Federation, the Blue Cross-Blue Shield, and the private health insurance industry, among many others-places its faith in traditional voluntary enterprise and resists Government intervention of the Forand type. It points to the dynamic and flexible nature of voluntary mechanisms, with all their diversification, to resolve health problems. It seeks to eliminate remaining deficiencies by methods that preserve individual and community freedoms. QUESTIONS AND ANSWERS But why not answer the whole problem immediately with national compulsory health insurance? Isn't this approach equitable? Isn't this proposed health benefit a reasonable expansion of the present cash benefit system? These are fair questions, but there are good answers. Federal old-age and survivors insurance was set up in 1935 to provide a floor of cash maintenance for eligible beneficiaries. Although subject to numerous amendments since its enacement, it has always preserved its basic character of a cash benefit program. The Forand bill, and other bills that introduce health benefits into the OASDI structure, introduce a new concept of service rather than cash benefits. This proposal is dangerous. It is our conviction that the following developments would occur soon after the enactment of such legislation. 1. The physician-patient relationship as we have known it in this country would change profoundly. The confidentially and mutual respect that generally characterize the relationship between patients and their physicians could not continue under a nationalized program. 2. The limited Forand approach to retired and other beneficiaries of OASDI would inevitably be expanded to all persons under the OASDI system. 3. The cost would be far higher than anticipated. 4. Abuse of a politically inspired nature would be certain. 5. Overutilization of hospital and medical facilities is a built-in feature of such programs. 6. The rapidly progressing voluntary health insurance industry-including the Blue Cross-Blue Shield and the private insurers-would be destroyed, since voluntary purchase of health insurance would gradually be replaced by national compulsory health insurance. 7. The Federal Government would promulgate standards of health care and levels of compensation. In time, physicians, hospitals, nurses, and ancillary professional groups would be subject to extensive Federal regulatory controls. What, then, is the alternative? We believe that the combined efforts of individuals, families, communities, voluntary organizations, and-within boundsFederal, State, and local governmental agencies can provide for the health needs of the aged. The American Medical Association has had a committee on aging for over 2 years, which has devoted its full time to this problem. Over 35 State medical associations have now established similar committees. The American Hospital Association, likewise, has been conducting research, meeting with the insurance industry, and studying practices with the objective of containing rising costs. The health insurance companies only 2 years ago formed the Health Insurance Association of America in order to step up their important contribution to the financing of medical care. They are now engaged in intensive studies designed to create new types of coverage tailored to meet the needs of the aged ill. Preretirement financing of health insurance policies with paid-up status at 65 years of age; use of life insurance after 65 to pay for health care; the application of deductibles and coinsurance to permit coverage of costly illnesses at a low premium rate; and many other approaches will soon help spread health insurance, to an ever-increasing degree, among the aged. The nursing home operators are earnestly seeking to improve their standards and provide a quality service that will bridge the present gap between inexpensive but inadequate home care and adequate but overexpensive hospital care. Innumerable other instances could be cited of enterprising activity to analyze and meet the problem. In an effort to provide better coordination and stronger, swifter action in this area, a Joint Council to Improve the Health Care of the Aged was founded recently. Charter members are the American Medical Association, American Hospital Association, American Dental Association, and the American Nursing Home Assoication. The joint council will— (1) Identify and analyze the health needs of the aging. (2) Appraise available health resources for the aging. (3) Develop programs to foster the best possible health care for the aging regardless of their economic status. In addition, the joint council will (1) Obtain the facts through a coordinated program of research. (2) Encourage the expansion and improvement of health care facilities for the aging. (Under this item the joint council members have endorsed loan programs by the Federal Government for hospitals and nursing homes, and encouraged greater use of Hill-Burton funds for chronic disease units.) (3) Expand the development of community health services for the aging. (Visiting nurse services, homemaker programs, and other projects will be pushed.) (4) Cooperate with the Joint Commission on Mental Illness and Health. (5) Intensify education, research, and action programs. (6) Promote the expansion of investigations into the characteristics of health problems of the aging. (7) Increase the availability of improved voluntary health insurance coverage for older people. (Much remains to be done, but the history of this dynamic movement provides no fodder for the pessimism of its detractors.) (8) Urge State and local governments to provide realistic financial support for medical, dental, hospital, and nursing home care of aging public assistance recipients. Forand-type legislation would not only stifle these energetic, imaginative programs which show great promise and which should be given the opportunity to develop fully, but would propel us irreversibly toward a federally controlled health care program. Voluntary enterprise by individual groups, as we know it in this country, is almost unique among the nations of the world. Working together, I am confident that we can conquer this health problem of the aging just as we have mastered so many others. [From the American Journal of Nursing, November 1958] THE AHA POSITION ON HOSPITAL NEEDS OF THE AGED (Ray Amberg 1) In September, the Journal published the position of the American Medical Association on health insurance for the aged, and is now pleased to publish the policies of the American Hospital Association on the same general subject; the position on health insurance for the disabled, retired, and aged, adopted by the American Nurses' Association at its 1958 convention, is on page 984 of the July Journal. I am delighted to have an opportunity to bring to the nursing profession, through the Journal, a statement of the position of the American Hospital Association concerning the health needs of the aged. First, let me say that the association properly restricts its attention to the hospital needs of the aged and further qualifies this by addressing itself to the hospital needs of the retired aged, on the basis that those who are substantially employed can meet their hospital needs through present mechanisms regardless of their age. The present policy of the association was adopted by its house of delegates at the annual meeting in Chicago on August 20, 1958. This statement, printed on the opposite page, supersedes all previous policy. However, some background seems to be in order. The health needs of the aged have recently received a great amount of attention in the Congress and in the popular and professional press. The interest of the American Hospital Association antedates this flurry of headlines. The association was instrumental in organizing the independent Commission on Financing of Hospital Care. This commission was composed of members 1 Mr. Amberg is president of the American Hospital Association and director of the University of Minnesota hospitals. of the public and of the various disciplines including nursing, concerned with the problem. It issued its report in 1954 and spotlighted the special hospital problems of the aged. The association promptly appointed a committee to study the findings of the commission and to recommend policy. As a result of the work of this committee, a policy statement was approved by the association's house of delegates in September 1955, supporting Federal and State matching grants to underwrite, from general tax funds, a portion of the premium for voluntary health insurance for the aged. As Tol Terrell, then president of the American Hospital Association, reported to the membership in December 1957, "little support for the association's position was forthcoming and no action was taken" along the lines proposed. Recognizing that inaction would not solve this growing problem, the board of directors appointed another committee to see if a new and more acceptable approach could be formulated. This committee consulted all sorts of groups and got a wide range of expert opinion. While the committee was at work, Representative Aime J. Forand introduced his well-known bill on the health needs of the aged. The committee took his proposal as part of its field of study. Last November, the board of trustees of the association adopted a statement on financing of the hospital needs of the retired aged. This statement reiterated the position of the association that "retired aged persons face a serious problem in financing their hospital care." It recognized the necessity for Federal legislation to solve the problem satisfactorily. It expressed its preference for a voluntary rather than a governmental system and said that the Forand bill was "not a suitable solution to the problem of financing the hospital needs of the retired aged." Between approval of that statement and submission of a new policy statement to the house of delegates, the association was far from inactive. It arranged a meeting between leaders of the insurance industry and the Blue Cross plans to explore methods by which the voluntary prepayment system could come up with an answer which would make Government assumption of this problem unnecessary. The association also joined with the American Dental Association, the American Medical Association, and the American Nursing Home Association in the formation of the Joint Council To Improve the Health Care of the Aged. special report, the membership of the association was informed that- In a * * * despite reports to the contrary, this council was not formed for the negative purpose of defeating the Forand bill, nor any other currently proposed Federal legislation. The council has a positive program to obtain the facts about the health problems of the aged through a coordinated program of research, the encouragement of the expansion and improvement of health care facilities for the aging, expansion of the development of community health services for the aging, cooperation with the Joint Commission on Mental Illness and Health, intensification of education, research and action programs, promotion of the expansion and investigation into the characteristics of these health problems, and to increase the availability and to improve the voluntary health service coverage for older people, and to urge State and local government to provide realistic financial support for medical, dental, hospital, and nursing home care of aging public assistance recipients. In addition, the association has participated in two national conferences concerned with the health problems of the aged; has testified before the House Ways and Means Committee studying suggested social security changes; and has offered its assistance in any way to those grappling with this big task. On August 20, after lengthy debate and certain changes in the statement as submitted to it, the house of delegates of the American Hospital Association adopted a policy statement. The association's activities in this area will now be governed by this policy statement which appears below. THE AHA POLICY ON THE HOSPITAL NEEDS OF THE RETIRED AGED The house of delegates establishes the following policy of the American Hospital Association with respect to meeting the hospital needs of the retired aged, in lieu of all previous action taken by the American Hospital Association: 1. The American Hospital Association is convinced that retired aged persons face a pressing problem in financing their hospital care. 2. It believes that Federal legislation will be necessary to solve the problem satisfactorily. It has, however, serious misgivings with respect to the use of compulsory health insurance for financing hospital care even for the retired aged. 3. It believes that all possible solutions must be vigorously explored, including methods by which the dangers inherent in the social security approach can be avoided. 4. It believes that every realistic effort should be made to meet the hospital needs of the retired aged promptly through nechanisms utilizing existing systems of voluntary prepayment. It is conceivable, however, that the use of social security to provide the mechanism to assist in the solution of problems of financing these needs may be necessary ultimately. 5. It believes that any legislation developed to provide for Government participation to meet the hospital needs of the retired aged should be so devised as to strengthen the voluntary prepayment systems, and should conform to the following principles: (a) Legislation designed to provide for the hospital needs of the retired aged should provide essential hospital services and should exclude custodial care provided for nonmedical reasons. (b) Government participation should be restricted to persons over 65 who are not regularly and substantially employed. The voluntary prepayment system provides a satisfactory mechanism for the coverage of other persons, regardless of age. (c) Any program in which the Federal Government participates to meet the hospital needs of the nonindigent aged should emphasize individual responsibility and make the application of a means test unnecessary for obtaining benefits. (d) Such a program should be based on the service benefit principle and should provide benefits sufficiently comprehensive to remove the major economic barriers to hospital care for the retired aged. (c) Such a program should make benefits available through nonprofit prepayment plans. (f) Hospitals should be paid fully for the cost of care rendered. (g) Such a program should not provide services in facilities operated by the Federal Government. (h) Such a program should provide reasonable criteria to determine the eligibility of hospitals to participate, but the Federal Government should be precluded from interfering in the administration and operation of hospitals providing the services. (i) Such a program should maintain the free choice of doctor and hospital by the recipient. (j) Such a program should permit and encourage continuous adaptation to new knowledge in the provision of services. [From the American Journal of Nursing, January 1959] APHA ADOPTS RESOLUTION ON MEDICAL CARE FOR THE AGED At its annual convention held in St. Louis in October 1958, the American Public Health Association adopted a resolution on health care for our aged-the resolution is carried here in its entirety. FINANCING HEALTH SERVICES FOR THE AGED Whereas health services for the aged are inadequate throughout the Nation; and Whereas good health care is becoming more expensive to provide for the aged because of their high illness and disability rates, the increasing complexity and rising costs of good care, the growing number of aged persons and their relatively small personal financial resources; and Whereas adequate financing is essential to support comprehensive health care of high quality for the aged; and Whereas the burdens of the costs of good care for the aged can be minimized for the aged, their families, contributors to voluntary insurance plans, charitable agencies and taxpayers through arrangements, effective throughout the working lifetime, which provide paidup insurance for the older years: Therefore, be it Resolved, That the American Public Health Association support appropriate proposals to provide paidup insurance for health services required by aged per sons; which insurance financing should be accompanied by provisions to protect and encourage high quality care; and be it further Resolved, That the American Public Health Association support appropriate Federal, State, and local efforts to improve the financing and adequacy of health services for needy and medically needy aged persons through the supplementary public assistance programs and through other means such as medical care programs administered by health departments, and for all aged persons through public health and related programs. The American Nurses Association, American Medical Association, and American Hospital Association have also taken stands on this subject. For their views, see page 984 in the July Journal, page 1273 in September, and page 1568 in November. (The following correspondence was received from State nurses associations:) Hon. WILBUR MILLS, ALABAMA STATE NURSES' ASSOCIATION, Chairman, Committee on Ways and Means, U.S. House of Representatives, Washington, D.C. DEAR MR. MILLS: The members of the Alabama State Nurses' Association wish to urge your Committee on Ways and Means to give favorable consideration to H.R. 4222, which was introduced by Representative Cecil King and which is for the purpose of extending social security to provide health insurance for recipients of OASDI. In June 1958 the following resolution was adopted by the house of delegates of the American Nurses Association composed of representatives of the State nurses associations: Whereas necessary health services should be available to all people in this country without regard to their ability to purchase; and Whereas prepayment through insurance has become a major and effective method of financing health services; and Whereas certain groups in our population, particularly the disabled, retired, and aged, are neither eligible nor able to avail themselves of voluntary health insurance: Be it therefore Resolved, That the American Nurses' Association support the extension and improvement of the contributory social insurance to include health insurancefor beneficiaries of old-age, survivors, and disability insurance; and be it further Resolved, That nursing service, including nursing care in the home, be included as a benefit of any prepaid health insurance program. The house of delegates of the Alabama State Nurses' Association in 1959 unanimously confirmed the position of ANA and at its biennial convention the ANA reaffirmed its position. Sincerely, LILLIAN SMITH, Mrs. Walter Bragg Smith, R.N. Representative WILBUR MILLS, Chairman, Committee on Ways and Means, COLORADO NURSES' ASSOCIATION, U.S. House of Representatives, Washington, D.C. DEAR REPRESENTATIVE MILLS: Because of the interest of professional nurses in good health care for all people, the American Nurses Association's house of delegates, in 1958 and again in 1960, voted to support legislation that would include health insurance under the social security programs. We believe that the King bill, H.R. 4222, would provide just such legislation, and urge that your committee give favorable consideration to this bill when hearings are held on it this month. Despite the pressures that have been brought to bear by other organizations, the American Nurses Association has stood firm in its support of legislation which will provide health insurance benefits for recipients of old-age, survivors, and disability insurance. In many States and instances, these pressures have been severe, even to the extent of threatening reprisal against nurses who belong 76123-61-pt. 2—10 |