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speaking, however, it is difficult to conceive of a dental disease in an elderly person which would not have serious effect upon his general health. In any event, a proposed Federal statute such as H.R. 12580 need not contain such limitations. The State and local administrators, in cooperation and consultation with professional people who understand the problems, can best determine the medical, dental, and other health needs of persons eligible for care. The medical care authorizations in the existing assistance statutes make no distinctions and carry no restrictions of the type referred to in H.R. 12580, and programs operated thereunder have not encountered difficulty in this regard; under those programs eligible persons having conditions or diseases requiring treatment receive it without particular regard to the anatomical location of such disease or condition.

It is also noted that under section 1606 (b) (2) (1) an aged person with a serious oral infection could not receive penicillin or other medication on the prescription of his dentist.

It is submitted that the restrictions referred to above are unnecessary and unrealistic and should be deleted from the bill.


The South Dakota State Medical Association has considered carefully the problems surrounding provision of medical care for the elderly, some of which are covered in title XVI of H.R. 12580.

The deliberations of the house of delegates during the association's annual meeting in May resulted in what we consider a logical five-point program. Basic points in that program are as follows:

1. Implementation of a statewide medical care program for the indigent aged (categorical assistance recipients).

2. Possible implementation of the above program to provide services to the near needy who do not meet the rigid requirements for indigency under oldage assistance.

3. Improvement locally of nursing home facilities.

4. Broadening of voluntary health insurance plans to cover aged with ability to purchase coverage.

5. Removal of the $1,200 per annum ceiling of earnings of social security beneficiaries.

Title XVI, as passed by the House of Representatives, may well meet the requirements of our point No. 2. Any change that would provide medical care to all beneficiaries of social security would be most unwelcome and ill timed.

The doctors of South Dakota cannot accept the premise that all social security beneficiaries are destitute any more than we can accept social security as insurance. Such programs are not actuarily sound, have established no real need for being, and are exorbitant in cost.

It is respectfully recommended that title XVI of H.R. 12580 be accepted as passed by the House or deleted entirely pending deliberations of the White House Conference on Aging in January.


Chief Clerk, Senate Finance Committee,

New Senate Office Building, Washington, D.C.:

HARRISBURG, PA., July 1, 1960.

Obviously time does not permit Pennsylvania Medical Society preparing testimony on H.R. 12580 suitable for printing in record. We have reviewed statement of Dr. Leonard W. Larson supporting H.R. 12580 and endorse his position. Please inform committee to this effect.


Chairman, Board of Trustees, Pennsylvania Medical Society.

STATEMENT OF SENATOR E. L. (BOB) BARTLETT IN SUPPORT OF S. 3503, JUNE 29, 1960 One of the great problems of our Nation, and one of the distressing facts, is that about 92 to 10 million persons over 65 have no medical care insurance. Although the Department of Health, Education, and Welfare has estimated that as many as 62 million persons over 65 have some coverage, a 1957 survey showed

that among hospitalized insured couples, 73 percent had zero to one-half of their medical costs met by insurance.

It is clear that private insurance plans have been unable to meet the need for health insurance in this age group. The very period of life when the need for medical care is most urgent is the period of life when vast numbers of our fellow citizens are lacking the income or the insurance to provide that care. Many of these citizens must rely upon charity for assistance. Others live with the dayto-day dread of serious illness, which, when it comes, can erase savings.

One consequence of this situation is that many Americans over 65 years of age are without the contentment and the peace of mind to which they aspire so justly. A second consequence is that preventive medicine, an area of medical science of increasing significance, is largely neglected insofar as millions of our fellow citizens are concerned.

It now appears that our country's political leadership, regardless of party, recognizes the need for Federal legislation. The question is not whether there should be legislation, but what type of legislation should be enacted.

As for me, I believe that S. 3503-the McNamara bill-is legislation America needs. By providing coverage for home health services, laboratory and X-ray services without the prerequisite of hospitalization, S. 3503 encourages preventive medicine and discourages unnesessary congestion of our limited hospital facilities.

Primarily, the costs of insurance under the bill would be financed through the social security system. The dignity of American men and women would be enhanced not only by protection against the increasingly prohibitive cost of medical care, but also by their realization that benefits under this program are made possible only by their own contributions during the working years. A country which prides itself on self-reliance and initiative should be a country where men and women need not rely on charity or doles to meet medical needs in old age. At the same time, the concept of self-reliance does not prohibit our national community from facing the problem of medical costs for the aged in a sensible manner, apportioning the costs among the entire working population to minimize hardship and catastrophe to the individual. This principle is nothing more than the principle of all insurance programs, expressed by our people in a national decision.

One of the virtues of S. 3503 is that provision is made for coverage of those citizens among whom the need is frequently most crucial. I refer to those retired persons who do not qualify for OASI benefits.

While using the simple administrative mechanism of the social security system, the bill does not neglect those who are not qualified for social security payments. A provision is in the bill to meet their need and to give them coverage. This provision, I believe, is one of the chief advantages of S. 3503 over H.R. 4700.

There are some who object to so-called compulsory features of the bill, but I submit that it is no less compulsory to pay charitable contributions to the sick out of general tax revenues than it is to increase social security levies to pay for this program of vital social legislation.

The United States is the only major industrial Nation which has no plan for medical insurance for the aged. It is an old principle of government, and a conservative principle, that it is proper for government to help people to help themselves.. Approval of S. 3503 offers that kind of help and provides a real answer to a pressing national problem.

I am hopeful that the committee and the Senate will act favorably on S. 3503, so that the retirement years can be more truly "the golden years" and so that our senior citizens can know freedom from fear more completely.

CAMDEN, N.J., July 6, 1960.

New Senate Office Building,
Washington, D.C.:

The members of the Industrial Union of Marine and Shipbuilding Workers of America, AFL-CIO, urge the Senate Finance Committee to adopt medical care benefits for the aged within the social security system. Only through this Imethod can we insure equitable medical coverage for all the people in this country under an administratively feasible program which can be tied in with one already in existence. We unalterably oppose any medical program which

establishes a means test as a standard of whether or not such individual shall receive such care. By the time the means test is undergone the individual may well be dead. We hold that it is a matter of right and equity that those people who have established insurance for themselves under the social security system shall be assisted in furthering such self-insurance through a program of medical care which is covered by this system. This is not socialized medicine, it is merely insurance against disaster and grief which strikes every individual during his lifetime and only on a national scale can the cost be brought down to the pocketbook of the average citizen.


President. ANDREW A. PETTIS,

Vice President.



Raleigh, N.C., June 29, 1960.

Chairman, Committee on Finance,
U.S. Senate, Washington, D.C.

DEAR MR. CHAIRMAN: We regret the seeming urgency in legislative procedure which forecloses the opportunity of the Medical Society of North Carolina, through its officers, in having allocation of time in which to present in emphatic and personal testimony the sentiment expressed by this society and its members on the provisions of H.R. 12580 now before the Senate and your committee. It would seem highly desirable to us that the usual processes of government and legislation permit an adequate study of the problem of medical care and services to be required of the upcoming group of elder citizens which have so markedly excited leaders of a political concern and attitudes. To be sure, wise decisions nor workable plans are scarcely born of hasty considerations and action such as certain pressure groups are wont to devolve upon the Congress. This society conscientiously initiated a study of the question in 1955 based upon a natural and logical concern as it would with any etiology. As a result, this society adopted in its house of delegates in 1958 the principle of a general assistance program for the medical care of the aged and so recommended it to the North Carolina Advisory Budget Commission in 1958 and to the General Assembly of North Carolina in 1959. Out of this movement courses of action are in effect regarding many facets of the problem which are bringing solutions which the taxing Congress can never bring for lack of understanding and appreciation of the human equation as to gift of government on the one side and benefits to the citizen on the other.

Briefly this society takes the following categorical stand:

1. It never favors the taxing powers of government to do for people that which they can do adequately and do better for themselves than government


2. It finds vast inequities in the Forand principle of legislation and fears the threat of it in the form of amendments to H.R. 12580 should hearings fail to bring out needed study of the bill.

3. By policy the Government has authorized and financed a citizens conference to treat with the subject of the aging-anent the White House Conference of 1961. Therefore, the Congress should give heed to its own directed course and await the word which may emanate from this voice of citizen-leadership participating in the 1961 White House Conference on Aging.

4. In North Carolina there is in effect at this time programs of voluntary insurance wherein 55 percent of the citizens 65 years and above are covered by hospital and medical care insurance and all logical trends in the development of this movement indicates that the figure of 65 to 68 percent will be reached by 1965. Therefore, a grant-in-aid program designed solely for those in need, proven by physician and local administration investigation constitutes sound public policy and programing.

5. This society desires to assert its faith in community programs of teamwork in which the practicing physician participates and where we are demonstrating in this State that the combined approach of home nursing, physical therapy, community social and technical guidance is resulting in superior care in the home to that frequently afforded, with less efficiency, in the general hospital.

In such programs one takes note of the pride of achievement manifested in the chronically ill and aged care in the home and, indeed, pride of the family, community, and health team which has made such individualized home care possible and practicable.

6. Wherein H.R. 12580 purports to extend the eligibility of compensation benefits to the totally disabled under OASDI, there is now strong indication of laxity in medical evaluations on the present nonpatient contact basis of team evaluations, including physicians who do not practice medicine nor keep abreast of the accomplishments for the disabled through clinical medicine. This maloperation in evaluations can only be extended and exaggerated were the Congress to add yet hundreds of thousands additional disabled to the scale of eligibility. Moreover, this whole system of premium placed upon disability when related to voluntary compensation, industrial compensation, and veteran benefits, raises a point of grave concern whether the Congress does not indiscriminately create a class of malingerers and cheats for whom no self-respect or rehabilitation service serves to prise him away from the "benefit trough."

7. The previous Government policy approach to similar problems of economic need and of professional services has been efficiently devised in grant-in-aid programs participated in wisely by State and local governments and usually administered wisely and efficiently at the community and State levels without a marked abuse in bureaucracy. Such devices need to be spelled out in a proper bill drawn after adequate study.

8. Perhaps many citizens have equal or greater needs before the magic age of retirement (65) and for that reason adequate study of equivalent needs should be made before enacting half measures for those 65 and above. Investigation should be made of all who need general assistance in health services.

9. Whatever plan is authorized in current enactments should be so stable as to not warrant tampering by immediate succeeding Congresses nor subject to the whims of political pressure groups. To do otherwise will invite political wreckage of any program undertaken. Now this society favors the principles involved in H.R. 12580 or in title XVI.

10. The society has never favored inclusion of medical physicians under social security, as the tax is discriminatingly high on the concentrated period of physician earning. Moreover, physicians tend to live shorter lives and work later age levels than other groups in the working market and thus would discriminately receive fewer benefits from social security, and thereby would pay greater proportions of social security in support of other workers.

11. Physicians throughout the world resist the impact of socialiaztion of medicine because all cases prove lowered standards of services and care under such systems and socialization is noted for its sordid interference with choice of and patient relationship with physician. These facts the Forand type proposal has never taken into consideration.

For these reasons and other influences, we feel certain, the Congress will desire to take cognizance of and in so doing will yet desire to give deeper study to the overall program, thereby the present departures proposed and born of pressure tactics are being implemented in acts proposed in the Congress.

Finally we file herewith and make a part of the Committee on Finance record a document entitled "Statement of the Medical Society of the State of North Carolina, H.R. bill 4700, 86th Congress, by John Robert Kernodle, M.D., July 10, 1959, to the Committee on Ways and Means, U.S. House of Representatives." 1 Respectfully submitted.

AMOS N. JOHNSON, M.D., President.

New York, N.Y., June 28, 1960.

Chairman, Finance Committee,
U.S. Senate, Washington, D.C.

DEAR SENATOR BYRD: We are writing to express the views of 2,600 pensioners and 35,000 active members of the New York Hotel Trades Council.

We strongly urge that you support legislation to provide prepaid health care for our aging citizens. We favor the social security mechanism as the most efficient, economical, and practical method. Health care insurance is a logical addition to the social security system.

1 Filed in Finance Committee files.

Our pensioners, whose income from social security and their pension combined averages about $103 monthly, can barely afford the daily necessities of life. They cannot additionally pay for health insurance.

The entire membership of our council is unalterably opposed to legislation, which requires older people, with reduced income, to pay for health insurance. They are opposed to subsidizing commercial insurance as too costly. We see no possibility that all States will raise the necessary funds to put a Federal-State subsidized insurance program into effect.

Most of our States are having difficulty meeting their budgets now. Further tax increases are anticipated without adding the heavy burden of health care. New York State officials have publicly stated that the expense of subsidizing health care insurance would be beyond the ability of the State to meet. Governor Rockefeller has vigorously opposed the subsidizing method and has de clared for the social secuirty principle as most sound and practical.

Only yesterday six other Governors including Brown of California rejected all other methods of financing health care and endorsed the Forand principle, through social security.

The people do not want charity. They will not accept a means test or investigation of their private affairs. They want security with dignity. They are willing to pay for it, now, when they can afford it, so that when they are forced to retire this problem won't exist.

We urge you to actively support legislation providing health care for the aging under social security and to seek passage of it at this session of Congress. Very truly yours,


PITTSBURGH, PA., June, 29, 1960.

Senator HARRY F. BYRD,

Chairman, Senate Finance Committee,
Senate Office Building, Washington D.C.:

Would like to appear before committee to testify in support of legislation to provide health benefits to aged through contributory social security system. However do not want to delay completion of committee's work in the closing days of session, therefore would prefer to be recorded favoring adding health benefits to the OASDI system and having this telegram included in the committee's record. MARVIN R. PLESSET, M.D.

Oakland, Calif., June 24, 1960.

Senate Office Building,
Washington, D.C.

DEAR SIR: It is a pleasure to communicate with you with regard to a piece of legislation which can be honestly supported by the vast majority of medical doctors in our Nation who are the only people who have daily contact and intimate acquaintance with the health problems and needs of the aged.

This is title XVI of H.R. 12580. The diligent work of the House Ways and Means Committee has closely identified the needs of indigent old people, and has taken a long step toward solving them in a manner which is not disruptive of present mechanisms of medical practice and medical economics. This solution will permit continued improvement and evolution in the fields of health insurance and particularly in the field of providing medical services to the aged. It has the additional virtue of economy, local control, and local self-determinism to permit recognition of the variability of medical problems in the widely differing areas of our Nation.

The medical association urgently suggests that further necessary consideration by the Senate Finance Committee be accorded this legislation.

Yours very truly,

JOHN G. MORRISON, M.D., President.

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