plication. We must look to you to experiment with new forms of the organization and administration and financing of medical care. We must look to you to experiment in the reorganization of medical practice to provide total medical care. Our objective should be to do this as far as possible through voluntary means, by doctors and patients acting freely together. In this, developments like group practice, group health associations and HIP are important milestones. Legislation should encourage such voluntary action. In the meantime, however, there are things we can do, things we can and must do quickly. doctors, We must move on to overcome the shortage of health personnel nurses, therapists, medical social workers. The shortage of these is becoming acute and will become worse as our population increases. We need to expand our medical schools and other training facilities. We need to expand our hospital facilities. Recent amendments to the HillBurton program have made possible the expansion of facilities for long-term medical care and for rehabilitation and out-patient services. We need to encourage the establishment of group practice facilities for voluntary nonprofit prepaid health service associations. Since the 81st Congress, I have introduced community health facilities bills to provide long-term, lowinterest loans for such facilities. I have reintroduced that bill within the last week. It is essential that we encourage and help these voluntary associations to bring health services to American people just as the principles of cooperative voluntary association brought electricity to rural America. And like the REA cooperatives, these facilities are particularly important in bringing medical services to rural communities. We need to step up the pace of medical research. We should thank Senator Hill and Congressman Fogarty for taking the lead in providing for expanded appropriations for the National Institutes of Health. We need to encourage research not only in the diagnosis and treatment of illness, but also in the social and economic aspects of health and medical care. And we must be sure that we train competent research personnel. I wish that I could make the case for medical research as eloquently as Mrs. Lasker did a few nights ago in her interview with Ed Murrow on TV. Politically we are in the stage where we need to experiment with programs for meeting the needs of special groups within our population. We must try to legislate wisely, but this does not mean that we should procrastinate. As the AFL-CIO said not long ago, paraphrasing the old legal maxim, "Health delayed is health denied." There are two groups in our population for whom it is possible and necessary in the near future to develop special health programs. One of these groups consists of those employed by the Federal Government. The 22 million Federal employees have been denied the benefits of health plans under collective bargaining, but the Federal Government, their employer, has the same responsibility as private employers for the health of employees. Legislation is now pending before Congress to provide health insurance for these 22 million employees and their families. Under the leadership of Senator Neuberger a bill is now taking shape in the Senate. I intend to support it. I hope it will permit employees to choose from among various types of plans, including group practice plans. The other group whose health needs require and permit special attention are our older citizens. They deserve special attention for a number of reasons. The reasons boil down to this: Older people have low incomes, small liquid assets, and heavy medical needs. This alone would demand of us that we take special and tender cognizance of them. I believe we should consider the health needs of our older citizens in the context not only of the Nation's health needs and resources, but in the context of the total needs of our older citizens and our resources for meeting them. These basic needs include income adequate to their needs, employment opportunities and suitable housing, as well as health. Forgive me if I cite briefly some facts which are part of your every day's work but which I think must be in the forefront of our thinking here. In these days of medical miracles and longer life, a man who reaches the age of 65 has a life expectancy to 79 years; a woman a life expectancy to 81 years. There are now more than 15 million people in these age groups, and their number is increasing by about 1 million every 3 years. The aim of any program for our older citizens must be to keep them functioning happily and usefully in the community. What we need is a many-sided program which insures their productiveness, independence, and self-reliance, and which prevents physical and moral decay. The No. 1 objective of a sound program is the maintenance of incomes. Threefifths of all people 65 and over have money incomes from all sources of less than $1,000 and only one-fifth have more than $2,000. Only recently, for the first time, the number of people receiving social security benefits exceeded the number of older people receiving public assistance. It is here that we have made the greatest progress through the social security system, and it is here that the direction of future progress is clearest. The case for rapid increase in old-age benefits is imperative. But there is no magic in the age 65 which makes it good public policy to force people to leave employment while they are still healthy and productive. Full employment means jobs for all who are able and willing to work. Older workers are among the chief beneficiaries of a full employment program, just because they are especially vulnerable to unemployment in times of job scarcity. Certainly we must do everything possible to prevent discrimination against older workers in the labor market. We must provide suitable housing for older people. We must make it possible for them to live out their years fruitfully in a community rather than in an institutional environment. One of the most promising developments in this direction is the provision recently written into the Housing Act of 1959 by the House Banking and Currency Committee, under the leadership of Congressman Rains, to make available direct low-interest Federal loans to nonprofit corporations for housing for elderly people. The House of Representatives should be congratulated for refusing to delete this provision of the bill, and I hope fervently that the Senate will accept it and that the President will forbear to veto it. We must provide medical and hospital care for our older people. We must see that it is furnished to them in a way which will preserve their independence and their self-respect and their peace of mind. These have been also, of course, the objectives of the old-age and survivors insurance program. Consequently, it was logical and practicable to turn to the framework and machinery of social security as a means of providing the necessary health care efficiently, economically, universally, and democratically. I do not think we can ever overstate our debt to Congressman Forand for the courage and foresight of his efforts to bring this sound and workable idea to reality. I realize that this is a much-disputed subject, and I wish to make my position perfectly clear. I am in favor of providing hospital and nursing home care as part of the social security system immediately. It will meet a pressing and urgent need. Costs associated with hospital and nursing home care account for a very large part of the total expenses of medical care for older people. By insuring these costs we lift a heavy burden of expense and of fear. In my own State of Minnesota, the largest expense in the entire welfare program is for hospital care for the aged. Many of these people are victims of diseases which keep them in hospitals for months. Hospital and nursing home benefits under social security would help not only the beneficiaries, but would relieve local and State governments of these very heavy burdens, thereby releasing public funds for a positive health program. There is no question that a problem exists. The rising costs of medical care and hospital care, coupled with the greater medical needs and lower incomes of older people, have created the problem. But there are some who argue that it is not a problem which calls for action by the Federal Government. The fact is that no satisfactory voluntary hospital plan has yet been brought forward which will give to people over 65 protection they need at costs they can afford to pay. Period. This is why I have advocated and will continue to advocate hospital insurance for social security beneficiaries as an integral part of our social security system. I wish to make it plain that when we have reached this objective-which we will, and soon, I hope-we will not be finished, by any means. Important as hospital insurance is, there will still be the need for a total health program for older people. The primary emphasis should be on the prevention of illness and the maintenance of health. The first objective of a health program for older people should be to keep them out of the hospital and functioning in their homes and in the community. The medical profession and those associated with it have a special obligation and a unique opportunity to develop programs and personnel to meet this total need. Financing is not the only problem. Equally important is raising the quality of medical care and making it universally available. If social security financ ing is required to make health services of high quality available to social security beneficiaries, I will be the first to support it. I am perfectly aware that even a bill for hospital and nursing home insurance will provoke outcries of "socialism," "socialized medicine," and such. This does not worry me. As I said before, this has been the cry that has greeted every significant advance of this country. I do not believe that this is the view even of the doctors of this country, though it is the cry of some who claim to speak for them. No one knows better than the doctors the devastating effects of expensive hospital and medical care on older people of limited means. I cannot believe that the doctors, who have done so much for medical welfare, wish to pauperize these most economically defenseless of their patients. No one can forget that our doctors and hospitals have given of their services and facilities to people who could not afford to pay. For a long time this was the only way for poor people to get medical care at all. But by now we have progressed beyond the free ward concept of medical care. Now medical care and hospital care for those on public assistance is a challenge to provide high quality, sensitive, individualized service equivalent to that we give to more fortunate patients. These public assistance patients, young and old, are a first order of business in the search for comprehensive health services. Here also is a challenge to the medical profession to cooperate with Government in working out programs to meet the need. The search for solutions to our medical needs must go on, on all fronts. Young and old, in high, middle, or low income, Americans are entitled to the best medical care that science can invent and our economy can provide, without sacrifice of professional freedom or individual dignity. The search must go on, in private medicine, in group practice, in voluntary insurance, in labor health programs, and in Government. It must go on in the medical school, in the laboratory, in the hospital and in the clinic. It must go on with open eyes and open minds. Let us not get bogged down in dogmas or in vested interests of the past. I promise you this: As fast as you who are in the business of health come up with solutions that are workable and equitable, we who are in the business of Government will do our best to take the legislative and administrative action needed to make them work. Together we will get it done. The CHAIRMAN. The hearing record will remain open until the close of business July 31 next for submission of data, material, and statistics which have been requested to be supplied. Mr. FORAND. Mr. Chairman, I want to be sure that anyone desiring an extension of remarks will be permitted to insert statements and letters received. The CHAIRMAN. I think that is important. We should give permission to Members of Congress who may want to file their own statements in one way or the other on this. Is there any objection to Members of Congress, both House and Senate, having permission to extend their remarks and insert material in the record at this point? The Chair hears none. Then we have asked for a terrific amount of additional information from most of the witnesses to be supplied. That will have to be in by that date, July 31. All members of the committee, if they desire to include something in the record that they have received that they think ought to be in the record, have that permission also. Is there objection to that? The Chair hears none. until 10 a.m. on Monday. Without objection the committee adjourns (The following matter was filed with the committee:) STATEMENT BY HON. G. MENNEN WILLIAMS, GOVERNOR OF MICHIGAN It is a privilege to have this opportunity to express my views on H.R. 4700, sponsored by the distinguished member of this committee, Representative Aime J. Forand, of Rhode Island. It is a source of great regret that urgent State legislative business prevented my appearing personally during the important hearings on the Forand bill. This committee has heard from many organizations and individuals expressing expert testimony in support or opposition to the Forand bill. I want to go on record in support of the Forand bill for the reasons which follow in this statement. Adequate provision for America's aged is one of the Nation's most pressing problems. This has long been recognized by Government at all levels, by our social workers, by those who approach the problem with a viewpoint of human kindness and those of us who see in our own families, among our relatives and in our circle of friends, the problems that arise with advancing age. It is recognized as a national problem in the setting up of a White House Conference on Aging for 1961. Even now the leadership training institutes are being held throughout the country. It is with a feeling of pride that I point out the first such institute was held in Michigan not long ago. One of the most serious problems of older citizens is the greater incidence of illness and the greater need for medical and surgical care, precisely when their income is substantially reduced. There are about 15 million Americans aged 65 or older and the number increases each year as life expectancy is extended. It is grim irony that the medical advances which have added years to our lives are often beyond the reach of people living in those added years because they can't afford them. This problem is not met by voluntary private hospital insurance programs. Only about 40 percent of our aged people have hospital insurance, according to recent estimates. It is estimated further that voluntary programs even at best could not include more than 50 to 60 percent of our senior citizens. Voluntary private hospital insurance makes sense for those who are employed, but the cost of maintaining such insurance after employment stops and the worker retires is frequently prohibitive. The Forand bill would close a very serious gap in our social security laws by extending benefits to include payment of certain hospital, nursing home, and surgical costs for many now eligible for social security. The Forand bill would do this within the framework of the insurance concept now basic to existing OASDI programs. The Forand bill provides a natural and desirable extension of benefits in the old age and survivors insurance program and is entirely consistent with the 1956 amendments to the law which provided disability benefits under OASDI. An important feature of this insurance concept is that those who will receive benefits will have paid for them during their years of employment. It will not be provided to them as a charity or welfare for which they must pass a means test, but as a service for which they have made contributions, based on earning power in their productive years. It relieves them of what stigma they may think is attached to being hospitalized as a welfare patient. The burden of paying for this insurance would be assumed during the years the worker is best able to carry it-while he has earning power. Payments are geared to ability to pay, through a uniform percentage of earnings, the most equitable method of financing such a program. This method of paying for such an insurance program lifts it from the realm of a welfare program financed by General Government. It would be financed instead by contributions from covered employees and employers the same as old age, survivors, and disability insurance. The Forand bill would serve precisely those people whose need is clear, immediate and readily demonstrable. In Michigan, for example, the inadequacy of OASDI benefits is shown by the fact that 33.2 percent of old age assistance beneficiaries are also OASDI beneficiaries. Further proof lies in the fact that during fiscal 1958, $1,519,206 worth of care was provided in county medical care facilities to OASDI beneficiaries who were being supplemented by old age assistance, and the cost of hospitalization pro vided by county departments of social welfare in fiscal 1958 attributable to OASDI beneficiaries who were also receiving old age assistance was $1,735,946. The human anguish which would be relieved by the Forand bill is best illustrated by specific examples from the files. Our department of social welfare gathered these examples as typical, and I am sure that similar examples are easily found in each of the 49 other States. A 68-year-old retiree lives with his wife and 90-year-old mother. He receives a pension of $68 a month. He and his wife receive total social security benefits of $147 a month. Hospitalization insurance is carried for the man and wife, but not for the mother who is in need of considerable medical attention. This insurance runs $16.13 a month. Drugs and medical expenses last year amounted to $475, of which $325 was expended for the mother. Out of the modest $215 a month available for all expenses, the man sets aside the amount for hospitalization insurance and is now trying to budget $40 a month for drugs and medical expenses. Whether he will be able to continue to do this and still maintain a home is problematical. A widow, over 65 years old, a former practical nurse and beautician, has for her support only $66.80 a month received from social security. She owns her own home and rents part of it. The rental is used for maintenance and other expenses. For lack of funds she was forced to drop her hospital and surgical insurance. Her comment is, "I can't afford to get sick." But she does have need for surgery. She has given herself some self-treatment and as a practical nurse realizes danger signals are present, but she can't afford the necessary treatment. A man retired after working 35 years in an auto plant at the age of 67. He and his wife own their own home and, in his words, he "is in good shape for retirement, except for illnesses in the future." Out of his total retirement income of $225 a month, he pays hospitalization. This enabled him to undergo surgery recently with costs to him of only $10. But when similar surgery was necessary for his wife, his share of the hospital, surgical, and medical costs was $101. It is charges such as this which make his retirement difficult and he fears even greater expense in the future. A retired auto worker, now 75 years old, receives a total income of $150 a month, pays $100 a month for board and $6.18 a month for hospitalization insurance. After a recent stay in the hospital, the fourth in his 12 years of retirement, he was told by his physician he needs special shoes costing $25 a pair and special elastic stockings costing $10 a pair. After meeting these extraordinary expenses last month, he had $1.10 left for incidental expenses for a full month. The pathos in such cases was pointed up when one of his longtime friends died and this man was unable to send even a few flowers because he lacked money. His fear is that surgical and hospital costs are likely to mount in the near future. These senior citizens have given their best years to our Nation's industrial and economic growth. They have raised families who have been a part of our industrial and business life. In many instances, in earlier years, they have offered their lives in the defense of our country. They deserve far better treatment in many cases than they now receive. Therefore, I am for the Forand bill because it fills a clear and present need not now being filled either by private insurance plans or by OASDI. I am for it because many of our aged people simply are not getting the medical care they need under present arrangements, and when they do get medical care through public assistance it is provided on the basis of a means test, or as welfare relief. The Forand bill provides a far better way, consistent with human dignity and with the respect we owe our aged citizens. It is needed. It is workable. It is equitable. It is dignified and humanitarian. It should be adopted. To this end, I respectfully recommend its favorable consideration by this committee and by the Congress of the United States. HOUSE OF REPRESENTATIVES, Hon. WILBUR D. MILLS, Washington, D.C. DEAR COLLEAGUE: I imagine that as a result of suggestions by the American Medical Association to its members you are receiving a number of letters in regard to H.R. 4700. I have been asked by physicians in my district to write |