At that time I said that while I Mr. Chairman, I appeared before the Subcommittee on Economy in Government, Joint Economic Committee, three months ago to discuss the changing of our national priorities. have no medical credentials, I do have a wealth of experience in dealing with the poor who sorely need improved health services. In spite of the fact that we spend billions of dollars for health, we have failed to establish the national priorities necessary to provide every citizen full access to humane and comprehensive health care. One obvious approach to the solution of this problem is a national health insurance program which includes a well-planned and carefully coordinated system of health care for all Americans. This Nation must make health services accessible---both physically as well as financially. The National Urban League supports the principle of a national health insurance program which provides universal coverage without exception for all persons, so long as such coverage is based upon the development of a comprehensive delivery system available to all. The League's Board of Trustees has endorsed a national health program in which the following components are included: general tax revenue as the source of financing; emphasis on improving the geographic distribution of health services; no reimbursement formulae or use of private insurance carriers; and funding for the education of health manpower. The United States ranks 17th among all nations in the life expectancy of men; 10th in life expectancy of women, and 13th in the rate of infant mortality. One-fourth of all children face the probability of untreated physical and mental disorder. More importantly, as in other areas of our national life, health care for blacks presents an especially dismal picture. Chairman, the following facts: Consider, Mr. life expectancy is lower for blacks than for whites at all ages; the average black male baby cannot expect to live long enough to collect social security; the black maternal death rate is almost four times the white rate in spite of substantial reductions during the past three decades; and almost twice as many black as white families have no hospitalization or surgical insurance coverage. We feel, therefore, that it is imperative that the Nation move rapidly toward a national system of health insurance and delivery of medical care and medical education on an equal basis for all. We do not argue here for a specific proposal. While most of the popular NHI proposals differ in some details, they all have the same general goals. Even the proposals supported by the two organizations I represent today differ in some ways. These differences, however, are not major obstacles and can be reconciled. All of them call for tremendous budgets, but this country can afford the cost, whatever it may be. All we need is the will. When we wanted to expand the highway system, we found the method and the money. When we wanted to explore the moon, we developed the technology and we didn't let the budget bother us. Now we are pumping an estimated $290 million into the SST program. Something is wrong with our national priorities, and I trust that this Committee will see fit to begin a reordering of those priorities---at least to a point where a national health insurance program will become the order of the day, replacing space exploration, highway construction, and super transports as the "fair headed" children of American progress. The obvious need for a national health insurance program was summed up expertly by the Washington Post when it said: "A legislative proposal is put forward every now and then insurance seems to us just such an idea." The Post editorial concluded that "the time is ripe for national discussion and national resolution of the national health problem." The Washington Evening Star, editorializing on NHI, concluded that "cradle-to-the-grave health insurance is coming, possibly in the first half of this decade." The Star continued: "It is coming not because, to use the well-worn phrase, it is an idea whose time has come. National health insurance will be adopted because it is a necessity that can no longer be avoided." We agree with the conclusions of these two stalwarts of the Fourth Estate. The Nation cannot afford to delay enactment of a national health insurance program much longer if it is to continue in a position of world leadership. America's most precious resource is its citizens. I thank you. The CHAIRMAN. The next panelist is Dr. I. S. Falk, professor emeritus of public health, Yale University. Dr. FALK. Mr. Chairman, I have no prepared statement, but I will be glad to assist the course of these hearings by making available information we have accumulated in the development of the proposals which are embodied in the bill which is before the committee. I would first like to direct my remarks to the question raised earlier with respect to the estimate of $77 billion presented by Secretary Veneman in his testimony on this bill as the Department's estimate of the costs for the first fiscal year, or the first year in which the program proposed in this bill may become operational. Not knowing the details about the data that were used for the development of the estimate or arithmetic processes to which the data were subjected, I cannot undertake to comment on the reasons why the figure presented by Secretary Veneman is in very substantial variance from the estimates we have developed in our studies. I would like to explain our objections to that figure: When our committee was at work on the development of specifications for a health security program, we undertook to act responsibly with respect to the prospective costs in the program, so we undertook as careful studies as we could, of what the costs might be. The methodology in this field is to undertake first to analyze substantive proposals as to the existing situation and, thus, to say: What would the costs have been, had the program been operational in the latest year for which we have reliable data? At that time, the last formal figures were for the fiscal year 19681969. We, therefore, undertook an analysis of what the benchmark costs might have been, had the program we were developing and designing been in operation in fiscal 1969. In the course of our studies, we took the fullest advantage of the agreement which had been effected between the late Mr. Walter Reuther and former Secretary Finch, and which made it possible for us to work collaboratively with the experts in the Department of Health, Education, and Welfare who are knowledgeable about medical care costs and expenditures. We developed the cost estimates for the benchmark fiscal year 1968-1969 The CHAIRMAN. Doctor, I am forced to stop you. The morning hour has ended in the Senate, and there has been an official protest by the Republicans of the Senate concerning our committee's hearings. They have that right under the rules to stop our hearing if they wish after the morning hour, since it takes unanimous consent to continue hearings after the Senate begins conducting business. They have stopped this hearing. I will announce publicly why it is stopped. I want the record to show here, Mr. Melvin Glasser came with the panel. He has been working on this for years as director of the social security department at the UAW. I invite all the Senators to file any written questions they have with the members of this panel. I am concerned about the stoppage of our hearing here. I can not conceive how any procedure in the Senate was ended, retarded, or slowed up by the hearings we are holding, and we would have stopped probably by 12:30 anyway, but the minority has protested. It is their right, but I don't think it is proper to stop this matter of such importance. Now we have another panel here of medical students. I invite them to come back tomorrow if they can possibly stay in town. I am going to recess this hearing until 9 o'clock in the morning to give us extra time to move ahead. The CHAIRMAN. If any other witnesses have additional statements they can file them later on. We are grateful for the great support you witnesses have given in the months of working out this bill. With your help we have been able to bring this bill this far. Thank you. (The following information was subsequently supplied for the record :) COST ESTIMATES FOR THE HEALTH SECURITY PROGRAM SUBMITTED BY THE TECHNICAL COMMITTEE FOR NATIONAL HEALTH INSURANCE The Technical Committee of the Committee for National Health Insurance has been asked to submit additional data to the Senate Committee on Labor and Public Welfare with respect to cost estimates for the Health Security Program. The Technical Committee has estimated that Health Security would have cost $37.0 billion in FY 1969. Since the proposed Health Security program would not become operational until FY 1974, and since hospital, medical and other health costs would continue to rise in the interim (by an estimated 10 percent annually), the estimates for Health Security in FY 1974 would reflect the cost increases which would already have occurred. HEW experts estimated that the costs of personal health care services (within the scope of services covered by Health Security) would approximate $57 billion in FY 1974. The Technical Committee's own estimates are of the same general magnitude. It is a basic position of the Technical Committee and CNHI, that the $57 billion to be channeled through the system established by Health Security beginning with FY 1974 would produce more services, for more people, and would revitalize the archaic health care delivery system that currently produces double or triple inflation of health care costs. These estimates take into account increases in population, utilization of services, and general increase in the cost of living. To give a more detailed picture, our starting point in developing the estimates was an estimate of what the cost would have been if the proposed program had been operational in the last year for which detailed cost and expenditure data were available: fiscal year 1968-69. At price and utilization rates of that year, our program would have cost $37.0 billion. This estimate was worked out more or less independently by us in the Committee and by the experts on this subject in the U.S. Social Security Administration. Even if our program were enacted in 1970, we had to allow time for the "tooling up" for program operations. It would, therefore, be mid-1973 before the program could become operational. We had to ask: What would happen to medical care costs in the meantime, and what would the Health Security Program cost be in its first full operational year, fiscal year 1973-74? It had already become evident that medical care costs in general had continued to go up steeply between fiscal year 1968-69 and the fiscal year which ended in July 1970. Also, the Social Security Administration's forecasts indicated that the costs may be expected to climb further. If medical care costs continue to rise by approximately 10 percent a year (the average rate of increase in 19601968, both before and after the enactment of Medicare and Medicaid), the benchmark cost for Health Security would have gone up from $37.0 billion (1968-69) to $54.2 billion (1972-73) before the program can become operational. In other words, the Health Security program will have to start with cost and expenditure levels that will prevail in the country before this new program goes |