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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 subsidize the Medicare fund through:

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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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22-0200-83_-9

MAR 2 1 1983 Senior Citizens of Manville, Ine. WAR 7 - 1082

BOROUGH HALL

101 South Main Street Manville, New Jersey 08835

iarch 19, 1983

Congressman Matthew J. Rinaldo
Ranking Minority Member
U.S. House of Representatives
Select Committee on Aging
Washington, D.C. 20515
Honorable Conexes sman Rihaldo, )

Thank you for the opportunity to submit some of our Senior Citizens of l'anville, Inc.,

thoughts, relative to l'edicare.

We plan to attend the Faring. Unfortunately, I will be

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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 vodicare-ledicaid and all

other Senior Citizen Programs, as indeed we were and are concerned about the final

outcome of Social Security.

Wo hear and read about more cuts -- increases in deduotibles and co-payments in

Medicare and Medicaid -- benefit reductions in other lealth Care areas, oto.

In 1981

Medicare Recipients were "hit" with a 27% increase in out of pocket costs.

We understand

that sone 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,

Many elderly today

fearful of escalating medical costs and reductions in the

Medicare-lledicaid Program, are paying large premiums for supplementary Insurance -

some of whioh they may not nood.

We submit the following suggestions s

The Whitehouse Conferenos on Aging Committees, who participated on the topio of

Medioare, made many worthy recommendations.

We suggest that the predicare 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.

Enoourage families to maintain elderly relations (pa rents, in-laws, etc.) in their

homes and allow them meaningful tax credits.

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

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cast incurred.

Doctor and Hospital charges should be so devised, as to eliminate the

incentive to perform more servioes than required.

Eliminate the cost-plus fee for

service plan.

Instituto an aoross-the-board limit on increases in Medicaid reimbursement to

Hospitals by all Third Party payers, inoluding Medicare and Medioaid.

Hospitals, thereby

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

to initiate economios.

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

Congress should

enaot strong Federally man dated penalties and enforcement against fraud in the MedioareMedicaid Programs.

Penalties should be dealt to Hospitals, Dootors, Technicians and/or

to rooipients of service, as warranted,

Why not reduce some of the Defioit spending and allot some of this morčey to jedioare.

For example, We would not impair our propar odness, by eliminating one of the nuo lear

Aircraft barriers, planned for construotion.

Reconsider the sensibility of the MX

Missle System

perhaps strike the B-1 Bomber from the plans.

(The B-52 18 8 worthy

present-day and near future weapon). As a 0. S. Marine Corps, Purple Heart Veteran,

I certainly want this Great Country to be ever ready to defend itself.

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