Muskie Congressional Record: Medicare Radio Debate

CONGRESSIONAL RECORD – EXTENSION OF REMARKS

October 22, 1963

PAGE 20111

The Role of the Federal Government in Providing Medical Care for the Nation's Senior Citizens

EXTENSION OF REMARKS of HON. PAT McNAMARA OF MICHIGAN IN THE SENATE OF THE UNITED STATES

Tuesday, October 22, 1963

Mr. McNAMARA. Mr. President, on October 6 of this year two of our colleagues -- Senator MUSKIE, of Maine, and Senator MUNDT, of South Dakota -- engaged in a debate on the topic of the role of the Federal Government in providing medical care for the Nation's senior citizens.

This discussion was carried over the Mutual Broadcasting System on the radio program "Reviewing Stand," which is sponsored by Northwestern University at Evanston, Ill.

Since this discussion sheds new light on an important public issue, I ask unanimous consent that the text of the debate be placed in the RECORD.

There being no objection, the text of the debate was ordered to be printed in the RECORD, as follows:

WHAT SHOULD BE THE ROLE OF THE FEDERAL GOVERNMENT IN PROVIDING MEDICAL CARE TO THE CITIZENS OF THE UNITED STATES?

(A radio discussion over WGN, Chicago, and the Mutual Broadcasting System. Guests: Hon. KARL MUNDT, U.S. Senator from South Dakota; Hon. EDMUND MUSKIE, U.S. Senator, Maine. Guest moderator: Mr. Norborne Robinson, editor, Congressional Digest. Host: James H. McBurney, dean, School of Speech, Northwestern University.)

SUNDAY, OCTOBER 6, 1963

Announcer: Northwestern University, in association with WGN and the Mutual Broadcasting System, presents the Reviewing Stand, now in its 30th year on the air. Tonight's subject: Medicare and the Federal Government. To introduce tonight's guests, here is moderator James H. McBurney, dean of the School of Speech at Northwestern University.

Dean McBurney: The Reviewing Stand is pleased indeed to join with the committee on discussion and debate of the National University Extension Association, in presenting this special broadcast. It signals the opening of the new high school debate season across the United States. Each year, the committee recommends a problem to be debated by high school groups throughout the country as the national high school debate question. Each fall, to mark the opening of the forensic season, the topic is discussed on a national broadcast by eminent speakers from public life.

The Reviewing Stand is happy to present the program on the 1963-64 subject: What should be the role of the Federal Government in providing Medical Care to the citizens of the United States?

To introduce today's guests, here is our guest moderator, Mr. Norborne Robinson, editor of the Congressional Digest, in Washington.

Mr. Robinson: Thank you, Dean McBurney. In the U.S. Congress where decisions on the Federal medical policy are made, interest has for some time been mainly concentrated in the area of medical care for the aged. In 1960 Congress enacted the Kerr-Mills bill in addition to expanding a longstanding program that provides Federal contributions to State welfare programs for the needy, part of which goes for the payment of the medical bills of needy persons.

The bill established a new program. Popularly referred to as Kerr-Mills, this program is designed to help older individuals whose income or resources are deemed otherwise sufficient, but who may be unable to meet all or part of their medical expenses. The program is operated by the States and financed on a joint Federal-State basis. Since World War II, a prominent proposal before the Congress would add to the social security system a program of hospital and nursing home payments for patients 65 or over to be financed by an increase in the social security tax.

Popularly referred to as medicare, this approach has the support of the Kennedy administration, among others. It is against this general background that the controversy is waged in Washington over what the role of the Federal Government on medical care should be.

We are privileged to have with us two distinguished US. Senators to discuss this role. Senator KARL MUNDT of South Dakota, a Republican, has been a successful educator, farmer, and businessman. Elected to the U.S. House of Representatives in 1938, he served there until his election to the Senate in 1948. He was reelected to the Senate in 1954 and 1960. Senator EDMUND MUSKIE of Maine, a Democrat, is a lawyer. He has served in the Maine Legislature and was elected Governor of Maine in 1954. Subsequently, he was elected to the Senate in 1958.

Senator MUSKIE, you're on record as favoring the medicare approach. What are some of the reasons?

Senator MUSKIE. Yes. I do support the social security approach to the problem of medical care for the aged and I do so for these reasons: Briefly; first, I think that the problem is such as to require a broader-based effort than we are now making. The Kerr-Mills legislation which was adopted by the Congress in 1960, has not met the problem and I doubt that it can meet it. Second, the problem is not being met and I doubt that it can be met by private insurance. The question of whether or not the Kerr-Mills program or private insurance is meeting the problem, I think, must be related also to the philosophy with which we approach this problem. It seems to me that the underlying issue in the current debate over medicare is whether we should forestall so far as we can the poverty which health costs create among the aged, or whether we shall wait for poverty to occur and minister to only those who have already exhausted their own resources.

Mr. ROBINSON. Senator MUNDT?

Senator MUNDT. Well, I oppose the King-Anderson approach or the medicare approach and favor the Kerr-Mills approach which was initiated in 1960. I think it's gratifying indeed that in 3 short years that the Kerr-Mills bill has been in operation, 40 different States and jurisdictions have set up their own machinery for cooperating with the Federal Government to provide the necessary medical and hospital expenses for the indigent aged. Ten States or nine States' jurisdictions are in the process and only three States' jurisdictions, out of the 52 involved altogether, have done nothing at all.

I think that this is a most encouraging sign and it seems to me that we should recognize that medical costs of people who are aged, their dental bills, the other optical costs, and the rest of the costs that they confront are just as serious and just as difficult to meet as are the hospital costs. So I oppose the King-Anderson approach, not only because it is compulsory, and not only because it is unnecessary, but because it is woefully inadequate, and does not provide the kind of care which is available under Kerr-Mills as it has been implemented by at least 40 States.

Senator MUSKIE. I must say that my statistics on the extent to which the States have implemented Kerr-Mills differ somewhat from Senator MUNDT's and there may really be no difference if we analyzed the statistics. As I understand it, from the latest figures provided for me by the Senate Committee on the Aging, 28 States actually have operating programs in effect compared with 24 about a year ago, so that there's been a gain of just 4 States in developing operating programs, even though this year has been a legislative year in most States. Now another 10 States have programs in some shape, that is, pending legislation or authorizing legislation approval. Whether or not in those States operating programs will finally be developed I can't evaluate at this point. And then, of course, there are some States which have not acted at all.

But I think, in addition to looking at the number of States which may or may not have acted in Kerr-Mills, we have to look at the adequacy of their program. There are many measures of this, of course, but the fact is that most of those programs are keyed to the needs of the indigent. For example, just to use one standard that is found in almost all of the State programs, those who earn more than $1,500 a year -- in some States it goes as high as $2,000 a year -- are not eligible for relief under the Kerr-Mills program. And this means, to go back to the philosophic statement I made earlier, that in those States they believe that the lower-income groups are to exhaust their resources before they're given assistance.

Senator MUNDT: I'd like to say something about that matter of adequacy, but first as to the number of States, I know that all of these figures in this whole concept of the discussion of the various programs, the compulsory and the voluntary one, you have a sort of a floating set of figures because they change. I am quoting from a report as of August 31, 1963 -- that's this year -- issued by the Department of Health, Education, and Welfare when I point out that 40 States have the program in effect or have it virtually completed. Nine are in process in one way or another or have made some effort and three have done nothing at all under Kerr-Mills.

Now, about the adequacy of the two programs. Let me point out that in this compulsory program of compulsory health insurance called the King-Anderson program, or sometimes called Medicare, we certainly have misnamed a monstrosity because it provides no medical care at all. It is simply a very inadequate and partial program of hospital insurance and does not give the aged or the needy the kind of care that they require. Now the King-Anderson program, let it be said, does provide for a certain kind of visitation by visiting nurses and so forth after a $20 minimum deduction has occurred.

But the thing about the Kerr-Mills program which I like is that it recognizes that after you're 65 you may have any one of a variety of ailments and so it provides for doctors and surgeons and hospitalization and nursing and drugs and dental benefits and provides an insurance program or an insurance protection for the various kind of maladies and problems that can confront somebody in old age and who needs it. Now the reason why the program provided under Kerr-Mills can give you a more adequate protection against a compulsory universal program is very simple. This Medicare program, by being compulsory, requires that it become available to everybody so it's available to those who are very rich and who don't need it at all instead of limiting it to those people who require some kind of assistance at the time of an ailment in old age.

Senator MUSKIE: I'm sure that I'm not going to be able to settle in a few minutes here the exact statistical count on Kerr-Mills, but we know that it lies somewhere between 28 and 40. I'd like to concentrate for just a few moments upon this question of adequacy of care.

In the first place, the King-Anderson bill is much broader in its benefits than has been suggested by Senator MUNDT's comments. It provides hospital care for periods ranging from 45 through 90 to 180 days depending upon the options selected. Secondly, it provides skilled nursing facility care to follow hospitalization, thus making available a lowcost service for prolonged service after needed hospitalization. Thirdly, it provides for hospital outpatient diagnostic services, again to avoid hospitalization, but a service enabling older people to pinpoint their difficulty and their problems. Finally, it provides home health services of up to a total of $240 a year.

Now, by contrast, Kerr-Mills. Federal law in Kerr-Mills requires that at least two types of care, one institutional and one noninstitutional, must be covered. The only type of care common to the 28 programs to which I referred earlier, is inpatient hospital care. Only four States provide substantial coverage of the five major types of service which are hospital care, physician services, nursing home care, prescribed drugs, and dental care. Only four States provide programs which are that broad and even those States do not cover all needed care.

Now, covered care is available in eight States under Kerr-Mills only in certain kinds or degree of illness, and in some of them the illness has to be acute or chronic before the applicant can qualify. Periods for which care is available are short and in four States no more than 15 days of hospital care are available and no more than 15 days per stay in four other States, so that the care provided under Kerr-Mills is by no means as broad as has been suggested.

Senator MUNDT. On the contrary, the care made available by Kerr-Mills is much broader. Now it is true because this is a voluntary program that each State works out its own basis for cooperation in partnership with the Federal Government. And the program is still 3 years old. States are moving forward in an orderly manner but at the ultimate and the optimum arrangement, it is very obvious that Kerr-Mills does cover a great many more things than are possible at all under the King-Anderson program. My colleague suggests that under the King-Anderson program you can get a diagnostic analysis. This is true, but that doesn't cure the patient. The beauty of the Kerr-Mills program is that after being diagnosed you can also get a cure and each State can provide its own kind of medical facilities.

There are other things that I don't like about this compulsory program besides the fact that it is inadequate and that it is unneeded, because you don't have very many people left in the category of over 65 who need the particular kind of selective treatment in a hospital provided under the King-Anderson program.

One thing I don't like about it very much is that it violates the whole American concept of taxation. We're dedicated in this country, I believe, to a system of progressive taxation based upon the concept that you take from people in accordance with their ability to pay. But the program which is compulsory, which adds to the social security tax of an individual, is regressive taxation because it taxes everybody alike for the first part of their income and, incidentally, makes the benefits available to everybody alike. The millionaire and the pauper get the same benefits and each is required to pay on the standpoint of his initial income the same exact tax rate, which in my opinion is not an American concept of raising revenue.

Senator MUSKIE. Senator MUNDT says that the King-Anderson bill violates American concepts of taxation. Well now, all it does is take advantage of the system that's been in effect since the mid-thirties, the social security system.

Now, this is as American at this point as any program in this field that I can think of. For almost 30 years now, Americans have been paying the social security tax under a compulsory program to guard against the hazards of unemployment, disability, and other hazards which afflict us in modern society. Now Senator MUNDT calls this regressive taxation. Well, under the Kerr-Mills program, the responsibility is thrown back upon the States, most of which rely upon the sales tax to support their programs. Well, now, certainly, no tax is more regressive than the sales tax.

Now, Senator MUNDT has constantly referred to the social security program as being compulsory. It is no more compulsory than it is in the case of retirement pensions under the social security system, but the purpose of the social security approach, and I think that this ought to be hammered home, is that it provides a means for the average citizen to contribute during his working years to a program which will assure him that these benefits will be available to him when he reaches age 65.

Now it seems to me that you've got to make your choice. Either this is a good thing to do -- that is, to save during your working years to provide for this care that you may need when you reach 65 -- or it isn't. Now, if we say it's a good thing to do then I know of no way to do it except on a broad-based scale such as social security provides. Now, if what we're talking about is a relief program available to people only after they have exhausted all their resources and only after they have reached 65 in whatever economic situation they may be, why then perhaps the voluntary approach which would make the program available only to those people in such dire circumstances is the approach. But I think you've got to come back to this underlying philosophy which provides the most, if you want to use that term, the most dignified kind of assistance, the most realistic, the most adequate when one reaches the age of 65.

Senator MUNDT. I'd like to say something about that "working years" concept because one of the many reasons why it seems to me the King-Anderson compulsory Medicare concept is wrong is that it does nothing whatsoever to protect the young family during its working years. It requires them to pay a tax sometimes as long as 40 years on the gamble that sometime after they're 65 they will need some health benefits. But they get nothing during the working years and it takes out of their income money which they might better have placed into some kind of private insurance program or company insurance program. That way, if during the productive years of the young family life, the head of the family is stricken, he can get some benefits. This, after all, simply provides a bet that you provide and you'll pay your taxes under a compulsory program until you're 65 on the gamble you won't be sick before you're 65, you'll be so sure you'll be sick after you're 65 you need some Government aid. Now, it tends to destroy the initiative, the desire, and the capability of a young family to provide the kind of health insurance and the kind of protection it requires during its formative years and during its productive years. So this is another reason why it moves against the concept.

Now, my friend from Maine said that most of the States raise their money by sales tax. I point out to him that a great many average States have income taxes based on a progressive program just the same as we have in the Federal Government and that when you provide a tax compelling the poor to pay for the health needs of the rich after they're 65, this also is not compatible with our American concept.

Senator MUSKIE. The Senator complains that the social security approach provides nothing for people in their working years but only after they reach age 65. Well, the complaint that the policyholder gets no benefits until the hazard strikes could be made against private insurance as well as the social security insurance system. The very purpose of insurance is to provide for the payment of premiums to make available certain benefits and certain protections against hazards when the hazard strikes. So I see no difference between the social security system and private insurance in this respect. Now, on that point –

Mr. ROBINSON. Our time seems to be running out in the very fast-moving debate, regrettably. Senator MUNDT, in closing, how would you summarize your position on the role of the Federal Government in providing medical care?

Senator MUNDT. Well, of course in the minute and a half we have for a summary, it's very difficult to even summarize the reasons why I'm against this Medicare program. I'm against it for so many reasons. It leads toward socialized medicine. As I say, it compels the young working family to gamble and it has to pay a compulsory tax for the full lifetime until after 65 on the expectation and the improbable hope that nothing is going to happen to the family until after 65.

I'm against it because it's compulsory, because its benefits are inadequate. I consider it legislative alchemy because the pot of gold at the end of the rainbow is not there. It doesn't provide the medical facilities; it doesn't provide the doctors' cost; it doesn't provide for a great many things. It's regressive taxation and it's unnecessary because under the Kerr-Mills program in 3 years we've had an astronomical increase in the kind of protection made available to people who need medical attention. And it provides it in a full package and a full program so they can get the kind of medical care they require if they need it after 66. I'm against it because, after all, under our American concept, we in this country should promote the general welfare not provided for the individual.

Mr. ROBINSON. Senator MUSKIE, how would you summarize your position?

Senator MUSKIE. I'd like to touch just briefly again on this question of a compulsory program. The Kerr-Mills program is just as compulsory in the same sense that Senator MUNDT speaks of. The Kerr-Mills is supported by the general taxpayer -- the taxpayer who pays excise taxes and income taxes. He has no choice about paying those taxes so he is compelled to pay taxes to support this program in the same sense that under the social security plan the payer of social security taxes is compelled to pay them. In addition, the Kerr-Mills taxpayer has to pay State taxes and he has no choice about that.

Now, I am for the social security approach, again: first, because a broader-based effort is needed in order to meet the problems; secondly, because it is an insurance scheme which makes it possible for the average worker to contribute to his own benefits when he reaches retirement age; thirdly, because its aim is to prevent poverty and not deal with the problem after poverty has been enforced.

Mr. ROBINSON. I'm sorry, gentlemen, but our time is up. Our thanks to our guests for this evening, Senator KARL MUNDT of South Dakota, and Senator EDMUND MUSKIE of Maine. This is Norborne Robinson in Washington.

Dean McBurney. You have just heard a special Northwestern University Reviewing Stand discussion, presented in cooperation with the committee on discussion and debate of the National University Extension Association. The topic -- What Should Be the Role of the Federal Government in Providing Medical Care to the Citizens of the United States? -- is to be the subject of debate and discussion in high schools throughout the Nation during the 1963-64 forensic season.

Our thanks to the participants in Washington and to our guest moderator, Mr. Norborne Robinson.

Copies of this discussion are printed and made available to the public in order to further interest in such discussions of questions affecting the public welfare. Transcripts may be obtained by sending a stamped, self-addressed envelope and 15 cents for each copy to: National Publishing Co., 1300 Connecticut Avenue NW., Washington, D.C.

Thank you for listening. This is James H. McBurney, dean of the School of Speech at Northwestern University.

ANNOUNCER. The Reviewing Stand is produced for Northwestern University by Robert W. Thomas and directed by Gloria Werkmeister. The Reviewing Stand originates in the studios of WGN, Chicago, as a feature of public affairs.

This special program was presented in cooperation with the committee on discussion and debate of the National University Extension Association.