If you are for that, so are we because I think the younger worker is in the low-income bracket.

Mr. ALGER. You know, Mr. Chairman, I am now laughing at myself. I have unloaded so much on these gentlemen I would like to suggest that the record be left open and the transcript be sent to them and time be given for them to give rebuttal point by point.

That is a fair way to do it. Gentlemen, it is a pleasure to exchange views with you but I did not want to miss this opportunity to tell you the difference so that you could know I still want to help solve the problem even though I would go at it in an entirely different way.

Mr. OSSOFSKY. Congressman Alger, I believe it won't take a volume to answer you. I think if what you are asking us is are we prepared to pay taxes so that 18 million senior citizens today and many more in the future will be able to look forward to the rest of their lives with dignity and at the same time know that a few millionaires will get some health care and hospitalization I have no objection.

Mr. ALGER. If I ever get a chance to get inside a union hall this is scratching the surface of what I will say about how some folks with modest incomes are paying the bills for those who could pay for it themselves in many Government programs.

Mr. OSSOFSKY. I think we would welcome your appearance to district 65.

Mr. ALGER. I will await your invitation.

Mr. KEOGH. Mr. Chairman, may I make this observation at this point? I was fully conscious of the ability and the background and experience of these gentlemen. I knew that they could protect themselves in any kind of debate. I do think, however, that while we can differ with witnesses who come here, that it is, perhaps, not completely proper, in my opinion, for any member of this committee to characterize the views of a witness expressed as being immoral.

But I didn't bother to inject myself at that point.

Mr. CURTIS. I am pleased the gentleman didn't.
Mr. KEOGH. I did not yield to you.

The CHAIRMAN. Mr. Keogh has the floor.

Mr. KEOGH. I am finished, Mr. Chairman.

Mr. BURKE. I would like to make this observation. There is nothing immoral in advocating the Government do something to take care of the needs of the people when the private sector of the country has failed or is unable to take care of that need.

Mr. COLLIER. I would like to move from the realm of philosophy for a moment and get down to cases. First, I would like to join my colleagues in complimenting you on what I think is good testimony based on case history and directing your attention to one of the cases you have mentioned.

That is the case of Mr. B on page 6. Under the proposed legislation before us, taking your figure of $2,526 which represented the hospital care, nursing, and anesthesia bills, adding thereto the $1,032 for doctor's services and medication under the bill that is before this committee today, if it were presently law and Mr. B did not have your union insurance do you know what this family would get toward the total bill?

Mr. BALDINGER. I am sorry. I am not sure I understand your question. Are you asking me for an estimate?

Mr. COLLIER. I am asking you this. Under this bill do you know what this unfortunate family would have received in the way of aid toward the total cost of this medical obligation?

Mr. BALDINGER. Under this bill I would assume that the bulk of the hospital costs would have been covered. I might say that it would be our intent if this legislation were passed

Mr. COLLIER. Now, you are not answering my question. Actually the family would have received approximately $2,122.

Under the MAA program the same family in the State of New York would get what in return if they didn't have any other aid?

Mr. OSSOFSKY. The likelihood is that they would get nothing because they would refuse to go for a means test.

Mr. COLLIER. I don't know whether they would go or not. I am sure the witness really does not know either.

Mr. OssOFSKY. Congressman, we have had many instances where families have come to us where the plan did not extend coverage beyond the 21 days full coverage and 180 days half, where they absolutely refused to put themselves before the pauper's oath or put their children through the routine that is required.

Mr. COLLIER. What is the difference in your opinion between a pauper's oath and a financial statement? Is the pauper's oath required in the State of New York under MAA?

Mr. OSSOFSKY. As far as I am concerned, it is. You may call it a financial statement. Perhaps we have a difference in semantics, a difference in definition or title.

As far as we are concerned, this means that a family has to pauperize itself to get the aid that they ought to be able to get as a matter of right.

Mr. COLLIER. That is all, Mr. Chairman. I just want to make this concluding statement that assuming that this family would avail itself of a program which this Congress set up and which they would have every right as citizens to avail themselves of, not by taking the pauper's oath but by qualifying as the law provides in the State of New York, they would have been assisted to the extent of roughly $3.500 as compared to $2,122 had the benefits been paid under the bill which we have before us. That is all.

Mr. OSSOFSKY. Congressman, there is also the liklihood that if we took a look at the pension income of this family under the State regulations there is a very good chance that they would not even have been eligible.

Mr. COLLIER. Then your case history is incomplete. I merely based it on what I assumed to be the case history.

Mr. OSSOFSKY. The case history shows the facts as we had them in this particular instance. This family did not go for MAA.

Mr. KEOGH. So that in the illustration cited the difference between the present program and the program under the pending bill is more theoretical than real: is it not? There is a distinct possibility that that particular family or one similarly situated would not qualify for the existing program.

Mr. OSSOFSKY. Would not qualify under the MAA program. That is right.

The CHAIRMAN. Are there any further questions?

Mr. ALGER. Mr. Chairman, I want to expand something I said because evidently the recent exchange indicates that I might not have

said what I really had on my mind. When I call a Federal program, as I did in this instance, immoral, in my definition this means that whenever people are unwilling and refuse to pay their own bills and there becomes a complusory tax to pay for them, something they could have done themselves, I felt in that sense that is immoral.

I do not attribute it to the gentleman testifying. It is my way of describing the bill. My language is not the best, undoubtedly it is not. I think some of the things we do with tax laws is close to stealing where we take it from one man and give it to another. I certainly had no reference to the gentleman appearing before us today.

Mr. OSSOFSKY. Thank you, Congressman.

Mr. BALDINGER. We reconfirm our invitation.

Mr. ALGER. Fine, I am ready.

The CHAIRMAN. Mrs. Milton Dunn. Will you identify yourself for the record and give your name, address, and capacity in which you appear?

STATEMENT OF MRS. MILTON DUNN, IN BEHALF OF THE DEMOCRATIC CENTRAL COMMITTEE OF THE DISTRICT OF COLUMBIA

Mrs. DUNN. I am appearing in behalf of the Democratic Central Committee for the District of Columbia, of which I am a member. Since we in the District have no Congressmen to appeal to, we are taking this opportunity to express our views in favor of hospital care for the aged through the social security system.

In the study done by Eunice Grier, for the Washington Center for Metropolitan Studies we find that the District population between 1950 and 1960 dropped 5 percent but in spite of this loss of population the number of people over 60 was increased during this period by about 15,000. Studies have shown that the average income of persons over 65 living alone in the District of Columbia is $1,287, while the cost of hospital care per day is close to $40. But sometimes it is easier to judge a large issue like this by looking at the people it will affect individually, not as a statistic. Mr. and Mrs. City Dweller have worked all their lives and have been able to pay off on a small home. They may have a small amount of cash to supplement their meager social security payments, but more likely they are struggling along on social security with the occasional help from children who at that period are bearing the largest financial responsibilities of their lives. Suddenly, a major illness comes along. Is it the American way to make these people ask for charity? To submit to investigations? To sell their home? They have had a lifetime of independence. You and I know many old people who fit this description. They are probably your parents or friends. These people frequently have no insurance because their insurance was canceled a number of years ago when companies were in the habit of doing so, after the insured had had a series of illnesses.

We Americans like to pay our own way. Many old people would rather die than seek aid as set up under the Kerr-Mills bill. The only way we can be sure to meet our medical expenses when we are old is to pay for them while we are working.

We support the President's program for hospital insurance through social security.

The CHAIRMAN. We thank you for your statement, Mrs. Dunn. Mr. COLLIER. I would like to enter at this point in the record the qualification for medical assistance for the aged in the State of New York.

The CHAIRMAN. Without objection, that may be included. (The material referred to follows:)

NEW YORK

(Aged in population (April 1, 1960), 1,688,000)

MEDICAL ASSISTANCE FOR THE AGED

Program.-Servces began in April 1961. Within the first months of operation many persons classified as OAA recipients (primarily those receiving medical care only; i.e., not in need of subsistence payments) who were receiving nursing home care were transferred to MAA. Nursing home care as a service continues to be given in both the OAA and the MAA programs without distinction as to length of time such care is needed by a recipient.

Eligibility. All income and resources shall be deemed available to meet costs of medical care except as follows: Income: (1) In medical or nursing institutions for chronic care, up to $10 a month for personal care items; annual premiums for health insurance policy up to $150 for single recipient or $250 for married recipient if policy covers spouse; if marrier, up to $1,800 a year for support of spouse, including any income of spouse. (2) Not in facility for chronic care, $1,800 for single applicant; $2,600 for married applicant living with spouse; health insurance policy premiums up to $150 per year for single recipient or $250 if married and policy includes spouse. (See "Reserves," below.)

Assets: (1) Real property: Home is exempt; other real property not used as home must be utilized to apply to costs of care. (2) Personal property: Clothing and household effects are exempt; may have life insurance with cash surrender value of not more than $500 (single person or couple). Insurance in excess of this amount and nonessential property must be utilized.

Cash reserve permitted for persons not living in a medical facility: $900 for single person or $1,300 for married couple. If value of nonhome real estate, nonessential personal proprty, and excess insurance together with cash or liquid assets does not exceed this reserve limit, such resources need not be utilized and applied to costs of care.

Recovery provisions.—Provision for recovery from estate of deceased recipient after death of surviving spouse.

Relative responsibility.-Spouse, parents, and children are liable for payment of medical care insofar as they are found able to assist.

Deductible.-None required; eligibility is determined concurrently with need for medical care and in relation to the known or predictable extent and cost of such care. In cases of continuing care eligibility factors reconsidered once in 6 months or oftener if indicated.

Scope of medical care provided.-Hospital care nursing home care, services of medical doctor, osteopath, dentist, optometrist, podiatrist, dental care, prescribed drugs, sickroom supplies, special nursing services, physical therapy and related rehabilitation services, laboratory and X-ray, outpatient hospital and clinic, eyeglasses, dentures, and prosthetic appliances.

Additional provisions.—MAA services are part of plans for medical care developed by each local welfare district, based on State's manual and subject to approval of the State department of social welfare.

The CHAIRMAN. Any further questions? If not, we thank you gentlemen again. That completes the calendar today. Without objection the committee adjourns until 10 o'clock tomorrow morning.

(Whereupon, at 4:45 p.m., the committee recessed, to reconvene at 10 a.m., Wednesday, November 20, 1963.)

MEDICAL CARE FOR THE AGED

WEDNESDAY, NOVEMBER 20, 1963

HOUSE OF REPRESENTATIVES, COMMITTEE ON WAYS AND MEANS, Washington, D.C.

The committee met at 10 a.m., pursuant to recess, in the committee hearing room, Longworth Building, Hon. Wilbur D. Mills (chairman of the committee) presiding.

The CHAIRMAN. The committee will please be in order.

Is Mr. Dulski in the room? Mrs. Hansen? Dr. Hall?

Mr. MOSIER. I am Congressman Hall's assistant. He is at the Republican conference. He should be down here in 6 or 7 minutes. The CHAIRMAN. Thank you.

The CHAIRMAN. We have with us today the Honorable Torbert H. Macdonald, a Representative in Congress from the State of Massachusetts. We are pleased that you could be with us and you may come forward and identify yourself for the record.

STATEMENT OF HON. TORBERT H. MACDONALD, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF MASSACHUSETTS

Mr. MACDONALD. Mr. Chairman, members of the Ways and Means Committee, I appreciate the opportunity to appear before you in support of H.R. 3920, to amend the Social Security Act to provide hospital insurance benefits for the aged. If H.R. 3920 is enacted by this Congress, 597,000 of the 604,000 persons in Massachusetts aged 65 or over would become eligible for hospital insurance under social security.

It is a paradox of our times that the advances of modern medicine, which have helped add 22 years to the length of life, has brought with it what is close to being a crisis in the financing of health care for the aged. First, this vastly improved medical care has swelled the number of aged in the population. Despite the improvements in medicine, illness becomes increasingly prevalent with age. Second, as contrasted with the last century when medical science was not so effective as to be indispensable, today's medical services often spell the difference between life or death. Third, the increasing cost of health care and increasing need for it have not been accompanied by a workable method for financing this care for the aged.

While the cash social security benefits go a long way in helping to meet regular and recurring expenses like food, clothing, and rent, the impact of health costs varies greatly from month to month and even from year to year. A person over 65 may have no appreciable health costs for several years and then in a short time have health