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LaJuana Jenkins was discharged to the family home on February 28, 1959. Every test and treatment known to our specialists were tried to restore the child to good health but all failed. It is the unanimous opinion of all that the brain damage is too severe for full recovery. Institutionalization was recommended and the parents made application for the child's commitment to a State institution,

The Jenkins' family was accorded every consideration throughout the period of the child's hospitalization. At no time did they indicate full realization or acceptance of their child's condition and prognosis. The family was allowed free medical supervision following surgery to relieve the financial strain.

Of the total hospital bill of $1,988, the Jenkins have paid $368 to date. The several official and voluntary agencies to which Mr. Jenkins applied for financial assistance rejected his application because of the family's financial resources. Mr. Jenkins has not applied directly to Harper Hospital for assistance. Certainly we will consider bis request for long-term credit arrangements if he should make such a request. Should you bave additional questions which I may answer, please let me know. Sincerely yours,

GEORGE E. CARTMILL, Director.

DETROIT, MICH., February 28, 1959. Representative Louis C. RABAUT, 1232 House Office, Washington, D.O.

DEAR SIR: I think the proposed bill of socialized medicine is good for this country. I do hope that you will support Representative Dingell in getting this bill passed.

Doctors and hospitals in this country are just plain robbers. The prices they charge people are definitely getting out of hand. Not only do they rob people, but they wreck their health also.

Following is a typical example:

On January 2, 1959, I took my little 6-year-old daughter to Harper Hospital for a simple tonsillectomy. They told me she would be able to go home the same day. I was informed that the charges would be approximately $135, which would cover the complete charges. How wrong they were. At the present time my daughter is still in the hospital. I am being charged approximately $400 a week. (I don't have Blue Cross. I was priced out of it by their high rate several months ago.) Not only is all of my money gone, but her health is gone as well.

Since I am unable to pay these exorbitant rates they are making every effort to discharge my daughter from the hospital.

The doctors at Harper Hospital, after extensive examination, have informed me that my baby will never be normal again, and also stated that she should be institutionalized.

Sir, how in the name of God can something like this happen in a State which is supposed to be up to date and civilized? I am being charged for something for which they were the cause.

When I brought my child to this hospital, she was a picture of health-smiling, happy, and joyful. You should see her now. What a difference. How cruel can this world be?

I have been to various agencies around the city. No one will give me any type of assistance-medically, spiritually, or financially. The crippled children's commission refused me aid because I am a property owner. I applied at the veterans trust fund which has $50,000 to aid veterans who need financial assistance. They refused to give me any assistance because they feel that my case is not an emergency.

In view of the above-mentioned facts, you can readily see why we need some type of socialized medicine in order that this vicious thing will not happen to some other unfortunate person. Democratically yours,

RAYMOND C. JENKINS,

Democratic Delegate, Ward 17, Precinct 25. The CHAIRMAN. Are there any further questions of Mr. Marshall ?

If not, again, Mr. Marshall, we thank you, sir, for coming to the committee and giving us the thinking of the Chamber of Commerce of the United States.

Without objection, the committee will now recess until 1:30 this afternoon.

(Thereupon, at 12:15 p.m., the committee recessed, to reconvene at 1:30 p.m., same day.)

AFTERNOON SESSION

The CHAIRMAN. The committee will please be in order.
Our next witnesses are Mr. Lourie and Dr. Schottland.
Mr. Lourie, are you to make the presentation ?

STATEMENTS OF NORMAN V. LOURIE, VICE PRESIDENT, NATIONAL

ASSOCIATION OF SOCIAL WORKERS, AND CHAIRMAN, COMMISSION ON SOCIAL POLICY AND ACTION; AND DR. CHARLES I. SCHOTTLAND, DEAN, FLORENCE HELLER SCHOOL FOR ADVANCED STUDIES IN SOCIAL WELFARE, BRANDEIS UNIVERSITY, REPRESENTING NATIONAL ASSOCIATION OF SOCIAL WORKERS

Mr. LOURIE. I will make a presentation and Mr. Schottland will also make a presentation. We will divide the time, sir.

The CHAIRMAN. Do you want to be notified at a certain point?

Mr. LOURIE. I think between us we will take about 30 minutes. We will take 30 minutes, totally.

The CHAIRMAN. Do you want 20 minutes, and then 10 minutes for
Mr. Schottland ?

Mr. LOURIE. We will each take about 10.
The CHAIRMAN. Do you want me to notify you at any point?
Mr. LOURIE. At the end of the 30 minutes, sir.
The CHAIRMAN. You will watch your division.

Mr. UTT. Mr. Chairman, I would like to welcome Mr. Schottland to the witness table. He has a long and enviable record of serving California for many, many years before he came to HEW. He had retired and now is back at work again.

Mr. SCHOTTLAND. Thank you, sir.
The CHAIRMAN. Will you identify yourself for the record.

Mr. LOURIE. I am Norman V. Lourie, vice president of the National Association of Social Workers, and chairman of the commission on social policy and action. I am accompanied today by Dr. Charles I. Schottland, dean, Florence Heller School for Advanced Studies in Social Welfare, Brandeis University, who will also make a statement for the association immediately following the completion of my remarks.

The CHAIRMAN. You are recognized for 30 minutes. Mr. LOURIE. I would like to identify myself further by indicating that I am deputy secretary of the Department of Public Welfare of the Commonwealth of Pennsylvania.

The National Association of Social Workers is the professional association representing 23,000 social workers in the United States. Our members work in public and private social welfare and health organizations. We work for every State government, the Federal Government, in most counties in the country, and for practically every sectarian and nonsectarian philanthropy.

The concern and leadership of the Committee on Ways and Means for improving the health and welfare of all Americans is well known

to all of us and much appreciated. We welcome the opportunity to submit our point of view with respect to the necessity for initiating a program of health-care benefits.

We feel close to you in this matter because our work, too, represents unselfish, humanitarian concerns for people. Historically, you find our profession among the social security pioneers in America. Many of the organizations which testify have our members in their midst. We are proud that several of the Commissioners of Social Security have been and are members of our profession, as are many of the personnel in the Department of Health, Education, and Welfare.

Our association has long had among its goals of public social policy statements on social insurance and health. I would like to ask that these two policy statements, which were approved at our delegate assembly in May 1958, be included as part of my statement.

With respect to our policy statement on social insurance, included among the recommendations is the following:

Included in this system should be provision for medical services to covered persons and their dependents.

In our statement on health, we indicate as follows:

A comprehensive national health program, which will assure full health care to all individuals by applying the principles of group payment and tax support or the principles of compulsory national health insurance to a total range of health measures, is endorsed and the development of such a program recom

mended.

From this last excerpt from the health statement, it is obvious that we do not believe that the bill (H.R. 4700) being considered by this committee goes far enough, and we hold that a national health insurance system is not only desirable but is possible to achieve.

Alternatives to hospital and nursing home care are available. We will not suggest them here. The American Public Welfare Association which appears before you tomorrow will propose amendments to H.R. 4700. Many of our members are in APWA and on the committee that drafted the proposals.

On the broad question of health insurance these are the facts as we understand them.

Voluntary health insurance, according to December 1958 preliminary estimates, covered 121 million people, 70 percent of our population.

However, less than half of our older citizens have any kind of health insurance. As you know from the study made for your committee by the Department of Health, Education, and Welfare, older people use 21/2 times as much general hospital care as those under 65. Încome for this group is lower than for the rest of the population. Proportionally more people over 65 rely on public assistance or free care than

any other age groups. Many of these are self-sustaining for all necessities of life except medical care. They have profound and rightful objection to a means test for medical care, particularly when it can be provided through insurance.

This report also revealed to you that persons with health insurance enter hospitals more frequently but have more short-duration stays than those who are uninsured.

Persons with insurance go in early for treatment or diagnosis; persons without insurance include many uninsurables and those who postpone care until need is overwhelming.

In Pennsylvania, where naturally I am most familiar with facts with respect to medical care needs of the aged, almost 10 percent of the total population, or about 1 million persons, are over 65 years of age. As a group, these people not only have the highest costs for medical care but are least able to pay for it.

A major factor in the high costs of medical care for aged people is hospitalization. Older people have more illnesses and disabilities than those in the prime of life. Injuries due to accidents are often more serious; older bones break more easily and heal more slowly. The result is that people over 65 years of age need to go into hospitals more often and stay longer when admitted.

A number of efforts have been made in Pennsylvania to cope with the problem of medical care needs of the aged. Yesterday you heard from some of our Philadelphia people. The solutions, however, have been less than satisfactory. The General Assembly of Pennsylvania, for example, provides $28.5 million in subsidies to hospitals for “free care.” This amount may possibly be increased. However, the subsidies at best pay about one-half of the cost of this so-called free care. The hospitals make up the other half as best they can. This presents, we know, a very serious problem to hospitals in Pennsylvania; so serious, in fact, that some Chests and United Funds are considering discontinuing their support of hospitals because of the unrealistic financial burden placed upon them.

An arrangement, therefore, that would permit the costs of hospitalization of older persons to be pooled over all wage earners through the social security system might insure first, that such care would be made available, and secondly, would relieve the State of Pennsylvania and its municipalities and voluntary groups of increasingly difficult and almost impossible problems of financing such medical care.

We have studied the arguments against extension of OASDI to health care. We cannot agree with them. The patient's free choice of hospital or physician is not curtailed. It is not a free service. It does not have to reduce the quality of care. It will not discourage medical education, research, or advancement. It is not socialized medicine. It is not a system of regimenting doctors or bringing them under bureaucratic control.

We are opposed to extension of public assistance grants and governmental subsidies as a method of meeting health needs. Purchases of medical care by OASDI beneficiaries are regarded as consumer expenditures, not governmental expenditures. It seems so logical to meet the expanding need in this way rather than to extend tax support surrounded by all the uncertainties of local government and its financing

Tax support is highly developed for mental and tuberculosis care. Why? Because a long time ago citizens decided that their Government had to take over this responsibility. No one objected because no one else could bear the burden. Care was too expensive for the average man. Government, in fact, entered what was a profitless area for the medical practitioner.

Should our approach to general medical care be direct Government intervention? For the medically indigent, including the OASDI beneficiary, this is becoming an increasing reality.

We forget that the first compulsory insurance system in the world was American. The Congress in 1798 set up and operated health insurance for seamen—the Marine Hospital Service. Stopped in 1884, it began with deducting from wages until in 1905 the system became tax-supported. Health insurance was replaced by wholly tax-supported medical care. When we examine the ever-increasing number of OASDI beneficiaries who get public assistance grants and a major number get their medical care paid for by tax funds, even though Mr. Marshall said the percentage was down, the actual number of OASDI beneficiaries who get their medical care paid for is larger and we must recognize as spurious the "socialized medicine bogey."

Certainly, payment of medical care out of governmental tax funds is less desirable within our "way of life” than the purchase of medical care by beneficiaries with OASDI insurance funds.

We would like your committee to consider seriously the following suggestions before reaching its final decision.

1. Do not think of hospital and nursing home care as the sole methods for meeting the health needs of aged persons.

2. In listing the institutions and agencies to receive Federal assistance, do not exclude facilities operated by State and local governments.

3. Provide for the setting and maintaining of proper standards in the facilities your committee decides should receive payment.

4. Establish safeguards around your determinations of reasonable costs for hospital and nursing care to be paid out of insurance funds.

Again, I appreciate very much this opportunity to present the point of view of the National Association of Social Workers to this committee. As I indicated earlier, Dr. Charles I. Schottland will now present his statement to the committee.

The CHAIRMAN. Before you proceed, Mr. Schottland, I notice that there is some additional material here. Do you want to make that part of your statement?

Mr. LOURIE. That is the policy statement that I referred to earlier. We would like to make it part of the record.

The CHAIRMAN. Without objection, that will be part of the record. Mr. LOURIE. Thank you, sir. (Mr. Lourie's prepared statement and the policy statement follow:)

STATEMENT ON H.R. 4700 FOR THE NATIONAL ASSOCIATION OF SOCIAL WORKERS BY

MR. NORMAN V. LOURIE, VICE PRESIDENT OF THE ASSOCIATION AND CHAIRMAN OF COMMISSION ON SOCIAL POLICY AND ACTION, JULY 14, 1959

Mr. Chairman and members of the committee, I am Norman V. Lourie, vice president of the National Association of Social Workers and chairman of the Commission on Social Policy and Action. I am accompanied today by Dr. Charles I. Schottland-dean, Florence Heller School for Advanced Studies in Social Welfare, Brandeis University, who will also make a statement for the association immediately following the completion of my remarks. I would like to identify myself further by indicating that I am deputy secretary of the Department of Public Welfare of the Commonwealth of Pennsylvania.

The National Association of Social Workers is the professional association representing 23,000 social workers in the United States. Our members work in public and private social welfare and health organizations. We work for every State government, the Federal Government, in most counties in the country, and for practically every sectarian and nonsectarian philanthropy.

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