instance, New Jersey has its own State program to aid the elderly in prescription drugs. I am just addressing this to the panel generally for whoever would like to comment on it. Do you think, since you mentioned this in some respect, there is any desirability of trying to do this at the Federal level?

Mrs. SOMERS. Yes, absolutely. But I do not think it can be blanket coverage. The reimbursement list will have to be carefully worked out. Also, it is estimated that one-half of the people over 65 are edentulous, that is, no teeth at all. Ten percent have neither dentures nor teeth.

Now, you can imagine what that contributes to gastrointestinal problems, as well as mental health problems. This whole preventive thing is such a penny-wise, pound-foolish approach. I also think we are pursuing a double standard in this respect.

Dr. Davis mentioned this morning that HCFA is going to fund a lot of new studies to see what is cost effective and health effective in the field of preventive services. Why do they not do that in the field of high technology? The same administration, which worries about a $50 pair of eyeglasses or a $25 visit to the podiatrist, opposed continuation of the Center for Health Technology Assessment, the area that accounts for such a large proportion of medicare's multibillion-dollar costs.

I think everything should be assessed, but there have already been studies. The previous Surgeon General, Dr. Julius Richmond, requested of the Institute of Medicine, which is part of the National Academy of Sciences, a report on preventive services which might be included in national health insurance as well as medicare.

I participated in the IOM study. We sent that to the Surgeon General 5 years ago. The only thing that survived from it was the pneumococcal vaccine that was referred to. Everything else was ignored.

Not every preventive service has been studied. It is no more static than is medical technology. The annual physical, 15 or 20 years ago, was considered very good. Now, I was one of the first people who said it was not cost effective or health effective, but there are other periodic schedules that are being followed today.

Mr. RINALDO. What should it be? What in your opinion should it be?

Mrs. SOMERS. It should vary according to age. An infant in the first year of life obviously needs to be seen more than once a year on a preventive basis.

Mr. RINALDO. I am talking about primarily adults and senior citiMrs. SOMERS. I think it varies every 5 years for a healthy young

a adult down to every year for the old. One easy-to-remember schedule calls for two preventive visits for healthy adults in their twenties (that is one every 5 years), three in their thirties; four in their forties; five in their fifties (every 2 years) and every year after 65.

zens.

Also the particular procedures should vary. They are not the same for men and women. They are not the same depending on your occupational background. They are not the same depending on your age. All of those things have been carefully studied. We are not starting with a clean slate. One has the impression that there is a little foot-dragging here.

Mr. RINALDO. I want to thank you very much. I think the testimony of this panel has been very constructive. As you know, by way of summary, we in Congress, in my view, are going to have to approve some medicare legislation in the next few years, possibly as early as the next year or two. And we have to do our best to maintain benefits in the face of health care inflation that is projected to remain at double digit rates. The Congressional Budget Office puts it at 13.8 percent through 1995.

It is obvious we will need revenues. We may not be able to expand benefits as much as we would like, and we have got to get a handle on health costs. I think that has been dramatically pointed out at this hearing.

I am going to push for more hearings by this committee and I want to state to all of the people who could not testify today that I would appreciate it if they would like to testify at some future hearing, to please write to the Select Committee on Aging and we will do everything possible in an effort to have your name placed on a list for one of our future hearings.

I want to once again thank all of the panelists. I think you have come up with some excellent proposed solutions, and maybe one of these days we will see them put into effect.

The hearing of the Select Committee on Aging is now adjourned. [Whereupon at 12:37 p.m., the hearing was adjourned.]

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APPENDIX

510 East Front Street Plainfield, New Jersey 07060 March 24, 1983

Congressman Matt Rinaldo
U.S. House of Representatives
Select Committee on Aging
1961 Morris Avenue
Union, New Jersey 07083

Dear Congressman Rinaldo:

On behalf of the residents of Richmond Towers, we would like to thank the House Select Committee on Aging for the opportunity to present testimony to the hearing reviewing the issue of the impending crisis in Medicare financing.

Richmond Towers is a federally subsidized low-income senior citizen apartment complex in Plainfield, New Jersey, housing 265 residents. All the residents live on fixed retirement incomes; the majority of the residents survive economically on social security alone.

As our resident population has become older, there has been a greater dependency on medical care. We have consequently seen a greater share of our fixed incomes being spent to pay medical bills.

The Residents Association of Richmond Towers would like to go on record as having presented our options and opinions to the House Select Committee on Aging. The four alternatives to Medicare financing suggested in your letter of March 15, 1983, were presented to our residents at our monthly meeting of the Residents Association. The Residents Association is an independent incorporated body of the residents living at Richmond Towers. The residents strongly urge the Congress to subsidize the Medicare fund through:

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Enacting additional cost containment reforms that would not cut the
current level of Medicare reimbursement nor limit eligibility for
Medicare for those who have fixed incomes.

It is necessary to the survival of every senior citizen to have adequate medical care available. It is as equally important to be able to afford medical care on a fixed income. We appeal to the House Select Committee on Aging to find viable and ethically moral solutions to the financial crisis.

Sincerely,

Frances Gerty, President, Residents Assn.
Eileen Vroom, Former President

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MAR 2 1 1983 Senior Citizens of Manville, Ine. HAR ) - 1022

2

BOROUGH HALL

101 South Main Street Manville, New Jersey 08835

Jaarch 19, 1983

Congressman Matthew J. Rinaldo
Ranking Minority Member
U.S. House of Representatives
Select Committee on Aging
Washington, D.C. 20515
Honorable Conexes snian Rihaldo, )

Thank you for the opportunity to subroit some of our Senior Citizens of y'anville, Inc.,

thoughts, relative to l'edicare.

We plan to attend the laring. Unfortunately, I will be

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-- this week. Today, I received your letter, which does not allow

sufficient time for me to notify many interested members, nor to more vividly express

our thoughts.

Wo naturally are deeply concerned about the future of Hodicare-liedicaid and all

other Senior Citizen Programs, as indeed we were and are concerned about the final

outcome of Social Security.

We hear and read about more cuts -- increases in doduotibles and co-payments in

Medicare and Medicaid

benefit reductions in other lealth Care areas, oto.

In 1981

Medioaro Recipients were "hit" with a 27% increase in out of pocket costs.

We understand

that some Committee members, who are studying the Medicare System and Program and are

entrusted to make recommendations for economic changes, are not versed well enough on

the subject of Medioare to make a fair impartial judgement.

Many elderly today -- fearful of escalating medical costs and reductions in the

Medicare-lledicaid Program, are paying large premiums for supplementary Insurance

some of which they may not neod.

We submit the following suggestionss

The fhitehouse Conferenoo on Aging Coruittees, who participated on the topio of

Medioare, ma de many worthy recommendations.

We suggest that the Nedicare Study Conani

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