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administration provided in title VI of the bill should make possible the most effective utilization of the funds appropriated.

The society, however, strongly urges that your committee reject any amendments to title VI of the bill which would bring these benefits under the old-age survivors and disability insurance program. The society is unqualifiedly opposed to such amendments or any legislation which would bring health care benefits under that program.

Providing health care benefits for the aged through the OASDI program would transfer to the Federal Government the major responsibility for furnishing those services and remove most of the local administrative features of title VI of H.R. 12580. The vast majority of our citizens 65 and over are capable of and prefer to finance the cost of their health care by their own resources. Yet, under an OASDI program, the nonneedy as well as the near-needy and needy would become wards of the Federal Government. Moreover, through such legislation, an avenue would be opened for the extension of such a program to include all our citizens under a national compulsory health insurance system with all its demonstrated disadvantages and astronomical costs.

You and the members of your committee are, most certainly, fully aware of the tremendous growth in voluntary health insurance during the past decade. This growth has been not only in the number of our citizens who have taken advantage of this protection but in the broadening of benefits as well. The broadening of benefits offered by the many voluntary health insurance plans has been a result of the experiences gained during the not much more than a quarter century that this relatively new form of insurance protection has been so generally available.

As a result of this experience and success, voluntary health insurance plans have learned that their benefits can be extended to retired and aged persons. Here, the growth has been most astonishing. More plans are constantly being developed and offered and nearly 60 percent of our over-65 citizens have taken advantage of them. Their popularity is evidenced by the 135 percent increase in the number covered since 1952.

Just as voluntary health insurance plans have demonstrated their ability to protect the employed worker and his family against health care costs, just so can it be unquestionably anticipated that these plans will be able to provide this protection to all our aged citizens. The record of voluntary health insurance in the United States is clear and it should be given full recognition and every opportunity to fulfill the obligation it is assuming.

Therefore, we express again our support of title VI of H.R. 12580 and reemphasize our unqualified opposition to any OASDI amendments which might be proposed.

Thank you again for affording this opportunity to give the view of the Oregon State Medical Society regarding title VI of H.R. 12580. Respectfully,

LOUIS J. FEVES, M.D., President,

AETNA LIFE INSURANCE Co.,

Indianapolis, Ind., June 27, 1960. Re hospitalization insurance for senior citizens. Hon. HARRY F. BYRD, Chairman, Senate Finance Committee, Senate Office Building, Washington, D.C.

DEAR SENATOR BYRD: It has come to my attention that following a statement made by the president of the Nationwide Insurance Co. to the effect that in his opinion use of the social security system as a vehicle for providing hospitalization insurance for senior citizens is the proper means to provide an answer to any such problem which may exist, certain Senators and Congressmen have concluded that this is the considered opinion of the insurance industry. I wish to go on record firmly and emphatically that, it is my belief, quite the reverse is true, and that the great majority of those engaged in serving the public in accident and health underwriting feel that: (1) Those in need of coverage will be served more efficiently and more completely through the insured approach in private industry; (2) that it has not been demonstrated that those who actually need and want coverage cannot obtain it through private means; (3) that in the semihysteria of an election year this matter should not be decided ; (4) that this subject might be more properly and more accurately discussed

the first of next year when the conference for aging convenes; and (5) at least 65 percent of people who need and want this type of coverage will be able to obtain it through private means and that this percentage will increase rather rapidly in years to come to about 90 percent.

Over and beyond the points which have been raised in the preceding paragraph is my urgent request that items of prime importance to our national morale and welfare be given prompt consideration. The tendency to shift the responsibility of care for senior citizens from the individual, the family, and the community to our Federal Government is another step in weakening our national stamina.

I urge respectively that these points be considered carefully and thoroughly when this matter is brought up for discussion. Very truly yours,

HOWARD BULL, C.L.U.

THE RHODE ISLAND MEDICAL SOCIETY,

Providence, R.I., June 28, 1960. Hon. HARRY BYRD, Chairman, Senate Finance Committee, Senate Office Building, Washington, D.C.

DEAR SENATOR BYRD: Naturally the Rhode Island Medical Society is very much concerned with the legislation as adopted by the House of Representatives in H.R. 12580, and particularly as regards the new medical care title 16 which provides medical benefits for the “near-needy” aged.

We are sure that you know of the outstanding medical aid program that has been developed by the division of public assistance of the State department of social welfare with the full cooperation of the Rhode Island Medical Society.

What you may not know is the outstanding record of enrollment in our voluntary Blue Cross and Physicians Service programs by persons over the age of 65. We question that there is a State in the Nation that has such a fine record. I am enclosing a study that has just been completed by the Blue Cross and Physicians Service, and I call to your attention the conclusion on the first page which shows that the self-supporting persons in Rhode Island over the age of 65 have willingly secured our hospital and surgical-medical program.

The percentage of over age 65 persons purchasing this coverage is greater than the percentage of those under that age. Thus it is apparent that the older citizens in Rhode Island recognize the liberal benefits of our program and the outstanding service that is rendered by the physicians who accept the indemnities as full payment for all persons whose annual family income is below $6,000.

We feel strongly that the success of the voluntary effort in Rhode Island could be equally duplicated in the other States with encouragement and advice from legislative as well as other sources. We certainly hope that you will see that adequate hearings are held on H.R. 12580 before any amendments are added to it that would tend to destroy the voluntary effort that we have proved workable and successful in our Rhode Island. Sincerely yours,

EARL J. MARA, M.D., President.

PHYSICIANS & SURGEONS CLINIC,

Corsicana, Tex., July 1, 1960. Senator HARRY F. BYRD, Chairman, Senate Finance Committee, Washington, D.C.

DEAR SENATOR BYRD: My friends, my patients, my fellow physicians, and I are becoming increasingly alarmed about the ever-growing tendency of our Nation toward more and more centralized government. We know that every nation in the history of man in which the central government has become all powerful has fallen into ruin. We fear for the sacred heritage that our forefathers left to us. We believe, as did our forefathers, that eternal vigilance is the price of freedom.

We have never yet been convinced that there is a need for any kind of Federal medical care bill. In our area, we take care of our aged, needy, and indigent on a local and State basis, the way our forefathers did. We know of no one who lacks for medical care due to age or inability to pay.

According to extensive surveys, the only problem that has even hinted at being prevalent has been a temporary one which is rapidly being solved by private enterprise in the field of private health insurance and by medical society committees on aging, local and State projects.

Are we expected to sit idly by while pressure groups, especially AFL-CIO, through COPE, continue to sell our freedom down the river to oblivion?

We consider the individual primarily responsible for his care, either through his own financing or private health insurance, the family secondarily responsible, and the local and State communities finally responsible. Is this not the American way?

The bill which has already been passed, allowing income tax relief for family expenditures on medical care, should stimulate the second group. The individuals I know are proud and want to care for themselves when they possibly can.

As you and I both know and as proven by reliable surveys, not everyone over 65 is indigent or needy. Seventy percent own their own homes, and of those 80 percent are mortgage free. In 1957 their median net worth was $10,000. Most of them no longer have children at home to support and educate. Actually, their children are now able to help them in most cases.

Sixty-five percent of the aged needing and wanting protection will be insured by the end of this year, 80 percent by the end of 1965, and 90 percent by 1970.

Based on the above facts, Senator Byrd, we urge and implore you to use
whatever influence you may have with your committee to defeat House-passed
H.R. 12580 and any other proposed Federal medical care bills.
We cannot afford to compromise with socialism.
Yours truly,

R. L. CAMPBELL, M.D.
J. H. BARNEBEE, M.D.
WM. B. MAYFIELD, M.D.
A. L. GRIZZAFFI, M.D.
C. D. CAMPBELL, M.D.

BRIEF ANALYSES OF, DEPARTMENTAL VIEWS ON, AND TEXT OF SENATE AMENDMENTS TO H.R. 12580, AS INTRODUCED THROUGH JULY 2, 1960

1. AMENDMENT 6-24-60-C-INTRODUCED BY SENATOR MCNAMARA

STAFF ANALYSIS

Eligibility.Individuals who have reached retirement age and are (A) eligible to receive, but not necessarily receiving, social security old-age and survivors insurance benefits, and who meet an income (retirement) test provided in the bill; or (B) not eligible for social security benefits who meet the income (retirement) test provided in the bill (except persons eligible for civil service and railroad retirement benefits).

Benefits.-1. Hospital services—90 days per year (effective between July 1, 1960 and January 1, 1962).

2. Nursing home care -180 days per year (effective between January 1, 1963 and July 1, 1963).

3. Home health services—240 days per year (effective between January 1, 1962 and July 1, 1962). (The first 3 benefits may be combined for a total of 90 “units” per year-1 unit comprising 1 hospital day, or 2 nursing home days or 243 home health service days.)

4. Diagnostic outpatient services as prescribed by regulation. 5. Very expensive drugs as prescribed by regulation.

Cost.-For individuals eligible for social security ((A) above) : $2.79 billion per year, or 0.86 percent of payroll on a level premium basis; $1.01 billion per year or 0.48 percent of payroll on an early year basis. For individuals not eligibile for social security ((B) above) : Over $430 million a year out of general revenue when the program is fully operating. Offsetting this cost would be an estimated saving of about $100 million in the old-age assistance and veterans' medical programs.

Financing.For individuals eligible for social security ((A) above), benefits would be payable out of a Federal medical insurance trust fund, established for this purpose, to be financed by an increase in the contribution rate on both employer and employee of one-fourth of 1 percent, and for the self-employed an increase of three-eights of 1 percent, beginning in 1961, and, beginning in 1972, an additional one-eighth of 1 percent each for employer and employee and threesixteenths of 1 percent for the self-employed. For individuals not eligible for social security ((B) above) benefits would be financed out of the general revenue of the Federal Government.

NOTE.—The revenues derived from the tax increases provided in the amendment for individuals eligible for social security ((A) above) would amount to only 0.70 percent of payroll on a level premium basis; thus, this feature of the amendment is somewhat underfinanced. VIEWS OF DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE ON AMENDMENT

2–24-60-C INCLUDED IN FOLLOWING JOINT REPORT The Department of Health, Education, and Welfare would recommend against adoption of each of the following four amendments : Amendment No. 1, 6–24-60-C (Mr. McNamara); Amendment No. 11, 6–27-60-F (Mr. Morse); amendment No. 20 6–28–60–G (Mr. Humphrey); and amendment No. 27, 6–30–60–B (Mr. Anderson). Each of these bills proposes to amend title VI of H.R. 12580 to add health insurance benefits to the existing Federal old-age, survivors, and disability insurance system. The reasons for this recommendation are as follows:

1. The proposed extension of the existing old-age, survivors, and disability insurance system to encompass health insurance would make such insurance compulsory and would not be pinpointed to the need for aid in meeting the cost

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