Mr. ULLMAN. Are you saying that the Blue Cross does not cover anesthesiologists except nurse anesthesiologists even if they are an employee of the hospital? Dr. LEFFINGWELL. It is my belief that Blue Cross contracts are written so that anesthesiologists who are employed as hospital employees are covered, including nurse technicians. Mr. ULLMAN. Both. In other words, they could include both? Dr. LEFFINGWELL. That is right, sir. Mr. ULLMAN. And then in addition, there are some contracts, I understand, and correct me if I am wrong, whereby if there is a contractual relationship between anesthesiologists and the hospital, Blue Cross does cover the expense if the payment is made to the hospital. Dr. LEFFINGWELL. That is right. Blue Cross, I believe will not make any payment directly to a private physician but will only make payment for anesthesia to a hospital. Mr. ULLMAN. Let me understand your position. You are not willing here to accept the same provisions in this bill you do have under Blue Cross? that Dr. LeFFINGWELL. We are willing to accept it, sir, but we would prefer that professional anesthesiologists be excluded from the bill on the basis that an anesthesiologist is a doctor of medicine and deserves the same treatment which is accorded to his colleagues on the staff. Mr. ULLMAN. You do not think this conflicts in any way with the other position that you hold in the case of Blue Cross? Dr. LEFFINGWELL. No, I do not think so. We would prefer it not be included in Blue Cross, too, but some of us are. Mr. ULLMAN. This is what I wanted to know. Thank you. That is all, Mr. Chairman. Mr. BOGGS. Any further questions? Mr. Betts will inquire. Mr. BETTS. Doctor, do I understand from your statement that you are not speaking for the membership of your organization? Dr. LEFFINGWELL. I am in this prepared statement; yes, sir. The statement I made was that I had made no attempt to ascertain the membership of our organization as to the stand that the organization would take on this bill, H.R. 4222. We have official authority from the organization to take this stand on this portion of the bill which relates to anesthesia. I am speaking officially for the organization in this particular stand, in this particular portion of the bill. Mr. BETTS. In other words, you speak for the organization in expressing the hope that you would be eliminated from the bill, is that is that correct? Dr. LEFFINGWELL. That is right, sir. Mr. BETTS. That is the only position? Dr. LEFFINGWELL. That is the only position we care to take. Mr. BETTS. Then, do I understand from that if you were eliminated you would be for the bill? Dr. LEFFINGWELL. No, I am not in any position to state. Mr. BETTS. You are not for or against? Dr. LEFFINGWELL. I am not in any position to state as to whether the organization is for or against. The organization has never taken any stand for or against. They have taken a stand many years ago on the principle which is applicable in this particular statement which I am making; namely, that they are for the private practice of anesthesia. Mr. BETTS. If you were eliminated you would still be neither for or against it; is that correct? Dr. LEFFINGWELL. Certainly, we would be officially until we have some official stand to take; yes, sir. Mr. BETTS. If we eliminate your organization then, we would have to have you come back again and see what your organization's position was; is that correct? I mean if you represent the organization you would have to find out whether they would be for or against the bill if the organization were eliminated; is that right? Dr. LEFFINGWELL. May I ask Mr. Lansdale to comment on this? Mr. LANSDALE. I do not think he understands your question, Mr. Betts, but the question is if this is eliminated would you then go back to the society and find out whether you are for or against the bill, or would you just simply be quiet about it? It is not our current intent to go back to the society; no, sir. Thank you very much, Doctor. Dr. LEFFINGWELL. Thank you. Mr. BOGGS. The next witnesses are Mr. Lester S. Levy, acting chairman of the public welfare committee, and Dr. Sidney S. Lee, a member of the board of directors of the Council of Jewish Federations and Welfare Funds. STATEMENTS OF LESTER S. LEVY, VICE CHAIRMAN, PUBLIC WELFARE COMMITTEE, AND DR. SIDNEY S. LEE, MEMBER, BOARD OF DIRECTORS, COUNCIL OF JEWISH FEDERATIONS AND WELFARE FUNDS, INC. Mr. LEVY. My name is Lester S. Levy and I live in Pikesville, Md. I serve as vice chairman of the Public Welfare Committee of the Council of Jewish Federations and Welfare Funds. I have been president of the Associated Jewish Charities and vice president of the Jewish Welfare Fund of Baltimore. These organizations share in the financing of the Sinai Hospital Medical Center, the Levindale Hebrew Home and Infirmary, and other social welfare agencies in Baltimore. With me is Dr. Sidney Lee, general director of the Beth Israel Hospital of Boston and a member of the faculty of the Harvard School of Public Health. We are testifying today as representatives of the board of directors of the Council of Jewish Federations and Welfare Funds. The council is an association of 215 central Jewish community organizations for financing and planning all types of health and welfare services. These federations and funds serve close to 800 communities in the The federations subsidize, budget and coordinate a network of health and adjustment services. Ámong others are included: 74 hospitals and specialized medical facilities with 16,000 beds. These hospitals are nonsectarian in their service; close to two-thirds of their patients are not Jewish. 76 homes for the aged providing 12,500 nursing and other beds. 81 family service agencies serving 54,000 clients per year. 55 children's agencies serving 7,000 children annually. 44 vocational counseling agencies serving over 85,000 clients per year, offering employment placement, advice, and sheltered workshop experience. 329 community centers serving more than 600,000 members annually. The position of the council is reflected in a resolution passed by its board of directors in 1959 and reaffirmed in March 1961: The board of directors of the Council of Jewish Federations and Welfare funds approves in principle the use of the mechanism of the old-age and survivors insurance program for financing an expanded program of health services for persons covered by the Social Security Act. This action was taken after careful study by our public welfare committee and as the result of the findings of a special 4-year study on the coordination of health services for the aged and chronically sick. That study was conducted by a professional staff of physicians, social scientists, social workers, and researchers. The programs of 196 health and closely related agencies were examined; and the requirements of 1,799 patients or clients of selected hospitals or agencies were analyzed on a case-by-case basis. Our studies revealed such facts as the following: The admission rate of people over 65 to our Jewish hospitals is twice that of younger people. Their stay in the hospitals is longer-1 out of 14 remains longer than 30 days. Of this number, one out of three remain for other than medical reasons. This is primarily due to the lack of health resources and home nursing programs or the patients' lack of financial resources to purchase such care. Many have family incomes of less than $3,000 per year-one-twelfth of long-stay patients in these general hospitals are unable to make any payment for their care from either their own or public resources. Half the residents of our homes for the aged are in infirmary or hospital units. The provision for their extended medical and nursing care accounts for the bulk of increased costs and increased deficits. Eighty percent of the residents of our homes for the aged are dependent primarily on public assistance grants or OASDI benefits. The detailed studies indicate the need for more medical staff, nurses, occupational therapists, social workers, recreational personnel, et cetera. The demands on hospitals, nursing homes, home health service programs, and other medical programs in homes for the aged, and so forth, are bound to grow rather than diminish. Private philanthropy alone cannot meet the deficit in presently accepted service requirements, to say nothing of the improvements which our studies indicate are necessary. We feel that, in addition, the comprehensive health and welfare needs of the people of our country require the pooling of funds from various sources: from the individuals receiving services according to their capacity to pay, from governmental social insurance, voluntary insurance, Blue Cross, public assistance, et cetera. While voluntary insurance has made and will continue to make a great contribution to health protection, it cannot be expected to meet adequately the needs of the aged who have marginal income after retirement. Public assistance also cannot adequately finance the medical needs of the majority of the aged whose incomes will continue to remain above the relief level. The use of the social security system to provide medical benefits will spread the cost of premium payments over the earning years. The social security system would be the most economical to operateat far less cost than 50 separate State systems or purchase from private insurance companies. It would be the simplest to administer and could be effective quickly to meet needs already urgent. The social security system respects the dignity and self-respect of individuals and would avoid a means test repugnant to American standards and principles. The social security system would enable the elderly to pay for their own medical care, choosing their own physicians, and so forth, and securing a high quality of medical care, crucial to any program which may be developed. Finally, private philanthropy will thus have greater freedom to make its own contribution by concentrating on those fields of social welfare which are not likely to-and should not-fall within the responsibility of any governmental program. Voluntary philanthropic agencies other circumstances being as they are now can make their investment in the form of "seed" or "risk" money required to initiate new programs for new groups of persons. They can also do much to raise the quality and increase the quantity of those services which are uniquely their own. These are the reasons why our organization supports the use of the social security system for providing health benefits to the aged. In behalf of the council, I thank you for the opportunity of appearing before the committee. Dr. Sidney Lee will supplement these remarks. Dr. LEE. Mr. Chairman and members of the committee, my name is Sidney S. Lee. I am the general director of Beth Israel Hospital in Boston and a lecturer on public health practice at the Harvard School of Public Health. I hold doctorate degrees in medicine and in public health. For 15 years I have been a student and teacher in the area of organization of medical care services. For 7 of those years, I have been involved in the operation of the Beth Israel Hospital, an integral part of the Harvard Medical Center and one of this country's major teaching hospitals. In addition to the provision of hospital inpatient services, our hospital has a large outpatient service, a home-care program for the chronically ill, and is responsible for medical care in a home for the aged and a convalescent center. In all of these agencies, the needs of the aged may be clearly seen. The proportion of aged patients is rising as is their age. The methods of financing the care which they need are clearly inadequate. This inadequacy is not something theoretical, but rather is part of the dayto-day problem of providing care for people. Each year, in this one of the country's 7,000 hospitals, we see thousands of patients and their families for whom the burden of costs of illness in the declining years is a major obstacle to happiness, to independence, and to a sense of well-being. Equally significant is the fact that people are deterred from seeking needed medical care by financial problems alone. Thus, we lose the opportunity to prevent disease or to treat disease in early stages. In some of the earlier testimony heard today there was mentioned the problem of services to patients in their homes. One of our activities is the operation of a home-care program for chronically ill patients. Ninety percent of the patients we have cared for over a 7-year period are over the age of 65. One-third of these are eligible for public assistance and are receiving it, but two-thirds are not. The resources of these people are little or nothing at all. Private philanthropy, through our combined Jewish philanthropies, has helped us in supporting these people and their medical needs. However, we are always tightly strapped for funds to extend services to people who need services at home. These patients require hospitalization from time to time, and their hospitalization costs are borne again by private philanthropy. These are people who have worked hard all their lives. Most of them are on social security. Many of them do not want to be on public assistance. They do not want to have their children pursued for information about whether they can participate in support. They frequently do not want their children to know that they are seriously ill. More and more frequently we see one of the things I read in the Kiplinger report just yesterday; the people who are reaching the age of retirement today still have their parents alive, and we are seeing this in our practice of medicine today. If the 85-year-old patient has a 65-year-old son who is now ready for retirement himself and ready to go on social security, can the son be asked to support his aged parent? This is something which is a reality of today's life. I |