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Los Angeles, Calif. The subcommittee met, pursuant to recess, at 10:30 a.m., in the assembly room, Old State Office Building, 217 West First Street, Los Angeles, Calif., Senator Harrison A. Williams, Jr. (chairman of the committee) presiding.

Present: Senators Williams and Randolph of West Virginia.

Also present: William E. Oriol, staff director; John Guy Miller, minority staff director; Shalon Ralph, professional staff member.


Senator WILLIAMs. The hearing will come to order. With this hearing, the Subcommittee on Health of the Elderly of the U.S. Senate Special Committee on Aging continues its study of the costs and delivery of health services to the elderly.

With this hearing, the Subcommittee on Health of the Elderly of the U.S. Senate Special Committee on Aging continues its study of the costs and delivery of health services to the elderly.

Testimony taken at two previous hearings has made several major points clear about the quality and availability of health care for older Americans.

First, there can be no doubt that medicare is already having tremendous impact. On July 1, when medicare was 2 years old, President Johnson reported that 20 million Americans of age 65 and over-10 percent of the Nation's population-were covered by the program.

More than $8 billion had been paid for expenses incurred in 10.6 million hospital stays and 45 million medical bills. Well over a million persons had received care after their stay in the hospital, in nursing homes or—when home health care is available-right in their own bedrooms.

Another million and a half persons had received hospital outpatient diagnostic services.

Judged strictly in terms of statistics, the medicare program certainly has produced results. But it is impossible to measure the amount of dignity and security it has provided to the elderly, as well as the assurance it has brought to younger families whose parents need no


longer live in dread of financial disaster because of extended hospital treatment or major medical costs.

But even if medicare has already proved itself to be a blessing, it should not be regarded as a cure-all for all that may be wrong with our health care services today.

Medicare, after all, merely provides the wherewithal to pay for certain health care expenses. It may have some effect in improving the quality of such care, but it can't be held responsible for long-standing deficiencies or failures in the organization of health care.

At its field hearing in New York City, for example, the subcommittee took testimony in a part of the Bronx where there is only one doctor for every 10,000 people. Twenty or 30 years ago there were five times as many doctors and only about half the number residents. We learned that much the same was true in some parts of St. Louis, too. And of course it is the elderly—with a high rate of chronic illness—who live in large numbers in the central city neighborhoods. They suffer severely from shortages of trained medical personnel. Much the same is true in many rural areas; we're not dealing with just a city problem.


We have to ask ourselves: How are we going to organize health services so that high-quality care is available to all ?

Another subject that received a considerable amount of attention at the first two hearings was the medicaid, or the title 19 program, as it is so often called. Congress intended that this program should help take away some of the welfare taint that overshadows the care given to low-income people. Congress declared that there was a large group in need of help, the so-called medically indigent who earn enough to take care of themselves, except when they are hit hard by high medical bills. Medicaid, of course, applies to all age groups, but it is important to many elderly people, especially when medicare benefits run out.

The subcommittee has found considerable confusion and concern about some aspects of the medicaid program. Some elderly people believe that their hard-earned nest eggs are placed in danger when they sign up. Others regard it as a welfare program, with a welfare stigma.

Within recent weeks, Congress has—I am afraid—contributed to the uncertainty by proposing major cutbacks, even after many States have made extensive plans for putting medicaid to work for their residents.

One of the major reasons for calling this hearing in California was to get firsthand information about your medicaid program-or MediCal as it is called. As I understand it, there was some fear 8 or 9 months ago

that this program would produce a deficit.

Then it turned out that you had a surplus.

And now there are new State laws that permit cutbacks when costs reach a certain level.

a What are the effects of the Medi-Cal program on the provision of health services for the elderly in California? We will look for some answers to that question today.

The first two hearings have also yielded much informative discussion about the need for prevention or early detection of chronic illness. One of the hospital directors interviewed during preparations for this hearing was asked how to keep hospital costs down, especially those hospital costs supported by medicare. His answer was prompt. He said we should try to keep as many people as possible out of hospitals. One way to do that is to promote health maintenance programs, including regular disease detection screening. As things stand now, however, we focus Federal funds and attention on the obviously ill person, while withholding the funds and concern needed for actions that will prevent such illness.

HEALTH CARE IN THE HOME Another way to keep people out of hospitals is to provide the means to give health care to people in their own homes. I personally know of people who are in hospitals only because there was no one, not even family, who could give them their daily meals and a few essential services.

We'll look to our witnesses today for a few good ideas about home health care, too.

In fact, we expect to receive many good ideas here today. California has many problems; but it also has many people who care about solving those problems. We've found over the years that many far-reaching innovations have originated in this State, and there is no reason to believe that this is no longer true.

To close, I would like to thank Senator George Smathers, who conducted the first two of the hearings on this subject as chairman of the Health Subcommittee, for taking us so far along in our study. I know that he had hoped to be here today but I have agreed to conduct the hearing in his place in order to advance our work in this area.

We will move on to our first witnesses after a statement from one of our most eloquent and distinguished Senators, Senator Jennings Randolph of West Virginia.

Senator RANDOLPH. Mr. Chairman, I have no desire to speak this morning. I think it is important that we proceed with the hearing.

I thank you very much. I am delighted to be here to join with all those present who want to make this program here today one of one purpose.

Thank you very much.

Senator WILLIAMS. Our first witnesses will be Miss Elsa Carrow, administrative assistant to Mayor Yorty, and Mrs. A. M. G. Russell, chairman of the California Commission on Aging.

Now, these girls know what they are doing here. They are already in place. Who goes first?

Miss CARROW. I am the chairman. Shall I go ahead?


TO MAYOR YORTY, MAYOR OF LOS ANGELES, CALIF. Miss CARROW. Honorable Chairman and members, I am pleased to welcome your committee to the city of Los Angeles on behalf of our mayor, Sam Yorty.

A previous commitment prevents Mayor Yorty from welcoming you personally today. He asked me, as his coordinator for senior citizen activities, to bring you his personal greetings.

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