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who could be classed as elderly. From this sample, various conclusions were reached by accepted statistical methods to determine the number of families having individuals 65 or older in the entire city, and the number of such individuals. The conclusion was reached that there are in the city of Milwaukee 53,394 elderly families, and of these 35,775 families or 67 percent receive annual gross incomes of less than $3,000. The average for these families is $2,491.

The source of this income is also shown in the survey. For example, 3.7 percent of the elderly families report that they receive some income from their own business ; 28.5 percent receive income from wages; 65.7 percent receive it from social security; 27.6 percent receive some from pensions; 27.2 percent receive some from rental property; 5.9 percent receive some from insurance; 12.6 percent receive some from stocks or bonds; and 8.7 percent receive some income from other sources.

It was found that 29.7 percent of elderly families in Milwaukee pay rent for shelter; 52 percent own their home debt free; 7.3 percent own their own home but pay on a mortgage; 10.9 percent do not pay for shelter.

The average mortgage payment of elderly families in Milwaukee who pay on a mortgage is reported as $65 per month; the average rent payment for those living in a rented home is reported as $72 per month; the average rent for those paying rent in a relative's home is reported as $49 per month; and the average for those paying rent in a furnished room is $42 per month; those in a rooming house pay $41 per month. The average rent payment of elderly families for all types of shelter is $67 per month. So much for income.

Regarding insurance and the need for medical care, the survey uncovered these facts : 93.8 percent of residents in homes for the aged in Milwaukee are reported to be 65 years of age or older ; 3.9 percent would not be residents if adequate housing facilities were available; 71.8 percent require continuous nursing care; and 28.1 percent require a special diet.

Estimates indicate that 97.9 percent of residents in homes for the aged have an annual gross income, excluding those amounts which are the direct result of being a resident, of less than $3,000.

Of the 53,394 elderly families, only 35,081 have social security ; 15,218 get some of their income from wages; 14,737 from a pension ; nd 3,150 receive income from insurance.

The survey uncovered other important data concerning elderly families in Milwaukee, but not information applicable to the present case.

Another source of information concerning the carrying of hospital-surgical insurance by the elderly was obtained from our own city of Milwaukee Employees' Retirement System. The executive secretary, Miss Ruth Poehlmann, supplied us with the following table:

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Retired payroll.
Over age 65.
Number carrying hospital-surgical insurance.
Average retirement allowance, per month..

982 300 450 $135

994 769 $120


332 $125

1 Approximately one-third of total.

Miss Poehlmann also pointed out a trend that she has noticed which is that as the premiums for hospital-medical care increase, the number of retired persons canceling contracts increases also. Under the Employees' Retirement System since March 1, 1959, when the new higher premium rates were set, there have been 40 cancellations of contracts. According to Miss Poehlmann, the Firemen's and Policemen's Retirement Systenis have had similar experiences.

We hope the information contained in this letter will help your support of H.R. 4700. Very truly yours,


Municipal Reference Librarian. (Source: Marquette University. Studies in Business and Economics: A study of quantitative and qualitative characteristics of elderly families and individuals residing in the city of Milwaukee, Wis. Monograph No. 3, Series 4, May 1958.)


Mr. ZABLOCKI. This, then, is a complex and grave problem, and I must admit that I do not have an immediate solution for it. It would seem to me, however, that the proposal embodied in the bill being considered by your committee represents a step in the right direction. It may not solve the whole problem, but it contains some carefully studied and constructive suggestions.

I want to take this opportunity to commend the author of the bill, Congressman Forand, for the lengthy and thorough consideration which he has been giving this subject, and for seeking information, in developing the final legislative proposals, from persons closely connected with the problems of the people who need medical care, and with the people who furnish that care, including hospital administrators, physicians, nurses, and representatives of health and technical groups.

I know that your committee will give thorough study and attention to the evidence submitted by all such persons during these hearings. I believe that it is only by working carefully and drawing upon the wealth of experience and information possessed by all interested parties, that we can hope to find a fair and effective remedy to this grave and complex problem.

I want to thank you, Mr. Chairman, and the committee, for the opportunity of appearing before you today to testify on this legislation.

The CHAIRMAN. Mr. Zablocki, we thank you, sir for bringing your views to the committee on this legislation. We appreciate them.

Are there any questions!
Mr. Forand.

Mr. FORAND. Mr. Zablocki, I join with the chairman in saying thanks for your coming here. I appreciate not only the kind words you have spoken in my behalf, but also appreciate the great interest and assistance you have given me in this task.

You have proven to me over the years your sincerity in trying to help find a solution to this troublesome problem. Again I say thank you.

Mr. ZABLOCKI. It was a privilege to work with you in seeking a solution to this problem. Thank you very much.

The CHAIRMAN. Are there any further questions.
We thank you, sir.
Mr.ZABLOCKI. Thank you, Mr. Chairman.

The CHAIRMAN. We will now hear from our colleague, Hon. James Roosevelt from the State of California. We are happy to welcome you, Mr. Roosevelt.

Mr. ROOSEVELT. Thank you, Mr. Chairman.



Mr. ROOSEVELT. Mr. Chairman and members of the committee, it is with deep conviction that I say the Forand bill, H.R. 4700, of which I am proud to be a cosponsor, is one of the most significant and forwardlooking proposals to come before you for your consideration and, I


hope, favorable action. I wish, therefore, to take this opportunity to commend you for conducting a hearing in this matter.

I believe it necessary to state at the outset that the arguments against this bill are not consistent with the available facts at hand and are not responsive to a demonstrated human need. Further, I think the descriptive words, such as "socialistic," are misleading and illogical, and are used to play on the human emotion of fear rather than on the distinctive human gift of reason.

If one is interested in discussing the issue in the realm of semantics, may I respectfully point out that in the title of the bill is the word “insurance.” This is a word that perhaps the opponents of the bill prefer to overlook, because the insurance principle has proved to be à sound, budgetary approach to our social-security law, providing retirement benefits based on contributions of both the employer and employee. And certainly this concept of insurance protection, in one form or another, is an integral and successful aspect of our business and personal world. Yet, when a new application of this principle is proposed, suddenly certain groups charge an “alien” flavor to it.

My observations in the matter of the insurance principle may well evoke from the opposition the counterargument that this prepaid medical care program involves more than just the employee, the one to benefit, since the employer would also be required to pay more into the fund if the Forand bill is enacted into law. While this observation is true, it is important to note that the proposed increase in OASI contributions would not be financially burdensome to the employer, or to the employee for that matter. The Secretary of Health, Education, and Welfare has indicated that medical care could be extended to the 16.2 million social-security recipients at a cost of less than one-quarter of 1 pecent each for both employers and employees.

As you know, the 1957 survey or study, conducted by the Bureau of Old-Age and Survivors Insurance, offers factual support of the need for the pending proposal. Likewise, the 1959 report, submitted by the Department of Health, Education, and Welfare, is one more exhibit to substantiate the claim that there is a pressing need to provide our retired senior citizens, eligible under the provisions of the bill, with medical care they cannot now afford.

The 1957 survey highlights the need for the enactment of the Forand bill and confirms the position long argued by its advocates. Now we have reached the stage, happily, of an increasing awareness of this need. In this connection, I wish to refer to the Social Security Bulletin of April of this year, from which I quote the following comment or conclusion made in this official publication:

In recent years there has been increasing awareness that the aged, like other predominantly low-income groups, are apt to find the financing of their medical needs a heavy burden. Sometimes they forgo necessary medical care entirely or defer it much longer than is desirable. In some instances they get the care they need but must rely on others to help pay for it. The degree to which aged persons fail to obtain adequate medical care can only be inferred. On the other hand, the degree to which they encounter difficulty in paying for the medical care they do receive--as well as the amount of these costs can be illustrated by preliminary findings from the 1957 survey of old-age and survivors insur

ance beneficiaries.

Mr. Chairman, I shall not detail facts and figures since the membership of this committee is adequately apprised of them from various sources, including the 1957 survey and 1959 report to which I have referred.

However, I do believe it proper to focus attention on the 1959 HEW report because it offers impressive stastical evidence supporting the contention that retired workers have, for the most part, incomes too low to meet the rising costs of medical care, particularly when it involves hospitalization and chronic illnesses which are associated with advancing years.

I join with my distinguished colleague, Mr. Forand, when he stated the report proved conclusively that "the Federal social security system can, as a practical matter, be used for paying medical care costs for persons entitled to old-age and survivors benefits with good effects on the kind of care they receive.”

The situation as outlined by the HEW report is deserving of reemphasis and I therefore offer this synopsis which sets forth the dimensions of the problem with which we are faced : There is general agreement that a problem does exist.

The rising cost of medical care, and particularly of hospital care, over the past decade has been felt by persons of all ages. Older persons have larger than average medical care needs. As a group they use about two and a half times as much general hospital care as the average for persons under age 65, and they have special need for long-term institutional care.

Their incomes are generally considerably lower than those of the rest of the population, and in many cases are either fixed or declining in amount. They have less opportunity than employed persons to spread the cost burden through health insurance.

A larger proportion of the aged than of other persons must turn to public assistance for payment of their medical bills or rely on "free" care from hospitals and physicians.

Because both the number and proportion of older persons in the population are increasing, a satisfactory solution to the problem of paying for adequate medical care of the aged will become more rather than less important.

Finally, I think it well to note that the lengthy HEW report, while containing no administration recommendations, does not suggest that the Department could not successfully administer the proposed program.

The Forand bill offers an opportunity to the American people who obviously want and need high quality medical care or services as much-indeed even more-after retirement as they do during their more financially productive working years. I am fully convinced that the American worker can only afford to achieve a degree of health protection and care, upon his retirement, through the proposed bill since other means of obtaining this protection are more costly and often prohibitive.

Frankly, I believe the American worker has a right to become resentful of those who tell him, in effect, that if he doesn't have a private health insurance plan to cover his years of retirement, then he can, if need be, look for help from welfare agencies. No one likes to be subjected to this, particularly when welfare aid is based on means tests and is generally not available before savings, if any, are practically exhausted.

Present social security benefits are accepted as a matter of right, despite the early years of propaganda charging that not only would this program lead this country to ruin, economically, but that it

was a grandiose national dole scheme. I submit that it is equally as important that our retired citizens, receipients of social security benefits, be able to obtain hospital, nursing, and surgical services as a matter of right also, not as a matter of charity:

I can think of no other item of legislation before this Congress that better reflects national concern for a national problem experienced daily by our ever-growing population of senior citizens. How ironic it is, indeed, to lengthen a person's lifespan through the marvels of medical science and then to penalize him for these very marvels by having him fall prey to the infirmities of old age without any surety of needed medical help.

It is my sincere hope that this committee, by favorably reporting the Forand bill, will demonstrate that this national concern has finally translated itself into initial national action.

The CHAIRMAN. Thank you Mr. Roosevelt, for coming to us and giving us your views on the subject. Mr. ROOSEVELT. Thank you, Mr. Chairman.

The CHAIRMAN. We will now hear from our colleague, Hon. Phil Weaver from the State of Nebraska. We are happy to welcome you, Mr. Weaver.

Mr. WEAVER. Thank you, Mr. Chairman.


Mr. WEAVER. Mr. Chairman, and members of the committee, I wish to take this opportunity to thank you for the privilege of presenting this statement to your committee in opposition to the Forand bill, H.R. 4700.

Had his bill been opposed by any single group of special pleaders, I would have shown a great deal of hesitancy in appearing here. However, the opposition to this type of legislation in the First Congressional District of Nebraska, and, indeed, throughout the State of Nebraska, is so widespread that I felt it my duty and an obligation to my constituents to be heard. I have talked about this legislation with many, many people in Nebraska and almost without exception they are sincerely and honestly opposed to this sort of program.

Opposition to H.R. 4700 in my home State stems from two sources. One is the belief that the bill is not necessary because those who are listed as the indigent aged are receiving medical care at the State and local level and through the fine work done by many hundreds of doctors at their own expense. The second source of opposition to this type of program is based on the belief that it won't work.

Ît is with a degree of trepidation that I would like to remind the members of the committee that the United States is a nation in which the citizens prefer to solve their own problems through local institutions, locally sponsored and locally controlled. This basic fact of American history and American life is overlooked in the present bill, H.R. 4700. This is a measure which seeks to impose a pat solution to a complex problem from on high. It is an effort to impose on our citizens a revolution in American medicine and in the American way of life. Finally, it is an effort to solve a complicated problem by creating another Federal bureaucracy,

Were American medical authorities and American doctors convinced that the only way to solve the problem of caring for the aged

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