and I will make a separate statement regarding them-the Young Women's Christian Association, the National Board; the United Seamen's Service, and I am also speaking for three groups that are for their own reasons presenting their own testimony, the American Foundation for the Blind, the National Urban League, and the National Jewish Welfare Board. In addition to these 14 organizations, there are several hundred individuals associated with the field of social welfare, either in executive positions or retired from active participation in the field of professors in schools of social work, who wish to be associated with the statement. I will now read the statement and interpolate a few comments. We, the undersigned organization and individuals associated with the field of social welfare, wish to urge the Ways and Means Committee to take early and positive action to provide more adequately for the health needs of our aged population. It is evident to us that the present financing provisions available through public assistance, private insurance, voluntary philanthropy, and family resources are insufficient to cope with the disproportionately costly health needs that occur in a period of life when income is typically reduced. I would like to make a few comments on that section. Of course, when I speak for 14 organizations, there is some difficulty but I know these organizations well and I do not think there is a one of them that agrees with the frequent implication that one hears in these hearings that these are questions of choice. Every one of these organizations is in favor of voluntary commercial insurance doing whatever it can do within the logical motivation of the profit motive. Every single one of them is committed to voluntary philanthropy, that is what they do. Every one of them is for family solidarity. I would like to say, since I know it most intimately, that every single one of them is committed to the value of public assistance and to the Kerr-Mills bill. You know, Mr. Mills, and others of you who have been here a while, that I have come before this committee for public assistance expansion, improvement, for at least 25 years, but what people do not seem to realize is that these are complementary programs, not alternatives. The reason we have had an expanded social insurance system over the years is that when you see a problem growing under public assistance, when you find an increasing number of people who reflect a particular group of need, you then look around for a way to prevent that need. Consequently, I think it was 1948 when we began talking social insurance coverage for farmers, the reason we had this strong pressure to bring farmers under social insurance was that the agricultural States found themselves having to meet a disproportionate amount of the cost of meeting the needs of the aged under assistance. Similarly, the better a job the States do, and it does not matter whether it is under public welfare or under public health, the same thing will be true that the better the job they do the more costly it is bound to become unless they are relieved of this enormously heavy cost of meeting hospital and related needs. In my own State of New York, which has been complained about here for the inadequacy of its public assistance provision for the aged, the monthly expenditures are now running $10 million a month. They are going up every month. Ninety-five percent of those, I think I am correct, are for various forms of institutional care. What people in the welfare field want is to free public assistance to do the job that you and Senator Kerr and all the others who supported this program over the years intended for it to do; which is to pick up on the unusual needs that cannot be met on a mass basis through assistance. We have also heard some talk today about the means test. I consider myself really something of an expert on the means test. People talk as if the means test were something social workers dreamed up just to persecute the aged. The means test is no such thing. The means test is a way of dividing a limited sum of money, usually an inadequate sum of money, among a total number of people who are in need of the benefit provided. If the number of people, and if the need becomes greater than the amount of money that States, aided by the Federal Government, can provide, naturally they are bound to impose restrictive eligibility requirements. They have no other way to make the money go around. At the present time, we are spending, I think, about $750 million a year on care for the aged under assistance. Either that amount has to go up into the billions or the means test is bound to be restrictive. I will now continue to read the rest of a very short statement. We, therefore, urge the Ways and Means Committee to take early action looking to the inclusion within the contributory social insurance system of hospital, nursing home, diagnostic, and home care benefits which will be available to persons over 65 years of age as a matter of right without regard to personal or family resources. Now, it had been my hope that I would be able to submit supporting statements from most of these organizations but because of the pressures, the timing of the hearing, some of these will only come in prior to the close of the hearings. I would like to state what the individual statements are: The Family Service, the Council of Jewish Federations and Welfare Funds has given me a statement to submit in its behalf which I will leave with the recorder. Mr. ALGER. What was that statement? Miss WICKENDEN. I am submitting a statement in behalf of the Council of Jewish Federations and Welfare Funds. Mr. Alger, this only reached me yesterday afternoon. Mr. ALGER. That is all right. I see a number of statements to be submitted. Is this one of several, the YWCA, for example-you say you have other statements. Miss WICKENDEN. Yes. I am now proceeding to submit them. The CHAIRMAN. Read the list and we will consent all at one time. Miss WICKENDEN. The Family Service Association is preparing a statement. They just completed their biennial conference. It will be here before the close of the hearing. In behalf of the National Conference of Catholic Charities, I would like to submit a letter by the Right Reverend Monsignor Raymond J. Gallagher, The National Conference of Jewish Women is submitting a statement. The National Federation of Settlements and Neighborhood is submitting a statement. The National League for Nursing statement I was able to append to your material. This group, I think, is particularly significant because it represents the organizations that are now giving home nursing. They have submitted in their statement references to a survey that they have made of their own members which reflect their disappointment in the amount of payment that has come to them through the medical assistance program amounting only to 1 percent of their revenue. In talking with them, they said to me that, under the Community Health and Facilities Act, which has been a form of grant-in-aid intended to encourage the expansion of home care for the aged, they have been undertaking to expand this type of care and they are extremely worried as to how they are going to secure financing for it. I am also submitting a statement for the YWCA, which is particularly concerned with the effect of the absence of an insurance provision on the middle generation group. Their concern has been for those people who, in order to care for the medical expenses of their aged parents, as they must of necessity do under the assistance provisions of most States, have found themselves torn between the pressures of their own children, protection for their own old age, and the needs of their aged parents. The CHAIRMAN. Without objection, those additional statements will be included at the conclusion of your remarks, Miss Wickenden. We appreciate very much your coming to the committee and consolidating the testimony of the many organizations is most helpful to us. We thank you. Miss WICKENDEN. Thank you. Mr. LEO H. IRWIN, COUNCIL OF JEWISH FEDERATIONS AND WELFARE FUNDS, INC., Chief Counsel, Committee on Ways and Means, DEAR MR. IRWIN: The Council of Jewish Federations and Welfare Funds submits the enclosed statement for inclusion in the record of the hearings being held by the Ways and Means Committee of the House of Representatives on health and hospital service benefits for the aged. Sincerely yours, LOUIS STERN, President. STATEMENT ON H.R. 3290, MEDICAL CARE FOR THE AGED, BY LOUIS STERN, PRESIDENT, COUNCIL OF JEWISH FEDERATIONS AND WELFARE FUNDS The Council of Jewish Federations and Welfare Funds has submitted testimony on this subject to the Committee on Ways and Means at prior hearings: On June 30, 1958, by Frank F. Furstenberg, M.D., and on July 26, 1961 by Lester S. Levy of Baltimore, vice chairman of our Public Welfare Committee, and by Sidney S. Lee, M.D., executive director of Beth Israel Hospital of Boston. Their testimony is a matter of record and we wish to reaffirm the positions taken therein, supporting legislation to provide health and hospital service benefits under the mechanism of the old age and survivors insurance program. This position has been reaffirmed by our highest governing body, our general assembly, in resolutions adopted on November 18, 1962, and November 10, 1963. The latter urged the Congress to "enact medical care for the aged through the mechanism of the old-age and survivors insurance program while making adequate provision for those persons not so covered." Our council is an association of 218 central Jewish community organizations responsible for financing and planning all types of health and welfare services. Our federations reflect the experience of 74 general and specialized hospitals, 76 homes for the aged, 81 family and children's service agencies, a large part of whose caseload are the aged, and 44 vocational service and group counseling agencies, a number of which provide rehabilitation and retraining assistance to the aged, and other agencies in a comprehensive network of services to this part of our population. Our conviction regarding the inadequacies of current provision for their health and hospital needs is based upon this very extensive experience throughout the country, and upon the special 4-year study on community health services for the aged and chronically ill which we recently completed. This experience has led us to conclude: The requirements of the aged for health and hospital services continue to grow. Private philanthropy cannot meet the deficits involved in providing services to patients unable to meet the full costs. It has been demonstrated that the comprehensive health and welfare needs of the country require the pooling of funds from various sources: from individuals according to their capacity to pay, voluntary insurance, Blue Cross, governmental social insurance, public welfare assistance. The social security system will provide medical benefits to spread the costs of premium payments over the earning years. It will do so most economically. It is the simplest to administer and can be most quickly effective. It respects the dignity of the individuals and avoids a "means test" repugnant to American standards and principles. The social security system would enable the aged to pay for their medical care, choose their own physicians, and safeguard a high quality of medical care. Such quality is indispensable to any program to be developed. With such provision, voluntary philanthropy can continue to concentrate on the fields of social welfare not coming within the responsibility of Govern, ment. We therefore support enactment of legislation that would provide health benefits to the aged under the social security system. Mr. ROBERT BONDY, NATIONAL CONFERENCE OF CATHOLIC CHARITIES, Director, National Social Welfare Assembly, New York, N.Y. DEAR BOB: Relative to the assembly statement on medical care for the aging I wish to indicate that the National Conference of Catholic Charities joins with the assembly and other member organizations in endorsing such legislative proposals as are geared to the social security method of financing. With kindest personal regards, Sincerely yours, Rt. Rev. Msgr. RAYMOND J. GALLAGHER, Secretary. STATEMENT OF THE NATIONAL LEAGUE FOR NURSING The National League for Nursing is a national nonprofit membership corporation organized in 1952 by the merger of seven national organizations and committees concerned with nursing, the earliest of which dated back to 1893. The object of the corporation is to foster the development and improvement of hospital, industrial, public health, and other organized nursing service and of nursing education through the coordinated action of nurses, allied professional groups, citizens, agencies, and schools to the end that the nursing needs of the people will be met. The Department of Public Health Nursing in the National League for Nursing numbers among its members 330 agencies administering public health nursing services, and 8 allied agencies interested in but not administratively engaged in providing public health nursing services, in 42 States and the District of Columbia. Annually the Department of Public Health Nursing conducts a study of agency financing and practice in a large sample of public health nursing services across the country. Payments for provision of nursing care to the sick at home under State medical assistance for the aged programs to agencies included in the study represented less than 1 percent of the income of these agencies in 1926. Only 76 agencies in 7 States reported such income for 1962, and the reported income from this source was $194,838. The aggregate budget for the reporting agencies (285 in 40 States) is conservatively estimated to be $25 million. These figures are all the more disappointing because one of the intents of the legislation-to make medical care and related services available to the aged sick at home is not being fulfilled in most States. Agency representatives in States providing MAA coverage tell us that many patients refuse to apply because they do not see themselves as "charity" patients, yet must submit to welfare department intake procedures in order to qualify. There is no doubt that the availability of nursing care of the sick at home could be extended and expanded if agencies could be assured, among other things, of payment for services provided to the chronically ill and aged in their homes. STATEMENT ON HEALTH CARE FOR THE AGED BY THE NATIONAL BOARD OF THE YOUNG WOMEN'S CHRISTIAN ASSOCIATION On April 5, 1961, the National Board of the Young Women's Christian Association endorsed the principle of extending the system of old-age, survivors, and disability insurance (OASDI) to include payments for health benefits for the aged. This action was based on the mandate to the board to implement previous convention action supporting adequate health services for all people and “a program social security adequate to the needs of our aging population, and a coordinated public assistance program." Subsequently at the last national convention held in May 1961 the action of the national board was overwhelmingly supported by floor vote. The YWCA has a long history of support for social security measures. As early as 1934 it voted in convention to support legislation which included a consideration for old-age pensions. In 1936 we again supported the principle of a national old-age security program. In 1946 the convention voted to work for extension of social security and to reaffirm action to "cooperate with Government and other agencies to make available to all people, equally, adequate health services and low-cost medical care." In 1949 the convention endorsed "an adequate health insurance plan" without specifying the respective roles to be played by commercial, nonprofit and social insurance. Each convention since that time has voted to "continue to support the social security program including extension to those not now covered" and to "continue to support the development of adequate health and disability insurance." The specific action taken in 1961 in support of the extension of Federal social insurance to the financing of health services for the aged was the direct result of YWCA concern with family life and the relationship between the generations. We were concerned by the evidence coming to our attention that failure to make provision for paying at least part of the health bills of older persons was placing an imposible burden on the middle generation. In the hearings held by this committee in August 1961 we placed in the record examples of the family tensions and conflicts created for the younger heads of families who, as we said at that time, "cannot in all conscience let the medical needs of their aged parents go unmet even though they are already struggling with the heavy cost of raising their own children and worrying about saving for their own old age. We feel that this conscientious, struggling, heavily burdened middle generation is often the real forgotten group in this situation. We feel, also, that too little attention is being paid to the tensions and problems which these conflicts produce for families with a natural affection and concern for their older members." In the 21⁄2 years that have passed since your last hearing we see only accumulating evidence of a growing need for this type of remedy. We are sympathetic to the efforts of the insurance industry to meet a part of this problem through such special programs as Connecticut 65 and New York 65 but by the very nature of the problem these policies are too expensive and too limited in benefits to meet the basic needs of a majority of older people. We also recognize the need for an underpinning plan of medical assistance for the needy under public welfare auspices. But here too, the experience of our members shows that this cannot relieve the burdens currently placed on the middle income group, especially in meeting the needs of aged relatives. For example. one of our members writes feelingly of recent experience with MAA in her State as follows: "The long-awaited plan to give medical assistance to needy older persons has now come to my State. As of July 1 we have been seeing what those who don't like the President's program under social security are now offering under the |