The problems of the aged are different from those of the blind, and the problems of the disabled are different from both. Each group needs separate and categorical consideration. Each group needs separate and specially trained personnel, informed on the nature of their difficulties and particularly qualified to help toward their solu

tion.

We believe that, if rehabilitation is to be the goal of public assistance and we firmly believe it should be-then the categorical approach must be retained and strengthened, not abandoned or weakened.

Although the National Federation of the Blind approves the provisions of H.R. 10032 which would reduce residence as an eligibility requirement in public assistance, we believe that the rehabilitative objectives asserted by the bill would be better served, at least for recipients of aid to the blind, by the prohibition of any residence requirements by the States.

If the goal of self-help and self-support is to have reality for many blind recipients, they must be free to move from one part of the country to another in search of greater economic opportunity.

We recommend, therefore, H.R. 3729 as an amendment to H.R. 10032 to achieve this desirable result.

Mr. Chairman, members of the committee, with periodic regularity since 1950 you have been faced with the problem of the solely Statefinanced aid-to-the-blind programs in Pennsylvania and Missouriand with the same periodic regularity these States have been faced with the loss of funds in their federally supported blind-aid programs if you failed to renew their right to continue their State programs. We urgently request that you solve this perennial problem permanently, by adopting the identical bills, H.R. 4580, 4581, as an amendment to the bill you are considering.

We believe that the policies prevailing in the Pennsylvania-Missouri State blind-aid programs more liberal than those allowable in the Federal-State programs have resulted in greater numbers of rehabilitation because of this liberality. These programs should be permanently assured of continuance, and, we believe, other States should be granted the right to establish similar programs, using their own funds for this purpose, without imperiling their federally supported programs.

I could not mention the Pennsylvania-Missouri problem without acknowledging a debt of gratitude owed by the blind of these States and of the entire Nation to Congressmen Green, Karsten, and Curtis, and to other Members of Congress, for their stalwart support, for their tireless efforts to secure a permanent solution to this problem. Over the years, as we of the National Federation of the Blind have sought by legislative proposals to change title X of the Social Security Act into a mechanism which would encourage and promote self-help and indepedence, we have had the constant and concerned help of another distinguished member of this committee, Congressman Cecil R. King, of California. Aware of the benefits which have resulted to blind people in his own State from the liberal, rehabilitatively oriented blind-aid programs, Congressman King has joined with our organization to make these gains available to all the blind of America. Although the objectives of H.R. 10032 are rehabilitation and the

attainment of independence through self-sufficiency, we do not believe that all avenues have been explored which would make the full realization of these objectives possible.

We believe that, if substantial numbers of blind-aid recipients are to be stimulated and encouraged toward the goal of economic selfhelp, toward the ultimate goal of complete liberation from dependence upon public assistance then certain fundamental and far-reaching changes should be made in title X of the Social Security Act, and these changes would be accomplished by the enactment into law of bills H.R. 5014, 5018, introduced by Congressman King, and they have the vigorous and unqualified support of the National Federation of the Blind.

Four of these bills would orient blind aid toward rehabilitation to a far greater degree than would the provisions of H.R. 10032; the fifth bill would so alter the Federal-State financing formula that the more than 100,000 blind-aid recipients would be enabled to live better, not lavishly, and certainly not luxuriously-but with an increased measure of dignity and decency.

I request that each of these bills be considered and adopted by you as amendments to H.R. 10032.

H.R. 5014 would establish equal minimum monthly payments for recipients of aid to the blind. It would permit the ascertaining and the meeting of the presumed and demonstrated needs of the blind as a group, as opposed to the present practice of individual needs individually determined.

The principle of equal minimum payments to all blind recipients enacted into law, with its provision of a floor of security and a positive stimulus to self-help and independence, would tend to counteract the harshest features of the individualized means test; would reduce administrative costs and simplify procedures, and, most vital of all, would preserve and promote the moral and psychological well-being of blind recipients and would encourage them toward greater efforts in the direction of self-care and self-support.

H.R. 5015 would abolish the legally enforcible obligation of relatives to contribute to the support of needy blind persons.

Not only self-care and self-support, but the strengthening of family life, too, was established as a purpose to be served by public assistance by the 1956 amendments to the Social Security Act and this, too, is declared as an objective of H.R. 10032. The legally enforcible duty of a family member to financially assist a needy blind person does not strengthen but tends to destroy family life, makes the blind person a drain and a burden upon the family's meager resources, and creates a home atmosphere far from conducive to stimulate self-care and self-support.

H.R. 5017 would prohibit any State agency from requiring blind aid recipients to subject their property to liens or transfers to such agency as a condition for receiving aid.

To permit States to require the encumbering of the small amounts of property held by some blind aid recipients deprives these individuals of any ability to use their own possessions for self-care and rehabilitation. It is not possible to help the blind person to return to productive and useful living if his very future is to be mortgaged or his property is to be taken from him because he receives assistance in time of need.

H.R. 5018 would require that not less than $3,000 of the assessed valuation (less all encumbrances) of real and personal property be disregarded when determining the need of recipients of blind aid and, in determining the need of an individual who has an approved plan for achieving self-support, such additional amounts of other income and resources be disregarded as may be necessary for the fulfillment of the plan.

The requirement in the present provisions of title X, that all property and resources of a blind aid recipient (except a certain portion of his earned income) must be utilized exclusively for his maintenance as a prior condition for receiving assistance, has succeeded only in impoverishing the individual who becomes a recipient or compels him to live in impoverished circumstances without assistance. This situation hardly serves to encourage a person to attempt self-care, let alone self-support.

We certainly endorse section 132 of H.R. 10032 which would make permanent the increased Federal money made available for the three adult aid titles in last year's social security amendments, but we urge that this provision be amended so as to require that the additional dollars be passed on to recipients as was originally the case in the Senate-passed version of this increase. But even this action will be of slight benefit to recipients-at best only 80 cents per recipient monthly.

We vigorously recommend, therefore, that you adopt H.R. 5016 to improve the depressed financial condition of blind-aid recipients by providing for an increase in the matching of State funds by the Federal Government whereby it would pay $30 of the first $35 of the average blind-aid payment, and from 50 percent to 65 percent (in accord with the variable grant formula) of the difference between $35 and $75.

This proposed changes in the matching formula alone will assure that blind-aid payments in the States will more adequately meet the actual financial needs of recipients while they are in distress. The consequences of the present low Federal ceiling on matching has been that many of the States have been unable to keep pace with rising living costs, thus imposing even greater poverty and distress upon the needy blind persons of the Nation who must depend solely upon public assistance for survival.

According to the January issue of the Social Security Bulletin, a publication of the Department of Health, Education, and Welfare, there were 104,394 blind-aid recipients as of last September, receiving an average monthly grant of $67.29. The highest average State payment was $110.58, and the lowest was $38.49. This was at a time when, according to the Bureau of Labor statistics, the average hourly industrial earning was $2.33; at a time when the national minimum wage had become $1.15 a hour.

The dire distress of the 104,394 blind-aid recipients is obvious from this comparison.

We urge the adoption of H.R. 5016 as a remedy to this grievous condition.

In conclusion, Mr. Chairman, and members of the committee, for many years we of the National Federation of the Blind have urged that rehabilitation and restoration, not relief and resignation, should

be the objectives to be served by the federally supported public assistance programs in the States.

For years, we found few adherents to this doctrine in high places. Now, we are extremely gratified by the declarations made and the proposals offered by this Department of Health, Education, and Welfare.

I thank you very much, Mr. Chairman, for this opportunity to present the views of my organization.

The CHAIRMAN. Mr. Nagle, we thank you, sir, for bringing them to us. Are there any questions of Mr. Nagle? Thank you, Mr. Nagle.

Mr. NAGLE. Thank you very much.

The CHAIRMAN. Is Dr. Jaeckle present?

Without objection the committee will adjourn until 2 p.m. this afternoon.

(Whereupon, at 12:25 p.m., Tuesday, February 13, 1962, the committee was recessed, to be reconvened at 2 p.m. the same day.)

AFTERNOON SESSION

The CHAIRMAN. The committee will please be in order.
Dr. Jaeckle?

I understand you are to speak in lieu of Dr. Dryden, is that right?
Dr. JAECKLE. Yes, sir.

The CHAIRMAN. If you will identify yourself and give us your name and address and capacity in which you appear, we will appreciate it.

STATEMENT OF CHARLES E. JAECKLE, M.D., MEMBER, BOARD OF TRUSTEES, NATIONAL MEDICAL FOUNDATION FOR EYE CARE

Dr. JAECKLE. My name is Charles E. Jaeckle. I am a physician. I live and practice in Defiance, Ohio.

The CHAIRMAN. You are recognized, sir.

Dr. JAECKLE. I am here as a member of the Board of Trustees of the National Medical Foundation for Eye Care.

Mr. ALGER. If I might interrupt, I would like to say this. Dr. Jaeckle would have been greeted today by Congressman Betts, our colleague, had he been here. I am filling in for him and I welcome you here today, Dr. Jaeckle. We are glad to have you here. I welcome you in Mr. Betts' name, also.

Dr. JAECKLE. Thank you, sir.

Prior to studying medicine I was graduated with the degree of bachelor of science in optics and optometry, and practical optometry 9 years. After additional science courses, I qualified to enter medical school. After receiving the degree of doctor of medicine from New York University, I was trained in ophthalmology at Northwestern University. I have served as ophthalmological consultant to the American Medical Association's Committee on the Rating of Physical Impairment. My appearance here is as a member of the Board of Trustees of the National Medical Foundation for Eye Care.

H.R. 10032, through a new, constructive approach, emphasizes prevention and rehabilitation. We concur in the statement of the American Medical Association on this bill. We are concerned by one clause

which in our opinion does not foster prevention and rehabilitation. I refer to section 1602 (a), (12) which provides that

in determining whether an individual is blind, there shall be an examination by a physician skilled in the diseases of the eye or by an optometrist, whichever the individual may select.

A similar provision is found in section 1002 (a) (10) in existing law. In stipulating that the physician who makes this examination shall be "skilled in the diseases of the eye," the Congress has taken the position that in determining physical impairment in this one area, even a complete general medical training is not enough; and the Congress has further recognized that blindness must be diagnosed, that its determination requires not only measurement of the degree of vision, but the diagnosis of the disease which is the cause of blindness, and the determination of the possibility of restoration of sight.

The addition of the words "or an optometrist," following the phrase, "physician skilled in the diseases of the eye," presumably indicates that those who drafted this clause regarded the optometrist as having a competence comparable to that of such a physician which is not the case. We are certain that it was not the intent of the Congress that the individual choose between the services of one qualified and those of one not qualified. Yet such is the effect of the present law and of this provision of H.R. 10032. As a consequence, the States have commonly, having accepted the optometrist's report, nevertheless found it necessary to call for an examination by an eye physician.

The eye training of every physician begins in the first week of medical school, and continues throughout the 4 years. On graduation from medical school, the general physician is well grounded in the eye. The educational qualifications of the optometrist do not approach those of the general physician, either in general subjects or in the eye.

It takes at least 4 years more to make the physician into an ophthalmologist-a physician specially trained in the eye.

The optometrist has an acknowledged competence in the measurement of ocular refractive errors and their correction by glasses. The need for glasses, however, is never the cause of blindness. When there is blindness, there is disease.

Optometrists sometimes observe signs of disease, and then may or may not advise medical examination. The optometrist cannot always know when disease is present. Frequently when optometrists have informed a patient of the presence of such signs, they have also advised him that he needed no treatment, or that there was no treatment for his condition. The good intention of the optometrist notwithstanding, he is not qualified to diagnose disease, to determine the treatment required, or to diagnose the absence of disease. The majority of patients who come to the ophthalmologist come on the referral of other physicians or on their own initiative, and these patients arrive earlier in the course of disease, offering better prospect for prevention and rehabilitation.

In one study of glaucoma patients, only 18 percent were referred by optometrists, and half of those were in the very late stages. An equal number in the late stages had been seen by an optometrist, but not referred. The majority of the patients were referred by other