June 27,1973
Page 21689
Mr. MUSKIE. Mr. President, I strongly support the adoption of the Church-Mondale amendment to H.R. 8410.
Average health care expenditures for older Americans now amount to $981 a year, nearly seven times that for persons under 19 and about three times the expenses for individuals in the 19- to- 64-year age category.
Today the high cost of health care represents the greatest single threat to the economic well-being of the elderly. Unfortunately illness strikes with far greater frequency and severity at a time in life when those victimized are least able to afford it.
This point was brought home very forcefully during hearings which I conducted – as chairman of the Committee on Aging's Subcommittee on Health Care of the Elderly – on "Barriers to Health Care for Older Americans."
At these hearings, we had an opportunity to hear firsthand from HEW Secretary Caspar Weinberger concerning the administration's rationale for cutting back medicare coverage for the aged and disabled. His line of reasoning was, however, challenged vigorously by every other witness who testified during our initial 2-day inquiry.
A major argument advanced by the Secretary was that cutbacks in medicare coverage were necessary to encourage greater cost consciousness by elderly health consumers. But older Americans living on less than $125 a month certainly do not need this type of "encouragement." They are already struggling to make ends meet, and additional health costs could leave them financially bankrupt. Moreover, it is physicians – not elderly patients – who determine the mode and timing of medical services.
Secretary Weinberger also maintained that increased deductibles and coinsurance charges were necessary to guard against overutilization of health services. However, there is no convincing evidence whatsoever to suggest that the elderly overutilize medical and hospital services. Quite to the contrary, the average hospital stay for aged Americans has declined from 14.1 days in 1967 to 12 days in 1972, for a 15-percent reduction. Older Americans do not derive great pleasure in going to the hospital. Those who are hospitalized are there – almost without exception – because it is necessary, not because they like it.
Secretary Weinberger further argued that recent social security increases would make it easier for the elderly to assume greater "cost sharing" under medicare. Unfortunately he overlooked some very crucial facts. Despite recent improvements in social security, more than 3 million older Americans still live in poverty. And the poverty threshold, I should hasten to add, is pegged at a bare minimum standard: $2,060 for a single aged person and $2,600 for an elderly couple.
Additionally, nearly 11 million older Americans – a clear majority of all persons 65 and older – have incomes below the Department of Labor's intermediate budgets for elderly persons.
Moreover, the Congress never intended to provide the aged with a much needed social security increase and then dilute its impact by approving staggering increases in health care costs for the elderly.
Finally, the Secretary maintained that the administration's proposals would encourage the use of alternatives to more expensive forms of institutionalization. But the harsh reality is that these alternatives frequently do not exist. A classic example is home health care which accounts for only about 0.7 percent of all projected medicare payments under part A for fiscal 1973. Furthermore, the estimated payments for fiscal 1973 are expected to be about $3 million below the fiscal 1970 level.
However, an expression of congressional opposition to the administration's proposed cutbacks in coverage is not enough. Efforts must also be initiated, I strongly believe, to improve Medicare by closing gaps in coverage.
Consequently, I am especially pleased that the Church-Mondale amendment calls upon the administration to submit concrete recommendations at an early date – by September 1 – for strengthening medicare coverage. Specifically, the administration would be directed to make recommendations for covering essential out-of-hospital prescription drugs.
Prescriptions now constitute the largest personal health care expenditure which the aged must meet almost entirely from their own resources. In fact, drug costs for persons 65 and above are about three times as great as for younger Americans. And for elderly persons with severe chronic conditions – about 15 percent of all older Americans – their prescription expenses are approximately six times as great as for younger individuals.
Today, the threat of costly illness is all too apparent for millions of aged and disabled Americans. That threat – intensified by the continuing upward spiral of health care costs – must be effectively dealt with as soon as possible.
The Church-Mondale amendment which I support, would help meet that threat.