other age group and there are a great variety of policies now available to all the aged everywhere.

Of course, not all of the health insurance programs pay all medical care costs, but neither would the King-Anderson proposal. It would cover less than 25 percent of the total yearly health care costs of the average aged person (Congressional Record, Mar. 6, 1962). I am sure that most health insurance policies do far better than that.

Mr. Chairman, I strongly believe that the Kerr-Mills law and health insurance should be given an opportunity to provide for the health needs of our elderly citizens, the voluntary way, which has always been the American way. Or establish a program providing for the Government purchase of private health insurance for those needy over 65. This is by far more desirable than a compulsory health program under the social security system which covers just about everybody regardless of need or desire.

The CHAIRMAN. Thank you for your statement today.

We are pleased to have with us today the Honorable Elmer J. Holland, a Representative from the State of Pennsylvania. The members of the committee appreciate your coming to us with your views and you are recognized, sir.

STATEMENT OF HON. ELMER J. HOLLAND, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF PENNSYLVANIA

Mr. HOLLAND. Mr. Chairman and members of the committee, I appreciate this opportunity to present to you my reasons for supporting the King-Anderson bill on health care for our senior citizens.

For many years I have been an advocate of complete medical care for our elder citizens whose only means of support are pensions secured under our social security program. The legislation which I have introduced, year after year, would provide not only hospital and nursing home care, but would also provide for physicians' and surgeons' expenses, medicines, and diagnostic care.

Frankly I have not been able to secure sufficient congressional support for my bill to be considered, although I must admit I have gotten full support from those receiving social security pensions. However, since Congress is not yet ready to face the problem fully, I feel the King-Anderson bill is a step in the right direction and I am supporting it wholeheartedly.

Let me assure you, Mr. Chairman, I am not advocating the elimination of the Kerr-Mills Act, as this has been most beneficial to our elder citizens who are on old-age assistance, and receiving money from the department of public assistance.

As you know, many States did not provide medical or hospital care for those over 65 who were on relief. My Statae of Pennsylvania has done this for many years and the Kerr-Mills Act, with the offer to share the costs of this program on a 50-50 basis, was most helpful to us financially. I believe there were several other States in similar situations but the majority, I know, did not provide this

care.

It was rather interesting to note, though, that some of the States that have accepted the plan under Kerr-Mills stipulate only a week or so of hospital care, and when one is over 65 illnesses are much

longer than only 1 week. Many older people have, therefore, been placed in nursing homes for care as expenses are less in such institutions.

The group of people we are trying to help-social security pensioners received very little help under the Kerr-Mills Act. Eligibility for this care must be established, and a means test is required. Families are brought in to prove they cannot afford to give their parents the necessary care, and actual proof must be available, in dollars and cents and expenses they personally must meet.

Even if these requirements are met and the pensioner receives hospital or nursing home care, the cost incurred is paid by the State, but the State places a lien on any property the pensioner might own, and upon its sale the State is repaid the amount it advanced for the needed care.

These pensioners could do as well if they borrowed money from a private bank, and they would not have to degrade themselves by divulging their own and their childrens' private financial affairs to a public agency.

Apparently it is hard for the Members of Congress to realize that we are discussing the needs of entirely two different groups of people.

Our elderly citizens who are receiving public assistance help through old age assistance payments have met misfortunes and, possibly through no fault of their own, are forced to look to the State for existence. They have qualified for relief, and this makes them automatically eligible for medical care and hospitalization. Our pensioners, on the other hand, are individuals who have worked throughout their lifetime and have contributed to the social security program, thereby insuring themselves a small income when they are no longer capable of being employed. These people have not applied to the State for food, rent, and clothing. These people have maintained themselves, raised and educated their families, paid off the mortgages on their small but adequate homes, paid taxes to all levels of government, and have contributed much to the growth of this Nation.

These pensioners are a proud lot of men and women, and they should be.

They do not begrudge the care given to their less fortunate brothers and sisters but they do not feel they should be required to meet the same qualifications.

In fact, rather than do what is required, such as bring their children into court, have a lien placed on their home, display their need for financial need for medical care at the office of the department of public assistance, these men and women will go without

necessary care.

I cannot understand the reticence of some of my colleagues to provide for these pensioners the right to secure hospitalization, nursing home care, diagnostic care, and nursing care at home under the social security program. This program is the King-Anderson plan. Under such a plan as this, the pensioners would pay $10 a day for the first 9 days, and other expenses in the hospital will be covered. Under this plan, the pensioner would have his own physician and he would be responsible for paying him; also his surgeon if surgical care is necessary.

This is not always possible under the Kerr-Mills MAA, for patients under that plan are ward patients and in many hospitals they receive the same attentions as do those on OAA; they are attended by the resident doctor as well as other members of the staff. The care they receive is good, no question about that, but seldom do they have their own doctor for hospital policy does not permit this.

For 6 years I have been trying to get proper and adequate care for the pensioner. I have appeared before this committee many times and have presented numerous reasons for setting up a health program under social security.

I voted for the Kerr-Mills bill when it was on the floor of Congress, but at that time I said it would be of little use to the pensioners although it would be beneficial to those receiving old-age assistance from relief, and although we already did that in Pennsylvania I felt that all old people throughout our Nation should have this care. For that reason, I voted for Kerr-Mills.

I feel the same way-3 years later.

And in these past 3 years, I believe that many of the Members of Congress have discovered what I knew then-very few pensioners can and will benefit from this act.

In 1964 the Secretary of the Treasury has stated-to this committee, I believe the U.S. economy will be turning out goods and services at an annual rate of $608 billion in the first quarter and $620 billion in the second quarter.

In other words, when we reach a gross national product of $600 billion, we will have achieved a size no other nation has ever approached.

Yet we say we cannot afford to provide a health program for our elder citizens such as the King-Anderson bill provides.

Day in and day out I appeal to various companies in private enterprise in an effort to get them to recognize their moral responsibility to the thousands of workers they are displacing by the installation of machines.

I ask that they at least retrain these men and women who have been loyal, hard workers, and have helped their company to reach its present heights where it can afford to improve and enlarge its facilities. I appeal to them to help these displaced workers become reemployable and not leave them for the Government to feed, clothe, and retrain.

I feel that we here in Government should recognize our moral responsibility too and provide our pensioners, who have contributed much through the years in blood, sweat, and tears, to make our Nation the greatest in the world, adequate health care in their declining years. Without them we could not be where we are today.

If we continue to force this group of persons to meet relief standards in order to get health care, then our Government is far from the shining example we hope to establish throughout the world. I ask you to think this over seriously.

The CHAIRMAN. Thank you, Mr. Holland. If there are no questions, we shall proceed.

The Honorable Victor Wickersham, a Representative in Congress from the State of Oklahoma. Please come forward and identify yourself for the record.

STATEMENT OF HON. VICTOR WICKERSHAM, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF OKLAHOMA

Mr. WICKERSHAM. Mr. Chairman, I am here to introduce a statement on behalf of the Oklahoma State Medical Association, which is represented today by one of my constituents, R. R. Hannas, M.D., vice president of the Oklahoma State Medical Association, from Sentinel, Okla. I would like to add my own recommendations to the Oklahoma State Medical Association's written statement to the extent that I feel that the elderly citizens of my State are being well served through the provisions of the Kerr-Mills program.

STATEMENT OF THE OKLAHOMA STATE MEDICAL ASSOCIATION

Mr. Chairman and members of the committee, I am R. R. Hannas, Jr., M.D., vice president of the Oklahoma State Medical Association. A 1950 graduate of the Harvard Medical School, I am presently in the private practice of medicine and surgery in Sentinel, Okla., where I own and operate a general hospital.

For 9 years I have been a member of the association's board of trustees, and I am now beginning my third term as chairman of our medical organization's council on professional education. In addition, I am an assistant clinical professor of medicine at the University of Oklahoma School of Medicine, Oklahoma City, a member of the board of directors of Oklahoma Blue Cross, and a contributing editor of the Journal of the Oklahoma State Medical Association.

The following statement concerning H.R. 3920 is presented on behalf of the 2,000 doctors of medicine who comprise the Oklahoma State Medical Association, a nonprofit professional corporation founded before statehood in 1905 and dedicated to the promotion of the science and art of medicine and the betterment of public health.

Positions of policy taken by the association are clearly supported by the vast majority of association members, since such policies are formulated by the board of trustees and the house of delegates, the elected representatives of geographical areas and the physician population, respectively. In the long history of the association, no legislative proposal has been more consistently, universally, and vigorously opposed than H.R. 3920, 88th Congress. Our convictions have been strengthened by the support of thousands of nonmedical persons throughout Oklahoma.

The health and economic problems associated with growing old are not recent discoveries, having been recognized long ago by medical groups, insurance organizations, and previous Congresses. In Oklahoma, a medical assistance program for the aged was inaugurated on June 18, 1957, under the department of public welfare, made possible by the passage of Public Law 84-880.

Working with the department of public welfare, the Oklahoma State Medical Association supported and assisted in the original design of the medical care program of our State, a program aimed at providing high-quality medical, hospital, and nursing home care to elderly Oklahomans unable to provide for themselves.

The Kerr-Mills law, Public Law 86-778, was directed through Congress in 1960 by our own Senator Robert S. Kerr, who sought and received the support and counsel of the Oklahoma State Medical Association in the law's design and development.

Oklahoma was one of the first States in the Nation to implement the KerrMills law (October 1960), and again the medical association which I represent was in full accord with using State and Federal tax funds to help those who are unable to help themselves. Since 1960, our association has cooperated on several occasions in modifying the health care programs to provide improved benefits and to increase the scope of eligible recipients.

For instance, as recently as September 1962, the house of delegates endorsed the liberalization of eligibility requirements for medical assistance for the aged (MMA) recipients. Whereas the previous permissible income levels of

$1,500 for a single person and $2,000 for a couple had enabled only 2,363 persons to qualify for MAA benefits in 1962, the extension of the income allowable to $2,000 and $3,000, respectively, has approximately doubled the caseload in this category of health care assistance.

Not only has the medical association been an active partner in the development of tax-supported health care programs for the needy aged of Oklahoma, but we have also worked closely with voluntary prepayment plans in developing special health insurance programs for senior citizens who are able to budget ahead for their health care needs. For example, in 1959, at the request of a medical association committee established for this purpose, Blue Cross-Blue Shield inaugurated its Special 60 prepayment program. This plan offers persons over age 60 up to 90 days of general hospital and medical care per year at a cost as low as $8.80 per month for man and wife. We are at work at the present time to promote a high-benefit major medical insurance plan for senior citizens through a pooling arrangement by commercial health insurance companies.

The progress already accomplished in Oklahoma and the plans in progress decry the need for drastic legislation as proposed in H.R. 3920. There are

many arguments against the wisdom of H.R. 3920, but in the interest of brevity, the balance of this statement shall be directed toward three specific areas of concern which must be considered upon the merit of each and upon their relationship to each other.

Any legislative proposal should, in our opinion, meet the following tests before receiving any degree of favorable consideration by your Ways and Means Committee:

1. Is the principle sound and well proven?

2. Is there demonstrated need for the legislation?

3. What will it cost?

THE PRINCIPLE

H.R. 3920 would provide limited health care benefits for everyone in the United States over age 65, regardless of financial status, to be financed through a compulsory tax on all working people covered by the Social Security Act. It is socialized medicine in its purest sense for nearly 18 million Americans, and it is socialized medicine for all of our working people who must pay the bill through higher taxes, yet who have no assurance they will ever receive the benefits of H.R. 3920.

Surely no American can honestly feel that it is fair and just to tax a low-income worker to pay the health care bill of another person of equal or greater means. The principle of providing tax-paid benefits to persons of all economic levels is unsound and unfair, but this principle is embodied in H.R. 3920.

The indiscriminate, widespread application of socialized medicine does not belong nor is it needed in the American system of economy. We need not pattern our health care system or any other system after those of lesser nations, and such a precedent is recommended by H.R. 3920. The experimentation of other nations in such schemes as H.R. 3920 may well be justified by economic and social conditions indigenous to those nations, but a great nation would not establish a pattern for progress by applying what is at best a shaky principle to dissimilar economic and social conditions.

Finally, the principle contained in H.R. 3920 will not only fail to solve the problem of aged care, but will actually breed greater dependence from all age groups upon the state. Many Americans who are able to budget for their retirement needs will not do so if they are forced to pay for the health care benefits of others. Human nature being what it is, the basic unfairness of H.R. 3920 will soon generate pressure to lower the age requirements so that those paying for the benefits may partake of them. The bill under your consideration, Mr. Chairman, will surely initiate, perpetuate, and nurture a regressive system of government medicine.

Principles are embraced in H.R. 3920 which cannot be accepted in good conscience by Americans interested in the caliber of our people and the preservation of our system of democracy. With its passage, a problem which is otherwise being met will be compounded beyond recovery and our Nation and its people shall have lost another measure of self-respect.