CONGRESSIONAL RECORD -- SENATE

February 24, 1965

Page 3496

ELDERCARE

Mr. MUSKIE. Mr. President, during the past few weeks the American Medical Association has spent a great deal of time and money in promoting what it has chosen to call "eldercare."

"Eldercare," presumably, is the AMA's attempt to answer the King-Anderson bill.

The current issue of Consumer Reports contains an excellent analysis and evaluation of "eldercare" in relation to the King-Anderson bill. I believe Members of the Senate will find the article instructive and enlightening. Therefore, I ask unanimous consent that the article entitled "Medicare Versus the AMA's Latest Substitute," be printed at this point in the RECORD.

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

[From Consumer Reports for March 1965]

MEDICARE VERSUS THE AMA's LATEST SUBSTITUTE

After two decades of effort, 1965 appears to be the year for medicare -- a federally administered national hospital insurance plan, financed through social security contributions for persons over 65. This time the administration's medicare bill seems assured of passage. As usual, though, the American Medical Association has proposed a last-gasp substitute. A comparison of the two proposals is instructive.

The medicare bill may of course be altered in the legislative process, but its four basic provisions are not likely to be changed significantly. They can be outlined briefly. For those over 65, medicare would:

Pay the full costs of up to 60 days of hospitalization (in ward or semi-private accommodations), minus a first-day deductible, for each benefit period (which begins on the first day of hospitalization and ends whenever the patient has accumulated 90 days out of the hospital within a period of 180 days).

Provide for an additional 60 days of post-hospital care for each illness in a convalescent or rehabilitation center operating under an agreement with a hospital (not an ordinary, custodial-care nursing home).

Pay for up to 240 home nursing visits a year under medical supervision, in programs organized by nonprofit voluntary or public agencies.

Provide payment for hospital outpatient diagnostic services and tests, minus a deductible that would exclude routine low-cost laboratory or other diagnostic procedures.

These provisions would be financed by an increase in the social security withholding tax.

Ultimately, a citizen would contribute (to a special, separate health care trust fund within the social security system) 0.45 percent of his earnings up to $5,600, and his employer would contribute an equal amount. Special provision would be made for those now over 65 who are not covered by social security through the Government's general fund.

The medicare program gives the citizen free choice of physician and hospital. It does not pay the costs of doctor bills, out-of-hospital drugs, prolonged or catastrophic illness requiring long, continuous hospitalization, or extended custodial care in nursing homes.

CU's medical consultants believe that this is, by and large, a sound basic package. The 60-day provision would encompass all but about 5 percent of the usual hospital stays of older persons, and the extended-care proposal would both relieve the pressure on general hospital beds and spur the construction of badly needed convalescent and rehabilitation facilities in many communities. Services of this kind are essential in many illnesses following their acute stage and prior to the time a patient can return to his home or transfer (if necessary) to a custodial institution.

The provision for organized home nursing services has obvious value: such services often preclude the need for hospitalization and permit earlier discharge from hospital or convalescent center. Outpatient diagnostic services also are capable of averting many costly hospitalizations by encouraging the early detection and treatment of disease at a time when it may be cured or controlled by relatively simple short-term procedures,

Since the heaviest health cost of the elderly is hospitalization, the medicare coverage could make it financially possible for the first time for many citizens to purchase voluntary insurance (of the Blue Shield type) to cover physicians' bills and other supplementary costs.

The AMA substitute for medicare at first glance seems invitingly comprehensive, (it is, in fact, a resurrection of proposals made during the Eisenhower administration that the AMA bitterly opposed at the time, and again just a few months ago at its house of delegates meeting. The AMA now refers to its "new" proposal as a "redefinition" of policy.) The AMA substitute simply proposes the use of State and Federal funds to buy Blue Cross-Blue Shield or commercial health insurance for indigent persons over 65 -- it does not say how the funds would be raised, in the absence of a social security tax.

The proposal does say, however, that a means test would be required to determine the eligible poor, with the States using State and Federal money to pay all, some, or none of the insurance premium cost, depending on the citizen's qualification under the means test. Means tests are -- moral considerations aside -- enormously expensive and difficult to administer. Furthermore, the program would be administered by the States, raising the possibility that there would be 50 different kinds of governmental machinery, eligibility standards, and payment procedures. (Under some State rules setting eligibility for help under the current Kerr-Mills law, ownership of property or even ability of one's children to pay can make an old person ineligible.)

The subsidized insurance would pay for physicians' and surgeons' bills and drug costs as well as hospital bills, and an AMA statement asserts that this would be "comprehensive health care" and not "limited to hospital and nursing home care representing only a fraction of the cost of sickness." As CU has pointed out, however, this "fraction" covers the heaviest, the most financially crippling share of the burden. Furthermore, since the AMA has not spelled out specifically what the private insurance would cover (and in existing voluntary insurance policies, cash benefits, days of coverage, and other provisions vary widely from plan to plan and from area to area), it is difficult to tell how "comprehensive" the protection of the AMA's proposal would be.

The current medicare proposal, obviously, will not solve every aspect of the Nation's health problems, even for those over 65. It does not and cannot guarantee good medical care to its beneficiaries, and it pays relatively little attention to the quality of the services it pays for (though the bill does contain a provision for periodic review, by the medical staffs of participating hospitals, of the necessity for hospitalization, length of stay, and other such features). However, it is a significant beginning.

Mr. MANSFIELD. Mr. President, I suggest the absence of a quorum.

The PRESIDING OFFICER. The clerk will call the roll.