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to foot the bill for medical care. It simply helps people help themselves.

Because the kind of health insurance we are calling for here is in effect in nearly all the nations of Western Europe, and even in Latin America, I do not doubt that eventually the United States, too, will take this great forward step in social insurance.

I hope it will be soon, and I hope it will be as a result of the work being done here now, by this committee. It is humanitarian; it is financially sound; its need is clear.

I hope it will not be further delayed.

The CHAIRMAN. We thank you, sir, for your statement. We appreciate very much your coming to the committee to discuss this matter with us.

Are there any questions of the Senator?
Mr. Forand will inquire.

Mr. FORAND. Senator, first of all, let me say thank you for the kind words you said regarding my work in this field.

I also compliment you on your paper. You have in a very few words set out the case about as forcefully as anyone can.

There is great need to find a solution to this pressing problem. I have expressed the hope numerous times, not necessarily my bill, or your bill or any particular bill introduced here become law, but if others have alternatives that will do the job better than the bill suggests that they come forward with it.

Up until now I confess nothing worthwhile has been presented. Senator MORSE. Congressman Forand, I appreciate those remarks.

May I say facetiously I appreciate their coming from one who in quotation marks is a "fellow socialist”.

Mr. FORAND. I am more than a socialist according to some of the witnesses. I am practically a Communist.

Senator MORSE. We are not going to be stopped by labels.

Mr. FORAND. I have never been disturbed by name calling. If they think by use of such terms they will discourage my efforts to reach the goal and the goal is the solution of this problem, they are mistaken, if they think that regardless of the actions of this committee, whether this committee does not take action, or if it does, that I am going to stop

Again I want to say they are mistaken because I want to see this problem solved and I am going to continue to work for it as long as I can.

Senator MORSE. May I say for the record that I am not given to preach, but I do believe as legislators we have the responsibility of putting into legislative form the great moral teachings, one, of course, binding upon us that we are our brother's keeper, so I, too, am never concerned about the charge that this will lead to socialism in medicine which, of course, I categorically deny.

What I do propose to do is to protect the elderly from undue commercialism in medicine.

Mr. FORAND. Thank you very much.
The CHAIRMAN. Are there any further questions?
If not, again we thank you, Senator.
Senator MORSE. Thank you very much.

The CHAIRMAN. We will now hear from our colleague, Hon. Thomas J. Lane, from the State of Massachusetts. We are happy to welcome you, Mr. Lane.

Mr. LANE. Thank you, Mr. Chairman.



Mr. LANE. Mr. Chairman, and members of the committee, no one can dispute the fact that our social security program leaves much to be desired. Since 1935, we have extended the range of its coverage, and have increased its benefits on a number of occasions. As the United States, however, was one of the last of the established nations to inaugurate a system of social insurance, it was obvious that we would have to accelerate its development, in order to match the progress of other nations in this field.

There is some difference of opinion as to whether we are expanding our program fast enough. In this age of social and economic change, it is plain to see that our people regard the program in the United States as being far from adequate. The chief criticisms leveled at its deficiencies, center on the lack of insurance to cover the cost of hospital, nursing home, and surgical services for persons eligible for old-age and survivors insurance benefits.

The surprising and commendable support of group insurance to cover hospital and medical expenses, by our working population, is one of the significant developments in our society since the end of World War II. People need and want security, against the economic hazards of old age, and the physical impairments that inevitably accompany the years of deterioration.

The aged require more medical care, but under the present organization of our society, they are the ones who are unable to pay for it. Rather than appeal to charity, some of them, clinging to their human dignity, prefer to suffer in silence.

This is a deplorable situation, unworthy of the world's richest nation. We have had 25 years in which to expand the Social Security Act and to provide health insurance for the aged, but have failed to make a beginning in this respect.

Those who oppose the legislation designed to balance that social deficit, claim that it is unnecessary due to the number of the aged who are covered by private medical and hospitalization programs. This argument is self-defeating because of its contradictions. It fails to mention the drastic curtailment in benefits after the insured reaches the age of 65, or the millions who, because this is a voluntary decision, neglect to take out such insurance.

I was impressed last year by the statement of Dr. Eveline M. Burns, who testified on behalf of the National Association of Social Workers, the professionals who have the most practical knowledge and experi. ence in this field. She testified in part:

We endorse the proposals contained in Congressman Forand's bill, H.R. 9467, for the payment of hospital, nursing home, and surgical expenses for individuals entitled to OASI benefits. Even if it were deemed undesirable at this time to extend this privilege to survivor beneficiaries, we believe there is an overwhelmingly strong case for doing so in the case of the retired aged * * * The cost of medical care to the aged is increasingly becoming our major national social

problem. It is the cause of a large part of the supplementation of OASI benefits and of the rising costs of public assistance, despite the declining numbers of old-age assistance recipients. It will become increasingly important with the growth in numbers of the aged * * * The question the Nation faces is merely the question of the best way to meet these costs * * * We believe that, for the long run, the most rational method is by way of insurance, and that the most feasible method of making sure that everyone shall be insured is to utilize the machinery of compulsory premium payment through OASI.

Congressman Forand's bill which this year bears the identification H.R. 4700, is notable because it will not only provide insurance against the costs of hospital and surgical services, but takes cognizance of the growing need for nursing home care. With the lengthening span of human life, we shall need more of this special type of service for the aged.

Congressman Forand's bill will finance the extra cost, with respect to employees and employers, by gradual increases for both under the Federal Insurance Contributions Act to a maximum after December 31, 1968, of 434 percent. This, even though it is an addition to other taxes under the F.I.C.A. to finance the provisions of the Social Security Act, is a small price to pay for removing the dread specter of fear and worry from the last years of our older citizens who are in need of medical care but are unable to pay for it from their social security checks.

As long as legislation to provide such insurance is certain to be enacted in the near future, in response to public demand and social needs, I believe that our best course is to make the beginning, now, so that our program will be adjusted to the increasing percentage of the aged in our population.

The CHAIRMAN. Thank you, Mr. Lane, for coming to us and giving us the benefit of your views on this subject.

Mr. LANE. Thank you, Mr. Chairman.

The CHAIRMAN. We will now hear from our colleague, Hon. John B. Bennett from the State of Michigan. We are happy to welcome you, Mr. Bennett.

Mr. BENNETT. Thank you, Mr. Chairman.


Mr. BENNETT. It is my sincere belief favorable consideration should be given at an early date to provide medical and hospital care in our social security system. It is very apparent our numerous retired people find it impossible to pay for the cost of medical care associated with hospitalization on the meager pensions now available to them. My proposal is that the cost of hospital care and surgical services should be provided in the hospital up to 60 days for people eligible for social security benefits. Then, if further care in a nursing home is indicated by the physician, additional costs up to 120 days of combined hospital and nursing home care is provided. It incorporates an income test, used in many private plans, by limiting this protection to those people whose total family income, including social security benefits, does not exceed $2,400 a year. The method of confining payments to those hospital services where cost schedules have already been tested by Blue Cross plans, also preserves the professional independence of doctors. We must take this forward step to provide a form

of insurance protection for those people on social security whose income is so limited they cannot afford to pay the premiums for this kind of prepaid care. I am convinced our older people are not getting their share of the modern but increasingly costly miracles of medical care, which high cost is felt more acutely by older people because their illnesses are usually of longer duration.

It is well known that the wider application of preventive measures which we are getting today will lead to less infirmity in older years in the future. This is one of the reasons why I am not persuaded by the argument sometimes presented that my proposal would lead eventually to excessive medical costs. I also believe the doctors of this country are competent enough, and honest enough, to insure against any abuse of this provision.

Good evidence indicates that it is not through negligence that many older people are without medical care protection. It simply is not available to them at a price they can pay. My plan with its $2,400 income ceiling is designed specifically to meet the medical care needs of people with a low retirement income who would otherwise be selfsufficient. In this way we will not only preserve individual selfrespect, but will also be helping hospitals to meet the mounting costs of providing the best kind of medical care for people who cannot now afford it.

I also propose a more liberal definition of permanent and total disability for social security benefits and a modification of the present stringent length of service requirements. I believe such modifications should apply to the benefits payable to people 50 and over and also to the "disability freeze” which applies to workers at any age. The definition of disability in the law is strict and it is even more strictly administered. My proposal is to modify the present law by stating a person must be unable to "engage in a substantial gainful activity which is the same as or similar to the occupation or employment last performed by him on a regular basis before the onset of such impairment.”. This terminology is closer to what Congress really intended in passing the 1956 amendments and will insure administration of the act in a way that will give the American worker real protection against crippling injury or disease. Then, too, I propose the period be reduced to 15 out of the last 30 quarters of coverage for an individual to qualify for disability. Such revision will take care of some of the tragic cases of middle-age workers who are incapacitated in the early years of their coverage under this system.

We must keep our social security system up to date because we believe in the inherent dignity and worth of each individual. The above described changes are required in our present social security program. It is my sincere hope the Members of this Congress will enact such changes into law.

The CHAIRMAN. Thank you, Mr. Bennett, for coming to us and giving us the benefit of your views on this subject.

Mr. BENNETT. Thank you, Mr. Chairman.

The CHAIRMAN. We will now hear from our colleague, the Honorable A. S. J. Carnahan, from the State of Missouri. We are happy to welcome you, Mr. Carnahan.

Mr. CARNAHAN. Thank you, Mr. Chairman.


Mr. CARNAHAN. Mr. Chairman, and members of the committee, I appreciate the opportunity to appear before you. Each of us in Congress has had an opportunity to observe the extraordinary interest and concern that has been evoked by H.R. 4700, introduced by the Honorable Aime J. Forand, which is designed to ease the problems of the old-age and survivors insurance beneficiaries in regard to certain medical costs. I believe I speak in behalf of a large number of my constituents when I say that this bill deserves favorable action by this committee and this Congress. The problem of how to pay increasing medical costs is a frighteningly serious one for all of us, but especially for those who are forced to live on meager, fixed retirement incomes.

We in Missouri have particular cause for concern, because our population of elderly persons is even higher than the national average. Figures from the Census Bureau show that in 1960 the number of persons 65 years old and more will reach 10.6 percent of our total State population. This is almost 2 percentage points higher than that for the United States as a whole.

Throughout the country, however, the number of elderly persons who need this legislation is growing at an extremely rapid rate. The problem of adequate medical care for these people cannot, therefore, be regarded as a local or regional one. Everywhere it has reached serious enough proportions to warrant the attention of each Member of Congress. It is clear that we must have an answer to it, and we must find it soon.

As I have indicated earlier, I believe the best answer lies in passage of the bill the committee is now considering. It has one basic advantage which no other public or private proposal has offered: It would enable persons to pay for the cost of the insurance at a time when they were employed and could afford it. After retirement they would be free of the burden of monthly premium payments which inevitably are a serious drain on small pension incomes.

The method of payment for the medical insurance program under the Forand bill is well conceived. It makes uses of existing social security machinery, and makes it easy and painless for each person under the social security system to qualify for benefits. According to reliable estimates, the initial costs of the program, which would amount to about $1 billion annually, would be covered adequately by increasing the social security tax by a very small percentage. Each employer and employee would pay about three-eights of 1 percent of payroll on earnings up to $4,800 each year. The self-employed would рау

nine-sixteenths of 1 percent. This seems to me a very reasonable price to pay for the benefits which would be gained.

The medical coverage offered under the Forand bill would not be comprehensive. But it would have certain basic advantages over the insurance that is available to older citizens under existing plans. Most important, every person entitled to old-age and survivors insurance benefits would be eligible, which means that no one could be arbitrarily denied insurance coverage. In addition, the benefits which would be provided are ones which the elderly are most likely to need. The cost of surgery, which today often is far beyond their means would be covered. Expensive hospital and nursing home care would also come

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