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can-are the very old. It certainly seems to me justifiable to start with them.

Mr. RINALDO. Many Members of Congress feel very strongly that we ought to modify medicare to cover eyeglasses, prescription drugs and other items of that nature. For instance, New Jersey has its own State program to aid the elderly in prescription drugs. I am just addressing this to the panel generally for whoever would like to comment on it. Do you think, since you mentioned this in some respect, there is any desirability of trying to do this at the Federal level?

Mrs. SOMERS. Yes, absolutely. But I do not think it can be blanket coverage. The reimbursement list will have to be carefully worked out. Also, it is estimated that one-half of the people over 65 are edentulous, that is, no teeth at all. Ten percent have neither dentures nor teeth.

Now, you can imagine what that contributes to gastrointestinal problems, as well as mental health problems. This whole preventive thing is such a penny-wise, pound-foolish approach. I also think we are pursuing a double standard in this respect.

Dr. Davis mentioned this morning that HCFA is going to fund a lot of new studies to see what is cost effective and health effective in the field of preventive services. Why do they not do that in the field of high technology? The same administration, which worries about a $50 pair of eyeglasses or a $25 visit to the podiatrist, opposed continuation of the Center for Health Technology Assessment, the area that accounts for such a large proportion of medicare's multibillion-dollar costs.

I think everything should be assessed, but there have already been studies. The previous Surgeon General, Dr. Julius Richmond, requested of the Institute of Medicine, which is part of the National Academy of Sciences, a report on preventive services which might be included in national health insurance as well as medi

care.

I participated in the IOM study. We sent that to the Surgeon General 5 years ago. The only thing that survived from it was the pneumococcal vaccine that was referred to. Everything else was ignored.

Not every preventive service has been studied. It is no more static than is medical technology. The annual physical, 15 or 20 years ago, was considered very good. Now, I was one of the first people who said it was not cost effective or health effective, but there are other periodic schedules that are being followed today. Mr. RINALDO. What should it be? What in your opinion should it be?

Mrs. SOMERS. It should vary according to age. An infant in the first year of life obviously needs to be seen more than once a year on a preventive basis.

Mr. RINALDO. I am talking about primarily adults and senior citi

zens.

Mrs. SOMERS. I think it varies every 5 years for a healthy young adult down to every year for the old. One easy-to-remember schedule calls for two preventive visits for healthy adults in their twenties (that is one every 5 years), three in their thirties; four in their forties; five in their fifties (every 2 years) and every year after 65.

Also the particular procedures should vary. They are not the same for men and women. They are not the same depending on your occupational background. They are not the same depending on your age. All of those things have been carefully studied. We are not starting with a clean slate. One has the impression that there is a little foot-dragging here.

Mr. RINALDO. I want to thank you very much. I think the testimony of this panel has been very constructive. As you know, by way of summary, we in Congress, in my view, are going to have to approve some medicare legislation in the next few years, possibly as early as the next year or two. And we have to do our best to maintain benefits in the face of health care inflation that is projected to remain at double digit rates. The Congressional Budget Office puts it at 13.8 percent through 1995.

It is obvious we will need revenues. We may not be able to expand benefits as much as we would like, and we have got to get a handle on health costs. I think that has been dramatically pointed out at this hearing.

I am going to push for more hearings by this committee and I want to state to all of the people who could not testify today that I would appreciate it if they would like to testify at some future hearing, to please write to the Select Committee on Aging and we will do everything possible in an effort to have your name placed on a list for one of our future hearings.

I want to once again thank all of the panelists. I think you have come up with some excellent proposed solutions, and maybe one of these days we will see them put into effect.

The hearing of the Select Committee on Aging is now adjourned. [Whereupon at 12:37 p.m., the hearing was adjourned.]

APPENDIX

510 East Front Street Plainfield, New Jersey 07060 March 24, 1983

Congressman Matt Rinaldo
U.S. House of Representatives
Select Committee on Aging
1961 Morris Avenue
Union, New Jersey 07083

Dear Congressman Rinaldo:

On behalf of the residents of Richmond Towers, we would like to thank the House Select Committee on Aging for the opportunity to present testimony to the hearing reviewing the issue of the impending crisis in Medicare financing.

Richmond Towers is a federally subsidized low-income senior citizen apartment complex in Plainfield, New Jersey, housing 265 residents. All the residents live on fixed retirement incomes; the majority of the residents survive economically on social security alone.

As our resident population has become older, there has been a greater dependency on medical care. We have consequently seen a greater share of our fixed incomes being spent to pay medical bills.

The Residents Association of Richmond Towers would like to go on record as having presented our options and opinions to the House Select Committee on Aging. The four alternatives to Medicare financing suggested in your letter of March 15, 1983, were presented to our residents at our monthly meeting of the Residents Association. The Residents Association is an independent incorporated body of the residents living at Richmond Towers. The residents strongly urge the Congress to

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2. Enacting additional cost containment reforms that would not cut the
current level of Medicare reimbursement nor limit eligibility for
Medicare for those who have fixed incomes.

It is necessary to the survival of every senior citizen to have adequate medical care available. It is as equally important to be able to afford medical care on a fixed income. We appeal to the House Select Committee on Aging to find viable and ethically moral solutions to the financial crisis.

Sincerely,

Frances Gerty, President, Residents Assn.
Eileen Vroom, Former President

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Senior Citizens of Manville, Inc.

Congressman Matthew J. Rinaldo
Ranking Minority Member

U.S. House of Representatives
Select Committee on Aging

Washington, D.C. 20515

Honorable Congressman Rihaldo, >

BOROUGH HALL

101 South Main Street Manville, New Jersey 08835

March 19, 1983

MAR 21 1983 MAR 2-1022

Thank you for the opportunity to submit some of our Senior Citizens of Kanville, Inc., thoughts, relative to Medicare. We plan to attend the Hearing.

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away out of State

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Unfortunately, I will be

this week. Today, I received your letter, which does not allow sufficient time for me to notify many interested members, nor to more vividly express

our thoughts.

We naturally are deeply concerned about the future of Hodicare-Medicaid and all other Senior Citizen Programs, as indeed we were and are concerned about the final outcome of Social Security.

We hear and read about more cuts

Medicare and Medioaid

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benefit reductions in other Health Care areas, etc. In 1981

Medicare Recipients were "hit" with a 27% increase in out of pocket costs. We understand that some Committee members, who are studying the Medicare System and Program and are entrusted to make recommendations for economic changes, are not versed well enough on the subject of Medicare to make a fair impartial judgement.

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Many elderly today fearful of escalating medical costs and reductions in the Medicare-Medicaid Program, are paying large premiums for supplementary Insurance some of which they may not need.

We submit the following suggestions:

The Whitehouse Conference on Aging Committees, who participated on the topic of Medicare, made many worthy recommendations. We suggest that the Medicare Study Commi

Senior Citizens of Manville, Inc.

BOROUGH HALL

101 South Main Street Manville, New Jersey 08835 -2

ttee, currently charged with this task, review these recommendations and propose action on those with beneficial merit.

Encourage families to maintain elderly relations (parents, in-laws, etc.) in their homes and allow them meaningful tax credits.

Establish a National Health Insurance Policy, through Public or Private Insurance

Plans.

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Establish a Schedule of surgery charges Hospital charges, etc. Compel more Doctors to accept these charges. Payment to Hospitals, only for the amount of necessary cost incurred. Doctor and Hospital charges should be so devised, as to eliminate the incentive to perform more services than required. Eliminate the cost-plus fee for

service plan.

Institute an across-the-board limit on increases in Medicaid reimbursement to

Hospitals by all Third Party payers, including Medicare and Medicaid.

Hospitals, thereby

would not be able to shift their costs onto private-pay patients. Thus, they would have to initiate economies.

All Plans and payments, should be subject to more thorough audit.

Congress should

enact strong Federally mandated penalties and enforcement against fraud in the MedicareMedicaid Programs. Penalties should be dealt to Hospitals, Doctors, Technicians and/or to recipients of service, as warranted.

Why not reduce some of the Deficit spending and allot some of this money to Medicare. For example: We would not impair our preparedness, by eliminating one of the nuclear Aircraft carriers, planned for construction. Reconsider the sensibility of the MX Missle System

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perhaps strike the B-1 Bomber from the plans. (The B-52 is a worthy present-day and near future weapon). As a U. S. Marine Corps, Purple Heart Veteran, I certainly want this Great Country to be ever ready to defend itself.

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