Attached is a reproduction of a news item that appeared in a local newspaper on June 18, 1959, which illustrates how important the podiatrists'-chiropodists'-services are to social security payment

recipients.

Members of our profession are legally qualified by licensure, and by education and training, to diagnose and treat the human foot by medical, surgical, and other means in all the States, Territories, and the District of Columbia.

A very large percentage of our practitioners' patient population are in the older group, and it is extremely likely that they would elect a podiatrist-chiropodist to perform a provided health service. The present legislation is not clear as to whether or not this would be reimbursable. This right of free choice by the patient should not be abridged by legislation, administrative regulations, or contractural agreement with an insurance carrier.

This represents a fundamental philosophy in that the individual is insured for health insurance benefits to be provided, and not for who shall perform the service. Permitting eligibles to elect a podiatristchiropodist will not in any way increase the cost of providing health service benefits, since the specific service or procedure must be one that is provided in any contract or agreement.

Much effort has been expended to correct inequities, and sometimes to reduce hardships, at both Federal and State levels in the field of health service benefits. We believe that you will recognize the wisdom in preventing this at its source. This can be insured in several ways. Three such means are

A. Requiring that surgical, medical, or other health services provided shall be performed by a practitioner legally qualified in the State in which he performs such services.

B. By specifically naming the kinds of practitioners such as physician, dentist, podiatrist-chiropodist, et cetera.

Č. By defining physician and/or surgeon for this act to be an individual legally qualified in the State in which he practices to perform the medical, surgical, or other health service provided for in this or similar acts.

It is our belief that this statement suggests some means and justifies our petitioning you to provide that the legislation under consideration insure eligibles of their free choice of doctor for benefits provided, and that resulting administrative regulations and contracts do likewise.

It would please me to be of service to you by attempting to answer any question you might raise. If I cannot answer your question, I will make a note of it and endeavor to provide a satisfactory reply by letter to your committee.

(Attachment to Dr. Rubin's statement follows:)

[From Evening Star, Washington, D.C., June 18, 1959]

THE GOLDEN YEARS-A WIDOW MAKES IT ON $71.02 A MONTH

(By Thomas Collins)

Here we go again-this time to Sacramento, Calif., where a widow says she is living her golden years quite happily on an income of $71.02 a month. This will seem unreal to many people.

The widow is 73. She is getting $71 a month from social security, which is just 2 cents shy of her monthly budget. She also is getting $25 a month from her daughter's husband. She moved to Sacramento last January.

The reason this will seem unreal to many is that they have become used to the standard of living they can afford. They can see a few areas where they can do without. They can see items in their budgets they can trim. But you can't trim a good standard of living down to $71.02 a month. You have to throw the whole thing out the window and start over with a new concept of what an economical life is.

WHY THEY'RE UNHAPPY

Well-off people can seldom do this when they retire, which is why so many of them become disenchanted with what they find.

"When I came here," the widow says, "I found a cute little two-room apartment in a nice residential district looking out on a park with palm trees.

My monthly expenses are: Rent, $35; gas, $1.39; phone, $3.63; food, $25; church, $6. The $25 from my son-in-law goes to pay for the doctor and chiropodist, when necessary, and for writing paper, stamps, and laundry.

"I am well supplied with clothing, and my family gives me gifts of clothing on Mother's Day and Christmas. They insisted on getting me a television set, so I have plenty of entertainment from that and my radio.

"I belong to a senior group in Sacramento, and to a circle at my church

Now Sacramento is not a $70 town. It is one of the retirement jewels of California. But you can live there for $70. And you can live in Chicago for $70, if you readjust your thinking to accept what $70 a month will buy.

For 7 years I have been traveling to all corners of the country in search of a "cheap" place to retire. I haven't found it, and by now I have come to the conclusion it doesn't exist. National magazines and network TV and radio are offering coffee for the same price in lower Florida as in upper Minnesota.

There are some differences-heating and clothing costs are less under the palms-but the big-ticket items of food, housing, and medical bills are about the same.

Last month I spent some time along the gulf coast between Mobile and New Orleans. I found the retired couples living on $250 or so a month no less hungry for things they couldn't have than they are in New Jersey or Kansas.

HOW IT CAN BE DONE

There are two ways to beat the situation:

1. Throw your standard of living out the window and get a fresh one. On $200 a month you can't have a 1957 car-you just can't. You can't have fine clothes, color TV, trips, golf, theater tickets, and most of the other trappings your salary gave you.

To start out on a new standard of living, which is down to the fundamentals the widow in Sacramento has been willing to accept, a new locale where people don't know you-under the palms perhaps-will make it easier.

2. Move to a rural community. On a farm road, especially in the South, you can get housing cheap. You can get much of your food from a garden and from neighbors. There are few pressures to force you into activities that cost money. This is possibly the cheapest living in America. But, as compared to Sacramento or the city where you live, you aren't getting much-you're getting, as always, what you pay for.

Too many people continue to retire with the idea that on an income that has been cut 75 percent they can cut a few corners and get by. They can't.

The CHAIRMAN. Dr. Rubin, we thank you, sir, for your reporting to us the views of your association.

Are there any questions? If not, we thank you, Dr. Rubin.

Dr. RUBIN. Thank you.

The CHAIRMAN. Our next witness is Mrs. Mayer.

Will you please identify yourself by giving us your full name, address, and capacity in which you appear?

STATEMENT OF MRS. VERA MAYER, GENERAL SECRETARY, NATIONAL CONSUMERS LEAGUE

Mrs. MAYER. My name is Vera Mayer, general secretary of the National Consumers League, which is located at 1025 Vermont Avenue, in the District of Columbia.

The National Consumers League is an organization which has been active for 60 years in support of legislation to improve working and living conditions in our Nation. Prof. Seymour E. Harris of the Harvard University department of economics and author of several books on social security laws and economics and medicine had hoped to be able to testify today in person in support of the Forand bill on behalf of the league.

Unfortunately, his schedule could not be adjusted and he has, therefore, sent a brief statement which I would like to read to the committee.

STATEMENT OF SEYMOUR E. HARRIS, PROFESSOR OF ECONOMICS, HARVARD UNIVERSITY, AS READ BY MRS. VERA MAYER

Mrs. MAYER. I am sorry that prior commitments prevent me from presenting this statement in person, but I have followed the progress of this bill with much interest and admiration for Congressman Forand.

In the process of writing a book on the "Economics of Medicine," I have been especially interested in H.R. 4700. One of the most serious gaps in our social security legislation is the absence of adequate insurance against medical costs.

We have made little headway since the 1940's when national health insurance was first seriously discussed by the Federal Government. Indeed, we are grateful for the advances made in voluntary insur

ance.

But though most people are covered, the insurance only pays about one-quarter to one-third of all medical costs and the low-income groups, and notably the old, especially, suffer from inadequate coverage.

In fact, the old, beyond 65, are insured only one-half as much as others; and yet, their costs are twice as great; that is, they are covered only one-quarter as much as the general population.

One disturbing aspect of prepayment insurance is to be noted. The surge in recent years has been especially by the commercial companies. They are high-cost operations and they are gradually obtaining the cream of the business. For the price charged, they provide much less than, say, Blue Cross.

One of the most troublesome aspects of our economy is the bad time distribution of income. In recent years OASDI and private pension programs have tended to improve the distribution of income between working years and retirement years.

A sudden deterioration of one-half to three-quarters in income upon retirement raises serious and medical problems. These problems are greatly aggravated when, as so often happens, large medical and hospital bills have to be paid.

It is of some interest that in the late 1940's such Republican leaders as Senators Taft, Ives, and Flanders, supported legislation which would have financed comprehensive prepayment insurance has been disappointingly slow. Hence, all the greater is the need for a program such as that proposed in the Forand bill.

This bill recognizes the need of helping the old pay for their hospital bills through assessments on them and their employers when they are employed and members of the labor market.

This bill reflects the fact that medical costs are soaring, and especially hospital costs. The rapid rise of medical and hospital costs reflects not only the general inflationary conditions, but also the pressure on hospitals resulting from the rise of insurance, the rise of pay of the underprivileged hospital workers--still paid only two-thirds as much as the average workers-and the increased services offered by the hospitals.

Undoubtedly economies in the management of hospitals could be made. One important economy could be increased use of nursing homes, a trend that might be encouraged by the Forand bill.

The Forand bill stems also from a realization of the difficulties of obtaining insurance for the old. Among these difficulties are the high rates when insurance is available because of the heavy incidence of hospital care for the old-a rate 211⁄2 times that of the general population the unavailability of insurance to the old under a large percentage of the insurance schemes; the termination of benefits upon retire

ment.

It is well to realize that the cost of this program is estimated about $1 billion. But this is not a burden on the taxpayer.

In fact, the employer and the employee share the costs. The program is self-financing, with an increase of rates of one-half to 1 percent of payrolls.

It is generally agreed by economists that payroll taxes are borne primarily by the workers. That is to say, as the payroll tax is imposed, the employer pays less in regular wages. I have developed this theory fully in my 1941 book, "The Economics of Social Security."

In short, the Forand bill deserves the support of all those who wish this country to improve its welfare program.

In speech after speech, President Eisenhower, in 1952, announced the intention of the Republican Party to advance social security and in 1956 he boasted of the advances. I can think of no other area where an advance could be made of such importance with so little cost to our economy.

Surely a $450 billion economy can divert a billion dollars per year to provide important hospital services to its older citizens, and the funds are diverted rather than added.

The passage of the Forand bill, the spread of comprehensive prepayment medical insurance to which the Forand bill would contribute, the permanent disability legislation, improved medical aid under our assistance program, provision of Government aid to increase the flow of medical personnel, continuation of the Hill-Burton program, all of these are facets of an adequate social security program that will help all and especially the old. One serious gap still remains sickness insurance, available in only four States.

The CHAIRMAN. Does that conclude your statement?

Mrs. MAYER. Yes.

The CHAIRMAN. We thank you for bringing to us the views of the National Consumers League. We are sorry that Professor Harris could not arrange his schedule to be here. We appreciate your substituting for him.

Are there any questions of Mrs. Mayer?

If not, we thank you.

Mrs. MAYER. Thank you, Mr. Chairman.

The CHAIRMAN. The next witness is Mr. Dover.

Mr. Dover, will you identify yourself for the record by giving us your full name and address?

STATEMENT OF FLOYD K. DOVER, NATIONAL PRESIDENT,

NATIONAL SOCIAL SECURITY CLUBS OF AMERICA

Mr. DOVER. Floyd K. Dover, of Portland, Oreg. My office is at 408 Southwest Second Avenue, Portland, Oreg.

The CHAIRMAN. You are recognized for 10 minutes.

Mr. DOVER. Mr. Chairman, honorable members of the committee, my name is Floyd K. Dover, of Portland, Oreg., national president of the National Social Security Clubs of America, Inc., which has a membership of a little over 5,000 covering 21 States, the west coast being the heaviest in membership.

We maintain a full-time office with volunteer help-six full time and six part time-but, first, permit me to say that our organization is a nonprofit corporation set up specifically to represent the aged, blind, and disabled, on the local, State, and National level, in the same manner that veterans' organizations give to their members through their service department, with which we are all so familiar.

It is also a privilege to have this opportunity to appear in person before this committee on behalf of the National Social Security Clubs of America, Inc., whose national headquarters are established at 408 Southwest Second Avenue, Portland, Oreg.

Many seek medical help: I am also the accredited national claims officer for the Veterans of World War I, Department of Oregon. In this capacity I have three full-time helpers who volunteer their work. I bring this matter to the attention of the committee to show that I deal almost entirely with elderly people, 95 percent of whom are sick and hungry, and all are seeking some type of relief either through State public welfare assistance, veterans' benefits, or social security benefits. And in practically all instances at least two Government agencies are involved in taking care of one person; in some instances, there are three Government agencies involved in supplying the bare necessities for one family to barely exist.

This relief is an extremely expensive method when we must deal with more than one Government agency, and even then the sick do not get medical and hospital care. We already have a plan in operation-the Social Security Act-which could and should be amended to use as the one agency to care for all of our elderly upon becoming eligible for retirement, or in the event of serious illness or total disability preventing them from carrying on a gainful occupation.

Our people are getting sick and tired of being supplemented by an old-age State public welfare dole, not knowing from 1 month to another how much they will receive in their old-age assistance check. It is common practice in most States, and it certainly is in Oregon, for the State public welfare caseworkers to cut the old-age assistance check without first notifying the recipients that a cut would be made. In some instances they are cut completely off the rolls without being

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