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We know of no sounder approach, Mr. Chairman, to solving the health and security problem of the aged than to use the time-tested program of OASI and the insurance principle on which it is based. Farm people had much rather pay for the health care that they will need after retirement or disability while they are active and working. Such a program as proposed by H.R. 4700 will fill an urgent need for the young as well as the aged on farms.

There are many cases on farms where young people have the burden of caring for aged parents in poor health. For that reason a program such as provided by H.R. 4700 would be of immediate benefit to young and aged alike.

We strongly urge that the committee give its approval to the bill introduced by Congressman Forand.

It is of significance that the American Hospital Association has recognized the need for Federal action in connection with the problem of geriatrics and that their position is counter to that of the American Medical Association.

We sincerely feel that the public interest should be considered in your deliberation on H.R. 4700. We regret that the doctors do not recognize the need for this kind of intelligent and constructive action on the part of our Government.

The CHAIRMAN. Mr. Johnson, first of all, let me commend you for a very good paper.

I would like to ask you if it is your impression that the farmers are well pleased that they were included under the old-age and survivors insurance program?

Mr. Johnson. The farmers are indeed well pleased that they are covered under this program. As you know, a great number of farm people are already receiving OASI benefits. The field staffs of the Social Security Administration were enlarged to take care of the influx of farm applicants that were eligible, or who have become eligible, since that program went into effect.

I might add here they have done an excellent job of only informing farmers about the provisions of the law, but in seeing that they got equitable and proper coverage under that law-whatever they were entitled to.

Mr. FORAND. Is it not true that farmers and other groups, if they were to get voluntary health insurance, would benefit from the additional benefits proposed in this bill?

Mr. Johnson. Very definitely.

The CHAIRMAN. If there are no other questions of Mr. Johnson, thank you very much, sir.



Mrs. STEPHENS. I would like to be recognized for 2 or 3 minutes. The CHAIRMAN. We will recognize you for 2 minutes.

Mrs. STEPHENS. My name is Mrs. Nell F. Stephens, Georgia, registered licensed practical nurse. I have worked around the District of Columbia a little over 7 years.

The CHAIRMAN. Do you live here in the District ?

Mrs. STEPHENS. Yes. I am a registered lobbyist for 7 years.

I have helped cut much on nursing homes, nursing conditions, and nursing needs in the District of Columbia on a voluntary basis.

The nursing homes, as has been proven in the District of Columbia, are simply a haven for addicts, alcoholics, and what have you. It seems to me the unlicensed personnel attending these poor, sick, afflicted, and helpless, is calling again and again for the need of licensed practical nurses in the District of Columbia-of which legislation is pending.

I find many of these nursing homes are not operated by graduate nurses. Some of them claim to be graduate nurses, but are not. We have had cases where I had to lock the patients in the home and call the police to take over. And that home was over in the Takoma Park area on the Washington side. I was forced to do it to get quick action for the care of those people. After working all day Saturday and all night Saturday and Sunday, it was time this nurse had some rest.

When the doctors refused to give me assistance, I called in police, I had to do it to protect the sick.

Mr. Chairman, there are many, many conditions that caused me to make this strong statement. It is simply a disgrace to the United States of America for the care of sick, allicted, and helpless are receiving all throughout the Nation.

I have worked in Montgomery County and because I received an infection from drinking tea from a soiled glass or eating from a soiled spoon thought to be clean, I began to lose my teeth. I now have, thank God, some good dentures.

These homes should be taken care of, should be equipped as a small hospital. They could be run as such with licensed nurses. The cleanliness and the sanitation should be looked into just as in our own private commercial homes--more so because of the sick, afflicted, and homeless.

Present interest is in the interest of nursing. I love it. After 40 years of it I think I know something about it. I would think that all that has come out up to now regarding the nursing conditions in the District of Columbia, that you men who make the laws have a whole lot to go on and I have a list of people that I would like to give and I

give to the committee to subpena them and have them brought here as witnesses as to conditions that have been found in the District of Columbia.

First of all, I suggest you call in Miss Tresher of the U.S. Public Health Service.

I was a witness in a courtroom regarding the situation out in Takoma Park. To improve this situation, let me give you this thought. Let's make the District General Hospital a model as to what a State hospital in the States should be. Get rid of these racketeering nursing homes. It is simply a means of getting rich quick. If you want to get rich, open up a nursing home.

The CHAIRMAN. We thank you very much for giving us this information,

Without objection, the committee adjourns until 10 a.m., tomorrow.

(Whereupon, at 2:30 p.m., the hearing in the above-entitled matter was recessed, to be reconvened at 10 a.m., Tuesday, July 14, 1959.)

Thank you.



TUESDAY, JULY 14, 1959


Washington,'D.C. The committee met at 10 a.m., pursuant to recess, in the committee hearing room, New House Office Building, Hon. Wilbur D. Mills, chairman of the committee, presiding.

The CHAIRMAN. The committee will please be in order.
Our first witness this morning is Mr. Nelson H. Cruikshank.

Mr. Cruikshank, although we know you quite well, for purposes of this record will you please identify yourself and also introduce to the committee Mrs. Ellickson.



Mr. CRUIKSHANK. Mr. Chairman and members of the committee, I am very glad to appear here again on this occasion before your distinguished committee.

My name is Nelson H. Cruikshank and I am director of the Department of Social Security of the American Federation of Labor and Congress of Industrial Organizations. With me is my associate, the assistant director of the department, Mrs. Katherine Ellickson. Her office and mine are both at the AFLCIO headquarters at 815 16th Street NW., Washington, D.C.

The CHAIRMAN. Mr. Cruikshank, will you consume the time, or will you and Mrs. Ellickson divided the time?

Mr. CRUIKSHANKS. She and I will divide the time. I think I will take the major part of it probably.

The CHAIRMAN. Would you like to be notified after you have consumed so many minutes ? Mr. CRUIKSHANK. I would appreciate that; yes, sir. The CHAIRMAN. How many minutes do you want? Mr. CRUIKSHANK. Oh, give me 10 minutes' warning. The CHAIRMAN. Ten minutes and then notify? Mr. CRUIKSHANK. No, 10 minutes' warning. I am down for 45 minutes I believe on the schedule.

The CHAIRMAN. You will consume 35 minutes before we will warn you then. Mr. CRUIKSHANK. All right, sir.


The CHAIRMAN. All right. You are recognized for 45 minutes.

Mr. CRUIKSHANK. Mr. Chairman and members of the committee, I and my associates are very glad to have the opportunity to present our views in support of this bill, H.R. 4700, introduced by Congressman Forand, because it is one of the proposals that is of the greatest interest to our members.

I have here a full statement which, if I may, I would like to have inserted in toto in the record, but I would like to summarize it in my oral statement, and possibly bring in some other points that are not outlined here.

The CHAIRMAN. Without objection, your whole statement will appear in the record.

(Prepared statement of Mr. Cruikshank follows:)



My name is Nelson H. Cruikshank, and I am director of the Department of Social Security of the American Federation of Labor and Congress of Industrial Organizations. I am here with my associates representing the AFL-CIO in support of the addition of health benefits for beneficiaries of the old-age, survivors and disability insurance program along the lines proposed by a distinguished member of this committee, Congressman Forand, in H.R. 4700.

This proposal is of great interest and importance to our members. We appreciate the opportunity to present our viewpoint to your committee at this time although we regret that in the time now available for hearings before Congress adjourns it will not be possible to explore fully the problems of health care for older people and other social security beneficiaries.


Developments since we discussed this matter before your committee a year ago have further demonstrated the need for Federal legislation to assure good health care to the aging on a basis they can afford.

The recession of 1958 reduced incomes and resources of many older workers and of younger adults supporting retired parents. In spite of the recent increases in benefits proposed last year by your committee and wisely enacted by Congress, most persons over 65 still have too little money to meet the rising costs of medical care. The proportion of Americans covered by voluntary health insurance declined slightly in 1958, and presumably the aged were similarly affected.

Adequate alternatives to Federal action have not been developed. New types of insurance policies have been initiated but they have not met the need. For example, one highly advertised type charges $6.50 per person a month for very limited protection.

The American Medical Association proposes that doctors cut their fees for the aged so that private insurance will cost less. But the AMA has no way of enforcing its plea for lower charges, and hospital care is a far greater expense for the aged than doctors' services.

Hospitals continue to be squeezed by rising costs. The American Hospital Association stands by its position that some form of Federal action is needed even though the AHA leaders are under great pressure from the AMA to change its stand.

The Forand bill is receiving ever-wider support. Our members continue to be very enthusiastic about it.

We have received many comments on specific phases of the proposal from doctors and others. These have helped to guide our thinking and our testimony before your committee today.

The report of the Secretary of Health, Education, and Welfare has provided us and others with much information and useful analysis. You will note there is nothing in the report that indicates that the Federal Government could not ad. minister the proposed benefits.

Thus developments of the last year have emphasized the failure of other approaches and the feasibility of adding health benefits to the old-age, survivors and disability insurance program.



Your committee has wisely participated in far-reaching improvements in the Federal program and has thus provided a floor of security for most older persons. It must be a gratification to you to know that 11 million persons age 62 and over are now receiving benefits as a matter of right each month, and that the average primary benefit is now $72, or $6 more than a year ago. This is in addition to the protection extended to young survivors and seriously disabled workers and their dependents. In talking of further improvements in social security, we should bear in mind the amazing accomplishments that have been achieved in spite of dire predictions of socialism and of obstacles too great to be surmounted.

Private pension plans have likewise grown tremendously larger under the impetus of union bargaining. However, only a little over 1 million out of the 11 million aged persons who are not working receive such private benefits. The Federal program covers a far larger number.

The absence of protection against heavy medical costs is today the greatest gap in the security of older citizens. A couple who have saved some money and are now entitled to a modest income through governmental and private protection can plan for a reasonably comfortable and dignified old age. But if one or both become sick, charges for doctors, hospitals, drugs, and appliances can mount in a short time to thousands of dollars. The whole underpinning of retirement is swept away. For fear of such loss, many couples postpone securing medical attention until too late, with resultant tragedy.

Your committee can now solidify social security by adding a reasonable degree of protection against health costs. The role of public assistance

The public assistance titles of the Social Security Act have done much to provide minimum subsistence to certain groups of the needy.

But as spokesmen for organized labor we cannot state too strongly that the public assistance approach is not a satisfactory solution to the medical needs of our members and they constitute a very large part of the wage earners of this Nation.

Public assistance by its very nature is based on the means test. The States develop budgets which are considered enough to live on. These budgets often are very low, many are out of date, and in many places available funds do not permit maintenance of even the minimum standard. The level of living to which people must descend to receive public assistance is far below what most American workers consider acceptable.

Our older members are proud that through decades of hard work, they have acquired some life insurance, savings, and often a modest home. But they would largely have to forfeit or mortgage these fruits of a lifetime of labor before they could receive public help in most localities in paying for their medical bills.

Even if they were not barred, they would be subjected to an intensive inquiry into all their resources and sometimes into the ability of relatives to support them. Under the better programs, such inquiries are made sympathetically by well-trained workers. Not all agencies, however, carry out in practice the high standards set by leaders of the welfare professions.

Leaders of the AMA talk glibly of the opportunities for free care open to the medically indigent.” But people should not be forced by high medical bills to use up their savings and thus become “medically indigent." Nor should they be forced to undergo the means test which may be applied by public clinics or hospitals where care is theoretically available to them. Such care, moreover, is not always of a high quality.

The AFL-CIO favors extensive improvements in public assistance and in public medical care for persons who have no other way of obtaining it, but we do not consider these programs a substitute for social insurance. Our members want to obtain social insurance for the cost of medical care as a matter of right just as they are now receiving old-age and survivors benefits as a matter of right without application of the means test.

We know that in many communities leaders of the medical profession have become involved in attempting to improve medical care under public assistance or for other low-income people. We hope that in every community they will take responsibility for assuring that every one does have access to high-quality care no matter what his financial resources. But we realize that many shocking situations still continue.

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