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The CHAIRMAN. Mr. Betts.

Mr. BETTS. I have a telegram from the Academy of Medicine of the city of Fostoria, Ohio, stating their position on the Forand bill, and I am going to ask unanimous consent to submit it for the record.

The CHAIRMAN. Without objection, it will be included in the record. (The telegram referred to follows:)

FOSTORIA, OHIO. Representative JACKSON C. BETTS, Washington, D.C.:

Because we believe it will not be to the best interest of the elderly people, we respectfully request you to register our objection to the Forand bill.

FOSTORIA ACADEMY OF MEDICINE. The CHAIRMAN. Is our colleague, Mr. Dingell, here? Mr. DINGELL. Yes, sir; Mr. Chairman.

The CHAIRMAN. We are glad to have you with us this morning, Mr. Dingell, and you are recognized, sir.



Mr. DINGELL. Thank you, Mr. Chairman.

Mr. Chairman and members of the committee, for the record my name is John D. Dingell. I am a Member of Congress from the 15th District of Michigan.

I would like to thank the Chair and my colleagues on the committee for this opportunity to be here. I would also like to apologize for having been just a few minutes late this morning in appearing before the committee. Mr. Chairman, with permission of the Chair and the members of the committee, since I have already submitted my prepared statement to the committee, and in view of the time factor, I would like to just make a few brief comments and then I will be prepared to answer any questions.

The CHAIRMAN. You want your entire statement included in the record ?

Mr. DINGELL. Yes, Mr. Chairman; thank you very much.

The CHAIRMAN. Without objection, your entire statement will be included in the record.

(The statement referred to follows:) Mr. Chairman and members of the committee, for the record my name is John D. Dingell. I am a Member of Congress from the 15th District of Michigan.

I would like to express by sincere thanks for an opportunity to discuss the legislation now pending-H.R. 4700 by our colleague, Mr. Forand, and identical legislation sponsored by me, H.R. 5923. I have also introduced in this Congress H.R. 3897, a similar bill, to provide 60 days free hospitalization each year to any recipient of social security benefits.

I have been interested in the insurmountable problems faced by most of our aged in securing even minimal health care under today's system of prepaid medical insurance and private medical care. I have sponsored legislation in each Congress since the 84th to have hospitalization furnished as a part of the social security program to recipients of benefits thereunder. The need for such an extension of the social security system is both obvious and compelling. Under the legislation before the committee, the Social Security Administration would pay from the OASDI fund for services received from a qualified hospital for a period of up to 60 days a year for anyone eligible for retirement, survivor, or dependent benefits under the Social Security Act. If the patient goes directly or is transferred to a nursing home, benefits are received for another 60 days annually. Nursing homes qualified to receive payments under the program must provide skilled nursing services and be operated in conjunction with a hospital or under direction of doctors of medicine. A qualified physician must certify the need for hospital or nursing home services.

Payments in the bill follow the pattern developed by existing payment plans under the Social Security Act. The cost of the program would be met through an increase in contribution rates of one-fourth of 1 percent for employers and employees, and an increase of three-eighths of 1 percent for self-employed.

I wish to briefly direct myself to the reasons for this legislation and for its speedy enactment. Today citizens over 65 number 15.3 million and increase at the rate of 1 million every 3 years. Only about 40 percent of them have health insurance. We must assume that if they could afford it, this group would be covered almost 100 percent, since worry about sickness is a constant pressing preoccupation to our senior citizens. The study on hospitalization insurance for OASDI beneficiaries anticipates that expansion of coverage for persons not now covered in the 65-plus age group will be extremely difficult under private programs because of cost, health, and income limitations. Indeed, that study indicates it will be virtually impossible to cover, under existing programs, substantial numbers in long-stay institutions, particularly those with very low income, and a large number of others unable to pay even the lowest premium.

Despite pious protestations to the contrary, private programs have never met the needs of this group and it is most unlikely that they ever will. The coverage is often canceled when the insured reaches the age where it is most needed. If caverage is not canceled then, chances are it could be when the insured has his first major illness after reaching his sixties. Coverage of persons is usually limited to less than their real need, especially those of advanced age, as with chronic illness, both as to dollar amount and as to the quantity and quality of services included.

We have heard how the so-called 65-plus policy is a panacea for the medical problems of the oldsters. That program falls flat on its face when exposed to the tremendous needs of our aged. To understand that program, let's look at its provisions.

It provides for a $6.50 monthly premium by the insured to cover up to $10 a day for hospital room and board for a maximum of 31 days per confinement. I defy anyone to find a $10 a day hospital room anywhere. The Secretary of Health, Education, and Welfare says the national average for a room is in excess of $24 per day. Only $100 is allowed for miscellaneous hospital expenses. Payment for surgery is limited to not over $200. Neither figure comes close to meeting the cost of even a short hospital stay for the most unimportant illness. The company also reserves the right to increase rates or cancel on a statewide basis.

The legislation before the committee is not "socialized medicine" as the spokesmen for reaction and do-nothingism would have us believe. Complete freedom of choice of physician is expressly preserved. Moreover, the bill provides for parment of only such surgical and medical services as are "customarily furnished by such hospital to its bed patients.” What the AMA opposes as “socialized medicine" is the only program which will come close to solving the hospitalization problems of our aged.

Medical care is expensive; it has risen in cost faster than the other items on the consumer index by some 23 percentage points since 1947–49. Medical care has risen 44 percent since 1949 and hospital room rates have doubled. Surgeons fees are up 26 percent and general practitioners' fees are up 39 percent.

I want the record to show some other grim statistics. Of all persons 65 and older more than one-third have passed 75, one in seven is an octogenarian. Only one in five has a job. About 2.5 million or 16 percent of the aged receive old age assistance.

Outside income from savings, jobs, etc., bring in little money. Three-fifths of these people had incomes of less than $1,000 per year, one-fifth had incomes of from $1,000 to $2,000 per year, and only one-fifth had incomes of over $2,000 per annum including social security benefits.

Forty-five percent of the spending units headed by a person of 65 or older had financial assets of less than $500. Median net worth for retirees vas $9,620, mostly represented by equity in a modest home. Liquid assets accounted for only a small part of net worth, and only half had as much as $1,580 in liquid assets.

The cost of such a program, in terms of payroll as figured by HEW would be 0.428 percent of taxable payroll, about the same as provided for in the 0.5

percent taxing provision in the legislation before the committee. This cost is very moderate in view of the tremendous need of our aged who have the highest incidence of all medical care (except dental since they have usually long since lost their teeth) and only the slenderest means to meet it.

The study on hospitalization insurance for OASDI beneficiaries raised one very difficult question, which it cited as one of the principal problems for the aged, “How can higher than average medical needs be financed out of lower than average financial resources?

The conclusion is inescapable. Only through early enactment of the legislation before the committee.

Mr. DINGELL. I think as one who has sponsored for a number of years a program of national health insurance I am entitled to say that this is not a program of national contributory health insurance, which the AMA happens to call, erroneously, by the misnomer of "socialized medicine." This is entirely apart and different and distinct from that program. All of the vices which the AMA incorrectly and improperly attributes to national health insurance, and I want to stress that, improperly and incorrectly attributes, to a program of national health insurance would not be inherent in this system any more than they are inherent in the other system of hospital care. This is not a program of national contributory health insurance at all. This is merely a proposal to cover the old folks of this country with the first real opportunity which they have ever been offered for adequate health care.

I think the language of the bill is very plain on one page where it states that the only medical care which shall be available is such medical and surgical care as is ordinarily available to bed patients in the hospital. In other words, we are not opening this broadcast to medical care. We are just including this for such surgical and medical care as is ordinarily offered to bed patients in the hospital.

Mr. Chairman, I attend many old folks meetings at home. While I think the statistical evidence which has been placed before this committee is overwhelming, but I would like to give very briefly some of the things that I have observed in my association with old folks. I think that I am as capable to testify on this particular aspect and on most other aspects of this as the doctors are. They may have some professional knowledge of care of the sick, but I happen to have knowledge of the immediate problems that these old folks face from long association with them and their organizations.

The biggest fear that the old folks in this country face today is not death; it is just illness. They know that on the income which they have they are incapable of meeting the needs of providing adequate health care for themselves. They are usually capable of providing only the barest necessities of life on their meager income. They know that hospitalization and doctor bills are above and beyond anything that they have the ability to meet through their own resources and through the private plans presently available to them, such as Blue Cross or any of the private insurance company plans.

They are well aware of the fact that if serious illness comes along it will most probably wipe out whatever small savings they have. They are equally well aware, Mr. Chairman, that it will probably eliminate the small equity which they may have in their home or place them at the mercy of private or public charity or, worse, to compel them to solicit the aid and help of relatives.

I don't think this is a good situation. I think that these old folks are well aware of the need for legislation like the Forand bill. I think if you were to ask the old people of this country, Mr. Chairman, I don't think you would find a single one opposed to the bill before the committee. I would like to point out that the private programs are too costly for our old folks. They require a prorating of costs across the community if they are going to even come within reach of the need of the old folks, and that of course causes the unfairness that opponents to the Forand bill find in prorating through the Social Security System.

I would like to comment briefly on this 65-plus proposal which we have heard so much about. That is a practically worthless program, Mr. Chairman. It provides for 31 days of illness at $10 a day in a hospital, $100 miscellaneous hospital expenses, and $200 for the surgery. I defy any witness before this committee from the AMA or anywhere else to say that this is an adequate program to meet the needs of a person who is chronically ill or who suffers a severe illness after he reaches 60 or 65. In fact, it is inadequate for persons of any age, but especially so for persons over 65.

Some of the comments I heard the previous witness, Dr. Robins, make I would like to comment on briefly. He admitted that he was not an expert on British health service. He went further to state that the proposal, H.R. 4700, is not necessarily a repetition of the British system. I think those two statements alone would tend to discredit or to throw out many of the scare stories and many of the so-called frightening incidents of public or national health systems in other countries that were made by the previous witness. I think we have to understand certain other things about this. If this program, as the opponents say, will overload our hospitals and overload our doctors, it merely proves something that I have been saying all along, that the present system of hospitals and medical care as well as the number of doctors in this country are grossly inadequate to provide proper health needs for our people. I think that we will more and more realize these facts as time goes on.

Mr. Chairman, this committee in its wisdom, and I say in its wisdom because it was a very wise act, had the Department of Health, Education, and Welfare and staff of the committee perform a very valuable study on the problem of providing for proper health care for our aged. Mr. Chairman, that should be required reading not only for Members of the Congress in general, but especially for members of this committee.

I am sure most of the members of the committee will read that study. I am sure that anyone who reads it will come to the conclusion, as I did and, I am sure, as many others have, that there is only one way that we can provide adequate care for the older citizens of this country and that is by having a proposal of the type that we have here sponsored by my distinguished friend, the gentleman from Rhode Island, and by myself, and by several other Members of this Congress.

One thing I read in that study is :

"How can higher than average medical needs be financed out of lower than average financial resources ?"

That question was asked. Mr. Chairman, I am sure that the chairman and the members of this committee are well aware of the fact that

the old folks of this country have the lowest financial means of any group in the country. They have the highest needs of medical care of any group in all things except dentistry and I think for the very good reason that very few of our old citizens have their own original teeth. They are mostly relying on dentures having long since lost their own teeth.

Mr. Chairman, I urge with every means at my ability and command that this committee report the Forand bill out at the earliest possible moment. When that bill becomes law we will have finally done something to enable our old folks to meet the most pressing need which they face, providing adequate health care for themselves.

Thank you, Mr. Chairman. The CHAIRMAN. Mr. Dingell, we thank you for bringing to us this discussion of your views on H.R. 4700.

Are there any questions of Mr. Dingell?
Mr. MASON. Mr. Chairman.
The CHAIRMAN. Mr. Mason.

Mr. Mason. Mr. Dingell, the doctor was modest to state that he was not an authority on the English system, although he did have some firsthand knowledge of it. Because he was that modest, do you think that that declaration of his disqualifies him as a witness to express what he actually observed?

Mr. DINGELL. I wouldn't say it disqualified him. I just say that it characterized his testimony and I would say that in evaluating his testimony, as in evaluating the testimony of any other witness, the committee ought to take that particular statement well into account.

Mr. Mason. Then, conversely, your knowledge of the subject places you in the position that your testimony should be valued at your statement, or at ours.

Mr. DINGELL. I would say the gentleman is intelligent enough to evaluate the testimony of witnesses without any help from me. I am not inferring

that the medical profession is engaged in chicken thievery, but I would say you don't have to be a chicken thief to know how to get a hen off the nest.

Mr. Mason. That is all, Mr. Chairman.
The CHAIRMAN. Any further questions?
If not, we thank you, Mr. Dingell.
Mr. DINGELL. Thank you, Mr. Chairman.

The CHAIRMAN. Is our colleague from New York, Mr. Halpern, in the room?

Mr. Halpern, what district in New York do you represent?



Mr. HALPERN. The Fourth District of New York. The CHAIRMAN. You are recognized, sir. How long will it take you to complete your statement?

Mr. HALPERN. I will try to keep it within 10 minutes.
The CHAIRMAN. All right, you are recognized.

Before you start, Mr. Halpern, if you do omit any parts of your statement your entire statement will appear in the record.

Mr. HALPERN. Thank you, sir.

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