April 3, 1973
Page 10761
BARRIERS TO HEALTH CARE FOR OLDER AMERICANS: VIEWS OF THE AMERICAN ASSOCIATION OF RETIRED PERSONS – NATIONAL RETIRED TEACHERS ASSOCIATION
Mr. MUSKIE. Mr. President, the Subcommittee on Health of the Elderly, of which I am chairman, is conducting hearings on "barriers to health care for older Americans." The opening round of hearings in this series – held in Washington on March 5 and 6 – gave the subcommittee vital information for our overall study. Witnesses outlined the key problems to be explored in greater detail at subsequent hearings in Washington and the field, or in special reports that might be issued in connection with the hearings.
These March hearings also had a more specific focus. We took testimony on the administration proposals to raise the cost of coinsurance and deductibles for medicare participants. This is an issue we will continue to examine in later hearings.
The American Association of Retired Persons-National Retired Teachers Association shared with me before the hearings their views on barriers to health care for older Americans and on the medicare cutbacks recommended by President Nixon. The cutbacks are, in the opinion of these associations, "ill-timed, based in myth, and harsh to older Americans." Their letter to me expresses the hope – and it is one which I share – that the President's proposal for more cost-sharing under medicare will be withdrawn.
The AARP-NRTA letter included these comments on deficiencies in our health care system:
Attention must be paid to the inadequacies of the present health care system; inadequate funding, maldistribution of services, insufficient personnel, inappropriate delivery systems, inattention to preventive care are the real difficulties in providing older Americans with quality care.
Mr. President, I am pleased to have the very helpful comments and suggestions of these leading associations in the field of aging as our subcommittee goes forward in its study of "barriers to health care for older Americans." What they have told us is, I am sure, of great interest to my colleagues in the Senate, who share our concern about the pressing need to improve health care for the elderly.
I ask unanimous consent that the letter to me from Cyril F. Brickfield, legislative counsel, American Association of Retired Persons-National Retired Teachers Association, be printed in the RECORD.
There being no objection, the letter was ordered to be printed in the RECORD, as follows:
AMERICAN ASSOCIATION OF RETIRED
PERSONS, NATIONAL RETIRED
TEACHERS ASSOCIATION,
Washington, D.C.,
February 27, 1973.
Hon. EDMUND S. MUSKIE,
Chairman,
Subcommittee on Health of the Elderly,
Washington, D.C.
DEAR SENATOR MUSKIE: Our Associations, the American Association of Retired Persons and the National Retired Teachers Association, with a combined membership of over five million persons, appreciate this opportunity to express our concern about the Administration's proposals to increase coinsurance and deductibles under Medicare.
We are particularly concerned that the cost-sharing proposals recommended by the President would strike hardest at older Americans relying on limited retirement income from public and private sources. These Americans are those whose income, while small and fixed, is nonetheless too high to meet Medicaid requirements. For these individuals who are deemed ineligible for Medicaid assistance because they had the foresight and the opportunity to invest for their retirement, the burden of medical expenditures not covered by Medicare must be shouldered by themselves. It is for this reason that our Associations' basic position is that any health proposal must take into account the substantial out-of-pocket outlay that older people now must make at a time when their income is apt to be fixed or diminished and their health care requirement increased.
In light of the fact that Medicare in fiscal year 1971 covered only 42 per cent of the total health payment of the elderly, that per capita expenditures in fiscal year 1971 were $861 for persons 65 and older compared to $228 for those under 65, that in fiscal year 1971 out-of-pocket payments for people 65 and older were about the same as the total medical care expenditures of the average person under 65 and were more than double the younger person's out-of-pocket payment, it is alarming that the President would recommend increased personal expenditures by older Americans to meet their health needs.
The President's proposed Medicare changes which would force Medicare patients to pay for actual hospital room and board charges for the first day plus 10 per cent of all subsequent hospital room and board cost is a cruel punishment to older persons. We wonder how the President expects the average Social Security recipient receiving an average cash benefit of $164 a month to pay the average daily charge for a hospital bed of $105.30 and still provide for his other needs during the month.
Our Associations fear that increased out-of-pocket costs to the patients are more likely to result in the postponement of needed care – especially preventive care – which might forestall longer and more costly treatment at a later date.
Spokesmen for the President have stated that the proposed increase in out-of-pocket cost is needed to prevent over-utilization of hospital facilities and doctors' services. The justification points out that both doctors and patients will become more cost conscious and reduce over- utilization of the patient's out-of-pocket share of the cost is increased. There is no evidence to support this claim. In fact, a survey by Blue Cross Association and the National Association of Blue Shield Plans indicates that unless deductibles and coinsurance payments are large enough to constitute a serious economic hardship they have no significant effect on utilization.
Furthermore, if out-of-pocket costs truly act as a deterrent to over-utilization, then patients who pay nothing for hospital care would spend more time in hospitals than patients who must make substantial out-of pocket payments for hospital stays. Department of Health, Education and Welfare figures demonstrate, however, that patients belonging to health maintenance organizations, where hospitalization is provided free, actually spend less time in hospitals than do other patients.
We are pleased that a number of the members of your committee, yourself included, share our conviction that the President's proposal is ill-timed, based in myth and harsh to older Americans.
We appreciate this opportunity to bring our views before this committee, and to express our concern. We would hope that our protest and those of groups sharing our interest in legislation affecting older Americans will illuminate the false logic upon which the suggested cutbacks are based. Furthermore, we hope that these preliminary hearings will demonstrate the strong sentiment against these cost-sharing proposals so that the President would not have to suffer the embarrassment of defending an untenable position before a hostile Congress. In short, we are hopeful that you will communicate to the President our views that the suggested increase in coinsurance and deductibles under Medicare is unacceptable to the older public and should be withdrawn.
The recommendations of the President only make it more obvious that our Nation must now find a comprehensive solution to the problems of delivering and financing health care and must reform substantively the present health care system. Attention must be paid to the inadequacies of the present health care system; inadequate funding, maldistribution of services, insufficient personnel, inappropriate delivery systems, inattention to preventive care are the real difficulties in providing older Americans with quality care.
Our Associations are in agreement with the fundamental proposition reflected in virtually all major health care proposals before Congress: the medical care system requires substantial and comprehensive improvement of the benefits of medical care, the manner of delivery of medical services, the quality of medical services and care and the means of financing the system. It is shortsighted to tax the older recipient of health services for the failure of the Congress and the President to recognize and act on the health crisis in our Nation. Unfortunately, it is sad commentary that our Nation, the richest and most powerful in the world, must resort to burdening those most in need to pay for their health services.
We would hope that during the coming months, your committee can explore steps to make immediate improvements in Medicare. New directions must be initiated to improve the administration of the Medicare program, to expand its coverage, and to insure that older Americans are receiving quality care under these services. A renewed effort must be made toward merging parts A and B of Medicare so that the health needs of older persons are better met. Emphasis should be placed on expanding geriatrics and the study of gerontology to further the research in health care for older persons. An investigation should be initiated into the quality of services available under Medicaid, and facts should be gathered on the effect of the Title XIX Amendments authorized under P. L. 92-603.
These areas are but a few of the major health issues in which we share your interest. As you know, our Legislative Council which formulates our legislative policies will be meeting in the near future, March 19-March 22, here in Washington. Following this meeting, I shall be in further communication with you as to our goals for 1973, and ways in which we hope we can be of assistance to the Congress in achieving these goals.
Again, Senator Muskie, I want to thank you for your invitation to comment on the upcoming hearings of the Subcommittee on Health of the Elderly. Needless to say, I look forward to our continued close liaison and working friendship.
Sincerely,
CYRIL F. BRICKFIELD,
Legislative Counsel.