Data show that 7.8 percent of all aged beneficiaries were also receiving old-age assistance in February 1957, and 7.1 percent in February 1958. At the time this sample survey was conducted (fall 1957), perhaps no more than 7.5 percent of aged beneficiaries were also receiving OAA. But the survey shows that 10.5 percent of the sample were also receiving OAA-or 40 percent more than was true of all aged beneficiaries. Those receiving social security benefits as well as OAA are more likely to be in the upper age groups, in the lower benefit brackets, and probably less likely to have other forms of income. Thus, it would appear that not only was the sample not representative of all aged beneficiaries, but it may have resulted in some bias in the income status of the aged beneficiaries as a group. The interview process of the survey probably yielded a strong downward bias in "total money income" status of the aged. Employees of Social Security Administration conducted this survey through personal interviews, using a 28page questionnaire. The instructions show that the social security employee interviewing an aged beneficiary was reminded that "The beneficiary [interviewed] is not required to give the information called for [in the questionnaire]; often he must be convinced of the need for giving the information *** and the beneficiary may consider the questions to be outside of the legitimate interests of the Social Security Administration. "The interviewer should explain that he has called because the Bureau of Old-Age and Survivors Insurance wishes to find out to what extent the benefits meet the needs of the beneficiary. "The beneficiary can be told that Congress did not intend the insurance program to provide all the income retired persons need to live on. It has always been assumed that most beneficiaries will have some other resources * * * "The beneficiary should not be promised any specific advantage to himself as a result of the study, but he may be told that earlier surveys provided facts and figures which helped Congress to understand the needs of beneficiaries when it was considering the increase in benefits provided by the 1950, 1952, and 1954 amendments to the act." Of course, these remarks were intended to enlist cooperation. Nevertheless, we believe that such statements undoubtedly resulted in underreporting or even nonreporting of money income other than social security benefits. The element of self-interest is obvious. In view of the indicated overweighting of the sample with beneficiaries in the upper age groups, and of the strong conditioning of responses to understate other forms of money income, we question the valdity of conclusions based on the survey results showing the "total money income" status of aged beneficiaries. Finally, the last section of this chapter fails to portray the very encouraging prospects for aged groups in the years to come. In considering the income status of the aged beneficiary group, one must bear in mind that this age group is constantly undergoing change. Those in the higher age brackets, and thus by and large in the lower benefit levels, are passing on. At the same time, people in their middle and late sixties are coming on the benefit rolls at substantially higher benefit levels. This changing composition of the aged group can be strikingly illustrated by comparing its likely composition in 1980 with that in 1960. In this 20-year interval the number of aged in our population will rise from roughly 16.4 million to 26.4 million. Of the 26.4 million who will be 65 and over in 1980, 24.3 million are now aged 45-64. In other words, less than 10 percent of those 65 and over in 1980 are a part of the 1960 aged population. Of the 24.3 million entering the aged group during the next 20 years, more than 90 percent will be eligible for social security benefits. And their benefits will be based on the highest levels of pay in the entire working lifetimes of these people. Thus, they will be drawing benefits substantially higher on the average than those already getting benefits. The continuing advance of millions of people to progressively higher levels of money income while working is a dramatic example of the fruits of our * See Social Security Bulletin, September 1958, p. 6. * See Department of Health, Education, and Welfare, Social Security Administration, Bureau of Old-Age Survivors Insurance, "Interviewers' Instruction Book, 1057, CrossSection Sample Survey of Resources of OASI Beneficiaries." 4 See the same, p. 5. [Italics supplied.] See U.S. Department of Health, Education, and Welfare, Social Security Administration, Actuarial Study No. 46, "Illustrative U.S. Population Projections," table 8, projection V, p. 24. The projected aged population for 1980 is based on most recent mortality rates, dynamic American economy and is of profound significance for our future aged. Attention should have been given in the last section of this chapter to the vital consequence of these underlying forces in the American private enterprise society. Sincerely yours, KARL T. SCHLOTTERBECK, Director, Economic Security Program. Mr. CURTIS. One comment I might make on this subject of the difference between social and private insurance is that to me one of the basic problems, the very element, is, we are talking about capital formation, either Government capital formation or private. If the Government provides the capital formula, we can only do it through taxes. At least we have not gotten to the point where we have the Government investing in anything other than its own securities. The only real way we gain from investment is investment in private enterprise, and it has always bothered me when we start accumulating these vast Federal funds as to how economically sound that is. This is one reason why, if we possibly can, we need to put it into private channels where the investment principles will permit it to go into the private enterprise. I have noticed that there have been these big Federal Government trust funds we have accumulated. The people of this country ought to begin thinking about it, because there have been groups suggesting that maybe the Government ought to invest these funds in public works bonds. We can just begin to see the implications of the Federal Government getting into the investment field. So there is the third element and factor that must be weighed, and part of that is this: That when we take any activity outside the private enterprise sector and turn it over to the Government, we are narrowing the tax base and imposing a further burden on that which still remains within the tax base. I think that we would do well to start broadening our tax base. The Government entirely too much in recent years has been going into things that private enterprise can handle. In my judgment, at any rate, there is no reason why Government must do it when it actually can be done in the private sector and broaden rather than narrow the tax base. One specific question. I was very happy to hear your comments in regard to catastrophic health insurance. I have made a little bit of a survey in this field and I find that it is a new field and what policies there are seem to be contributing policies and therefore, inasmuch as the beneficiary has to contribute a certain amount, it actually still puts him in a serious financial situation over a period of time. I honestly don't understand the reasons for the contributing feature. It does not encourage a man not to remain sick and the only thing it does contribute is to keep the cost to the insurance company down. It just makes no sense to me. I wonder if you had any comment on that. Mr. MARSHALL. May I just give you a word on this? I can use a personal example. Suppose I am in the hospital I have passed my $500 or something exemption that I have to pay myself. The insurance company is now paying 75 percent or 80 percent of my bills. Some policies are 75 or 80 percent. The question comes up: Should I keep three nurses on? If my insurance is paying the whole job, the answer is very easy. I need three nurses day and night. But if I have to pay 20 percent of those three nurses, a little different answer comes. Mr. CURTIS. I can see the reason. Mr. MARSHALL. It comes in these cases. That is one of the very difficult features of this health insurance program. It is possible to malinger and chisel, and not meaning to do it. You do it honestly. You need three if you don't have to pay for them. It is the old profit motive in reverse. Mr. CURTIS. We can put it the other way around and make your statement affirmative when we look at rehabilitation which in my judgment is one of the greatest programs that has been really blooming in recent years. The psychological factor in rehabilitation, they tell is so darn important that we can hurt that if we do not provide the proper incentive to want to be rehabilitated and get well. Mr. MARSHALL. That is right. Mr. CURTIS. I thank your for contributing to my thinking on this subject. Just one final remark to my good friend, Congressman Forand, whom I admire and enjoy discussing this problem with. I think that we need to be a little bit patient. Human beings have been on this earth for many, many centuries and we are coming as close as any society in history that I ever heard of or any present society to even be able to talk about solving these problems, and as long as we can show a good rate of progress, I think that is the key thing. I do believe that the rate of progress in the past few years has been encouraging and I want to say this: That I think part of that rate of progress comes from the stimulation that Mr. Forand provides in these kinds of suggestions, so I think this is all for the good, although I am against your bill. The CHAIRMAN. Are there any further questions? Mr. FORAND. Will Mr. Curtis yield? Mr. CURTIS. Certainly. Mr. FORAND. You may be interested to know, if you do not already know it, that people getting over the age of 65 are increasing at the rate of 1,000 a day. Mr. CURTIS. Just because our doctors and hospitals are doing such a swell job, so let's not criticize them that they are not interested in the people's welfare. Mr. MARSHALL. People are spending their money for vitamins perhaps instead of doctors. The CHAIRMAN. Mr. Alger will inquire. Mr. ALGER. Mr. Marshall, I will not ask further questions. I thought your statement was rather complete. You heard the earlier testimony. I have felt that the previous witness, Mr. Cruikshank, did not present the case clearly. The problem is obvious to us all. He did not present the case clearly, as I see it, where these medical needs occur, other than isolated cases. Whether it would be the suicide that was mentioned, human beings. do strange things. A few isolated cases do not think mean we immediately need a vast national program, but I may be wrong. Mr. Cruikshank agreed that he would give me a documentation for the record here of places where people are not getting medical care, period. You have just made the statement that in your area the people are not turned away from hospital care because they could not pay the bill. What area is that? Mr. MARSHALL. That was the city of Schenectady, N.Y., where for 25 years we have had a very definite policy of never asking when a doctor sent a patient to a hospital how much money the patient had or whether or not he would pay the bill. He was admitted immediately. We inquired later about his means. Mr. ALGER. I just wanted you to know that Mr. Cruikshank is going to offer this committee, I judge, a list of areas, or situations, or cases, however he chooses to do it, where people have been turned away because they could not pay. I think you should be apprised of that because I believe that we need to further develop that and possibly, Mr. Chairman, leave the record open so that if a witness wants to give us additional information on that score, he may, should it become a matter of contention here where we are seeking information. Thank you. (Letters of Mr. Rabaut follow :) HOUSE OF REPRESENTATIVES, Hon. AIME J. FORAND, Chairman, Subcommittee on Administration of the Social Security Law, 1107 New House Office Building. DEAR AIME: Earlier this year I discussed the case of Mr. Raymond G. Jenkins, 5767 Iroquois, Detroit 13, Mich. with you because I thought the bill presented to him by Harper Hospital was exorbitant. I have made copies of some of the pertinent letters in the case and they are herewith attached. This is a pitiful case and the suffering of the parents is tremendous without the added burden of a hospital bill they cannot afford. Yesterday I wrote the director of Harper Hospital and asked him to consider cancellation of the bill as Mr. Jenkins is an average working man, completely dependent upon his wages for the support of his family. The enclosures are being presented in support of your bill, H.R. 4700, which I understand will be called up for hearing next week. With best regards, I am, LOUIS C. RABAUT, DETROIT, MICH., June 9, 1959. Mr. GEORGE E. CARTMILL, Director, Harper Hospital, Detroit, Mich. DEAR SIR: I am writing in regard to my hospital bill No. 683616. At the present time I am totally unable to pay this bill. Since my baby has been sick, I have already spent more than $800 for doctor bills, wheelchair, medical prescription, etc. My little girl is still not well. Consequently, my expenses are still accumulating. Naturally other financial obligations have arisen due to her illness. I have always paid my bills promptly in the past when requiring the services of your hospital. If you check your records you can see that August 3, 1952, and October 1, 1954, my bills were paid promptly and in full by me. Due to the fact that Harper Hospital is supposedly a nonprofit hospital and also the fact that I have lost a completely healthy and normal child to the ravages of malpractice, why not cancel this bill completely? I don't think that I am asking an unfair request. After all my loss is far greater than yours. The extent of damage this tragedy has done to me and my family is incomprehensible. My wife is teetering on the verge of a nervous breakdown and I have lost the will to go on. My son, who is only 4 years old, has been greatly affected by this episode. He cannot understand why his sister who left home on that January day, laughing, running, playing, enjoying television, and relating enthusiastically all of her experiences at school can no longer see or walk. My confidence in mankind is completely annihilated. My child often asks me to take her to Belle Isle, which was her favorite park before she lost her health. As soon as she gets to this park she begins to cry because she cannot see the swings, slide, horses, or the beauty of the merry-goround. I ask you, is it fair for a completely innocent child to be deprived of the joy of walking, the excitement of seeing the comics on television, the beauty of colors, and the many wonders of everyday life? The pathetic part of this case is the fact that she has experienced these things. It is indubitably most piteous to see this child groping in the darkness to which she can never adjust. Yours sincerely, Mr. RAYMOND C. JENKINS, RAYMOND C. JENKINS. HARPER HOSPITAL, Detroit, Mich., June 23, 1959. DEAR MR. JENKINS: This is in reply to your letter of June 9 regarding your Harper Hospital bill. I do not agree with you that there exists any evidence of malpractice or negligence in your daughter's care. All aspects of her care preceding, during and following surgery have been thoroughly investigated. I am satisfied that not only was there no negligence whatsoever on the part of those attending your daughter, but that truly heroic emergency treatment was undertaken in her behalf. It is true that Harper Hospital is a nonprofit institution. As such our charges to patients are set at our costs. The days when civic minded individuals gave large donations to hospitals for free care of the less fortunate are over. Therefore, it is imperative that we make every effort to collect the amount of our costs from patients, their families, or their insurance companies. Inasmuch as the agencies to which you have applied for financial assistance have rejected your application because of certain assets, I cannot honor your request that your indebtedness to us be forgiven. Our credit office will be glad to accept your application for long-term credit arrangements should it be necessary for you to handle your account in this way. Please feel free to contact our credit office at your convenience. Sincerely yours, Hon. Louis C. RABAUT, GEORGE E. CARTMILL, Director. HARPER HOSPITAL, Detroit, Mich., March 24, 1959. House of Representatives, Washington, D.C. DEAR SIR: This is in reply to your letter of March 5 in which you enclosed a letter from Mr. Raymond C. Jenkins, 5767 Iroquois, Detroit, Mich. LaJuana Jenkins, 6 years old, was admitted on January 2, 1959, for a tonsillectomy and adenoidectomy. The surgeon who operated was selected by the family. He is a member of the Harper Hospital attending staff and a specialist certified by the American Academy of Otolaryngology. The surgery was performed on January 2. There were no complications during the surgery, but immediately postoperative the child nearly expired due to cardiac arrest. It is a tribute to the medical staff who attended the patient during this crisis that the patient was restored to life. Most regrettably, the child sustained severe brain damage during the cardiac arrest. I have investigated the incident thoroughly and I am satisfied that not only was there no negligence whatsoever on the part of those attending the patient, but truly heroic emergency treatment was undertaken. |