office, have a member of your family, a fellow employee or union member call the union. Make sure that the union is notified within the first week of disability. Upon receipt of a notice of claim from the union office, the insurance company will mail the necessary claim blanks to you at your home address with full instructions. If you are confined to a hospital and/or have surgery performed, give the union the information described above and also the name of the hospital. Your claim for hospitalization and surgical benefits will be considered separately and different types of claim blanks will be mailed to your home address unless you request that they be mailed to the hospital. The above claim blanks must be completed by your physician, hospital or surgeon and returned to the insurance company. Follow all instructions carefully, giving complete information to prevent a delay in the payment of your benefits. The hospitalization check will be made payable to you unless you authorize the insurance company to make the check payable to the order of the hospital and to send the check to the hospital to be applied to your bill. if you are covered under the associated hospital plan or any other plan and your hospital bills are paid for under such coverage, you may receive the cash benefits under this plan if you will have our claim blank completed by the hospital or if you furnish a statement of what the detailed charges were. The insurance company requires that it be notified not later than 20 days after the date of an accident, the start of a sickness, the date you enter a hospital, or the date surgery is performed. Extension of time will be allowed if it is shown that it was not reasonably possible for you to give the notice within the 20-day limit. SECTION VIII. TERMINATION OF ELIGIBILITY FOR WEEKLY DISABILITY, This insurance terminates immediately on the occurrence of any one of the following events: 1. When you resign or withdraw or are suspended or expelled from the union; or 2. The end of 4 months after you were last employed by an employer. 3. However, if you become employed by any person or organization (other than an employer) then your insurance shall terminate as soon as you become so employed. If you become disabled within 4 months of the date last employed by an employer, and if you become confined to a hospital or have surgery performed while you are contoinuously disabled and a member of the union and within 1 year of the date last employed by an employer, then you are entitled to hospital and/or surgical benefits up to the limit provided in this plan. If a female employee's insurance is terminated for any cause and if termination of pregnancy occurs within 9 months from the last date of active employment by an employer, the company will pay to such employee the obstetrical benefits as provided in section VI. See section XIV for the rights of retired members. SECTION IX. DESIGNATION OF BENEFICIARY FOR GROUP LIFE INSURANCE You may name any person as your beneficiary and you may change your beneficiary at any time. The change must be made on a form supplied by the insurance company and the change will take effect only upon receipt of this form at the home office of the insurance company. You may name more than one person as beneficiary and divide the group life insurance among them as you wish. If you do not indicate on the form what share each beneficiary is to receive, the insurance company will divide the death benefits equally to those persons named. If you have not named a beneficiary or if the person you name is not alive when payment is due, the insurance company will pay the insurance to the person or persons in the first surviving class of the following groups. The insured's (a) wife or husband, (b) surviving children, (c) surviving parents, (d) surviving brothers and sisters, (e) executor or administrator. SECTION X. WHAT IS TO BE DONE IN CASE OF DEATH? In the case of death of an insured member, his beneficiary should notify the member's union office. Upon receipt of a notice of claim from the union office, the insurance company will furnish the beneficiary with a death claim form with all instructions. The union office or insurance company will be glad to help in the completion of these forms. SECTION XI. WHEN DOES MY GROUP LIFE INSURANCE TERMINATE? Your group life insurance will terminate immediately upon the occurrence of any one of the following events: 1. The end of 31 days after your resignation or withdrawal or suspension or expulsion from the union; or 2. The end of 6 months after you were last actively at work for an employer. However, if you are totally disabled at the end of the 6 months period, then the insurance will not terminate until you recover from your disability, but in any event your group life insurance will terminate 12 months after the day you were last actively at work for an employer. SECTION XII. AFTER MY INSURANCE TERMINATES, MAY I CONTINUE IT DIRECTLY MYSELF? You may not continue your insurance which provides weekly accident and sickness, hospital, and surgical benefits after it has been terminated. You may arrange to continue your life insurance protection beyond the date your group life insurance terminates. This may be done by converting to a regular ordinary whole life insurance policy and paying the required premiums under the following requirements: 1. No medical examination is required. 2. Your application or request for conversion must be mailed or delivered to the home office of the insurance company not later than the day your group life insurance terminates. Your premium must accompany your application or request. 3. The amount of the whole life policy shall be, at your option, $250 or $500 and the premiums must be paid directly to the home office of the insurance company on an annual, semiannual or quarterly basis. Premiums are based upon rates filed with the New York insurance department and your age (nearest birthday) at the time of conversion. (Rates will be furnished you upon request.) 4. The converted whole life policy will become effective on the day your group life insurance expires. It is an individual policy and your payment of premiums as they become due is the only requirement to keep this policy in force. SECTION XIII. AFTER MY GROUP INSURANCE TERMINATES, HOW MAY IT BE REINSTATED? If since the date you were last employed by an employer, you have been engaged in any other gainful occupation, then all of your group insurance will be reinstated on the first day of the month following the date upon which you (a) Shall have been employed by an employer or employers for 6 consecntive months and for not less than 500 hours in the preceding period of not more than 12 months; and (b) Are then a member of the union. If you were unemployed after your last employment with an employer, your group insurance will be reinstated on the first of the month following your return to work for an employer if you are then a member of the union. SECTION XIV. BENEFITS AVAILABLE TO RETIRED MEMBERS 1. Group life insurance: A member receiving retirement benefits provided by the fund shall continue to be eligible as long as he is eligible to retirement benefits. 2. Weekly accident and sickness benefits: Payable only for a disability which begins within 4 months of the last date of employment preceding the employee's eligibility to retirement benefits as provided by the fund. 3. Hospitalization and surgical benefits: Payable only for those confinements or operations which occur or are performed within 1 year of the last date of employment preceding the employee's eligibility to retirement benefits as provided by the fund. SECTION XV. GENERAL PROVISIONS OF THE PLAN AND COMMENTS 1. This booklet is a nontechnical description of the insurance plan and in all circumstances the master group policies issued by the insurance company to the fund shall be the governing documents. A copy of each master policy will be on file with the union office where it may be examined by any member. 2. The master group policies are issued by the insurance company to the fund in the State of New York and shall be governed by the laws of the State of New York. 3. Except for the assignment of hospitalization and surgical benefits to a hospital, with consent of the insurance company, no assignment of any benefits under this plan by the member or beneficiary shall be valid. 4. It is not necessary for you to pay anyone a fee to help you or your beneficiary make a claim for any of the benefits. Your union office will be glad to assist you or you may write directly to the home office of the insurance company at any time. 5. If any weekly accident or sickness, hospital or surgical benefits are payable after the death of an insured employee, the insurance company may pay such benefits to the deceased employee's beneficiary under the group life insurance. 6. An individual group certificate will be issued to the fund by the insurance company for delivery to the insured employee. In addition to reading all 15 sections of this booklet, you should read your certificate. An employee's group certificate number shall be his social security number. Each employee should always give his certificate (social security) number in any notice to the insurance company. 7. If an employee's group life insurance has been terminated and converted to a whole life policy as provided in section XII, the insurance company may require that before he can again become insured under this plan for group life insurance, he must satisfy the insurance company that he is in good health and may be required to pass a medical examination at his own expense. The CHAIRMAN. Now, the remaining witness, as I understand, is Mr. James Brindle, acting director, social security department, a service department of the union which advises the officers, directors, and local unions on negotiated pension and health security programs and maintains contact with the Government agencies and the organizations active in the broad field of social security and health. The department also operates a health institute, including a medical diagnostic clinic, an eye clinic, and a mental hygiene unit. Mr. HESELTON. Mr. Chairman, I think it would be appropriate to put the President's message of yesterday in our hearings at this point. The CHAIRMAN. I agree with you. It will be so included. (The material referred to is as follows:) [H. Doc. 298, 83d Cong., 2d sess.] MESSAGE FROM THE PRESIDENT OF THE UNITED STATES, TRANSMITTING RECOMMENDATIONS TO IMPROVE THE HEALTH OF THE AMERICAN PEOPLE To the Congress of the United States: I submit herewith for the consideration of the Congress recommendations to improve the health of the American people. Among the concerns of our Government for the human problems of our citizens, the subject of health ranks high. For only as our citizens enjoy good physical and mental health can they win for themselves the satisfaction of a fully productive, useful life. THE HEALTH PROBLEM The progress of our people toward better health has been rapid. Fifty years ago their average life span was 49 years; today it is 68 years. In 1900 there were 676 deaths from infectious diseases for every 100,000 of our people; now there are 66. Between 1916 and 1950, maternal deaths per 100,000 live births dropped from 622 to 83. In 1916, 10 percent of the babies born in this country died before their first birthday; today, less than 3 percent die in their first year. This rapid progress toward better health has been the result of many particular efforts, and of one general effort. The general effort is the partnership and teamwork of private physicians and dentists and of those engaged in public health, with research scientists, sanitary engineers, the nursing profession, and the many auxiliary professions related to health protection and care in illness. To all these dedicated people America owes most of its recent progress toward better health. Yet, much remains to be done. Approximately 224,000 of our people died of cancer last year. This means that cancer will claim the lives of 25 million of our 160 million people unless the present cancer mortality rate is lowered. Diseases of the heart and blood vessels alone now take over 817,000 lives annually. Over 7 million Americans are estimated to suffer from arthritis and rheumatic diseases. Twenty-two thousand lose their sight each year. Diabetes annually adds 100,000 to its roll of sufferers. Two million of our fellow citizens now handicapped by physical disabilities could be, but are not, rehabilitated to lead full and productive lives. Ten million among our people will at some time in their lives be hospitalized with mental illness. There exist in our Nation the knowledge and skill to reduce these figures, to give us all still greater health protection and still longer life. But this knowledge and skill are not always available to all our people where and when they are needed. Two of the key problems in the field of health today are the distribution of medical facilities and the costs of medical care. Not all Americans can enjoy the best in medical care-because not always are the requisite facilities and professional personnel so distributed as to be available to them, particularly in our poorer communities and rural sections. There are, for example, 159 practicing physicians for every 100,000 of the civilian population in the Northeast United States. This is to be contrasted with 126 physicians in the West, 116 in the North Central area, and 92 in the South. There are, for another example, only 4 or 5 hospital beds for each 1,000 people in some States, as compared with 10 or 11 in others. Even where the best in medical care is available, its costs are often a serious burden. Major, long-term illness can become a financial catastrophe for a normal American family. Ten percent of American families are spending today more than $500 a year for medical care. Of our people reporting incomes under $3,000, about 6 percent spend almost a fifth of their gross income for medical and dental care. The total private medical bill of the Nation now exceeds $9 billion a year-an average of nearly $200 a family-and it is rising. This illustrates the seriousness of the problem of medical costs. We must, therefore, take further action on the problems of distribution of medical facilities and the costs of medical care, but we must be careful and farsighted in the action that we take. Freedom, consent, and individual responsibility are fundamental to our system. In the field of medical care, this means that the traditional relationship of the physician and his patient, and the right of the individual to elect freely the manner of his care in illness, must be preserved. In adhering to this principle, and rejecting the socialization of medicine, we can still confidently commit ourselves to certain national health goals. One such goal is that the means for achieving good health should be accessible to all. A person's location, occupation, age, race, creed, or financial status should not bar him from enjoying this access. Second, the results of our vast scientific research, which is constantly advaneing our knowledge of better health protection and better care in illness, should be broadly applied for the benefit of every citizen. There must be the fullest cooperation among the individual citizen, his personal physician, the research scientists, the schools of professional education, and our private and public institutions and services-local, State, and Federal. The specific recommendations which follow are designed to bring us closer to these goals. Continuation of present Federal programs In my budget message, appropriations will be requested to carry on during the coming fiscal year the health and related programs of the newly established Department of Health, Education, and Welfare. These programs should be continued because of their past success and their present and future usefulness. The Public Health Service, for example, has had a conspicuous share in the prevention of disease through its efforts to control health hazards on the farm, in industry, and in the home. Thirty years ago the Public Health Service first recommended a standard milk sanitation ordinance; by last year this ordinance had been voluntarily adopted by 1,558 municipalities with a total population of 70 million people. Almost 20 years ago the Public Health Service first recommended restaurant sanitation ordinances; today 685 municipalities and 347 counties, with a total population of 90 million people, have such ordinances. The purification of drinking water and the pasteurization of milk have prevented countless epidemics and saved thousands of lives. These and similar field projects of the Public Health Service, such as technical assistance to the States, and industrial hygienic work, have great public value and should be maintained. In addition, the Public Health Service should be strengthened in its research activities. Through its National Institutes of Health, it maintains a steady attack against cancer, mental illness, heart diseases, dental problems, arthritis and metabolic diseases, blindness, and problems in microbiology and neurology. The new sanitary engineering laboratory at Cincinnati, to be dedicated in April, will make possible a vigorous attack on health problems associated with the rapid technological advances in industry and agriculture. In such direct research programs and in Public Health Service research grants to State and local governments and to private research institutions lies the hope of solving many of today's perplexing health problems. The activities of the Children's Bureau and its assistance to the States for maternal and child health services are also of vital importance. The programs for children with such crippling diseases as epilepsy, cerebral palsy, congenital heart disease, and rheumatic fever should receive continued support. Meeting the cost of medical care The best way for most of our people to provide themselves the resources to obtain good medical care is to participate in voluntary health-insurance plans. During the past decade, private and nonprofit health insurance organizations have made striking progress in offering such plans. The most widely purchased type of health insurance, which is hospitalization insurance, already meets approximtely 40 percent of all private expenditures for hospital care. This progress indicates that these voluntary organizations can reach many more people and provide better and broader benefits. They should be encouraged and helped to do so. Better health insurance protection for more people can be provided. The Government need not and should not go into the insurance business to furnish the protection which private and nonprofit organizations do not now provide. But the Government can and should work with them to study and devise better insurance protection to meet the public need. I recommend the establishment of a limited Federal reinsurance service to encourage private and nonprofit health insurance organizations to offer broader health protection to more families. This service would reinsure the special additional risks involved in such broader protection. It can be launched with a capital fund of $25 million provided by the Government, to be retired from reinsurance fees. New grant-in-aid approach My message on the state of the Union and my special message of January 14 pointed out that Federal grants-in-aid have hitherto observed no uniform pattern. Response has been made first to one and then to another broad national need. In each of the grant-in-aid programs, including those dealing with health, child welfare, and rehabilitation of the disabled, a wide variety of complicated matching formulas have been used. Categorical grants have restricted funds to specified purposes so that States often have too much money for some programs and not enough for others. This patchwork of complex formulas and categorical grants should be simplified and improved. I propose a simplified formula for all of these basic grantin-aid programs which applies a new concept of Federal participation in State programs. This formula permits the States to use greater initiative and take more responsibility in the administration of the programs. It makes Federal assistance more responsive to the needs of the States and their citizens. Under it, Federal support of these grant-in-aid programs is based on three general criteria: First, the States are aided in inverse proportion to their financial capacity. By relating Federal financial support to the degree of need, we are applying the proven and sound formula adopted by the Congress in the Hospital Survey and Construction Act. Second, the States are also helped, in proportion to their population, to extend and improve the health and welfare services provided by the grant-in-aid programs. Third, a portion of the Federal assistance is set aside for the support of unique projects of regional or national significance which give promise of new and better ways of serving the human needs of our citizens. Two of these grant-in-aid programs warrant the following further recommendations. |