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HARRISON A. WILLIAMS, JR., New Jersey, Chairman ALAN BIBLE, Nevada

EVERETT MCKINLEY DIRKSEN, Illinois FRANK CHURCH, Idaho

WINSTON L. PROUTY, Vermont JENNINGS RANDOLPH, West Virginia HIRAM L. FONG, Hawaii EDMUND S. MUSKIE, Maine

JACK MILLER, Iowa FRANK E. MOSS, Utah

CLIFFORD P. HANSEN, Wyoming EDWARD M. KENNEDY, Massachusetts GEORGE MURPHY, California 1 RALPH YARBOROUGH, Texas

PAUL J. FANNIN, Arizona 1 STEPHEN M. YOUNG, Ohio

EDWARD J. GURNEY, Florida 1 WALTER F. MONDALE, Minnesota

WILLIAM B. SAXBE, Ohio 1 VANCE HARTKE, Indiana 1

1

1 Five vacancies in committee membership were caused by the departure from the Senate of Senators George A. Smathers (Democrat, Florida), Wayne Morse (Democrat, Oregon), Edward V. Long (Democrat, Missouri), Frank Carlson (Republican, Kansas), and Thruston B, Morton (Republican, Kentucky). With the adjustment early in 1969 of committee party ratio from 13–7 to 11-9, one Democratic vacancy existed and was illed by Senator Hartke. Senators Murphy, Fannin, Gurney and Saxbe were appointed to fill the remaining vacancies.

WILLIAM E. ORIOL, Staff Director
JOAN GUY MILLER, Minority Staff Director

SUBCOMMITTEE ON HEALTH OF THE ELDERLY

GEORGE A. SMATHERS, Florida, Chairman WAYNE MORSE, Oregon

EVERETT MCKINLEY DIRKSEN, Illinois EDMUND S. MUSKIE, Maine

FRANK CARLSON, Kansas EDWARD V. LONG, Missouri

HIRAM L. FONG, Hawaii
FRANK E. MOSS, Utah

THRUSTON B. MORTON, Kentucky
RALPH YARBOROUGH, Texas
HARRISON A. WILLIAMS, JR., New Jersey
EDWARD M. KENNEDY, Massachusetts
WALTER F. MONDALE, Minnesota

Part 1-Washington, D.C.
Part 2~New York, N.Y.
Part 3—Los Angeles, Calif.
(Additional hearings anticipated but not scheduled at the time of this printing.)

(II)

CONTENTS

Page.

611

Opening statement by the chairman..

CHRONOLOGICAL LIST OF WITNESSES

Carrow, Elsa, Miss, administrative assistant to Mayor Yorty, mayor of

Los Angeles, Calif

Russell, A. M. G., Mrs., chairman, California Commission on Aging--

Unruh, Jesse M., speaker of the Assembly of the State of California---

Reinecke, Hon. Ed., Representative in Congress, 27th Congressional

District California

Breslow, Lester, M.D., M.P.H., professor of health services administration,

School of Public Health, University of California at Los Angeles ---

Todd, Malcolm C., Dr., president, California Medical Association -

Shapiro, Marvin J., council member, California Medical Association.-

Carbray, James, chairman, Senior Citizens Activities Committee--

Hartley, Robert, for Senior Citizens Activities Committee...

Davidson, Louis, for the Senior Citizens Activities Committee, Los Angeles

Federation of Labor, AFL-CIO-

Thomas, Robert, vice president, Blue Cross of Southern California -

Dudley, Juanita C., assistant regional director, western regional office,

National Urban League-

Littlejohn, Clarence G., M.D., FAAP, member, board of directors and

chairman of health committee, Urban League of Greater Los Angeles --
Smith, Phillip M., Dr., vice president, Charles R. Drew Medical Society-

Mulder, Carel E. H., director, California Department of Health Care

Services, Human Relations Agency -

Skoien, Charles W., Jr., executive director, California Commission on

Aging--

Giorgi, Elsie A., Dr., assistant professor, School of Medicine, University

of Southern California, Los Angeles, Calif..

Alvin, Cass, education coordinator, United Steelworkers of America--

Gormly, Donald, president, California Association of Nursing Homes,

Sanitariums, Rest Homes, and Homes for the Aged, Inc.--

Chinn, Austin B., M.D., professor of medicine and director, rehabilitation

research and training center, University of Southern California----

APPENDIXES

APPENDIX 1. ADDITIONAL INFORMATION OR EXHIBITS FROM WITNESSES

Item 1: Exhibits related to statement of Dr. Malcolm C. Todd, president,

California Medical Association..

Exhibit A. California Hospital Association-California Medical Asso-

ciation

Exhibit B. The intermediary functioning of the title 19 program in

California with respect to institutional care..

Item 2: Exhibits related to statement of Juanita C. Dudley, assistant

regional director, western regional office, National Urban League--

Exhibit A. Letter to director of Human Relations Agency, State of

California..

Exhibit B. Newspaper article concerning report on Medi-Cal program

by California Department of Justice -

Exhibit C. Letter from Robert H. West, veterans affairs coordinator,

to advisory board members...

Exhibit D. Legislation introduced, California Legislature, designed

to provide an educational equivalence to veterans with certain

kinds of training: Senate bill 1263...

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APPENDIXES—Continued

APPENDIX 1. ADDITIONS, INFORMATION, OR EXHIBITS FROM WITNESSES—Continued

Page

Item 3: Exhibits related to Dr. Elsie A. Giorgi's statement.-

727

Exhibit A. Proposals for a community health planning foundation - 727

Exhibit B. Unified health care delivery system..

731

Item 4: Exhibit related to statement of Mr. Cass Alvin, education coor-

dinator, United Steelworkers of America---

734

Exhibit A. Memorandum on health care alternatives..

734

Item 5: Exhibit related to statement of Mr. Donald Gormly, president,

California Association of Nursing Homes, Sanitariums, Rest Homes, and

Homes for the Aged, Inc.--

739

Exhibit A. Excerpts from association testimony before the Senate Fi-

nance Committee on H.R. 12080—1967 amendents to the Social

Security Act----

739

APPENDIX 2. LETTERS AND STATEMENTS FROM INDIVIDUALS

AND ORGANIZATIONS

Item 1: Statement from Mark Berke, executive director and Dr. Harry

Weinstein, director of medical education, Mount Zion Hospital and

Medical Center--

743

Exhibit A. Statement of the U.S. Senate Special Committee on Aging- 743

Item 2: Letter from Philip E. Brown, chief administrator, California

Chiropractic Association Health Service Foundation.--

744

Item 3: Letter and statement from Joseph W. Ehreneich, director, Univer-

sity of Southern California Research Institute of Business and Econom-

ics

745

Exhibit A. Creating competition in the health-care industry: some re-

flections on possible impacts of major group purchasers on costs and

quality of health care..

746

Item 4: Letter and newspaper article from Marion B. Folsom, Health Coun-

cil of Monroe County, Rochester, N.Y.

756

Item 5: Letter from Jay W. Friedman, D.D.S., associate researcher, Uni-

versity of California, Los Angeles ---

757

Exhibit A. Dentistry in the geriatric patient.

760

Item 6: Statement of Seymour E. Harris, University of California, San

Diego, Calif.--

766

Item 7: Letter from David Littauer, M.D., executive director, Cedars-

Sinai Medical Center, Los Angeles, Calif--

771

Item 8: Questions submitted by the chairman to Dr. George B. Markle IV,

diplomate of the American Board of Surgery-

772

Exhibit A. Should hospitals require so many tests?-

774

Exhibit B. Spare the purse and please the patient.

777

Exhibit C. More ways to save your patients' money -

779

Item 9: Material submitted by Dr. Russell B. Roth, vice speaker, house

of delegates, American Medical Association.-

780

Exhibit A. The physicians as a guardian of health care costs -

780

Exhibit B. Medical care cost control..

784

Item 10: Statement of Dr. Alexander Simon, Department of Psychiatry,

University of California, San Francisco Medical Center -

785

Exhibit A. Questions submitted by the chairman to Dr. Alexander

Simon, University of California, San Francisco Medical Center---- 786

Item 11: Letter from Donald L. Spence, Ph. D., staff sociologist, Univer-

sity of California, San Francisco Medical Center..

789

Item 12: Letter from Dr. Harold Richter Stark, Littlerock, Calif..

790

Item 13: Statement of Boyd Thompson, executive director, San Joaquin

County Medical Society, Stockton, Calif.

791

Item 14: Letter from Don Vial, chairman, Center for Labor Research and

Education, Institute for Industrial Relations, University of California,

Berkeley

793

Exhibit A. Speech by Einar Mohn, chairman of the California Council

for Health Plan Alternatives, to the California Hospital Association. 794

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