|June 1, 1962
By Morris K. Udall
"Medicare"--The Battle of Madison Square Garden
The "Battle of Madison Square Garden" between President Kennedy and the American Medical Association has touched off a great mass of mail pro and con on the question of medical care for the aged. Though "Medicare" may never reach the floor of the House this year, the time has arrived when my constituents are entitled to a statement of my position. I intend to vote for the Administration's King-Anderson Bill as a sound solution to what nearly everyone considers a major national problem.
The "Medicare" proposal would extend the Social Security program to provide hospital services, home nursing services, outpatient hospital diagnostic services and home health services for persons 65 and over who are covered by Social Security and the Railroad Retirement Act. The bill would not pay doctor bills. It would be financed by an increase of 1/4 of one per cent of employees' pay and a similar increase in the contributions of employers. Also, the taxable base on which Social Security contributions would be calculated would be increased from $4,800 to $5,200.
For the average wage-earner this increase would amount to approximately $1 per month. With this increase he would be earning, for himself and his wife, some insurance against major hospital expenses after age 65.
LONG IN COMING
Like most big issues, this one has been long in coming; there have been similar proposals under discussion for years. The present bill began taking shape about two years ago when Governor Paul Fannin of Arizona and 29 other governors voted for a resolution calling on the Congress to enact health insurance for the aged through the Social Security system. The end of that long effort may be approaching, or it may carry over to next year. Ultimately some legislation will probably be enacted.
In recent weeks I have received many hundreds
of cards, letters and telegrams on the King-Anderson Bill. The ratio has
been better than 3 to 1 in favor of its passage. However, what people write
means more to me than actual numbers, and I have been most interested in
the views expressed on this important question. While I have been following
the hearings in the House and Senate most carefully, I regard my correspondence
as an equally important source of information. Occasionally, I will receive
a message that contributes little to the debate (like the Mesa doctor's
telegram, "NO TO KING-ANDERSON A THOUSAND TIMES NO NO NO."), but most of
my mail has been informative and helpful. Here are a few examples:
Literally hundreds of my letters have told stories of personal hardships to older persons who have been unable to meet medical expenses, who have gone without care they needed, who have lost all the savings of a lifetime with one catastrophic illness. I don't know how anyone could ignore these facts or fail to recognize that there is a great human need that is not being met by the wealthiest nation in the world.
EARNED BENEFITS vs. CHARITY
Nearly every member of Congress favors some plan of action. The main point at issue is one of earned benefits, which a person can accept with dignity, versus charity. Two years ago the Congress enacted a charity program known as the Kerr-Mills Act. A state which wants to participate in Kerr-Mills must pass enabling legislation and appropriate money to match the federal funds. Only 26 states have put the program into action. The Arizona Legislature has done nothing and there is little likelihood that it will act in the near future. This illustrates one of the ironic facts about current problems. Those Arizonans who talk the most about states' rights and who say "let Kerr-Mills do the job" are the ones least anxious for Arizona to meet its responsibilities by passing Kerr-Mills legislation.
|Thus far the Kerr-Mills program has been
anything but a success. Last year, for example, 92% of all federal money
expended went to the states of New York, Massachusetts and Michigan. Inequities
were enormous. The average payment per recipient in Illinois was $506.86,
whereas the average payment in Kentucky was $15.62. And this is the program
the American Medical Association describes as "the common sense approach
to solving a problem that concerns us all."
Under the Kerr-Mills program all but the poorest are left out. To receive aid an aged person (and, in some states, his children as well) must pass a "means" test and swear that he is in poverty. By comparison, the King-Anderson Bill would add medical care to Social Security insurance coverage and include persons who have already retired.
IS IT ACTUARIALLY SOUND?
Opponents of the bill (and of Social Security in general) talk a great deal about the actuarial soundness (or unsoundness) of Social Security financing. They compare the Social Security system with private insurance companies and say there should be money "in the bank" now to meet future needs. What they fail to recognize is that under a universal government program full cash reserves are not necessary. A social insurance program of this nature is financially sound if future income will support future disbursements. Like Social Security itself, this addition to the system can function successfully without recourse to general taxation.
Four years ago, during the Eisenhower Administration, a top-level advisory committee made a thorough study of the financing of Social Security and concluded that the program is "sound, practical and appropriate." I am confident this is still true today.
It is interesting that the arguments against "Medicare" are the same arguments used against Social Security 25 years ago, and that system has never yet had to go to the Congress for appropriations from the general fund. Social Security funds now total $22 billion and are expected to reach $80 billion by 1980.
WHO IS FOR IT?
Many Arizonans assume that medical care is
a program sponsored and favored only by Democrats. This is not the case
at all. The Republicans in Congress are divided into about 4 groups including
Watching the lines form on this battle has been interesting. The American Medical Association has led the fight against it, using essentially the same arguments that it used against Social Security and the same predictions of lost liberty it used against Blue Cross-type insurance programs in the 1930s.
This is not to say that individual Arizona doctors are unconcerned about meeting the medical needs of the aged. Our state has a fine group of doctors, and we can be proud of them. They give much of their time to charity cases. Nationally, medicine has made great strides in recent years, and I for one would never want to see our doctors lose the incentive to move ever ahead in medical progress. However, doctors are busy people and can't be expected to be experts in social problems. I think their leaders have allowed themselves in this instance to see monsters that don't exist. The likelihood of this country adopting socialized medicine (which I strongly oppose) has never been more remote. On the contrary, I believe passage of a sound program of medical insurance under Social Security financing will effectively demolish any argument that might otherwise crop up for socialized medicine.
Marion Folsom, Secretary of Health, Education and Welfare in the Eisenhower administration, takes the same point of view. "There does not seem to be any sound basis for describing a plan financed through Social Security as 'socialized medicine' nor should such a plan lower the quality of medical care," Mr. Folsom has said. "The individual would still have the same free choice of hospitals and doctors that he has now."
Lining up in support of the King-Anderson Bill are organizations of retired persons, the American Nurses' Association, many individual doctors and an extremely high percentage of respondents to polls all over the country.
I have taken note of the surveys made by colleagues of mine--particularly those from conservative Republican districts, where favorable results would have to be significant. I have been amazed to discover that heavy majorities have piled up in favor of the King-Anderson Bill in nearly every such district.
|In Phoenix, which can hardly be described
as a hotbed of liberalism, political science students at Union High School
polled all areas of Maricopa County. The results showed 1,401 persons interviewed
favoring the King-Anderson Bill, and 510 opposed, for a favorable response
of 73 per cent. While Phoenix is not in District 2, I have had a great
deal of mail from there on this question, and my mail has clearly confirmed
My Republican colleague, Rep. Hastings Keith of Massachusetts, recently described the King-Anderson Bill as "financially and philosophically sound" and "the true conservative approach to a problem we can no longer ignore." A former underwriter with one of the nation's largest insurance companies, Congressman Keith represents one of the most solidly conservative districts in the country. I regard his support of the bill as highly significant.
Because public sentiment is so strongly in favor of the program many members of the Congress, originally on record as opposed, have grasped at straws to put themselves on record as favoring medical care for the aged, if not the King-Anderson Bill. The bill introduced by Rep. Frank T. Bow, Republican of Ohio, is a case in point. Supported by Congressman Miller, the national chairman, and others, this bill includes physicians' fees and other liberalizing provisions, would cost the government $2 billion the first year and more later, and would take all of this money out of general taxes without providing one cent of additional revenue. And this proposal is being advocated by people who call the King-Anderson Bill "socialized medicine."
IS THIS A PERFECT BILL?
Those who criticize the King-Anderson Bill fall into two general categories--those who say it goes too far, and those who say it doesn't go far enough. Curiously, some critics seem to alternate between these contradictory propositions.
Limiting coverage to persons receiving Social Security checks is the shortcoming most frequently cited. However, the bill will cover 14.7 million out of 17.8 million persons in this country over 65 years of age, and it will apply to 95 per cent of all present workers. Keeping coverage within the Social Security system is the only means I know to make the program self-supporting and keep it from becoming public-supported charity. The King-Anderson Bill is not perfect; but I believe it is a sound approach.
WHAT IS THE PROBLEM?
Why is there so much concern about medical care for the aged? Here are the facts:
Older people have greater medical needs - Persons over 65 require 2,332 days of hospital care per thousand people compared with 883 days for those under 65.
Hospitalization lasts longer - The average stay for a person over 65 is 14.9 days, compared with 7.6 days for younger persons.
Medical costs are higher - Average yearly private spending for medical care of people over 65 is nearly twice as much as the rest of the population.
They have less income - Two-person families with head 65 or over have median income of $2,530 a year, compared with $5,314 for those under 65.
They have fewer assets - Four out of 10 older families have either no liquid assets or less than $200 in such assets.
They have less insurance - Insurance available to the aged is expensive, limited, restrictive, cancellable, and excludes pre-existing conditions. And only about half the aged have this, compared with 70% insurance coverage for younger people.
Recent improvements in medical care have added to our population over 65. At the same time, the costs of medical care have risen tremendously, reflecting the acquisition of expensive new equipment and general increases in the costs of providing medical services to the public. The result has been a steady increase in the number of persons on fixed incomes for whom medical costs have become a major problem.
The American Medical Association wrote me last January: "No one has yet produced documented evidence that the aged are not receiving the medical care they need." The statements in hundreds of letters received in my office seem to indicate the AMA hasn't looked too hard to find that evidence. It exists. It exists in Arizona, where the Kerr-Mills program has never been accepted, and it exists in 23 other states which have no such program. It even exists in states where the program operates, for most of the people who write me would never be able (or willing) to meet a poverty test. The poor and destitute can always get some kind of help, I imagine, but what of the good, hard working, honest Americans who have tried to prepare for the expenses of old age and found that skyrocketing medical costs have priced needed medical services out of sight? I believe the resources of our nation can very well be used to spread the risk among our people to provide necessary care and make the prospect of old age a less fearsome prospect. And I believe the insurance approach of the Social Security system is the proper mechanism to accomplish this end.
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