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Washington, D.C., July 17, 1959. Hon. WILBUR D. MILLS, Chairman, Committee on Ways and Means, House of Representatives, Washing

ton, D.C. DEAR CONGRESSMEN MILLS: I am taking this opportunity to express the interest of the United Association and its members in securing favorable action on the Forand bill, H.R. 4700, now being considered by your committee. This bill would amend the old-age and survivors insurance system so as to provide insurance against the cost of hospital, nursing homes, and surgical services to all those eligible for old-age and survivors benefits or who would be eligible if they applied.

The United Association, of which I am general president, is a labor organization of more than 255,000 plumbers and pipefitters affiliated with the AFL-CIO These members are usually dependent for their livelihood on wages earned in the construction industry. While some of our local unions have pension plans for older workers, most of our older members are dependent for support on social security benefits. After retirement they usually receive no support from either the union or the industry.

While the United Association and our local unions have been providing very substantially more than half of all working membership and, in addition, their wives and families with much needed hospital, surgical, maternity, medical, and loss of time benefits, through jointly administered health and welfare funds, it has not beeen practicable to provide the same benefits on a broad basis to retired workers. Advanced age unduly increases the cost of insurance for this older group. Moreover, the incidence and duration of illness is higher as men grow older, and, as a result, the various health coverages are more expensive. Meeting these costs could saddle any fund with too heavy a burden, thereby handicapping the fund in fulfilling its main purpose, namely, to provide benefits for active members and their families.

A study of our health and welfare plans, made 5 years ago, bear out this situation very graphically. At that time there were 106 funds involving 179 different local unions out of a total of some 750 local unions in the United Association. Only 34 out of these plans covered retired members. Only 16 of these 34 plans covered dependents of retired members. The cost of providing such coverage was then being met through contributions to joint funds on the basis of hours worked by active members. While, in these few cases, the joint funds may, in good times, be able to withstand the cost of covering retired members without specific contributions to the fund on their behalf, nevertheless, in times of unemployment it is doubtful whether such coverage could be continued.

These circumstances clearly show the need for health benefits for the aged. Rising medical costs are a special threat to them, who have little or no health insurance protection. Commercial insurance is unavailable or too expensive, and Blue Cross-Blue Shield plans are raising their rates. Public system medical allowances fail to meet the need. Health benefits through a self-supporting insurance system as provided by H.R. 4700, would fill the gap for an estimated 15 million older citizens.

I need not outline the provisions of the Forand bill for the benefit of the committee. This has been done very ably by others during hearings now being held on the bill. My purpose now is to record the strong support of our membership for the Forand bill and to request that this letter may be incorporated as a part of the hearings now in progress. We hope you can report favorably on this bill at an early date. Yours very truly,

PETER T. SCHOEMANN, General President.


San Francisco, July 1, 1959. Congressman WILBUR D. MILLS, Chairman, House Ways and Means Committee, Washington, D.C.

DEAR CONGRESSMAN : Hearings on the Forand bill (H.R. 4700) are scheduled to begin on July 13, 1959. This bill, which is designed to add certain health benefits to the old-age and survivors insurance, certainly merits the support of all segments of the citizenry of the United States. The International Organization of Masters, Mates, and Pilots fully endorses the Forand bill and requests that this letter be incorporated in the record of the hearings.

The problems of the aged in the maritime industry are basically the same as those problems confronting the aged throughout the country. However, certain peculiarities in the maritime field, especially in this organization, are worthy of note, since they bear directly on phases which the Forand bill covers.

The International Organization of Masters, Mates, and Pilots is composed of licensed deck officers who pursue a seagoing career in the American merchant marine, the fourth arm of defense. By virtue of Federal law, the facilities of the Public Health Service marine hospitals are available to the membership of this organization who meet the requirements of certain regulations. These regulations of themselves are felt to be much too restrictive, especially when the maritime industry is in a depressed state, such as now confronts us. However, Federal law does not permit the use of public health facilities for aged seamen who are no longer able to continue a sea-going career. Further, this organization appears to be far above average with respect to the life expectancy of our older members.

Through collective bargaining in 1955 a pension plan was negotiated to cover our older members who qualify by virtue of long years of service in the maritime industry. This pension plan is financially unable to sustain any form of medical care for the pensioner or his family. Two years ago there was a growing realization of the cost of medical care to the aged pensioner and/or his wife and an effort was made to alleviate the situation. In this organization it was accomplished by the use of welfare fund money to the extent of allocating to each pensioner the use of $500 for medical care for himself and wife. Obviously this amount of money is totally inadequate but represents a realization on the part of the labor-management trustees of the welfare and pension funds that medical care for the aged must be given serious consideration.

It is likewise obvious that the burden of assuming the social responsibility connected with medical care for the aged cannot be handled on an individual industry basis but must require Federal action in this field.

Far greater than the problem of the aged pensioner and wife, in this organization, is the medical problem of the older members who have not yet qualified for a pension and who likewise are not qualified, due to the restrictive regulations, to obtain medical care in the public health marine hospitals. The problem of this group becomes more acute as the depression in the shipping industry grows.

Most maritime welfare plan benefits cover the dependents of the working member who theoretically is eligible, in his individual case, to medical care at a public health marine hospital. However, in order that the coverage of the welfare plan be extended to the dependents of the member, he must meet minimum working period qualifications, which again, he cannot meet due to the depression in the shipping industry, thus leaving both himself and dependent without any medical care whatsoever.

The joint labor-management trustees of the welfare plan covering the members of this organization continue to give their best effort to resolve these problems but are only too aware of the inadequacy of the industry to do more at this time or in the foreseeable future.

For all of the foregoing reasons, this organization feels that the Congress must enact legislation consistent with the needs of our older citizens. Sincerely yours,

International President, and

President West Coast Local 90.




The Amalgamated Association of Street, Electric Railway and Motor Coach Employes of America, AFL-CIO, is the dominant union in the field of transportation of passengers by streetcar, motorbus, and trolley coach. Our organization is the pioneer among all trade unions in the field of the provision of

health and welfare benefits for union members. The Bureau of Labor Statistics has reported that the first such collectively bargained agreement which has come to its attention was one made in 1926 between the transit company in Newburgh, N.Y., and one of our local divisions. We are vitally interested in protecting the aged against the financial hazards of illness during old age. We believe such protection should be afforded not only for our own membership but for all Americans.

The importance of health insurance for the aged cannot be overstated. The tragic impact of heavy medical costs on retired persons has repeatedly been demonstrated. The retirement incomes of most Americans are extremely modest. According to a recent study by the Division of Program Research of the Office of the Commissioner of Social Security Administration about three-fifths of all persons aged 65 and over had less than $1,000 in money income in 1958.

When an aged person becomes ill, charges for medical care, hospitalization, surgical benefits, drugs, home and nursing care may well amount in 1 year to a sum exceeding the entire income of the aged person for that year. Since there is little chance of increases in income for an aged person who has had a severe illness, such an individual is apt to be left in dire financial straits. Moreover, because their incomes are in general so low, many aged persons fail to seek medical attention until it is either too late or the illness has become seriously aggravated.

Our organization has sought to secure protection against health costs for aged and retired workers through collective bargaining. We have encountered bitter resistance from employers in this area. Many employers in our industry take the position that once an employee has retired his relationship to the employer has ended and his welfare is a matter of no concern to the employer. We believe that as a matter of law, and as a matter of morality, there is no merit to such a position. The fact remains, however, that it has been used to make more difficult the achievement through collective bargaining of the benefits this bill would provide through legislation.

We have managed to obtain some limited protection for retired workers in a few contracts which do provide some benefits for hospitalization, and in some cases, surgical costs. In some cases retired workers may continue in the Blue Cross or Blue Shield program as a part of the group, but at their own expense.

Our industry has hundreds of employers. Bargaining is on a local basis. We shall continue to strive to protect our old people through collective bargaining, but it is obvious that we cannot wait to achieve adequate protection for retired workers through collective bargaining alone.

Nor does private insurance afford adequate protection against health costs for the aged. The cost of such insurance is too great for most retired persons to afford. Less than one-half of the aged persons today have any form of health insurance protection. Moreover, those that do have such protection have inade quate protection. Such protection is normally limited to only a portion of the large medical costs aged people are likely to incur.

Moreover, group insurance does not reach enough of the aged under any circumstances. It is typically related to employment. In many unorganized establishments workers have no private pension benefits and no protection against ill health upon retirement. Employees who do not have a regular employer, who become disabled before age 65, or who are unemployed at that time, frequently are found without income available through earnings and without the benefit of group health insurance or pension benefits.

Social security and private pension plans have been growing together. Each has played an important role in providing retirement income. Similarly, statutory health benefits under the social security program and private efforts at providing protection against the hazards of ill health will each have their respective roles in our country's future welfare programs.

We believe that the Federal old-age, survivors, and disability system should be supplemented by the addition of health benefits. We believe that the additional contributions required are within our country's means. We urge the Congress to adopt H.R. 4700, and we feel confident that the adoption of that program will be an achievement of historic importance. The next generation will look back upon the inauguration of such a program with the same sense of pride and achievement that this generation feels for the social security program as it now exists.


July 16, 1959. Hon. WILBUR D. MILLS, Chairman, Committee on Ways and Means, House of Representatives, Washington, D.C.

DEAR MR. CHAIRMAN: I respectfully request that the enclosed report to the Legislative Commission To Study the Administration of Public Medical Care from the Commission on the Aging, which was submitted to me by Mrs. Eone Harger, director of the division of aging of the New Jersey Department of Health, be included in the record of your committee's hearings on H.R. 4700, the Forand bill.

I woud also like to request that the enclosed speech by Gov. Robert B. Meyner of New Jersey be likewise included in the testimony. Sincerely,

HARRISON A. WILLIAMS, Jr. Report to: The Legislative Commission To Study the Administration of Public

Medical Care.
From: The Commission on the Aging.
Subject: "Medical Care and the Economics of Older People.”

Amount and source of income, people aged 65 and over, New Jersey, 1957

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465, 000



1 Medical institutions. 2 All others. 3 Statistical abstract of the United States, 1958. Median monthly income persons aged 65 and over, United States.

These figures show that most people aged 65 and over have incomes so low that they cannot adequately meet their medical needs. In order to meet these needs, many older people are becoming recipients of the medical provisions of old-age assistance. The high cost of medical, hospital, and nursing home care, together with the increased proportion of people who are on old-age assistance for medical care only, has resulted in the overall expense of the old-age assistance program increasing, even though the total number of recipients is decreasing. One-third of the old-age assistance recipients are also old-age survivors insurance beneficiaries.

Seventy-five percent of New Jersey's aged are now covered by old-age and survivors insurance. When the medical needs of this group are met, the largest part of our problem will have been solved. While Federal policy is being decided, we in New Jersey have the immediate responsibility of providing for the medical care of all our older people. For humanitarian reasons, we must meet our obligations to the medical needs of our older people, regardless of the money cost.

Now required under our welfare assistance laws is the providing of food, shelter, and clothing. To these should be added a fourth, medical care, which we define as including diagnosis, prevention, treatment, and rehabilitation.

The New Jersey Commission on the Aging respectfully submits this report to the commission on the administration of public medical care. Inasmuch as your commission is charged with the responsibility for recommending answers to these questions, we wish to indicate the principles of our support to you. We hope we can lend further support to your recommendations.

Members of the commission on the aging, April 29, 1959.
Present: Mrs. Eone Harger, chairman, Dr. Harold W. Dodds, Sister Mary

Andrew, Dr. Everett C. Preston, Mrs. William N. Gurtman, Dr. Lloyd W. McCorkle, Mr. Lawrence 0. Houstoun, Jr., Mr. David Davies, Mr. William J. Joseph.

Absent: Thomas J. Walker, Esq.



Mr. CHAIRMAN: First of all, I want to express my admiration for the groups and individuals who have gathered here from all parts of the country to develop ideas and plans for the improvement of health care of the aged. Here is an issue of profound national concern, and it is most encouraging that you in this audience have come to Washington to do something about it. Out of this meeting of the minds I am sure much progress will be made.

Ironically, it is the very fact of your success that has created a multitude of problems we face today. I am speaking, of course, of the problems stemming from a large and growing segment of our population over the age of 65.

Without the incredible successes of modern medicine, our aged would be relatively few in number, and their needs relatively easy to meet.

But you have brought added years to millions, and in the process set the scene for sweeping social changes.

This is a contribution of incalculable worth, whether measured in terms of human happiness, reinforcement of the Nation's skills and talents, or conservation of our common store of wisdom.

As Governor of New Jersey for the past 512 years, I have been in constant contact with the plight of the aging. It has become so acute that we have established a division of aging in our State government, where the various facets of the problem can be drawn together for observation and action. This year we held in Trenton our first Governor's conference on the aging, where numerous specialists gathered to give us the benefit of their experience and wisdom. I believe it was the best attended conference of its kind ever held in the United States. This demonstrates the growing interest in the problem of the aging.

I am also serving as chairman of the Special Committee on Aging of the Council of State Governments. Three years ago this month, speaking here in Washington, I cited the splendid report of the council. It shows that the ranks of the aged are growing, both relatively and absolutely; that the rate of increase of older people is twice that of the total population. They suffer from inequality of employment; inferior housing; separation, psychologically and physically, from family and friends; widowhood for more than half of the older women; loneliness; lack of social participation; shortage of trained personnel to deal with their problems; and inadequate medical, surgical, hospital, and nursing home care.

The council's report was forced to conclude that "these problems, in their totality, represent the failure of our Government and our society to design a program which permits our older citizens to contribute to our economy and to live healthful, useful, and happy lives in accordance with accepted American

standards." This is an indictment which must lie heavily on the consciences * of all of us. It cannot be swept under the rug nor, in my opinion, can it be left entirely to private and voluntary agencies, no matter how energetic and wellintentioned.

It is somewhat startling to realize that while, at the turn of this century, there were only 3 million citizens over the age of 65, today there are more than 15 million. That is more than 8 percent of the population, and the proportion is increasing each year. Only about 25 percent continue in gainful employment after 65, or are spouses of earners. Two-thirds of our senior citizens outside institutions have very low incomes, and from one-fifth to one-fourth have none whatever.

We are faced here not only with the health of 15 million people over 65, but of 35 million others between 45 and 64. Together they total about half of the eligible voting population of the country, and 50 million people will be heard in a democratic society. We must consider that, in the absence of constructive action, this huge proportion of our people could be spurred into political action

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