HOUSE OF REPRESENTATIVES, Washington, D.C., July 2, 1959. Hon. WILBUR D. MILLS, Chairman, House Ways and Means Committee, House Office Building. DEAR CHAIRMAN MILLS: I write to indicate my support for H.R. 4700, the Forand bill, to provide insurance against the cost of nursing home and surgical services to those receiving old-age and survivors benefits. I believe that such an extension of our social security system is warranted as an effort to assist those who are not able to protect themselves from the eventualities of medical and hospital expenses at a time when they are dependent upon social security benefits. Such care is needed if the ever-increasing cost of medical expenses are to be met by retired persons, widows, and others who are covered by the social security system. I have had numerous indications of support for such legislation from Vermont, and there is great need for medical assistance of this type in our State. I would appreciate having an early chance to consider this bill on the floor of the House. With best personal regards. WILLIAM H. MEYER. AMERICAN HOSPITAL, Re hospitalization for people over 65. House of Representatives, Washington, D.C. Los Angeles, Calif., July 17, 1959. DEAR MR. MILLS: I would like to express to you my very strong support for H.R. 4700, a bill to provide insurance against the cost of hospital and surgical services for recipients under OASI. I am of the opinion, however, that the bill is too generous in providing 60 days of hospitalization in each 12-month period and up to 120 days of nursing home care in a 12-month period. I would like to see this reduced until substantial experience has been gained. The bill, itself, is well written and it is my hope that your committee will approve it as soon as possible. Respectfully yours, GEORGE O. SHECTER, Hon. WILBUR D. MILLS, GOVERNMENT EMPLOYES' COUNCIL OF THE AFL-CIO, Chairman, House Ways and Means Committee, MY DEAR CHAIRMAN MILLS: By way of introduction I am Thomas G. Walters, operations director of the Government Employes' Council, AFL-CIO. The council is made up of 24 national and international unions and associations whose membership, in whole or in part, are Federal and postal employees, representing a membership in excess of one-half million. On behalf of the Government Employes' Council I express to Congressman Aime J. Forand our thanks and appreciation for the introduction of H.R. 4700, and to you, Mr. Chairman, for scheduling hearings on this most important and much needed legislation. We greatly appreciate the opportunity of presenting this statement as an endorsement of the intent of H.R. 4700. We believe that we have waited much too long to give some hospital and medical attention to our older people, and we trust that this committee will favorably report legislation having for its purpose the intent of H.R. 4700. Appreciate the opportunity of having the privilege of endorsing this type of legislation. Most sincerely, THOMAS G. WALTERS, LITTLE FALLS, N.Y., July 11, 1959. Hon. WILBUR D. MILLS, House of Representatives, DEAR SIR: Having spent 30 years in the (successful) practice of medicine as a general practitioner, as a physician in mental institutions, and in the private practice of psychiatry I feel qualified to express an opinion: All is not well with providing adequate medical care for the people in general, for the aged in particular, claims to the contrary notwithstanding. I am in favor of the Forand bill. Very truly yours, GUSTAV LOEWENSTEIN, M.D., Member, New York State Medical Society, the AMA and the American Psychiatric Association. The CHAIRMAN. Our next witness is Dr. Hampton. Mr. HERLONG. Mr. Chairman, while Dr. Hampton is taking his seat, I should like to present him to the committee. He is a warm personal friend of mine, a distinguished member of the medical profession of the State of Florida. He is the chairman of the committee on legislation and public policy of the Florida Medical Association, an association in which, in my judgment, is a most progressive association and which is doing something about this problem of medical assistance to the elderly in a State which has probably as high or a higher percentage of elderly people among its population as any other State. The CHAIRMAN. Thank you. Dr. Hampton, if you will, give us your full name, address, and the capacity in which you appear. STATEMENT OF DR. H. PHILLIP HAMPTON, CHAIRMAN, COMMITTEE ON LEGISLATION AND PUBLIC POLICY, FLORIDA MEDICAL ASSOCIATION Dr. HAMPTON. Thank you. I am Dr. H. Phillip Hampton, of Tampa, Fla., where I am engaged in the private practice of medicine. The CHAIRMAN. You are representing the Florida Medical Association? Dr. HAMPTON. Yes, sir. I am representing the Florida Medical Association as a member of the board of governors of the legislative and public policy committee. The CHAIRMAN. You are recognized, sir, for 5 minutes. Dr. HAMPTON. Thank you, sir. Due to limitations, I will not be able to read my entire statement. The CHAIRMAN. It will appear in the record. Dr. HAMPTON. Thank you, sir. If a problem in the economy and distribution of medical and hospital care exists in this country, can it not be solved by application of American ingenuity with the incentive and under the proven principles which have been our strength and not resort to questionably effective plans as tried by other governments foreign to our way and destructive of our traditional principles? That was the purpose of the medical doctors of Florida when, in 1954, they requested the Governor to appoint a committee to study the problems of medical and hospital care in this State with particular reference to those who were unable to provide this care for themselves. The committee report, published in two volumes, presented the following major findings: Although the Florida constitution charged the county government with the responsibility of providing hospital care for the indigent, the majority of counties either ignored the responsibility or budgeted an amount entirely inadequate to provide proper hospital care. As a result (a) hospitals were usually required to absorb all or part of the cost of indigent hospitalization and passed this cost on to paying hospital patients and (b) the county lines often acted as a barrier to good medical care and prevented efficient use of existing hospitals established under the regional hospital system in neighboring counties. There are two groups of individuals unable to pay for medical and hospital care: (a) those persons on the State welfare rolls who require public assistance for food, clothing, and shelter and (b) those persons who, after proper investigation, are found able to provide the basic necessities for themselves but cannot meet the cost of medical care and hospitalization-the medically indigent. The committee recognized that indigency was a disease with economic, sociologic, medical, and political causes which needed to be eradicated by specific treatment in order to rehabilitate the individual to independence. A merely supportive approach to the problems of indigence leads to an incurably chronic condition of indigence as a way of life with the individual completely dependent upon the State and free of responsibility. The committee recommended establishment of a uniform system of hospitalizing the acutely ill indigent by creation of a State and county matching fund out of which payments might be made directly to hospitals for the costs of caring for certified indigent; the smaller government (county) units would be encouraged to assume the major administrative and financial responsibility. Plans for care of the chronically ill and outpatient care of indigent were to be made after additional study. It was assumed the doctors of Florida would continue their services to the acutely ill, hospitalized indigent persons without charge, pending further study. The recommendations were enacted into law by the Florida Legislature and became effective January 1, 1956. The program is administered through the county health officers and is flexible enough to meet the individual problems of each county. The health officer may delegate determination of indigence and other duties to qualified agencies. A one-page form is used by the physician who makes the diagnosis and refers the patient for hospital admission, by the social worker who determines indigence, and by the hospital for the bill. Of Florida's 67 counties, 64 (97 percent of the population) voluntarily joined the statewide program to provide hospital care for the acutely ill indigent and the plan has functioned to the satisfaction of patients, hospitals, and physicians. No one is denied hospital care who needs it. With a yearly expenditure of approximately $2 million in State funds, and $2 million in county funds about 22,000 indigent are provided hospital care each year at an average hospital daily cost of $20 and average hospital stay of 9.6 days; 46 percent have been public assistance recipients and 54 percent medically indigent. Some 26 percent were age 65 and over. In only 10 percent of the admissions was there participation in payment to the hospital by family, charitable organizations, or insurance. As the 1959 Florida Legislature found itself hard pressed for funds, the State appropriation for hospital care of public assistance recipients was made to the State board of health with instructions to supplement it with Federal matching funds. Although we are of the opinion that indigent care programs should be administered and financed as close to home as possible, the doctors of Florida have cooperated in advising the State board of health and State welfare department on a contract by which hospital care can be provided welfare recipients by using State and Federal funds in the same program of hospital care for the medically indigent using State and county funds as previously described. However, the arrangements have not been easy due to the rigidity in Federal regulations, as interpreted by the State welfare board, concerning the use of Federal matching funds. One might almost conclude that the law and regulations were so written as to require medical care to be completely administered by welfare agencies and to exclude the medically oriented agencies and medical doctors from participation in the planning or administration of the health programs. The proposed legislation under consideration would vastly broaden health care under the department of welfare and another broad health program has been proposed to the Congress in an expansion of rehabilitation activities under the department of education. Continuing their study on the problems of medical care, the second Citizens Medical Committee on Health appointed by the Governor recently made the following pertinent recommendations: 1. For the extension of the benefits of health insurance: Through every practicable channel encourage the development and promote the use of voluntary low-cost health insurance which will extend benefits to the aged and cover long-term illnesses. 2. For reduction in the costs of hospital care in long-stay illnesses: The encouragement of the construction and operation of "limited service hospitals" in close proximity to major general hospitals to promote early transfer of patients from general hospitals and to provide efficient long-term care of chronic diseases. 3. For more adequate nursing home care: Legislative authorization for the welfare board to implement a program to pay the cost of nursing home care for public assistance recipients, this to be provided by county, State, and Federal matching funds; also encouragement of the active participation of religious groups in developing and maintaining nursing home facilities. 4. For accessible and economical medical care for the aged and those with chronic illness; The expansion of present outpatient clinics and the organization of additional clinics to meet the medical needs of the indigent aged and the chronically ill, with such services coordinated with and fully utilized in expanding and strengthening the intern and resident medical training program. 5. For home care of the aged and the chronically ill: Within the realm of existing health agencies expand and modify community 44432-5915 nursing programs so the services of visiting nurses will be widely available and existing welfare agencies to sponsor foster home care, and homemaker and friendly visitor services. 6. For the provision of medical services to recipients of public welfare: The assignment of responsibility for medical and health matters to the medically directed health agency with the evolution of appropriate interagency administrative relationships. 7. For increased State and local responsibility for medical care of the indigent program: Use every possible influence to obtain a release to the States of tax sources now utilized by the Federal Government for the support of health services with planning and administrative responsibility centered as close as practicable to those served. In accordance with these recommendations the Florida Legislature this year amended the hospital service for the indigent law to include outpatient medical care and development of ancillary medical and nursing outpatient services and implementation is proceeding as rapidly as available funds permit. The Florida Medical Association has created the Florida Medical Foundation for the purpose of providing medical services for care of the indigent, postgraduate medical education, and research. This organization can work closely with the State board of health and State welfare department in providing and coordinating these medical services. The fabulous advances made in the field of hospital and medical insurance in recent years attest the responsibility the people of this country feel to individually provide medical care for themselves. In 1958, a survey revealed that 63 percent of the population have health insurance, but only 35 percent of those aged 65 and over were insured. Led by Blue Shield and Blue Cross, insurance companies in Florida are improving their insurance coverage and are offering medical and hospital insurance on an individual basis to the aged. This is the American way. In Florida, no one who needs it goes without hospital care. Voluntary health insurance is being rapidly expanded and is the answer for the majority. Health needs of the indigent are provided for by medically directed statewide programs. Only the practicing medical doctor can prevent the abuses necessary to insure the economical and efficient operation of these medical insurance and indigent care programs. The initiative of the medical profession must be encouraged to assume the responsibility of these efforts, but it would be thwarted by Government programs such as the proposed legislation. Florida is well on the way to finding answers to the economic problems of modern medical care through novel applications of traditional principles of individual responsibility in a cooperative manner. We do not need additional Federal legislation to solve these problems but we do need a relaxation of the rigid regulations directing health activities under Federal welfare control and we do need release of certain Federal taxes collected in our State so that these funds might be applied to solving our particular health problems in our |