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Medical, Dental - Hospital Bureaus of America, Inc. Annual Convention, Washington, DC, September 12, 1967
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Medical, Dental - Hospital Bureaus of America, Inc. Annual Convention, Washington, DC, September 12, 1967
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The original documents are located in Box D22, folder "Medical, Dental - Hospital Bureaus
of America, Inc. Annual Convention, Washington, DC, September 12, 1967" of the Ford
Congressional Papers: Press Secretary and Speech File at the Gerald R. Ford Presidential
Library.
Copyright Notice
The copyright law of the United States (Title 17, United States Code) governs the making of
photocopies or other reproductions of copyrighted material. The Council donated to the United
States of America his copyrights in all of his unpublished writings in National Archives collections.
Works prepared by U.S. Government employees as part of their official duties are in the public
domain. The copyrights to materials written by other individuals or organizations are presumed to
remain with them. If you think any of the information displayed in the PDF is subject to a valid
copyright claim, please contact the Gerald R. Ford Presidential Library.
MEDICAL, DENTAL-HOSPITAL BUREAUS OF AMERICA, INC,
ANNUAL CONVENTION, 10 A.M. TUESDAY, SEPT. 12, 1967
SHOREHAM HOTEL, WASHINGTON, D.C.
IT USED TO BE THAT THE MOST POPULAR SAYING IN AMERICA
WAS, "IT'S A FREE COUNTRY." WELL, givte IT'S STILL A FREE COUNTRY,
BUT NOW THE EXPRESSION YOU HEAR MOST OFTEN IS "I COULDN'T
CARE LESS."
SINCE IT IS A FREE COUNTRY, I SUPPOSE EVERY AMERICAN
HAS A RIGHT TO BE DISINTERESTED OR TO FEEL ALIENATED OR TO
LOSE HIMSELF AMONG THE HIPPIES. IN SHORT, HE HAS A RIGHT TO
SAY "I COULDN'T CARE LESS." BUT THIS DOES NOT MEAN WHAT HE
IS DOING IS DESIRABLE EITHER IN TERMS OF HIS OWN SELF
INTEREST, OR THAT OF SOCIETY.
IT IS OFTEN SAID THAT THE PEOPLE OF THIS NATION GET
JUST THE KIND OF GOVERNMENT THEY DESERVE. BECAUSE THEY HAVE
LIBRAR
THE PRIVILEGE OF CHOOSING THE INDIVIDUALS WHO SERVE THEM IN
Digitized from Box D22 of The Ford Congressional Papers: Press Secretary and Speech File at the Gerald R. Ford Presidential Library
-2-
PLACES OF GOVERNMENT. THEY ARE TOLD IT IS THEIR DUTY TO
VOTE. BUT, INDEED, THEIR DUTY EXTENDS FAR BEYOND THAT. IT
MUST INCLUDE AN INTEREST IN THE EVERYDAY HAPPENINGS OF
GOVERNMENT AT THE LOCAL, STATE AND FEDERAL LEVELS IF
DEMOCRACY IS TO SUCCEED.
DEMOCRACY FAILS IN THIS COUNTRY TO THE EXTENT THAT
AMERICANS MUTTER, "I COULDN'T CARE LESS."
GOVERNMENT FAILS IN THIS COUNTRY TO THE EXTENT THAT IT
IGNORES THE WISHES OF THE PEOPLE AND REFUSES TO AVAIL ITSELF
OF THE EXPERTISE AVAILABLE FOR THE CARRYING OUT OF THOSE
WISHES.
YOU PEOPLE ASSEMBLED HERE ARE AMONG THE EXPERTS. YOU
SPECIALIZE IN PROVIDING THE BUSINESS SERVICES NEEDED FOR THE
EFFICIENT OPERATION OF THE OFFICES OF PHYSICIANS, DENTISTS,
HOSPITALS, CLINICS, AND OTHER HEALTH-RELATED ORGANIZATIONS.
-3-
I CAN ASSUME, THEN, THAT YOU CARE-CARE ABOUT HEALTH
LEGISLATION, CARE ABOUT MEDICARE AND MEDICAID AND THE
DIRECTION YOUR GOVERNMENT IS TAKING IN THE HEALTH FIELD.
I CAN ONLY GUESS WHETHER YOU HAVE CARED ENOUGH TO CONCERN
YOURSELF DIRECTLY WITH THAT LEGISLATION AND TO MAKE YOUR
VIEWS KNOWN TO MEMBERS OF CONGRESS.
LET ME BE COMPLETELY FRANK WITH YOU AND TELL YOU AT
THE OUTSET THAT I VOTED AGAINST THE MEDICARE BILL WHEN IT
FIRST CAME BEFORE CONGRESS IN 1965. I DO NOT REGRET THAT
VOTE, AND I STILL HAVE GRAVE MISGIVINGS ABOUT THE EVENTUAL
OUTCOME OF THE MEDICARE PROGRAM.
BUT I VOTED FOR THE SOCIAL SECURITY AMENDMENTS OF 1967,
WHICH INCLUDE CHANGES IN THE MEDICARE AND MEDICAID PROGRAMS.
THESE CHANGES REPRESENT IMPROVEMENTS WHICH ARE MUCH NEEDED--
JUST A FEW OF THE CHANGES CONGRESS WILL HAVE TO FORMULATE IBRAP TO
TRY TO MAKE MEDICAL ASSISTANCE PROGRAMS WORK PROPERLY.
-4-
TO MANY AMERICANS WHO HAVE HAD NO DIRECT EXPERIENCE
WITH MEDICARE, IT IS A PROGRAM THAT SOUNDS JUST FINE. BUT
THOSE WHO HAVE STRUGGLED WITH MEDICARE RED TAPE WIND UP
FRUSTRATED AND FURIOUS. THE EDITOR OF A WEEKLY NEWSPAPER IN
MY CONGRESSIONAL DISTRICT IN MICHIGAN SPOKE OUT WHEN HE
BECAME EXERCISED ABOUT MEDICARE ALONG ABOUT LAST MAY.
IN AN EDITORIAL HEADLINED, "MEDICARE'S A MESS." THIS
EDITOR WROTE IN PART:
"WE'RE BEGINNING TO GET A STRONG IMPRESSION THAT,
HOWEVER HELPFUL IT MAY BE TO OUR SENIOR CITIZENS, THE
OPERATION OF THE MEDICARE AND MEDICAID PROGRAMS ON THE LOCAL
LEVEL IS A MESS. IT'S SUPPOSED TO PAY FOR TREATING THE
AILMENTS OF THE ELDERLY, BUT THOSE WHO ARE TREATING THOSE
AILMENTS JUST AREN'T GETTING THEIR PAY. MUCH OF THIS IS
MUDDLED BY THE LONG, TIME-CONSUMING MEDICARE FORMS THAT HAVE
-5-
TO BE FILLED OUT. LOCAL AMBULANCE SERVICES AND AREA
HOSPITALS HAVE BOTH BEEN AFFECTED BY THIS MUDDLED MESS, QUITE
SEVERELY IN SOME CASES. THESE VARIOUS PROBLEMS MAY BE
IRONED OUT BY TIME, BUT RIGHT NOW MEDICARE'S A MESS." SO
WROTE AN EDITOR WHO CARES ABOUT THE PEOPLE IN HIS
COMMUNITY.
CONGRESS NOW IS TRYING TO CLEAN UP THE MESS. AS YOU
KNOW, THE HOUSE HAS PASSED A SOCIAL SECURITY BILL WHICH
SEEKS TO IMPROVE THE FUNCTIONING OF THE MEDICARE PROGRAM AND
PUTS A LIMIT ON RUNAWAY MEDICAID BEFORE IT BANKRUPTS US ALL.
Bill Runt
WHAT DOES THE BILL DO IN CONNECTION WITH MEDICARE?
IT INCREASES FROM 90 TO 120 THE NUMBER OF DAYS OF
HOSPITALIZATION COVERED IN A SPELL OF ILLNESS, WITH THE
PATIENT TO PAY A COINSURANCE AMOUNT OF $20 FOR EACH ADDITIONAL
DAY.
GERALD
LIBRARY
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IT ELIMINATES THE PRESENT REQUIREMENT THAT A
PHYSICIAN CERTIFY THAT AN INDIVIDUAL NEEDS HOSPITALIZATION
AT THE TIME OF ADMISSION TO A HOSPITAL OR THAT A PERSON
REQUIRES HOSPITAL OUT-PATIENT SERVICES.
UNDER THE SUPPLEMENTARY MEDICAL INSURANCE PROGRAM, THE
BILL PROVIDES FOR AN ALTERNATIVE TO THE TWO EXISTING METHODS
OF PAYING FOR PHYSICIANS' SERVICES--THE METHODS OF THE
RECEIPTED BILL AND ASSIGNMENT. UNDER THE NEW PROCEDURE,
PHYSICIANS OR OTHER PERSONS PROVIDING COVERED MEDICAL AND
HEALTH SERVICES MAY REQUEST PAYMENT ON THE BASIS OF AN
ITEMIZED UNPAID BILL WITHOUT HAVING TO AGREE, AS UNDER THE
ASSIGNMENT METHOD, THAT THE PROGRAM'S REASONABLE CHARGES
WILL BE ACCEPTED AS PAYMENT IN FULL. ALTHOUGH THE BENEFITS
STILL WOULD BE PAID TO THE PHYSICIAN ONLY IF HIS BILL DID NOT
EXCEED THE SO-CALLED REASONABLE CHARGES, THE PHYSICIAN NEED
NOT AGREE TO THE SO-CALLED REASONABLE CHARGES IN ADVANCE.
-7-
THE BILL ALSO SEEKS TO SIMPLIFY BILLING FOR HOSPITALS.
IT DOES THIS BY TRANSFERRING COVERAGE OF OUTPATIENT
HOSPITAL DIAGNOSTIC SERVICES TO THE SUPPLEMENTARY MEDICAL
INSURANCE PROGRAM AND BY ELIMINATING THE COINSURANCE PROVISION
FOR PATHOLOGY AND RADIOLOGY SERVICES. IT FURTHER PERMITS
HOSPITALS TO COLLECT CHARGES FROM OUTPATIENTS FOR RELATIVELY
INEXPENSIVE SERVICES, SUBJECT TO FINAL SETTLEMENT IN LINE
WITH MEDICARE PROVISIONS ON REIMBURSABLE COSTS.
THE BILL AMENDS THE DEFINITION OF A PHYSICIAN TO
INCLUDE A DOCTOR OF PODIATRY, BUT NO PAYMENTS WILL BE MADE FOR
ROUTINE FOOT CARE WHETHER PERFORMED BY A PODIATRIST OR A
MEDICAL DOCTOR.
IT IS HIGHLY IMPORTANT IN TERMS OF THE FUTURE OF MEDICARE
THAT CONGRESS IS TAKING A HARD LOOK AT THE COSTS OF THE
PROGRAM. THE HOUSE WAYS AND MEANS COMMITTEE TOOK REAMS OF
-8-
TESTIMONY ON THE SUBJECT OF MEDICAL AND HOSPITAL COSTS BUT
FOUND ITSELF SHY OF ANSWERS. AS A RESULT, THE HOUSE-APPROVED
BILL AUTHORIZES THE HEALTH-EDUCATION-AND-WELFARE DEPARTMENT
TO EXPERIMENT WITH VARIOUS METHODS OF REIMBURSING HOSPITALS
UNDER MEDICARE, MEDICAID AND THE CHILD HEALTH PROGRAMS. THE
AIM IS TO PROVIDE HOSPITALS WITH INCENTIVES FOR KEEPING COSTS
DOWN WHILE GIVING QUALITY CARE.
THERE ARE IMPORTANT DETAILS IN SOME OF THE MEDICARE
CHANGES IN THE HOUSE-APPROVED BILL AWAITING SENATE ACTION.
PHYSICAL THERAPY FURNISHED TO AN OUTPATIENT IN HIS HOME
OR A NURSING HOME WOULD BE COVERED UNDER THE SUPPLEMENTARY
MEDICAL INSURANCE PROGRAM. BUT THIS APPLIES ONLY IF THE
SERVICES ARE PROVIDED UNDER HOSPITAL SUPERVISION.
DIAGNOSTIC X-RAYS TAKEN IN A PATIENT'S HOME OR A NURSING
HOME WOULD BE SIMILARLY COVERED BUT SUCH SERVICE MUST BE
SUPERVISED BY A PHYSICIAN AND MUST BE IN KEEPING WITH HEALTH
-9-
AND SAFETY REGULATIONS.
CONSIDERATION IS BEING GIVEN TO EXTENDING COVERAGE
UNDER THE SUPPLEMTARY MEDICAL INSURANCE PROGRAM TO THE
SERVICES OF ADDITIONAL TYPES OF PERSONNEL WHO INDEPENDENTLY
PROVIDE HEALTH SERVICES. THE HOUSE-APPROVED BILL DIRECTS THE
SECRETARY OF HEALTH-EDUCATION-AND-WELFARE TO STUDY AND
RECOMMEND POSSIBLE ACTION IN THIS AREA.
AS YOU KNOW, THERE IS MUCH CONCERN IN THE CONGRESS
OVER THE COST OF MEDICARE AND MEDICAID. THIS HAS RESULTED
NOT ONLY IN COST STUDIES AND AN INCREASE IN PAYROLL TAX IN
CONNECTION WITH MEDICARE BUT A CLAMPDOWN ON MEDICAID.
THE PURPOSE OF MEDICAID WAS TO HELP THE STATES PROVIDE
BETTER MEDICAL CARE AND SERVICES TO PERSONS UNABLE TO AFFORD
ADEQUATE CARE. IT WAS NEVER INTENDED THAT THE FEDERAL
GERALD FORD LIBRARY
MATCHING FUNDS OFFERED UNDER THIS PROGRAM PAY THE HEALTH
-10-
CARE EXPENSES OF A LARGE PORTION OF THE WORKING POPULATION
IN THIS COUNTRY--PEOPLE OF MODERATE INCOME. YET SOME OF THE
STATES REACHED INTO THE MIDDLE INCOME GROUP IN DEFINING WHO
IS MEDICALLY NEEDY. THIS WAS A DISTORTION OF THE INTENT OF
CONGRESS AND DEMANDED CORRECTIVE ACTION.
THE HOUSE THEREFORE VOTED TO SLAP A CEILING ON FEDERAL
FUNDING OF SUCH PROGRAMS WHILE GIVING STATES WHICH HAVE GONE
BEYOND CONGRESSIONAL INTENT A CHANCE TO ADJUST.
THUS, THE BASIC LIMITATION IS THAT FEDERAL FUNDING WILL
BE AVAILABLE FOR FAMILIES WHOSE INCOME EXCEEDS 133-AND-1/3
PER CENT OF THE HIGHEST INCOME ORDINARILY PAID TO A FAMILY OF
THE SAME SIZE UNDER THE AID-TO-DEPENDENT-CHILDREN PROGRAM.
AN ALTERNATIVE FEDERAL SHARING TEST IN THE BILL IS THAT THE
FORD
FAMILY INCOME LEVEL COULD BE NO HIGHER THAN 133-AND-1/3 PER
BRARY
CENT OF THE STATE PER CAPITA INCOME FOR A FAMILY WITH FOUR
-11-
MEMBERS. THIS 133-AND-1/3 LIMITATION GOES INTO EFFECT NEXT
JULY 1 BUT INITIALLY WILL APPLY ONLY TO STATES WITH PLANS
APPROVED AFTER JULY 25.
FOR STATES WITH PLANS ALREADY APPROVED, THE CEILING
WILL BE 150 PER CENT EFFECTIVE NEXT JULY 1, 140 PER CENT
EFFECTIVE JAN. 1, 1969, AND 133-AND-1/3 PER CENT ON JAN. 1,
1970.
WE HAVE ALSO SOUGHT TO COORDINATE MEDICAID AND THE
SUPPLEMENTARY MEDICAL INSURANCE PROGRAM BY MAKING IT EASIER
FOR STATES TO "BUY IN" TO THE SUPPLEMENTARY PROGRAM FOR THEIR
PUBLIC ASSISTANCE RECIPIENTS AGED 65 AND OVER. THE HOUSE-
APPROVED BILL GIVES STATES THE OPTION TO "BUY IN" TO SMI FOR
ALL OF THEIR AGED IN NEED OF MEDICAL ASSISTANCE, NOT JUST
THOSE RECEIVING CASH ASSISTANCE.
ERALD FORD LIBRARY
THE BILL FURTHER GIVES STATES THE OPTION OF ALLOWING
-12-
MEDICAID RECIPIENTS WHO ARE NOT ALSO CASH ASSISTANCE
RECIPIENTS TO RECEIVE REIMBURSEMENT DIRECTLY FOR PHYSICIANS'
SERVICES ON THE BASIS OF AN ITEMIZED BILL, PAID OR UNPAID.
YOU PEOPLE ARE INTERESTED, OF COURSE, IN THE CHILD
HEALTH AMENDMENTS TO THE SOCIAL SECURITY ACT.
PERHAPS MOST IMPORTANTLY, THE STATES WILL BE EXPECTED
TO TAKE OVER RESPONSIBILITY FOR ADMINISTERING THE PROJECT
GRANTS BY JULY 1972. IN EFFECT, THIS IS THE BLOCK GRANT
APPROACH WHICH REPUBLICANS HAVE BEEN URGING IN PLACE OF
CATEGORICAL ASSISTANCE GRANTS HEDGED ABOUT WITH WASHINGTON
RED TAPE.
THE BILL MOVES IN THIS DIRECTION BY CONSOLIDATING ALL
THE CHILD HEALTH AUTHORIZATIONS. BEGINNING WITH FISCAL YEAR
1969, 50 PER CENT OF THE TOTAL AUTHORIZATION WILL BE FOR
ORD
LIBRA
FORMULA GRANTS, 40 PER CENT FOR PROJECT GRANTS AND 10 PER CENT
-13-
FOR RESEARCH. BY 1972, WHEN THE STATES TAKE OVER THE PROJECT
GRANTS, 90 PER CENT OF THE TOTAL AUTHORIZATION WILL GO TO
THE STATES AS FORMULA GRANTS.
THE BILL AUTHORIZES PROJECT GRANTS TO HELP REDUCE THE
INCIDENCE OF MENTAL RETARDATION AND OTHER HANDICAPPING
CONDITIONS ASSOCIATED WITH COMPLICATIONS IN CHILD-BEARING, TO
HELP REDUCE INFANT AND MENTAL MORTALITY, TO PROMOTE THE HEALTH
OF CHILDREN OF SCHOOL AND PRESCHOOL AGE, AND TO PROVIDE DENTAL
CARE AND SERVICES TO CHILDREN. IT IS THE RESPONSIBILITY FOR
THESE PROJECTS THAT IS TO BE TRANSFERRED TO THE STATES
BEGINNING IN JULY 1972.
THE HOUSE - APPROVED BILL AUTHORIZES FEDERAL PAYMENTS
COVERING UP TO 75 PER CENT OF THE COST OF COMPREHENSIVE
DENTAL HEALTH SERVICES FOR CHILDREN. THESE PAYMENTS WOULD
COVER ONLY CHILDREN FROM LOW-INCOME FAMILIES. THE PROBLEM
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-14-
OF PROVIDING DENTAL CARE FOR CHILDREN OF LOW-INCOME FAMILIES
IS SO GREAT THAT WE CAN EXPECT TO SEE COMMUNITY-WIDE DENTAL
HEALTH PROGRAMS ESTABLISHED.
EFFORTS MAY ALSO BE MADE TO INCREASE THE EFFICIENCY OF
DENTISTS THROUGH THE USE OF ASSISTANTS AND AUXILIARY
PERSONNEL.
THERE IS SPECIAL EMPHASIS IN THE HOUSE-PASSED SOCIAL
SECURITY BILL ON PROJECTS TO DEVELOP NEW AND MORE EFFICIENT
WAYS OF FURNISHING HEALTH SERVICES.
PRESENT AND ANTICIPATED MANPOWER REQUIREMENTS IN
OBSTETRICS AND PEDIATRICS ARE SO LARGE THAT THE NATION MAY
FACE A CRISIS IN MATERNAL AND CHILD HEALTH CARE UNLESS WAYS
CAN BE FOUND TO INCREASE THE NUMBER AND EXPAND THE EFFICIENCY
OF PROFESSIONAL PERSONNEL.
ERALD FORD LIBRAP)
COST. ALL OF THESE PROGRAMS COST MONEY. BASIC TO ALL
-15-
OF THEM IS THE QUESTION IS THIS THE RIGHT APPROACH.
MEDICARE IS ON THE BOOKS. WE SHOULD GIVE IT AS FAIR A
TEST AS POSSIBLE.
IT CAN HARDLY BE COINCIDENCE THAT MEDICAL COSTS HAVE
RISEN BY 6.6 PER CENT--THE SHARPEST INCREASE IN TWO DECADES--
DURING THE FIRST YEAR OF MEDICARE.
HOSPITAL EXPENSES ARE RISING 10 TO 12 PER CENT A YEAR,
AND PHYSICIANS' CHARGES ARE CLIMBING 8 PER CENT A YEAR. DRUG
COSTS ALSO ARE JUMPING AS THE USE OF EXPENSIVE MEDICATIONS
INCREASES.
MEDICARE INVITES THE USE OF HEALTH SERVICES AND
HOSPITALS--AND, IT INVITES INFLATION. HOSPITALS AND NURSING
HOMES NATURALLY SEEK THEIR FULL COSTS OF CARE FOR THE AGED,
FORD
PLUS AN ADDED PERCENTAGE FOR IMPROVEMENT AND MODERNIZATION.
LIBRAR
A PHYSICIAN NATURALLY CHARGES HIS "USUAL AND CUSTOMARY" FEES.
-16-
THUS, THE MORE A HOSPITAL SPENDS TO CARE FOR THE AGED
THE HIGHER ITS "PLUS" PAYMENTS. AND A PHYSICIAN, TO AVOID
GOVERNMENT COMPLAINTS OF EXCESSIVE MEDICARE FEES, COULD FIND
THE ANSWER BY RAISING HIS CHARGES FOR ALL HIS PATIENTS. LET
ME ASSURE YOU THAT AS A BILL-PAYING PATIENT I AM NOT
ADVOCATING THIS COURSE OF ACTION. THIS COUNTRY IS FINDING OUT
THAT YOU SIMPLY CANNOT HAVE QUALITY HEALTH CARE AT BARGAIN
BASEMENT PRICES.
ONE FACTOR IN THE SHARP RISE IN HOSPITAL COSTS
OBVIOUSLY IS THAT CERTAIN HOSPITAL EMPLOYEES HAVE BEEN IN THE
LOW-PAY BRACKET. THEY ARE CATCHING UP. THEY CAN BE
EXPECTED TO CATCH UP COMPLETELY AT SOME FUTURE DATE.
THERE WILL BE HIGHER COSTS AS MORE REFINED AND
FORD
EXTENSIVE MEDICAL TREATMENTS ARE DEVELOPED. BUT THESE COSTS
RAR
MAY BE OFFSET BY GREATER USE OF OUT-OF-HOSPITAL FACILITIES,
-17-
SHORTER HOSPITAL STAYS, AND REDUCED EXPENSE FOR CURATIVE
TREATMENT AS A RESULT OF IMPROVED ILLNESS PREVENTION.
THE AMERICAN HOSPITAL ASSOCIATION EXPECTS HOSPITAL CARE
COSTS NOW AVERAGING ROUGHLY $58 A DAY TO LEVEL OFF AT $75 A
DAY IN THREE TO FIVE YEARS. WILBUR MILLS, CHAIRMAN OF THE
HOUSE WAYS AND MEANS COMMITTEE, HAS REMARKED THAT THIS INCREASE
IS "ABOUT TWICE AS MUCH AS WE ESTIMATED IN FIXING THE TAX TO
PAY FOR MEDICARE."
I DON'T KNOW THAT THERE ARE ANY SOLID ANSWERS TO THE
QUESTION OF RISING HEALTH CARE COSTS. BUT I DO KNOW THAT
MEDICARE MUST BE KEPT FISCALLY SOUND. AND THIS WILL MEAN
STEADY INCREASES IN PAYROLL TAXES FOR THE FORESEEABLE FUTURE.
Tabes
WE STILL HAVE NOT, OF COURSE, SOLVED THE PROBLEM OF
FORD
CATASTROPHIC ILLNESS OR ACCIDENT REQUIRING HOSPITAL STAYS OF
A YEAR OR MORE. LET'S PUT AMERICA'S INGENUITY TO WORK 1839 ON
-18-
THIS PROBLEM.
YOU PEOPLE ARE KNOWLEDGABLE IN THE BUSINESS AFFAIRS OF
HEALTH CARE. BECOME INVOLVED IN THE LAW-MAKING THAT AFFECTS
YOU. MAKE YOUR VOICES HEARD AND YOUR PRESENCE FELT.
DON'T BE AMONG THOSE PEOPLE WHO SPEND A LOT OF TIME AND
EFFORT TRYING TO AVOID CIVIC RESPONSIBILITY. WHAT IF PAUL
REVERE HAD SAID: "WHAT DO YOU MEAN, ME RIDE THROUGH EVERY
MIDDLESEX VILLAGE AND TOWN, AND IN THE MIDDLE OF THE NIGHT,
TOO? WHY PICK ON ME? AM I THE ONLY MAN IN BOSTON WITH A
HORSE?"
REMEMBER ALWAYS AND PONDER UPION THE WARNING SOUNDED BY
EDMUND BURKE WHEN HE SAID: "ALL THAT IS NECESSARY FOR THE
FORCES OF EVIL TO WIN IN THE WORLD IS FOR ENOUGH GOOD MEN TO
DO NOTHING." THANK YOU.
Churchill - Demorracy wont
FORD is LIBRARY 9ERALD
Franklin - Monanehy na Ryullic. -END-
multich copy
AN ADDRESS BY REP. GERALD R. FORD, R-MICH.
BEFORE THE
MEDICAL, DENTAL-HOSPITAL BUREAUS OF AMERICA, INC., MEETING
IN ANNUAL CONVENTION
FOR RELEASE ON DELIVERY
AT 10 a.m. TUESDAY, SEPT. 12, 1967
THE SHOREHAM HOTEL, WASHINGTON, D.C.
It used to be that the most popular saying in America was, "It's a free
country." Well, it's still a free country, but now the expression you hear most
often is "I couldn't care less."
Since it is a free country, I suppose every American has a right to be
disinterested or to feel alienated or to lose himself among the hippies. In
short, he has a right to say "I couldn't care less." But this does not mean what
he is doing is desirable either in terms of his own self interest or that of
society.
It is often said that the people of this nation get just the kind of govern-
ment they deserve because they have the privilege of choosing the individuals who
serve them in places of government. They are told it is their duty to vote. But,
indeed, their duty extends far beyond that. It must include an interest in the
everyday happenings of government at the local, state and federal levels if
democracy is to succeed.
Democracy fails in this country to the extent that Americans mutter, "I
couldn't care less."
Government fails in this country to the extent that it ignores the wishes
of the people and refuses to avail itself of the expertise available for the
carrying out of those wishes.
You people assembled here are among the experts. You specialize in provid-
ing the business services needed for the efficient operation of the offices of
physicians, dentists, hospitals, clinics, and other health-related organizations.
I can assume, then, that you care--care about health legislation, care about
Medicare and Medicaid and the direction your government is taking in the health
field. I can only guess whether you have cared enough to concern yourself
directly with that legislation and to make your views known to members of Congress.
Let me be completely frank with you and tell you at the outset that I voted
against the Medicare Bill when it first came before Congress in 1965. I do not
regret that vote, and I still have grave misgivings about the eventual outcome
of the Medicare Program.
GERALD FORD LIBRARY
-2-
But I voted for the Social Security Amendments of 1967, which include
changes in the Medicare and Medicaid programs. Those changes represent improve-
ments which are much needed--just a few of the changes Congress will have to
formulate to try to make medical assistance programs work properly.
To many Americans who have had no direct experience with Medicare, it is a
program that sounds just fine. But those who have struggled with Medicare red
tape wind up frustrated and furious. The editor of a weekly newspaper in my
congressional district in Michigan spoke out when he became exercised about
Medicare along about last May.
In an editorial headlined, "Medicare's A Mess," this editor wrote in part:
"We're beginning to get a strong impression that, however helpful it may be
to our senior citizens, the operation of the Medicare and Medicaid programs on
the local level is a mess. It's supposed to pay for treating the ailments of
the elderly, but those who are treating those ailments just aren't getting their
pay. Much of this is muddled by the long, time-consuming Medicare forms that have
to be filled out. Local ambulance services and area hospitals have both been
affected by this muddled mess, quite severely in some cases. These various problems
may be ironed out by time, but right now. Medicare's a mess." So wrote an editor
who cares about the people in his community.
Congress now is trying to clean up the mess. As you know, the House has
passed a Social Security bill which seeks to improve the functioning of the
Medicare program and puts a limit on runaway Medicaid before it bankrupts us all.
What does the bill do in connection with Medicare?
It increases from 90 to 120 the number of days of hospitalization covered
in a spell of illness, with the patient to pay a coinsurance amount of $20 for
each additional day.
It eliminates the present requirement that a physician certify that an indiviual
needs hospitalization at the time of admission to a hospital or that a person
requires hospital out-patient services.
Under the supplementary medical insurance program, the bill provides for an
alternative to the two existing methods of paying for physicians' services--the
methods of the receipted bill and assignment. Under the new procedure, physicians
or other persons providing covered medical and health services may request payment
on the basis of an itemized unpaid bill without having to agree, as under the
assignment method, that the program's reasonable charges will be accepted as payment
in full. Although the benefits still would be paid to the physician only if his
GERALD
LIBRARY
-3-
bill did not exceed the so-called reasonable charges, the physician need not
agree to the so-called reasonable charges in advance.
The bill also seeks to simplify billing for hospitals. It does this by
transferring coverage of outpatient hospital diagnostic services to the
supplementary medical insurance program and by eliminating the coinsurance pro-
vision for pathology and radiology services. It further permits hospitals to
collect charges from outpatients for relatively inexpensive services, subject to
final settlement in line with Medicare provisions on reimbursable costs.
The bill amends the definition of a physician to include a doctor of
podiatry, but no payments will be made for routine foot care whether performed by
a podiatrist or a medical doctor.
It is highly important in terms of the future of Medicare that Congress is
taking a hard look at the costs of the program. The House Ways and Means Committee
took reams of testimony on the subject of medical and hospital costs but found
itself shy of answers. As a result, the House-approved bill authorizes the
Health-Education-and-Welfare Department to experiment with various methods of
reimbursing hospitals under Medicare, Medicaid and the child health programs. The
aim is to provide hospitals with incentives for keeping costs down while giving
quality care.
There are important details in some of the Medicare changes in the House-
approved bill awaiting Senate action.
Physical therapy furnished to an outpatient in his home or a nursing home
would be covered under the supplementary medical insurance program. But this
applies only if the services are provided under hospital supervision.
Diagnostic X-rays taken in a patient's home or a nursing home would be
similarly covered but such service must be supervised by a physician and must
be in keeping with health and safety regulations.
Consideration is being given to extending coverage under the supplementary
medical insurance program to the services of additional types of personnel who
independently provide health services. The House-approved bill directs the
Secretary of Health-Education-and-Welfare to study and recommend possible action
in this area.
As you know, there is much concern in the Congress over the cost of Medicare
and Medicaid. This has resulted not only in cost studies and an increase in
payroll tax in connection with Medicare but a clampdown on Medicaid.
-4-
The purpose of Medicaid was to help the states provide better medical care
and services to persons unable to afford adequate care. It was never intended
that the Federal matching funds offered under this program pay the health care
expenses of a large portion of the working population in this country--people of
moderate income. Yet some of the states reached into the middle income group
in defining who is medically needy. This was a distortion of the intent of Congress
and demanded corrective action.
The House therefore voted to slap a ceiling on Federal funding of such pro-
grams while giving states which have gone beyond congressional intent a chance
to adjust.
Thus, the basic limitation is that Federal funding will not be available
for families whose income exceeds 133-and-1/3 per cent of the highest income
ordinarily paid to a family of the same size under the aid-to-dependent-children
program. An alternative Federal sharing test in the bill is that the family
income level could be no higher than 133-and-1/3 per cent of the State per capita
income for a family with four members. This 133-and-1/3 limitation goes into
effect next July 1 but initially will apply only to states with plans approved
after July 25.
For states with plans already approved, the ceiling will be 150 per cent
effective next July 1, 140 per cent effective Jan. 1, 1969, and 133-and-1/3
per cent on Jan. 1, 1970.
We have also sought to coordinate Medicaid and the supplementary medical
insurance program by making it easier for states to "buy in" to the supplementary
program for their public assistance recipients aged 65 and over. The House-
approved bill gives states the option to "buy in" to SMI for all of their aged
in need of medical assistance, not just those receiving cash assistance.
The bill further gives states the option of allowing Medicaid recipients who
are not also cash assistance recipients to receive reimbursements directly for
physicians' services on the basis of an itemized bill, paid or unpaid.
You people are interested, of course, in the child health amendments to
the Social Security Act.
Perhaps most importantly, the states will be expected to take over responsibility
for administering the project grants by July 1972. In effect, this is the block
grant approach which Republicans have been urging in place of categorical assist-
ance grants hedged about with Washington red tape.
GERALD FORD LIBIARY
-5-
The bill moves in this direction by consolidating all of the child health
authorizations. Beginning with fiscal year 1969, 50 per cent of the total
authorization will be for formula grants, 40 per cent for project grants and
10 per cent for research. By 1972, when the states take over the project
grants, 90 per cent of the total authorization will go to the states as formula
grants.
The bill authorizes project grants to help reduce the incidence of mental
retardation and other handicapping conditions associated with complications
in child-bearing, to help reduce infant and maternal morality, to promote the
health of children of school and preschool age, and to provide dental care and
services to children. It is the responsibility for these projects that is to
be transferred to the states beginning in July 1972.
The House-approved bill authorizes Federal payments covering up to 75 per
cent of the cost of comprehensive dental health services for children. These
payments would cover only children from low-income families. The problem of
providing dental care for children of low-income families is so great that we
can expect to see community-wide dental health programs established. Efforts may
also be made to increase the efficiency of dentists through the use of assistants
and auxiliary personnel.
There is special emphasis in the House-passed Social Security bill on
projects to develop new and more efficient ways of furnishing health services.
Present and anticipated manpower requirements in obstetrics and pediatrics
are so large that the Nation may face a crisis in maternal and child health care
unless ways can be found to increase the number and expand the efficiency of
professional personnel.
Cost. All of these programs cost money. Basic to all of them is the question
is this the right approach.
Medicare is on the books. We should give it as fair a test as possible.
It can hardly be coincidence that medical costs have risen by 6.6 per cent--
the sharpest increase in two decades--during the first year of Medicare.
Hospital expenses are rising 10 to 12 per cent a year, and physicians'
charges are climbing 8 per cent a year. Drug costs also are jumping as the use
of expensive medications increases.
Medicare invites the use of health services and hospitals--and, it invites
inflation. Hospitals and nursing homes naturally seek their full costs of care
for the aged, plus an added percentage for improvement and modernization. A
physician naturally charges his "usual and customary" fees.
FORD LIBRAR
-6-
Thus, the more a hospital spends to care for the aged the higher its "plus"
payments. And a physician, to avoid Government complaints of excessive Medicare
fees could find the answer by raising his charges for all his patients. Let
me assure you as a bill-paying patient, I am not advocating this course of action.
This country is finding out that you simply cannot have quality health care at
bargain basement prices.
One factor in the sharp rise in hospital costs obviously is that certain
hospital employees have been in the low-pay bracket. They are catching up.
They can be expected to catch up completely at some future date.
There will be higher costs as more refined and extensive medical treatments
are developed. But these costs may be offset by greater use of out-of-hospital
facilities, shorter hospital stays, and reduced expense for curative treatment
as a result of improved illness prevention.
The American Hospital Association expects hospital care costs now averaging
roughly $58 a day to level off at $75 a day in three to five years. Wilbur
Mills, chairman of the House Ways and Means Committee, has remarked that this
increase is "about twice as much as we estimated in fixing the tax to pay for
Medicare."
I don't know that there are any soldi answers to the question of rising
health care costs. But I do know that Medicare must be kept fiscally sound. And
this will mean steady increases in payroll taxes for the foreseeable future.
We still have not, of course, solved the problem of catastrophic illness
or accident requiring hospital stays of a year or more. Let's put America's
ingenuity to work on this problem.
You people are knowledgable in the business affairs of health care. Become
involved in the law-making that affects you. Make your voices heard and your
presence felt.
Don't be among those people who spend a lot of time and effort trying to
avoid civic responsibility. What if Paul Revere had said: "What do you mean,
me ride through every Middlesex village and town, and in the middle of the night,
on
too? Why pick/me? Am I the only man in Boston with a horse?"
Remember always and ponder upon the warning sounded by Edmund Burke when
he said: "All that is necessary for the forces of evil to win in the world is
for enough good men to do nothing." Thank you.
###
FORD NIBRAGA
AN ADDRESS by REP. GERALD R. FORD, R-MICH.
NEFORE THE
MEDICAL, DENTAL-HOSPITAL BUREAUS OF AMERICA, INC., MEETING
IS ANNUAL CONVENTION
FOR RELEASE on DELIVERY
AT 10 s.m. TUESDAY, SEFT. 12, 1967
THE SHOREHAM HOTEL, WASHINGTON, D.C.
a used to be that the mest popular saying is America was, "It's a free
country." Well, 15's otill a Exce country, but - the expression you hear meat
eften to "I couldn't care less."
Since it is a free country, 8 suppose every American has a right to be
disinterested or to feel aliensted or to Lose himself among the hippies. In
short, be has a right to say "I couldn't care less." But this does not mond shat
he is doing is desirable either in terms of his em self interest or that of
society.
It is often said that the people of this nation get just the kind of governor
must they deserve because they have the privilege of choosing the individuals who
serve them is places of government. They are told it is their duty to vote. not,
infood, their duty extends for beyond that. It must (malude on interest in the
everyday happenings of government at the local, state and federal levels if
democracy is to succeed.
Democracy fails in this country to the extent that Americans mitter, "I
couldn't esra 1ses."
Government fails in this country to the extend that it fgneres the wishes
of the people and refused to evail itself of the expertise available for the
carrying out of those wishes.
You people assembled here are among the experts. The specialise in provid-
ing the business services needed for the efficient operation of the offices of
physicians, dentists, hospitals, clinics, and other health-colated organizations.
I can essuma, them, that you care care about health legislation, care about
Medicare and Medicaid and the direction your government is taking in the health
field. 1 can only guess whether you have cered amough to consern yourself
directly with that legislation end to make your view known to members of Congress.
Let - be completely fronk with you and tell you at the outset that I voted
against the Medicare Bill when is first esse before Congress is 1963. $ do not
regret that vote, and I still have grave niegivings about the eventual outcome
of the Medicare Program.
But I voted for the Secial Security Amendments of 1967, which include
changes in the Medicare and Medicaid programs. These changes represent improve-
ments which are such needed--just a few of the changes Congress will have to
formulate to try to make medical assistance programs week properly.
To many Americans who have had no direct experience with Medicare, it is a
program that sounds just fine. But these who have struggled with Medicare red
tape wind up frustrated and furious. The editor of a weekly newspaper is my
congressional district in Michigan spoke out when be because energieed about
Molicare along about last May.
In an editorial hoadlined, "Modicere's A Mass," this editor wrote in parts
"We're beginning to get a strong inpression that, housver helpful it may be
to our senior citizens, the operation of the Indicare and Medicaid programs -
the local level is 8 mes. 21% supposed to pay for treating the ailments of
the alderly, but those who are treating these silments just aren't getting their
pay. Much of this is muddled by the long, time-emeuning Medicare forms that have
to be filled out. Local subulance services and area hospitals have both been
effected by this muddled mess, quite severely in some cases. These problems
any be ircned out by time, but right now...Medicare's a mess." So wrote - editor
who cares about the people in his community.
Congress now is trying to clean up the mess. is you know, the House has
passed a Social Security bill which socks to improve the functioning of the
Medicare program and puts a limit on runeway Medicaid before it beakrupts us all.
What does the bill do in competion with Medicare?
It increases from 90 to 120 the number of days of hospitalination covered
in a spell of illness, with the patient to pay a acinourance amount of $20 for
each additional day.
It eliminates the present requirement that a physician certify that an indiviual
useds hospitalization at the time of admission to a hospital or that # passes
requires hospital out-pationt services.
Under the supplementary medical insurance program, the bill provides for -
alternative to the two existing methods of paying for physicians' services--the
methods of the receipted bill and assignment. Unles the new procedure, physicians
or other persons providing covered medical and health services may request payment
on the besis of an itemined unpaid bill without having to agree, as under the
assignment usthod, that the program's reconsable charges will be accepted w payment
la mill Although the henefits a+++1 would he said to the obveicies sale " his
Dill did not exceed the se-called receemable charges, the physician used not
agree to the so-celled reseenable charges in advance.
The bill also seeks to simplify billing for hospitals. It does this by
transferring coverage of outpetient hospital diagnostic services to the
supplementary medical insurance program and by eliminating the enformation year
vision for pathology and rediology services. It further permits hospitals to
sollect charges from outpotients tos relatively insupensive services, subject to
final acttlement is line with Medicare provisions on reimburasble casts.
The bill amends the definition of . physician to include a doctor of
pediatry, but no payments will be made for restime Esst care whather performed by
a podiatrist or a medical doctor.
It is highly important in terms of the future of Madicare that Congress is
taking a hard look at the costs of the program. The though Ways and Means Committee
took reams of tectimeny on the subject of anticel and hospital cests but found
Stoolf shy of answers. As e result, the News-epproved Mill authorizes the
Department to experiment with various mothods of
reimbursing hospitals under Madicare, Madicaid and the child health programs. The
atm is to provide hospitals with incentives for keeping costs down while giving
quality care.
There are Suportent details in some of the Medicare changes in the House-
spproved MII swaiting Senste action.
Physical therapy furnished to - outputions in his home or a nursing home
would be covered under the supplamentary medical insurance program. But this
applies only if the services are provided under hospital supervision.
Disgnostic X-rays taken in a patient's home or a nursing home would be
similarly covered but such service met be supervised by a physician and must
be in keeping with health and eafety regulations.
Consideration is buing given to extending coverage under the supplementary
medical insurance program to the services of additional types of personnel who
independently provide health services. the bill directs the
Secretary of to study and recommend possible action
is this eres.
As you know, there is each concern is the Congrees over the cost of Medicare
and Medicaid. This has resulted not only in cost studies and an increase in
payroll tax in commestion with Medicare but
The purpose of Medicaid was to help the states provide better medical eare
and services to persons unable to afford adequate care. It was never intended
that the Federal matching funds offered under this program pay the health care
expenses of a large portion of the working population in this country--pasple of
moderate income. Yet some of the states reached late the middle income group
in defining who is medically needy. This - 6 distertion of the intent of Congress
and desended corrective action,
The House therefore voted to slap a ceiling on Federal fudding of such pro-
grans while giving states whech have gone beyond intent a chance
to adjust.
Thus, the basic limitation is that Federal funding will not be available
for families whose income anceeds 133-md-1/3 per cont of the highest Income
ordinarily paid to a family of the same size under the
program. An alternative Federal sharing tent in the bill is that the family
income level could be no higher than 133-ond-1/3 per cant of the State per capital
income Zes . family with four mothers. This 133-mal-1/3 limitation goes into
effect next July 1 but initially will apply only to states with plans approved
after July 25.
For states with plans already approved, the coiling will be 150 per cont
effective next July 1, 140 par cent effective Jan. 1, 1969, and 133-and-1/3
per cent on Jan. 1, 1970.
We have also sought to considente Medicaid and the supplamentary medical
insurance program by making it easier for states to "buy in" to the supplementary
program for their public assistance aged 65 and over. The House-
approved bill gives states the option to "buy in" to SMX for all of their aged
in need of medical assistance, not just those reserving smok assistance.
The bill further gives states the option of allowing Medicaid teripients who
are not also cash assistance resigients to receive reinbursements directly for
physicians' services on the basis of an itentand bill, paid or uspaid.
You people are interested, of course, in the child health exeminents to
the Social Security Act.
Ferhage meet importantly, the states will be expensed to take over responsibilit
for administering the project grants by July 1972. In effect, this is the block
great approach which Republicons have been urging in place of estegerical assist-
ance grants hodged about with Washington red tope.
BRARD
The bill moves in this direction by consolidating all of the child health
authorizations. Beginning with fiscal year 1969, 50 par cent of the total
authorization will be for formule grants, 40 par cent for projectegramte and
10 per cent for research. By 1972, when the states take over the project
grants, 90 per cent of the total authorization will & to the states as fermals
grants.
The bill authorizes prgject grants to help reduce the insidence of mental
retardation and other handicopping conditions associated with complications
in child-beering, to help reduce inform and material memality, to promote the
health of children of school and preschool age, and to provide dental care asé
services to children. It is the responsibility for these projects that to to
be transferred to the states beginning is July 1972.
The House-approved bill authorizes Federal payments covering up to 75 your
CERS of the cost of comprehensive dental health services for children. These
payments would cover only children from low-incone families. The problem of
providing dental care for children of Isw-incone femilies is go great that we
can expect to see consunity-uide dental health programs established. Efforts may
also be máde to increase the efficiency of dentists through the use of assistants
and smillery personnel.
There is special exphasis in the Social Security MII on
projects to develop new and more effictent anys of furnishing health services.
Present and anticipated unspower requirements in obstetries and pediatries
are 60 large that the Nation any face a crisis in materal and child health care
unless ways cm be found to increase the number and unpand the efficiency of
professional personnel.
Cost. All of these programs cost money. Basic to all of then is the question..
to this the right approach.
Medicare is on the beaks. # should give it as fair a test as persible.
It can hardly be coincidence that medical costs have risen by 6.6 yer cont--
the sharpest increase in two decafes--during the first year of Indicare.
Hospital expenses are vising 10 to 12 per cent a year, and physicians'
charges are climbing 8 per cont a year. Drug costs also are jumping as the use
of expensive medications increases.
Medicare invites the use of health services and hospitals--ond, it invites
inflation. Hospitals and nursing house naturally seek their full costs of care
for the aged, plus an added percentage for improvement and modernization. A
physics naturally charges his "usual and customary" fees.
Thus, the more a hospital spends to eart the the aged the higher its "plus"
payments. And a physician, to avoid Government complaints of axcessive Medicare
fees. could find the enswer by reising his charges for all his petients, Let
se assure you as a bill-paying perient, I - not advocuting this of sesion.
This country is finding out that you stoply connet have quality health care at
burgain becoment prices.
One factor in the sharp visa in hospital costs eleviously is that certain
hospital employees have been in the low-pay breaket, They are notching we
they can be expected to catch - completely at some fature date.
there will be higher costs as more refined and entensive treatments
are developed. But these costs may be effect by greater use of out-of-hospital
fesilities, shorter hospital stays, and reduced supense for corstive treatment
as a result of improved illness provention.
The Anerican Hospital Association expects hospital care costs now averaging
roughly $58 a day to level off st $75 a day in three to the years. Wilbur
Mills, chairman of the House Mays and Means Consitton, toda Tenerkal that this
increase is "about twice as mith as - estimated to fising the tax to pay for
1 don't know that there are any colds exquire to the question of rising
health dare costs. But I 4a know that Madicare must be kept fisabily sound, And
this will mean steady increases is payroll tunes the the feveresable future.
- mill have not, of course, selved the problem of extastrophic illness
or accident requiring hospital steys of # year or more. lat's pet
Ingensity to work on this problem.
You people are knowledgeble is the business affairs of health care. Become
involved is the low-msking that affects you. Make your voices heard and your
presence felt.
Don't be among these people who opend a Lot of time and effort trying to
avoid civie responsibility. that 12 Paul Revere had saids "that do you mean,
- ride through every Middlessm village and town, and in the middle of the night,
too? Why pick/met Am I the only - in Boston with a horse?"
Remember always and pender upon the warning sounded by I Burke when
be said: "All that is necessary for the forees of will to via in the world is
for enough good non to do mething." Thank you.
0000