Mr. BETTS. I did not want the record to stand as an indictment against any State which is not implementing Kerr-Mills, that it has not made any progress.

Dr. WILSON. That is right.

Mr. BURKE. If this is true, why is it that certain States refuse to participate in the Kerr-Mills law? Under Kerr-Mills 50 percent of the cost would be borne by the Federal Government.

Dr. WILSON. It is not altogether financial, sir. I think it is a matter of an awful lot of people who have to know about this, would have to be advised concerning the contents, what it implies, and, of course, there are many other problems with which they are faced.

It just has not moved as fast as a lot of us would like to see it move. I don't think there is lack of interest but there is a time factor there. Mr. BURKE. Can you give any estimate on how much time it will take these States to finally come around to implement the Kerr-Mills law? Would you say 5, 10, 30 years? When do you think they will change their thinking?

Dr. WILSON. I really could not give you an estimate on that.

Mr. CURTIS. Inasmuch as points are being made that my State, Missouri, regrettably, from my standpoint, is one that has not implemented Kerr-Mills this year, the State legislature passed it and the Governor vetoed it.

The Governor of Indiana vetoed the Kerr-Mills implementation. The Governor of New Jersey, I understand, vetoed it.

Perhaps the gentleman being of the same party as the three Governors can persuade them that this is a desirable thing.

Mr. BURKE. I do not want to get drawn into any politically inspired discussion. I thought we were discussing the merits of the bill. If the gentleman wants to get into politics, I will be happy to get into that at a later date.

Mr. CURTIS. I thought the gentleman was, by implication. That is why I made my remarks.

Mr. BURKE. I made no political statement on it whatever. If the gentleman wants to debate politics on this, I will be glad to. Mr. KING. Any further questions?

There being no further questions, thank you again, gentlemen. The Honorable T. J. Dulski, Congressman from the 14th District of New York.

STATEMENT OF HON. THADDEUS J. DULSKI, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF NEW YORK

Mr. DULSKI. Thank you, Mr. Chairman.

Mr. Chairman and distinguished members of this committee, I appreciate this opportunity to appear before you today to express my views in favor of medical care legislation for our Nation's senior citizens. Both in the last Congress and in this session I have sponsored a bill to provide medicare and hospitalization benefits for the aged under the social security program.

Health protection and care for the elderly is one of the most pressing problems confronting us today. We all know the problem exists, and there is general agreement that a solution must be found-and soon. We must find a solution to meet not only today's needs, but also

the needs of the next and future generations who will be faced with this same problem.

All of us know the cost of medical care is constantly increasing. As a matter of fact, these costs have risen more rapidly than the costs

of other essentials.

Our population, aged 65 and over, spends approximately 50 percent more per capita for medical care than those under 65. The average number of days per year of hospital confinement is more than four times higher for a man aged 65 than for one aged 35, and the average annual surgery cost at age 65 is more than double that at age 35. On the average, 78 percent of those in the 65-plus age group have one or more chronic conditions.

According to 1960 census figures, the aged had to try to pay their medical bills out of annual incomes that averaged about half of what those under 65 receive-from $1,000 for single persons to $2,900 for families headed by aged persons. It is quite evident that those whose income was equal to the national average and those who were below the average didn't have much left for their medical bills after providing for the bare necessities of life.

Too many in this age group are not able to afford today's high premiums on private health insurance claims, or they are considered too poor a risk. A little over half carry some form of health insurance, but in most cases this falls far short of meeting the costs of illnesses.

The Kerr-Mills program has not met the need. Half the States have no Kerr-Mills program at all. Where there is a program in the State, very few get benefits and these are usually meager. Administrative costs are high, and there are gross inequities in the distribution of funds. For instance, Massachusetts has 60 times as many beneficiaries as New Hampshire. The average payment per individual varies from $18.88 in Kentucky to $512.74 in Illinois. Over 80 percent of the total funds are disbursed in only four States.

So a large proportion of the senior citizens of our great prosperous Nation have a choice. They can either turn to public or private relief agencies for payment of their medical bills, or neglect their health. Sadly, a great many choose to neglect their health.

The cruelest costs in old age are medical costs. I am acquainted with the problems of friends and constituents who have suffered chronic illnesses necessitating extended hospitalization, and their entire life savings have been wiped out by these costs.

In my own State of New York, we had 1,270,000 residents in 1950 who were 65 or over. Today, this group is over 1,900,000, and it is expected to increase in 1975 to 2,550,000.

The average social security payment in our State is $79 per month. According to a study made 5 years ago, 80 percent of this group have incomes of less than $2,000 a year; 60 percent receive less than $1,000.

Only 35 percent of New York State's citizens (65 and over) have any kind of hospital insurance.

On the basis of my own experience, I am firmly convinced that the problem of health and medical care for the aged will not be resolved by relying principally on private voluntary efforts. Existing medical plans have not met the need, and the Kerr-Mills legislation

has been a failure. It is a problem that is also beyond the means of local and State governments.

While the bill I have sponsored will not solve all the medical problems of the aged, and it was not designed to attain such a goal, it will guard against total disaster financially as a result of medical misfortunes beyond the control of individuals.

We, in the Congress, must take action to provide an adequate program so that our senior citizens can get the medical care they need without bankrupting themselves or accepting charity. I can see no better alternative to social security for getting the job done, which would spread the burdens of old age over the years when people are younger, are working, and have far more adequate incomes.

We can no longer afford to overlook or minimize the plight of our senior citizens. The need is now. The hour to act is now.

It is my earnest hope that your committee will take immediate action. to consider this legislation, and that you will be able to report a bill which will provide adequate medical and hospitalization protection for the elderly.

Mr. KING. Thank you, Mr. Dulski, for coming before our committee and giving us the benefit of your views.

Are there any questions of Mr. Dulski?

If not, thank you again.

Mr. DULSKI. Thank you, Mr. Chairman.
Mr. KING. Our next witness is Dr. Hall.

Mrs. GRIFFITHS. Dr. Hall represents the district in which my family has lived for many generations.

I would like to point out that he is the best surgeon and best doctor west of the Mississippi. But Mr. Mills got into an argument with me. So I am going to say he is one of the best.

Thank you, Mr. Chairman.

The CHAIRMAN. Dr. Hall, I was not raising questions about your qualifications. I merely called to Mrs. Griffiths' attention the fact that Arkansas was also west of the Mississippi.

Mrs. GRIFFITHS. I knew that.

Dr. HALL. I am sure the gentlelady's geography is airtight.

Mr. CURTIS. I simply would like to say for the record that I am particularly pleased to see my colleague, Dr. Hall, from Missouri, here testifying on a subject which he probably has more knowledge of than any Member of Congress, not just from the fact that he is one of the distinguished surgeons and physicians in this country but also the years that he has devoted to community and charity work on hospital boards in various other areas that pertain to medicine. He has gone way beyond the area of becoming one of the top men in the profession to move into the field of what we might call social conscience. The CHAIRMAN. We are pleased to have you with us. You are recognized, Dr. Hall.

STATEMENT OF HON. DURWARD G. HALL, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF MISSOURI

Dr. HALL. Thank you, Mr. Chairman. As a humble person, I am embarrassed by any allegation that one might be the best in the West. I think all of you have gone beyond propriety in your kind and charming comments.

I appreciate the opportunity of appearing again before this committee during its deliberations on H.R. 3920. As you know, I made a similar appearance during the hearings that were held last year and discussed the reasons why I believed this to be an entirely wrong approach to the question of medical care for our senior citizens. At that time, with my own experience as a doctor still very fresh in my memory, I emphasized what I sincerely believed would be the adverse effect on the quality of medical care in this country-care which no one will deny ranks far ahead of any country in the world, including those which have adopted this path.

My views have not changed since that time and I want to repeat my endorsement of those comments which are in the committee hearings of last year. I believe time has sustained them.

There are some additional factors bearing on the basic issues to which I would like to call the committee's attention:

One of the very basic questions involved in the philosophy behind this legislation is the question of need. Statistics which have been presented to the committee by supporters of the legislation have often been broad in scope, based on a feared or projected need, and drawing certain assumptions from those figures which may or may not represent the true facts regarding need.

More accurate and quite revealing figures are now on hand. As this committee knows, Missouri is considered a median State in per capita income. It qualifies for 50-percent matching funds on Federal programs. which is less than the 33% to which the wealthier States are entitled, and more than the 66% to which the poorer States are entitled, insofar as those programs which have sliding scales are concerned.

In June 1961, at the close of the 71st session of the Missouri General Assembly, a resolution was passed establishing a joint committee of the assembly for the purpose of making a complete and thorough study of the problem of providing health care assistance to the senior citizens of Missouri and reporting its findings and recommendations to the 72d session of the legislature convening in January 1963. The interim committee which made this study represented State senators and representatives of both political parties. It was as nonbiased as a study of this nature could hope to be. I believe their findings merit your considered attention.

The committee noted, first of all, that the State of Missouri ranks second only to the State of Iowa in the proportion of persons 65 years of age and over in relationship to the total poulation of the State. Over half a million Missourians representing 11.7 percent of the total State population are over 65. A tribute to its good environment and healthy, delightful climate.

The reports show that

Today, about 6 out of every 10 aged persons eligible for retirement in Missouri receive payments under the Federal social security program.

Mr. KING (presiding). Doctor, would you be willing to suspend now so that we may answer our call and return to the hearing? Dr. HALL. That will be fine with me. I await your pleasure.

Mr. KING. The committee will suspend and will reconvene immediately following the answering of the call.

(Short recess.)

The CHAIRMAN. The committee will please be in order.

Doctor, we apologize for having to interrupt you. Being one of us, I know you understand.

Dr. HALL. I certainly do. I apologize for not being on time this morning.

The CHAIRMAN. You are recognized, and you may resume your

statement.

Dr. HALL. I was talking about the first point, Mr. Chairman and colleagues, that I thought involved new philosophy during the year since my last testimony, the basic philosophy behind the legislation being the question of need.

I had reported about the ad hoc committee of the Missouri State Assembly in its 71st and 72d sessions and what evolved therefrom. The reports went on to say that the committee has viewed with pleasure the apparent growth of feeling of local responsibility and the growth of the use of private medical insurance by those senior citizens who can afford it.

It further reports that many senior citizens are in very good health and have few, if any, medical expenses. Many others, though not employed, are able to get along quite well through savings and Federal social security payments and other pension plans. Many have been able to provide themselves with insurance to help in their medical emergencies. Many are being assisted privately by families who are able and willing to assist their parents in medical emergencies, and who do so with pride when able. Many old folks homes have been done away with and nonprofit corporations provide wholesome, happy, total care for the aged, based on income available. We are very proud of our Sunshine Nursing Homes.

Statistics compiled recently by the Missouri Division of Health in cooperation with the Missouri Hospital Association concerning the methods of payment by patients dicharged from a random hospital sample, made up of 63 out-State Missouri institutions, between July and December 1962, indicate that the problems of the aged in obtaining and paying for hospital care have been greatly exaggerated.

The figures from this 6-month period show that a total of 90,192 persons discharged from care in these hospitals, of whom there were 15,732 aged over 65, only 929-or 1 percent-were unable to pay any of their costs. Of this number, just 186, two-tenths of 1 one percent of the overall total, were age 65 or over.

During this same period, Missouri's program of health care for the needy aged provided care for 2,122 patients over age 65 out of the 90,000 cases documented in the study. In addition, 416 persons aged 65 or over received some assistance in paying hospital costs from this State program to supplement resources of their own.

The conclusion-the striking fact-is then, that the remainder of the more than 90,000 cases in this study were able to pay for their own care through Blue Cross, insurance benefits, credit payments or cash resources. Only 2,724 people over age 65, out of more than 90,000 patients, needed assistance through the Kerr-Mills program or direct charity from the hospitals. This is only a little more than 3 percent and hardly supports the dire picture painted by the proponents of "fedicare.

I would like to say parenthetically at this time that even though our Governor did reject by veto, after our 72d general assembly, an

27-166-64-pt. 1- -29