The CHAIRMAN. Your entire statement will appear in the record, Mr. Fitzpatrick.

Mr. FITZPATRICK. Thank you.

The CHAIRMAN. You are recognized for 10 minutes.

Mr. FITZPATRICK. Now, I would like to tell you something about my personal experience in connection with the health needs of older people. In 1949, I was a union representative in a unit of skilled tradesmen of varied crafts totaling about 4,500. A substantial percent were 45 years or older. My contacts and experiences with older and retired workers' problems began when the UAW and the Ford Motor Co. signed the auto industry's first pension plan in September 1949.

At that time the maximum amount available from social security for a retired couple was $67.80. This was not enough to arouse anything but the faintest interest in retirement. The Ford-UAW pension plan changed all that. However, there remained one big and ever-disturbing problem for which neither social security nor the pension plan-or both combined, then or since-have provided a solution. The problem is: How do we, when 65 or older, finance an illness in retirement years on a retirement income?

Individual medical service is, for the vast majority of these needy, aged people, an impossible expense. The high cost of surgery, however necessary, is prohibitive. Recovery from many types of illness is seldom complete unless followed by a period of competently supervised convalescent care. So far, society has given little, if any, attention to the urgent needs of its impoverished aged in this sector of human welfare.

Health insurance premiums are payable in something too few aged people possess; namely, cash. The most optimistic studies show that somewhat less than 40 percent of retired people have, or can afford, any kind of health insurance.

According to the Legislative Advisory Commission report, older people without health insurance often stay longer and hence incur even larger bills than persons with insurance, and yet less than 20 percent of Michigan's older citizens were covered by Blue Cross in

1956.

Furthermore, it seems that the older the Michigan resident is the less likely he is to have insurance protection. For example, a little more than a third of those 65 to 69 had such protection; about onefourth of those 70 to 74 had such protection; but only 15 percent of

those 75 and over had it.

The same study showed that only 5 percent of the people over 65 with incomes of $1,000 or less had insurance protection as compared to 20 percent of those 65 and over with incomes of above $2,000. These conditions may have improved in the past 3 years, but I doubt that the overall situation is very different today.

These are some of the hard facts we face in discussing the ability of older people to meet the costs of medical care in Michigan, but this is only part of the story. My own contacts with retired persons add other dimensions to the problem. For example, here are a few further impressions.

Many retired couples still live in mortgaged homes. Many retired couples live in rented quarters. Rare indeed is the aged person who will ever again improve his or her economic situation. Other aspects of the story are no less grim. Every day far too many of Michigan's

aged couples, like their counterparts in other States, are faced with the problem of stretching a never adequate, low social security benefit to balance a household budget that includes such normal but imperative item as tax bills, fuel bills, light bills, gas bills, water bills, doctor bills, food bills, clothing bills, home upkeep, and incidentals.

Something surely has to give. And topping the list will be an old man's and an old woman's peace of mind.

As a member of the Retired Workers Steering Committee, I came into personal contact with many tragic cases of retired men and women who are suffering for lack of medical care because they can't afford it and who live in constant dread of serious illness. Here are

a few examples:

I may interject here that these are real people; they are not people I invented. I saw them a few days ago.

Mr. and Mrs. X: Mr. and Mrs. X are decent, kindly people. Mr. X is 83. He is badly crippled with arthritis. Mrs. X is 81. She suffered a severe heart attack in the late summer of 1957. Several times she was on the verge of death.

This old couple live alone in a five-room frame house. They have a total income of $96 a month from social security. At the time Mrs. X's heart attack occurred they had a savings nest egg of $1,800. The hospital and medical bills amounted to more than $1,300. There was no health insurance the premiums were beyond their financial reach. The last week of June 1959 brought temperatures of 90° plus to Detroit. Mrs. X was overcome by the heat. The nearby fire department was summoned and with efficient use of oxygen equipment revived her. About the same time a doctor was also called in. He supervised her treatment and collected a fee of $10. One fireman suggested that Mrs. X be removed to a hospital. It was a practical and kindly thought, but, unable to forget their meager means, the aged couple demurred.

Mrs. S: My wife and I met Mrs. S in October 1957. At that time she was 72 years old, weighed 81 pounds, and was almost blind from cataracts on both eyes.

She was living alone in the home she and her husband had bought when they were young. The auto pension received by Mr. S ended at his death; Blue Cross had ended, too. She was now reduced to a grim existence on a total monthly income of only $63.75 a month from social security.

A few days before we met Mrs. S she had visited an eye specialist in downtown Detroit. After her eyes were examined and the $15 fee was tendered, the doctor told her he would arrange for surgery in a hospital with which he was associated. She contacted us, and when we had all speculated about the costs we asked her if we might shop around and learn something about the cost of cataract surgery.

Thus began a web of calls and contacts with bureaus, clinics, and agencies. After about 3 weeks of this giddy circle, and by appointment, my wife and I and Mrs. S presented ourselves at the local bureau of medical aid. All the routine questions were asked and the replies noted. The decision was coldly routine, too-our old lady was denied help because she owned $506 in liquid assets. We took her back to her home and we returned to ours.

The CHAIRMAN. Mr. Fitzpatrick, you have consumed 10 minutes. How much more time do you think you will need?

Mr. FITZPATRICK. Probably about 5 minutes.

The CHAIRMAN. How about concluding this example you are on now and the others will be included in the record.

Mr. FITZPATRICK. Thank you.

After a breath-catching pause the calls and contracts started again. This time we asked for a review of Mrs. S's case. With her acceptance of terms that would cost her about $140 of her remaining savings, the review was granted and arrangements were made for her stay in a hospital.

Eventually the eye surgery was performed and was successful. As we were driving her home some weeks later, and after she had been fitted with glasses, it was a rewarding experience to observe her reading, for the first time in nearly 2 years, the various street signs, window signs, and billboards as we passed along the way.

My questions about this case, as they are about others, are this: Why should an old lady have to go through the mill in this way to get medical help? What would she have done without help from someone who wouldn't take no for an answer? If treatment had been urgently needed in point of time, what would have happened to Mrs. S while the wheels of a charity case ground slowly on?

Thank you.

The CHAIRMAN. Mr. Fitzpatrick, we are sorry that we did not hear you present all of your statement. But you may be sure that all of us will read these other examples that you have called to our attention. It is most helpful for you to bring this information to our committee, and please be assured that we are appreciative of your doing so.

Mr. MACHROWICZ. Earlier today Mr. Fitzpatrick and Mrs. Herbon, who will testify later, presented to Congressman Forand and myself a scroll of 1,700 signatures of retired persons and about 400 individual letters urging support of the Forand bill.

The CHAIRMAN. Thank you, sir, again.

Mr. FITZPATRICK. Thank you, Mr. Chairman.

(The prepared statement of Mr. Fitzpatrick follows:)

STATEMENT OF JOHN FITZPATRICK, RETIRED FORD MOTOR CO. WORKER, MEMBER OF THE ADMINISTRATION BOARD, FORD-UAW PENSION PLAN; SECRETARY OF THE STEERING COMMITTEE, UAW RETIREE PROGRAM IN METROPOLITAN DETROIT

Gentlemen, my name is John Fitzpatrick. I am 69 years old, and I have been retired from the Ford Motor Co. for 31⁄2 years.

I am a member of the administration board of the Ford-UAW pension plan and I am also secretary of the steering committee and a member of the legislative committee of the UAW retiree program in Metropolitan Detroit which represents about 60,000 UAW retired members and their wives.

Mrs. Herbon and I asked for an opportunity to be heard by this committee because the retired workers whom we represent are tremendously interested in the passage of the Forand bill. They are so interested that they have exercised their important role as senior citizens to inform their fellow retired workers in our drop-in centers, in their clubs and neighborhood activities and in their local unions about the bill and have urged them to write to you telling you of this interest. Part of this activity has resulted in the preparation of the scroll which Mrs. Herbon and I would like at this time to present to the committee. The scroll which is marked "special delivery-86th Congress, Washington, D.C." contains about 1,700 signatures of retired persons and about 400 individual letters to Congressmen urging support of the Forand bill. Mr. Chairman, Representative Forand and Representative Machrowicz, on behalf of the retired people of

Detroit, Mrs. Herbon and I take great pleasure in presenting to you this scroll which indicates the interest, hard work, and wholehearted support of our retired members for the Forand bill, H.R. 4700. This is only a small part of the results of their efforts in support of the bill, and I am sure that many Congressmen, Senators, and particularly the members of this committee, have already heard from their older constituents as a result of our efforts.

Now I would like to tell you something about my personal experiences in connection with the health needs of older people. In 1949 I was a union representative in a unit of skilled tradesmen, of varied crafts, totaling about 4,500. A substantial percent were 65 years or older. My contacts and experiences with older and retired workers' problems began when the UAW and the Ford Motor Co. signed the auto industry's first pension plan in September 1949.

At that time the maximum amount available from social security for a retired couple was $67.80. This was not enough to arouse anything but the faintest interest in retirement. The Ford-UAW pension plan changed all that. However, there remained one big and ever-disturbing problem for which neither social security nor the pension plan-or both combined, then or since-have provided a solution. The problem is: "How do we, when 65 or older, finance an illness in retirement years on a retirement income?"

There are 15,400,000 men and women 65 years and older living in America today. Millions of these aged people are living out their lives at a bare subsistence level, and the continued, ever-menacing threat of illness-without the means to pay for medical care-overshadows their day-to-day existence.

Individual medical service is, for the vast majority of these needy, aged people, an impossible expense. The high cost of surgery, however necessary, is prohibitive. Recovery from many types of illness is seldom complete unless followed by a period of competently supervised convalescent care. So far, society has given little, if any, attention to the urgent needs of its impoverished aged in this sector of human welfare.

Health insurance premiums are payable in something too few aged people possess, namely: cash. The most optimistic studies show that somewhat less than 40 percent of retired people have, or can afford, any kind of health insurance.

RELATED DATA

So that you, gentlemen of the committee, may more readily comprehend and evaluate the situations I am asking you to consider, let me review some of the basic facts pertaining to health problems of older people in the State of Michigan. The older population of Michigan has grown even more rapidly than that of the United States as a whole from 121,000 in 1900 to an estimated 594,000 in January 1958. By 1970 there will be more than 800,000 older people in the State, almost a sevenfold increase since 1900.

According to the 1958 report of Michigan's Legislative Advisory Council on Problems of the Aging it is "likely that at least one-fifth of the aged in the State live at a level of bare subsistence and more than half have less income than Government budget experts estimate is needed to maintain a 'modest but adequate' standard of living."

The health needs and problems of Michigan's older population are no less acute than those of other States and the Nation as a whole. Michigan Blue Cross reported in 1956 that the average charge per case for all insured cases was $215 as compared with a charge of $346 per case for persons over 65. Older persons' hospital bills were on the average 60 percent higher than those of the general population, because older persons stayed almost twice as many days per admission to the hospital. According to the Legislative Advisory Commission report, older people without health insurance often stay longer and hence incur even larger bills than persons with insurance *** and yet less than 20 percent of Michigan's older citizens were covered by Blue Cross in 1956. Furthermore, it seems that the older the Michigan resident is, the less likely he is to have insurance protection. For example, a little more than a third of those 65 to 69 had such protection; about one-fourth of those 70 to 74 had such protection; but only 15 percent of those 75 and over had it.

The same study showed that only 5 percent of the people over 65 with incomes of $1,000 or less had insurance protection as compared to 20 percent of those 65 and over with incomes of above $2,000. These conditions may have improved in the past 3 years, but I doubt that the overall situation is very different today.

These are some of the hard facts we face in discussing the ability of older people to meet the costs of medical care in Michigan, but this is only part of the story. My own contacts with retired persons add other dimensions to the problems. For example, here are a few further impressions:

Many retired couples still live in mortgaged homes. Many retired couples live in rented quarters. Rare indeed is the aged person who will ever again improve his or her economic situation. Other aspects of the story are no less grim. Every day far too many of Michigan's aged couples, like their counterparts in other States, are faced with the problem of stretching a never adequate, low social security benefit to balance a household budget that includes such normal, but imperative items, as tax bills, fuel bills, light bills, gas bills, water bills, doctor bills, food bills, clothing bills, and home upkeep, and incidentals. Something surely has to give. And topping the list will be an old man's and an old woman's peace of mind.

As a member of the Retired Workers Steering Committee, I came into personal contact with many tragic cases of retired men and women who are suffering for lack of medical care because they can't afford it and who live in constant dread of serious illness: Here are a few examples:

Mr. and Mrs. X

Mr. and Mrs. X are decent, kindly people. with arthritis.

Mr. X is 83. He is badly crippled

Mrs. X is 81. She suffered a severe heart attack in the late summer of 1957. Several times she was on the verge of death.

This old couple live alone in a five-room frame house. They have a total income of $96 a month, from social security.

At the time Mrs. X's heart attack occurred they had a savings nest egg of $1,800. The hospital and medical bills amounted to more than $1,300. There was no health insurance the premiums were beyond their financial reach. The last week of June 1959 brought temperatures of 90°-plus to Detroit. Mrs. X was overcome by the heat. The nearby fire department was summoned and with efficient use of oxygen equipment revived her. About the same time a doctor was also called in. He supervised her treatment and collected a fee of $10. One of the firemen suggested that Mrs. X be removed to a hospital. It was a practical and kindly thought. But, unable to forget their meager means, the aged couple demurred.

Mrs. S.

My wife and I met Mrs. S. in October 1957. At that time she was 72 years old, weighed 81 pounds, and was almost blind from cataracts on both eyes.

She was living alone in the home she and her husband had bought when they were young. The auto pension received by Mr, S. ended at his death. Blue Cross had ended too. She was now reduced to a grim existence on a total monthly income of only $63.75 a month from social security.

A few days before we met Mrs. S. she had visited an eye specialist in downtown Detroit. After her eyes were examined and the $15 fee was tendered, the doctor told her he would arrange for surgery in a hospital with which he was associated. She contacted us, and when we had all speculated about the costs, we asked her if we might "shop around" and learn something about the cost of cataract surgery.

Thus began a web of calls and contacts with bureaus, clinics, and agencies. After about 3 weeks of this "giddy circle", and by appointment, my wife and I and Mrs. S. presented ourselves at the local bureau of medical aid. All the routine questions were asked and the replies noted. The decision was coldly routine too our old lady was denied help because she owned $506 in liquid assets. We took her back to her home and we returned to ours.

After a breath-catching pause the calls and contacts started again. This time we asked for a review of Mrs. S.'s case. With her acceptance of terms that would cost her about $140 of her remaining savings, the review was granted and arrangements were made for her stay in a hospital.

Eventually the eye surgery was performed and was successful. Some weeks later, and after she had been fitted with glasses, as we were driving her home, it was a rewarding experience to observe her reading, for the first time in nearly 2 years, the various street signs, window signs and billboards we passed along the way.

My questions about this case as they are about the others, are this: "Why should an old lady have to go through the mill in this way to get medical help?