1. Statement by the President Upon Making Public the Report of the President's Council on Aging--February 9, 1964

This administration will continue to build on the efforts of President Kennedy to make this a better country for its older citizens. Under my 1965 budget proposals the Federal Government will spend an estimated $19 billion from budget and trust funds for benefits and services for older persons. We are moving ahead to keep the older American from becoming a second-class citizen.

Our programs in income maintenance, our efforts in supporting private industry in the building of better housing for older people, our investments in research, our assistance in the provision of medical facilities--these and other actions are bringing us closer to the time when elderly people generally can enjoy the independence and the sense of purpose and accomplishment that are their due.

Much more needs to be done to brighten the later years.

Longer life is both a major achievement and a major challenge of our time. Nearly 23 years have been added to the average life-time in our century. A child born in 1900 could expect 47 years of life; his grandchildren, born today, can look forward to 70. They will carry the continuity of America well toward the middle of the 21st century.

Today nearly 18 million men and women in the United States have reached or passed their 65th birthday. Approximately one-third of them are 75 or over. More than 12,000 have lived 100 years.

For these older Americans--and for those of us moving each year to join them--the lengthening of life gives an opportunity for a new dimension to living. The increased span of retirement provides time for self-realization, creative endeavor, and public service.

Old age is not a problem in itself. But the fact is, millions of older Americans face many problems. They face:

--The problem of poverty. There are 3 million elderly families with incomes of less than $3,000 a year, and two-thirds of all elderly persons, who live alone or with non-relatives, have incomes below $1,500.

--The problem of housing. One out of each five dwelling units occupied by persons over 60 is substandard.

--The problem of health. Older people need much more medical service than younger. They have much less money to pay for it.

--The problem of employment. Age alone is a too-frequent excuse to remove men and women needlessly and arbitrarily from active participation in life.

We must attack all these problems all the time, if we are to achieve goals of security and opportunity for all older Americans.

To fall behind on one front is to fail behind on all fronts. Poverty is an all-pervasive blight. And so are miserable housing, poor health, and social banishment.

One of the most urgent orders of business at this time is the enactment of hospital insurance for the aged through social security to help older people meet the high costs of illness without jeopardizing their economic independence.

This program would not only be a major attack on health problems among older people but a major attack on poverty.

At the same time, I urge all States to adopt adequate programs of medical assistance for the aged under the Kerr-Mills legislation. This assistance is needed now, and it will be needed later as a supplement to hospital insurance to deal with those special problems that private insurance and the social insurance program will not cover.

To the Congress of the United States:

The American people are not satisfied with better-than-average health. As a Nation, they want, they need, and they can afford the best of health:

--not just for those of comfortable means.
--but for all our citizens, old and young, rich and poor.

In America,

--There is no need and no room for second-class health services.
--There is no need and no room for denying, to any of our people the wonders of modern medicine.
--There is no need and no room for elderly people to suffer the personal economic disaster to which major illness all too commonly exposes them.

In seeking health improvements, we build on the past. For in the conquest of ill health our record is already a proud one:

--American medical research continues to score remarkable advances.
--We have mastered most of the major contagious diseases.
--Our life expectancy is increasing steadily.
--The overall quality of our physicians, dentists, and other health workers, of our professional schools, and of our hospitals and laboratories is unexcelled.
--Basic health protection is becoming more and more broadly available.

Federal programs have played a major role in these advances:

--Federal expenditures in the fiscal 1965 budget for health and health-related programs total $5.4 billion--about double the amount of 8 years ago.
--Federal participation and stimulus are partly responsible for the fact that last year--in 1963--the Nation's total health expenditures reached an unprecedented high of $34 billion, or 6 percent of the gross national product.

But progress means new problems:

--As the life span lengthens, the need for health services grows.
--As medical science grows more complex, health care becomes more expensive.
--As people move to urban centers, health hazards rise.
--As population, which has increased 27 percent since 1950, continues to grow, a greater strain is put on our limited supply of trained personnel.

Even worse, perhaps, are those problems that reflect the unequal sharing of the health services we have:

--Thousands suffer from diseases for which preventive measures are known but not applied.
--Thousands of babies die needlessly; 9 other nations have lower infant death rates than ours.
--Half of the young men found unqualified for military service are rejected for medical reasons; most of them come from poor homes.

Clearly, too many Americans still are cut off by low incomes from adequate health services. Too many older people are still deprived of hope and dignity by prolonged and costly illness. The linkage between ill-health and poverty in America is still all too plain.

In its first session, the 88th Congress made some important advances on the health front:

--It acted to increase our supply of physicians and dentists.
--It began a Nation-wide attack on mental illness and mental retardation.
--And it strengthened our efforts against air pollution.

But our remaining agenda is long, and it will be unfinished until each American enjoys the full benefits of modern medical knowledge.

Part of this agenda concerns a direct attack on that particular companion of poor health--poverty. Above all, we must see to it that all of our children, whatever the economic condition of their parents, can start life with sound minds and bodies.

My message to the Congress on poverty will set forth measures designed to advance us toward this goal.

In today's message, I present the rest of this year's agenda for America's good health.

I. HOSPITAL INSURANCE FOR THE AGED

Nearly thirty years ago, this Nation took the first long step to meet the needs of its older citizens by adopting the Social Security program. Today, most Americans look toward retirement with some confidence that they will be able to meet their basic needs for food and shelter.

But many of our older citizens are still defenseless against the heavy medical costs of severe illness or disability:

--One-third of the aged who are forced to ask for old age assistance do so because of ill health, and one-third of our public assistance funds going to older people is spent for medical care.
--For many others, serious illness wipes out savings and carries their families into poverty.
--For these people, old age can be a dark corridor of fear.

The irony is that this problem stems in part from the surging progress in medical science and medical techniques--the same progress that has brought longer life to Americans as a whole.

Modern medical care is marvelously effective--but increasingly expensive.

--Daily hospital costs are now four times as high as they were in 1946--now averaging about $37 a day.
--In contrast, the average Social Security benefit is just $77 a month for retired workers and $67 a month for widows.

Existing "solutions" to these problems are (1) private health insurance plans and (2) welfare medical assistance. No one of them is adequate, nor are they in combination:

--Private insurance, when available, usually costs more than the average retired couple can afford.
--Welfare medical assistance for the aged is not available in many States--and where it is available, it includes a needs test to which older citizens, with a lifetime of honorable, productive work behind them, should not be subjected.

This situation is not new.

For more than a decade we have failed to meet the problem.

There is a sound and workable solution. Hospital insurance based on Social Security payments is clearly the best method of meeting the need. It is a logical extension of the principle--established in 1935 and confirmed time after time by the Congress--that provision should be made for later years during the course of a lifetime of employment. Therefore:

I recommend a hospital insurance program for the aged aimed at two basic goals:

First, it should protect against the heaviest costs of a serious illness--the costs of hospital and skilled nursing home care, home health services, and outpatient hospital diagnostic services.

Second, it should provide a base that related private programs can supplement.

To achieve these goals:

1. These benefits should be available to everyone who reaches 65.

2. Benefit payments should cover the cost of services customarily furnished in semi-private accommodations in a hospital, but not the cost of the services of personal physicians.

3. The financing should be soundly funded through the Social Security system.

4. One-quarter of one percent should be added to the Social Security contribution paid by employers and by employees.

5. The annual earnings subject to Social Security taxes should be increased from $4,800 to $5,200.

6. For those not now covered by Social Security, the cost of similar protection would be provided from the administrative budget.

Under this proposals the costs of hospital and related services can be met without any interference whatever with the method of treatment. The arrangement would in no way hinder the patient's freedom to choose his doctor, hospital, or nurse.

The only change would be in the manner in which individuals would finance the hospital costs of their later years. The average worker under Social Security would contribute about a dollar a month during his working life to protect himself in old age in a dignified manner against the devastating costs of prolonged hospitalization.

Hospitalization, however, is not the end of older people's medical needs. Many aged individuals will have medical expenses that will be covered neither by social security, hospital insurance nor by private insurance.

Therefore, I urge all States to adopt adequate programs of medical assistance under the Kerr-Mills Legislation. This assistance is needed now. And it will be needed later as a supplement to hospital insurance.

II. HEALTH FACILITIES

Good health is the product of well-trained people working in modern and efficient hospitals and other facilities.

Extension and Expansion of Hill-Burton Program

We can be proud of the many fine hospitals throughout the country which were made possible in the last 16 years by the Hill-Burton program of Federal aid.

But there is more still to be done:

--too often a sick patient must wait until a hospital bed becomes available;
--too many hospitals are old and poorly equipped;
--new kinds of facilities are needed to care for the aged and the chronically ill.

I recommend that the Hill-Burton program--scheduled to end on June 30, 1964--be extended for an additional five years including the amendments outlined below.

1. Planning

Hospital care costs too much to permit duplication, inefficiency, or extravagance in building and locating hospitals. Individual hospitals and other health facilities should be located where they are most needed. Together, these facilities in a community should provide the services needed by its citizens. This means planning. Therefore:

(a) I recommend that the Congress authorize special grants to public and nonprofit agencies to assist them in developing comprehensive area, regional, and local plans for health and related facilities.

(b) I also recommend that limited matching funds be made available to help State agencies meet part of their costs of administering the Hill-Burton program, so that these agencies can plan wisely for our hospital systems.

2. Modernization

The Hill-Burton program has done much to help build general hospitals where they were most needed when the program began--particularly in rural areas.

While rural and suburban areas have been acquiring modern facilities, city hospitals have become more and more obsolete and inefficient. Yet city hospitals are largely responsible

--for applying the latest discoveries of medical science;
--for teaching the new generations of practitioners;
--for setting the pace and direction in care of the sick.

They must have adequate facilities.

A recent study showed that it would cost $3.6 billion to modernize and replace existing antiquated facilities--more than three times our annual expenditures for construction of all health facilities.

The present Hill-Burton Act cannot meet this critical need. Further neglect will only aggravate the problem. Therefore:

(c) I recommend that the Act be amended to authorize a new program of grants to help public and nonprofit agencies modernize or replace hospital and related health facilities.

3. Long-Term Care Facilities

Our lengthening life span has brought with it an increase in chronic diseases. This swells our need for long-term care facilities.

We have been making some progress in meeting the backlog of demand for nursing homes and chronic disease hospitals. But there is still a deficit of over 500,000 beds for the care of long-term patients.

This is a national health problem.

Our communities need better and more facilities to deal with prolonged illness, and to make community planning of these facilities more effective. Therefore:

(d) I recommend that the separate grant programs for chronic disease hospitals and nursing homes be combined into a single category of long-term care facilities. The annual appropriation for the combined categories should be increased from $40 million to $70 million.

4. Mortgage Insurance

Raising funds to build health facilities is a problem for almost every community:

--Federal aid is not always obtainable.
--States must set priorities for hospital projects which are to receive Federal aid; many worthwhile projects necessarily fail to win approval.
--Nonprofit agencies often have great difficulty raising local funds to match Federal grants.
--Loans available from private lenders often call for large annual payments and short payoff periods. This can either threaten a hospital's financial soundness or lead to excessive increases in the cost of hospital care.

These financing difficulties do not alter the fact that the need for hospital beds is increasing. Therefore:

(e) I recommend amendment of the Hill-Burton Act to permit mortgage insurance of loans with maturities up to 40 years to help build private nonprofit hospitals, nursing homes, and other medical facilities.

(f) In addition, I recommend that authority to insure mortgage loans for the construction of nursing homes operated for profit be transferred from the Federal Housing Administration to the Public Health Service.

These changes will help us build more hospitals and other medical facilities. And they will bring together in the Public Health Service an adequate and interlocking program of Federal aid to profit-making--as well as nonprofit-nursing homes, hospitals, and other facilities.

Encouragement of Group Practice

To meet the needs of their communities, groups of physicians--general practitioners and specialists--more and more are pooling their skills and using the same buildings, equipment, and personnel to care for their patients.

--This is a sound and practical approach to medical service.
--It provides better medical care, yet it yields economics which can be passed on to the consumer.
--It makes better use of scarce professional personnel.
--It offers benefits to physicians, patients, and the community.

The specialized facilities and equipment needed for group practice are often not available, especially in smaller communities. Therefore:

I recommend legislation to authorize a 5-year program of Federal mortgage insurance and loans to help build and equip group practice medical and dental facilities.

Priority should be given to facilities in smaller communities, and to those sponsored by nonprofit or cooperative organizations.

III. HEALTH MANPOWER

Medical science has grown vastly more complex in recent years--and its potential for human good has grown accordingly. But to convert its potential into actual good requires an ever-growing supply of ever better trained medical manpower.

--The quantity and quality of education for the health disciplines his been unable to keep pace.
--Shortages of medical manpower are acute.

By enacting the Health Professions Educational Assistance Act of 1963, the Congress took a major step to close this gap in medical manpower, especially as it relates to physicians and dentists.

But the task is far from finished.

A Stronger Nursing Profession

 The rapid development of medical science places heavy demands on the time and skill of the physician. Nurses must perform many functions that once were done only by doctors.

A panel of expert advisors to the Public Health Service has recommended that the number of professional nurses be increased from the current total of 550,000 to 680,000 by 1970.

This requires raising nursing school enrollments by 75 percent.

But larger enrollments alone are not enough. The efficiency of nursing schools and the quality of instruction must be improved. The nursing profession, too, is becoming more complex and exacting.

The longer we delay, the larger the deficit grows, and the harder it becomes to overcome it.

I recommend the authorization of grants to build and expand schools of nursing, to help the schools perfect new teaching methods, and to assist local, State and regional planning for nursing service.

We must remove financial barriers for students desiring to train for the nursing profession and we must attract highly talented youngsters.

I therefore recommend Federal loans and a national competitive merit scholarship program. For each year of service as a nurse up to 6 years a proportion of the loan should be forgiven.

In addition, I recommend continuation and expansion of the Professional Nurse Traineeship Program to increase the number of nurses trained for key supervisory and teaching positions.

Federal action alone is not enough:

--State and local governments, schools, hospitals, the health professions, and private citizens all have a big stake in solving the nursing shortage.
--Each must take on added responsibilities if the growing demand for essential and high quality nursing services is to be met.

Strengthened Training in Public Health

Our State and local public health agencies are attempting to cope with mounting problems, but with inadequate resources.

Our population has risen 27 percent since 1950, and public health problems have become more complex, But there are fewer public health physicians today than in 1950. The number of public health engineers has increased by only a small fraction; and other essential public health disciplines are in short supply.

These shortages have weakened health protection measures in many communities.

The situation would be much worse than it is, but for two Public Health Service training programs:

(1) the program of public health traineeships;

(2) the complementary program of project grants to schools of public health, nursing, and engineering designed to help strengthen graduate or specialized public health training.

The need for these programs is greater today than ever before.

I recommend that the Public Health Traineeship program and the project grant program for graduate training in public health be expanded and extended until 1969.

IV. MENTAL HEALTH AND MENTAL RETARDATION

Mental illness is a grave problem for the Nation, for the community, and for the family it strikes. It can be dealt with only through heroic measures. It must be dealt with generously and effectively.

Last year, President Kennedy proposed legislation to improve the Nation's mental health and to combat mental retardation.

Congress promptly responded. State and local governments and private organizations joined in that response.

The Congress enacted legislation which should enable us to reduce substantially the number of patients in existing custodial institutions within a decade, through comprehensive community-based mental health services.

Under new legislation passed last year we will train teachers and build community centers for the care and treatment of the mentally handicapped.

It was, as President Kennedy said, "the most significant effort that the Congress of the United States has ever undertaken" on behalf of human welfare and happiness.

We are now moving speedily to put this legislation into effect.

The mentally ill and the mentally retarded have a right to a decent, dignified place in society. I intend to assure them of that place.

The Congress has demonstrated its awareness of the need for action by approving my request for supplemental appropriations for mental retardation programs in the current fiscal year.

This will enable us to get started.

My 1965 budget includes a total of $467 million for the National Institute of Mental Health and for mental retardation activities.

I urge the Congress to approve the full amount requested.

V. HEALTH PROTECTION

Technological progress is not always an unmixed blessing.

To be sure, we have a wealth of new products, unimagined a few generations ago, that make life easier and more rewarding.

But these benefits sometimes carry a price in the shape of new hazards to our health:

--The air we breathe is being fouled by our great factories, our myriad automobiles and trucks, our huge urban centers.
--The pure water we once took for granted is being polluted by chemicals and foreign substances.
--The pesticides indispensable to our farmers sometimes introduce chemicals whose long-range effects upon man are dimly understood.

We must develop effective safeguards to protect our people from hazards in the air we breathe, the water we drink, and the food we eat.

To provide a focal point for vigorous research, training,, and control programs in environmental health, I have requested funds in the 1965 budget to develop plans for additional facilities to house our expanding Federal programs concerned with environmental health.

The Clean Air Act, which I approved last December 17, commits the Federal Government for the first time to substantially increased responsibilities in preventing and controlling air pollution.

I urge prompt action on the supplemental appropriation to finance this new authority in the current fiscal year.

Pesticides

The President's Science Advisory Committee report on Pesticides, released last May, alerted the country to the potential health dangers of pesticides.

To act without delay:

I have submitted requests to the Congress for additional funds for 1964 and 1965 for research on the effects of pesticides on our environment.

I recommend enactment of pending legislation prohibiting the registration and marketing of pesticides until a positive finding of safety has been made.

In addition, the Department of Agriculture, working with the Departments of Health, Education, and Welfare and of the Interior, is reviewing and revising procedures to make certain that the benefits and hazards of pesticides to human health, domestic animals, and wildlife are considered fully before their registration and sale are approved.

Finally, the Federal Government's own use and application of pesticides are being reviewed to assure that all safeguards are applied.

Foods, Drugs, and Cosmetics

The 1962 amendments to the Federal Food, Drug and Cosmetic Act will enhance the safety, the effectiveness, the reliability of drugs and cosmetics.

To give this Act the vigorous enforcement it contemplates, I am requesting increased appropriations to the Food and Drug Administration, largely for scientific and regulatory personnel.

In addition, I renew the recommendations contained in my Consumer Message for new legislation to extend and clarify the Food, Drug and Cosmetic laws.

VI. RESEARCH AND SPECIAL HEALTH NEEDS

Over the past decade, our Nation has developed an unparalleled program of medical research.

This investment has already paid rich dividends, and more dividends are within reach.

The budget that I have proposed for fiscal 1965 assures the rate of growth needed to meet current opportunities and to provide a sound base for future progress.

In addition, the Office of Science and Technology has assembled a group of eminent citizens to study thoroughly the medical research and training programs of the National Institutes of Health.

This study should point to new ways to improve our medical research.

Commission on Heart Disease, Cancer, and Strokes

Cancer, heart disease, and strokes stubbornly remain the leading causes of death in the United States. They now afflict 15 million Americans--two-thirds of all Americans now living will ultimately suffer or die from one of them.

These diseases are not confined to older people.

--Approximately half of the cases of cancer are found among persons under 65.
--Cancer causes more deaths among children under age 15 than any other disease.
--More than half the persons suffering from heart disease are in their most productive years.
--Fully a third of all persons with recent strokes or with paralysis due to strokes are under 65.

The Public Health Service is now spending well over a quarter of a billion dollars annually finding ways to combat these diseases. Other organizations, both public and private, also are investing considerable amounts in these efforts.

The flow of new discoveries, new drugs and new techniques is impressive and hopeful.

Much remains to be learned. But the American people are not receiving the full benefits of what medical research has already accomplished. In part, this is because of shortages of professional health workers and medical facilities. It is also partly due to the public's lack of awareness of recent developments and techniques of prevention and treatment.

I am establishing a Commission on Heart Disease, Cancer, and Strokes to recommend steps to reduce the incidence of these diseases through new knowledge and more complete utilization of the medical knowledge we already have.

The Commission will be made up of persons prominent in medicine and public affairs. I expect it to complete its study by the end of this year and submit recommendations for action.

Narcotics and Drug Abuse

Abuse of drugs and traffic in narcotics are a tragic menace to public health.

To deal promptly and intelligently with this situation we must take effective measures of education, regulation, law enforcement, rehabilitation.

We must strengthen the cooperative efforts of Federal, State and local authorities and public services.

The recent report of the Presidential Advisory Commission on Narcotics and Drug Abuse has rendered signal contributions:

--It places the problem in its proper perspective.
--It proposes policies and actions which deserve full consideration.

The appropriate Federal departments and agencies will review this report, and I shall at a later time send my recommendations to the Congress.

Vocational Rehabilitation

Disability--always a cruel burden--has partly succumbed to medical progress. Our Federal-State program of vocational rehabilitation has been demonstrating this fact for more than 40 years. Rehabilitation can help restore productivity and independence to millions of Americans who have been victims of serious illness and injury. Over 110,000 disabled men and women were returned to activity and jobs last year alone.

If more fully developed and supported by the States and the Federal Government, this program can be a powerful tool in combating poverty and unemployment among the millions of our citizens who face vocational handicaps which they cannot surmount without specialized help.

I have already recommended appropriation of increased Federal funds for vocational rehabilitation.

I now recommend enactment of legislation to facilitate the restoration of greater numbers of our mentally retarded and severely disabled to gainful employment, by permitting them up to eighteen months of rehabilitative services prior to the determination of their vocational feasibility.

I also recommend enactment of a new program for the construction and initial staffing of workshops and rehabilitation facilities, program expansion grants, and increased State fiscal and administrative flexibility.

International Health

Scientists from many countries have contributed to the enrichment of our national medical research effort. We in turn support medical research in other nations.

International collaboration in medical research, including support of research through the World Health Organization, is an efficient means of expanding knowledge and a powerful means of strengthening contacts among nations. It links not only scientists but nations and peoples in efforts to achieve a common aspiration of mankind--the reduction of suffering and the lengthening the prime of life.

The United States participates in an ambitious international effort to eradicate malaria--a disease which strikes untold millions throughout the world.

Both of my predecessors committed the United States to this campaign, now going forward under the leadership of the World Health Organization. The Congress has endorsed this objective and has supported it financially.

We will continue to encourage WHO in its work to eradicate malaria throughout the world.

We will continue to commit substantial resources to aid friendly nations through bilateral programs of malaria eradication.

The United States will also initiate in 1964 a program to eradicate the mosquito carrying yellow fever. My 1965 budget provides expanded funds for the second year of this program.

CONCLUSION

The measures recommended in this Message comprise a vigorous and many-sided attack on our most serious health problems.

These problems will not be fully solved in 1964 or for a long time to come.

They will not be solved by the Federal Government alone, nor even by government at all levels.

They are deeply rooted in American life.

They must be solved by society as a whole.

I ask the help of all Americans in this vital work.

Lyndon B. Johnson

Mr. Secretary Celebrezze and other Government officials, ladies and gentlemen:

Mr. Secretary, I want to thank you for giving me this opportunity to meet with this distinguished and constructive group who have lent their talents to helping us contribute a solution to bring happiness and improvement in health and comfort to some of the finest citizens of our land.

I am somewhat envious of the Secretary of Health, Education, and Welfare, really for two reasons. I never quite understand it but he has as his responsibility one of the most satisfying assignments that any man in the world today could have, and that is the improvement of mind and body and the leadership for programs that cover a wide variety of age groups, but which mean much to the happiness of most of the individuals in this country.

He has successfully presented to the Congress the boldest education program that any committee in the Congress has ever given serious consideration to. He has presented it with confidence and with judgment and with competence to the point where it is concluding its hearings already in the first month in both the House and the Senate.

He and some of his rather outstanding associates, Miss Winston, Mr. Cohen, and others, have presented to the Congress a medical care program the like of which our country has never seen before. He and some of his associates have presented a new improvement in our health research and our health facilities that will completely revolutionize our living. And he has done all this in his own quiet and unassuming effective way with a bunch of little feists barking at his heels but never with a moment of irritation--and with rather substantial results.

So I would like to have your job because you must go home satisfied at night that you have done a lot for humanity that day. I'd like to have your record of being able to work with the Congress as you have. Now I realize there are some tough days ahead and I don't want your hat to get too big for you because we have our problems in all the committees.

But I think it is phenomenal that during the month of January you should have made the advances on medical care, on education, on health facilities, on improvement of your personnel as you have done and I am glad to recognize it here this morning. I want to congratulate the members of this Council on Aging and I want to commend them on the high caliber of this fine report.

I have observed that it is organized and presented in such a way that I would hope that most Americans would have a chance to view it. I think our Government has done much in recent years to meet the problems of the aged.

When I came to Washington we were doing nothing. Social security was not even talked about. Old age assistance was not prevalent and it took the combined efforts of President Roosevelt and Huey Long, and a good many others to dramatize the situation where we could really have the Government do anything for the aged. Up to that time most of our elections had been run on the basis whether you were wet or dry, prohibitionist or anti-prohibitionist, Klan or anti-Klan, or whether you were for the local bridge or against the local bridge. I went through all those as a boy. I never heard of social security until I was 21 years old. All I heard was whether you were wet or dry, whether for the courthouse group or against them.

I am glad that we have reached a point now where we can discuss issues and discuss problems and try to not only discuss them but do something about them.

We have before the Congress some 17 messages and we are going to have some more and they will represent the best thinking in this Government and we hope they will command the best action in the other branch.

We must not assume that we have arrived at a resting point. Medical science and our rising health standards, as we all know, have greatly lengthened the span of life that we'll all live. And now our big assignment is to improve the quality of that life while we do live.

We have a great deal to learn and we have a great deal more to do. There are three items on our agenda this morning.

First, I am directing the Council on Aging to continue its study of the implications of aging for our Nation's economic and social policy. Specifically we want to know more about retraining and developing new skills for older workers. We want to know more about providing retirement income through private and public pension programs. We want to know more about the cost of living in comfort and dignity during old age. We want to know more about the use of leisure time before and after retirement. We want to know more about the role of education in later years. It is not just confined to those under 21.

I hope this council of constructive leaders will continue to spend some of their time studying and researching and thinking about these problems.

Second, I want to call on all Americans to get behind and help us and support prompt enactment of a comprehensive program of hospital care for the aged through social security. We are in the sight of the promised land. We just have two more big mountains to go over. I hope we don't get hung up on them like Bill Douglas did out in New Mexico.

We think people of all ages should be prepared to meet the high cost of illness in their old age and we all know that they are not. There is not a man or woman in this room that doesn't have an uncle or aunt, cousin, or mama or papa that needs this protection. There is no reason why we should continue year after year to talk about it. There is time to do something about it.

President Kennedy and I went into most of the 50 States in 1960 talking about it. I listened to the recordings of my appearances throughout this Nation in 1960 and the deafening applause, if there ever was any deafening applause to anything I said, always came when I talked about a program to provide medical care under social security for the aged. So make no mistake about it. The people are ahead of us in this field. They want this program. They will support this program. They are going to have this program. The question now is just its timing.

Third, I am going to designate the month of May 1965 as Senior Citizens Month. It is a time dedicated to community action on behalf of older Americans. There are now 18 million men and women that are 65 and over in the United States. Every 20 seconds another American joins their ranks. Their hopes and their problems are shared by us all. It is up to us to help them solve them. What we do for them today will enrich our own lives tomorrow and I think will enrich the lives of our children in the decades to come.

I know of nothing more necessary or desirable. I know nothing more rewarding or satisfying than to be able to participate in the transformation of the dreams that we have had for our fathers and our mothers and our aging into realities. And I think before the leaves turn brown in the fall and before we go back to counsel and consult and exchange views with our constituencies, I hope we can have a book like this filled with achievements and accomplishments. And we can have, as we say in our country, the coonskins on the wall instead of just a lot of conversation about them. And if we do, no group will be more responsible than those of you that are assembled here this morning.

Now finally, I think I have outlined some of my hopes for tomorrow and this land must never be content, this land must never reach the point where we have arrived. This land must always be a land with vision and with hope, and with struggle, and be willing to work and move and fight to improve and to better and to, we hope, ultimately achieve excellence. And when we do, we will find that progress will have moved on and there is still a part of the road to go.

So thank you for coming here. You will have not only the blessings of this administration but you will have the very active understanding and cooperation of this virile young Vice President, and he will be here on the job working with you every minute of the day--north, south, east, and west. I see where he has been down in Georgia this weekend facing the elements and getting heated up for the days ahead. He even burned his overcoat, I think, and if he is not out of the country attending some funeral he will be here working for you.

4. STATEMENT OF THE PRESIDENT – March 23, 1965

The Medical Care and Social Security Bill voted out today by the House Committee on Ways and Means is a tremendous step forward for all of our senior citizens. It incorporates all of the major provisions of the Administration's hospital insurance bill financed through social security which was introduced by Congressman Cecil King and Senator Clinton Anderson.

The Committee's action is an historic one -- the first time that a House Committee has acted favorably on a medical insurance bill for all of our older citizens. It is an action which all Americans can and should welcome.

Great credit goes to the hard-working members of the Ways and Means Committee and especially to the distinguished Chairman, Wilbur D. Mills., for the many weeks of work to make medical care protection for the older people of our nation a practical reality. Chairman Mills deserves special credit for his statesmanlike leadership in working out on a sound and practical basis a solution to one of the most important problems which has been pending before the Congress for nearly 15 years.

It is my hope that many Republicans will join with the Democrats in voting for this very fine bill. It is a bill which is financially sound and which will benefit the entire nation.

Mr. and Mrs. Kappel, Members of the Senate and the House, ladies and gentlemen:

It was 30 years ago when President Franklin Delano Roosevelt signed the Social Security Act of 1935 and made it the law of the land.

At that time he said, and I want to quote his words, "we have tried to frame a law which will give some measure of protection to the average citizen and his family against the loss of a job and against poverty-ridden old age."

That very simple statement still expresses the purposes of this wonderful program, though the social security system has grown vastly larger since 1935.

Today, as we meet here, more than 20 million Americans find social security benefit checks in their mailboxes each month. This represents more than $1 billion a month, more than $16 billion a year, providing a much more secure life for our citizens and contributing a great deal of economic soundness to our economic system.

Millions of other Americans at their jobs each day are building up future benefits and looking forward to the day when they will qualify.

Franklin Roosevelt called the original Social Security Act, and I quote, "a cornerstone in a structure which is being built but is by no means complete." That is true today as it was 30 years ago when President Roosevelt stated it.

We are working steadily with the enlightened Members of the Senate and the Congress and the Cabinet here with me this morning, to build and to strengthen the social security system. Legislation has already passed the House of Representatives--it is now pending in the Senate--which will provide increased monthly benefits to retired persons, to widows, to orphans, and to the disabled.

This year, for the first time, health insurance protection for persons of 65 and over will become a part of America's social security system. I believe that most Americans are looking forward with me to the day when these great measures are signed into law.

In this country we all believe that every man wants dignity and a decent life, and not a dole. We believe that every man wants a fair chance, and not charity. We believe that older Americans have earned and deserve peace of mind, not pain and panic, when misfortune strikes.

The social security system, and the historic legislation that is now pending in the Senate, are our testaments to those beliefs.

So, Mr. Kappel, it gives me a great deal of pleasure to meet with you today and to present to you the 20-millionth recipient of social security benefits, your first social security check.

I necessarily cut some of the observations I intended to make this morning when I saw Senator Gore, and the distinguished Senator from Indiana, Mr. Hartke, and Wilbur Cohen, and the Secretary, and some of the others here, because I do not want to delay them a moment. And I want them to return to the Capitol now and go back to their labors and continue to build this system and pass medical care.

PRESIDENT TRUMAN. Thank you very much. I am glad you like the President. I like him too. He is one of the finest men I ever ran across.

Mr. President, Mrs. Johnson, distinguished guests:

You have done me a great honor in coming here today, and you have made me a very, very happy man.

This is an important hour for the Nation, for those of our citizens who have completed their tour of duty and have moved to the sidelines. These are the days that we are trying to celebrate for them. These people are our prideful responsibility and they are entitled, among other benefits, to the best medical protection available.

Not one of these, our citizens, should ever be abandoned to the indignity of charity. Charity is indignity when you have to have it. But we don't want these people to have anything to do with charity and we don't want them to have any idea of hopeless despair.

Mr. President, I am glad to have lived this long and to witness today the signing of the Medicare bill which puts this Nation right where it needs to be, to be right. Your inspired leadership and a responsive forward-looking Congress have made it historically possible for this day to come about.

Thank all of you most highly for coming here. It is an honor I haven't had for, well, quite awhile, I'll say that to you, but here it is:

Ladies and gentlemen, the President of the United States.

THE PRESIDENT. President and Mrs. Truman, Secretary Celebrezze, Senator Mansfield, Senator Symington, Senator Long, Governor Hearnes, Senator Anderson and Congressman King of the Anderson-King team, Congressman Mills and Senator Long of the Mills-Long team, our beloved Vice President who worked in the vineyard many years to see this day come to pass, and all of my dear friends in the Congress--both Democrats and Republicans:

The people of the United States love and voted for Harry Truman, not because he gave them hell--but because he gave them hope.

I believe today that all America shares my joy that he is present now when the hope that he offered becomes a reality for millions of our fellow citizens.

I am so proud that this has come to pass in the Johnson Administration. But it was really Harry Truman of Missouri who planted the seeds of compassion and duty which have today flowered into care for the sick, and serenity for the fearful.

Many men can make many proposals. Many men can draft many laws. But few have the piercing and humane eye which can see beyond the words to the people that they touch. Few can see past the speeches and the political battles to the doctor over there that is tending the infirm, and to the hospital that is receiving those in anguish, or feel in their heart painful wrath it the injustice which denies the miracle of healing to the old and to the poor. And fewer still have the courage to stake reputation, and position, and the effort of a lifetime upon such a cause when there are so few that share it.

But it is just such men who illuminate the life and the history of a nation. And so, President Harry Truman, it is in tribute not to you, but to the America that you represent, that we have come here to pay our love and our respects to you today. For a country can be known by the quality of the men it honors. By praising you, and by carrying forward your dreams, we really reaffirm the greatness of America.

It was a generation ago that Harry Truman said, and I quote him: "Millions of our citizens do not now have a full measure of opportunity to achieve and to enjoy good health. Millions do not now have protection or security against the economic effects of sickness. And the time has now arrived for action to help them attain that opportunity and to help them get that protection."

Well, today, Mr. President, and my fellow Americans, we are taking such action--20 years later. And we are doing that under the great leadership of men like John McCormack, our Speaker; Carl Albert, our majority leader; our very able and beloved majority leader of the Senate, Mike Mansfield; and distinguished Members of the Ways and Means and Finance Committees of the House and Senate--of both parties, Democratic and Republican.

Because the need for this action is plain; and it is so clear indeed that we marvel not simply at the passage of this bill, but what we marvel at is that it took so many years to pass it. And I am so glad that Aime Forand is here to see it finally passed and signed--one of the first authors.

There are more than 18 million Americans over the age of 65. Most of them have low incomes. Most of them are threatened by illness and medical expenses that they cannot afford.

And through this new law, Mr. President, every citizen will be able, in his productive years when he is earning, to insure himself against the ravages of illness in his old age.

This insurance will help pay for care in hospitals, in skilled nursing homes, or in the home. And under a separate plan it will help meet the fees of the doctors.

Now here is how the plan will affect you.

During your working years, the people of America--you--will contribute through the social security program a small amount each payday for hospital insurance protection. For example, the average worker in 1966 will contribute about $1.50 per month. The employer will contribute a similar amount. And this will provide the funds to pay up to 90 days of hospital care for each illness, plus diagnostic care, and up to 100 home health visits after you are 65. And beginning in 1967, you will also be covered for up to 100 days of care in a skilled nursing home after a period of hospital care.

And under a separate plan, when you are 65--that the Congress originated itself, in its own good judgment--you may be covered for medical and surgical fees whether you are in or out of the hospital. You will pay $3 per month after you are 65 and your Government will contribute an equal amount.

The benefits under the law are as varied and broad as the marvelous modern medicine itself. If it has a few defects--such as the method of payment of certain specialists--then I am confident those can be quickly remedied and I hope they will be.

No longer will older Americans be denied the healing miracle of modern medicine. No longer will illness crush and destroy the savings that they have so carefully, put away over a lifetime so that they might enjoy dignity in their later years. No longer will young families see their own incomes, and their own hopes, eaten away simply because they are carrying out their deep moral obligations to their parents, and to their uncles, and their aunts.

And no longer will this Nation refuse the hand of justice to those who have given a lifetime of service and wisdom and labor to the progress of this progressive country.

And this bill, Mr. President, is even broader than that. It will increase social security benefits for all of our older Americans. It will improve wide range of health and medical services for Americans of all ages.

In 1935 when the man that both of us loved so much, Franklin Delano Roosevelt, signed the Social Security Act, he said it was, and I quote him, "a cornerstone in a structure which is being built but it is by no means complete."

Well, perhaps no single act in the entire administration of the beloved Franklin D. Roosevelt really did more to win him the illustrious place in history that he has as did the laying of that cornerstone. And I am so happy that his oldest son Jimmy could be here to share with us the joy that is ours today. And those who share this day will also be remembered for making the most important addition to that structure, and you are making it in this bill, the most important addition that has been made in three decades.

History shapes men, but it is a necessary faith of leadership that men can help shape history. There are many who led us to this historic day. Not out of courtesy or deference, but from the gratitude and remembrance which is our country's debt, if I may be pardoned for taking a moment, I want to call a part of the honor roll: it is the able leadership in both Houses of the Congress.

Congressman Celler, Chairman of the Judiciary Committee, introduced the hospital insurance in 1952. Aime Forand from Rhode Island, then Congressman, introduced it in the House. Senator Clinton Anderson from New Mexico fought for Medicare through the years in the Senate. Congressman Cecil King of California carried on the battle in the House. The legislative genius of the Chairman of the Ways and Means Committee, Congressman Wilbur Mills, and the effective and able work of Senator Russell Long, together transformed this desire into victory.

And those devoted public servants, former Secretary, Senator Ribicoff; present Secretary, Tony Celebrezze; Under Secretary Wilbur Cohen; the Democratic whip of the House, Hale Boggs on the Ways and Means Committee; and really the House's best legislator, Larry O'Brien, gave not just endless days and months and, yes, years of patience--but they gave their hearts--to passing this bill.

Let us also remember those who sadly cannot share this time for triumph. For it is their triumph too. It is the victory of great Members of Congress that are not with us, like John Dingell, Sr., and Robert Wagner, late a Member of the Senate, and James Murray of Montana.

And there is also John Fitzgerald Kennedy, who fought in the Senate and took his case to the people, and never yielded in pursuit, but was not spared to see the final concourse of the forces that he had helped to loose.

But it all started really with the man from Independence. And so, as it is fitting that we should, we have come back here to his home to complete what he began.

President Harry Truman, as any President must, made many decisions of great moment; although he always made them frankly and with a courage and a clarity that few men have ever shared. The immense and the intricate questions of freedom and survival were caught up many times in the web of Harry Truman's judgment. And this is in the tradition of leadership.

But there is another tradition that we share today. It calls upon us never to be indifferent toward despair. It commands us never to turn away from helplessness. It directs us never to ignore or to spurn those who suffer untended in a land that is bursting with abundance.

I said to Senator Smathers, the whip of the Democrats in the Senate, who worked with us in the Finance Committee on this legislation--I said, the highest traditions of the medical profession are really directed to the ends that we are trying to serve. And it was only yesterday, at the request of some of my friends, I met with the leaders of the American Medical Association to seek their assistance in advancing the cause of one of the greatest professions of all--the medical profession--in helping us to maintain and to improve the health of all Americans.

And this is not just our tradition--or the tradition of the Democratic Party--or even the tradition of the Nation. It is as old as the day it was first commanded: "Thou shalt open thine hand wide unto thy brother, to thy poor, to thy needy, in thy land."

And just think, Mr. President, because of this document--and the long years of struggle which so many have put into creating it--in this town, and a thousand other towns like it, there are men and women in pain who will now find ease. There are those, alone in suffering,, who will now hear the sound of some approaching footsteps coming to help. There are those fearing the terrible darkness of despairing poverty--despite their long years of labor and expectation--who will now look up to see the light of hope and realization.

There just can be no satisfaction, nor any act of leadership, that gives greater satisfaction than this.

And perhaps you alone, President Truman, perhaps you alone can fully know just how grateful I am for this day.

THIRTY YEARS ago yesterday--August 14, 1935--President Franklin D. Roosevelt signed into law the Social Security Act--an act which was to bring a better life to many millions of Americans then living and to countless generations yet unborn.

For millions of Americans the enactment of this legislation meant the beginning of a new era of hope and confidence, and the end of an era of bleak and bitter despair.

We pause now to remember that moment of great social renewal and to honor the memory of the man whose moral and political leadership brought this act into being, and who committed the Nation to the proposition that the man or woman who had labored over a lifetime was entitled to the grace and dignity of self-support in old age.

This anniversary is one of deep significance in the history of this country. For the act that was created on that August day, 30 years ago, became the foundation of a great new social structure built by all the people of this country for the protection of all the people.

--Here was the beginning of the world's largest social insurance program which today pays out benefits to more than 20 million people--the aged, the disabled, the widowed, and orphaned.

--Here were the social insurance programs which now provide a base on which our people can build, through their initiative, thrift, and hard work, the elements of a good life.

--Here was the start of our nationwide unemployment insurance program--a partnership of Federal and State Governments to protect workers and their families during periods of temporary joblessness.

--Here were the first threads of today's broad network of State and local public welfare agencies which, with the help of Federal funds, serve the blind, the destitute, the aged, and especially the needy children of this land.

The 1935 law laid the foundation for all of these measures which are so vital to the strength of American society.

We are still building, still improving that great social structure that was started three decades ago.

Two weeks ago, in Independence, Mo., in the presence of President Harry Truman, another social pioneer, I signed the amendments that this Congress--the great 89th Congress--has fashioned for this law to help shield our elderly people from the economic burdens of illness and to update our social security programs in many other ways.

But we know, as President Roosevelt knew and said 30 years ago, that this structure is not yet complete. It will continue to grow as our needs grow--a living monument to the American ideal of health, prosperity, and happiness for all.

Some of these needs are clear to us today, and have been translated into national goals. Among these are:

--first, the assurance of a level of income for every citizen of this Nation who is too young or too old to work, or has become physically or mentally disabled, or who is unable to find work that is sufficient to assure health and decency.

--second, the rehabilitation for gainful employment of every disabled person for whom such rehabilitation is possible.

--third, opportunity for the pursuit of meaningful civic, cultural, and recreational activities in the retirement years.

These are immediate national goals for improved social well-being. We are working to fulfill them today. At the same time we know there will be other needs tomorrow.

This great, living law allows us to respond, as a Nation, to meet those needs. It is the instrument of a democratic society, engaged in a great and historic effort to secure the well-being and happiness of all of its people.

[ Released September 6, 1965. Dated September 3, 1965 ]

Dear Miss Fuller:

My best wishes to you on your 91st birthday.

Since you became the first Social Security beneficiary in January, 1940, the size of the program--and of the more than 300 monthly checks you have received--has grown steadily. That growth means increased well-being for older people, widows and orphans everywhere in the Nation.

On July 30, I had the pleasure of signing an act which increased monthly benefits by seven per cent. As a major new advance, it added health insurance protection for the aging to the social security law.

This increase is retroactive to January--and so this month you are receiving an extra social security check for the amount of the increase due you for the months of January through August.

I am happy that you can receive this "bonus" check on your birthday; I hope that you receive it--and many others--in good health.

With kindest regards,

Sincerely,

Lyndon B. Johnson

9. Statement by the President Upon Signing the Social Security Amendments and Upon Appointing a Commission To Study the Nation's Welfare Programs -- January 2, 1968

SOCIAL SECURITY AMENDMENTS

This coming year will mark one-third of a century since social security became the law of the land.

Because of social security, tens of millions of Americans have been able to stand straighter and taller--unafraid of their future.

Social security has become so important to our lives, it is hard to remember that when it was first proposed it was bitterly attacked--much as Medicare was attacked and condemned before it came into being 2 years ago.

Today, for the second time in 30 months, I am signing into law a measure that will further strengthen and broaden the social security system. Measured in dollars of insurance benefits, the bill enacted into law today is the greatest stride forward since social security was launched in 1935.

In March, 24 million Americans will receive increased benefits of at least 13 percent. In the years to come, as the 75 million American earners now covered by social security become eligible, they will gain even greater benefits.

--For a retired couple, maximum benefits will rise from $207 to S234 and ultimately to $323 per month.

--Minimum benefits for an individual will be increased from $44 to $55 a month.

--Outside earnings can total $140 a month with no reduction in benefits.

--65,000 disabled widows and 175,000 children will receive benefits for the first time.

--Medicare benefits are expanded to include additional days of hospitalization.

Combined, the Social Security Amendments of 1965 and 1967 bring an average dollar increase of 23 percent. Medicare protection amounts on the average to an additional 12 percent. This makes total increases of 35 percent in the past 30 months.

When the benefit checks go out next March, 1 million more people will be lifted above the poverty line. This means that 9 million people will have risen above the poverty line since the beginning of 1964.

Social security benefits are not limited to the poor. They go to widows, orphans, and the disabled who without them would be reduced to poverty. They relieve an awful burden from the young who would otherwise have to divert income from the education of their children to take care of their parents.

Franklin Roosevelt's vision of social insurance has stood the test of the changing times. I wish I could say the same for our Nation's welfare system.

The welfare system today pleases no one. It is criticized by liberals and conservatives, by the poor and the wealthy, by social workers and politicians, by whites and by Negroes in every area of the Nation.

My recommendations to the Congress this year sought to make basic changes in the system.

Some of these recommendations were adopted. They include a work incentive program, incentives for earning, day care for children, child and maternal health services, and family planning services. I believe these changes will have a good effect.

Others of my recommendations were not adopted by the Congress. In their place, the Congress substituted certain severe restrictions.

I am directing Secretary Gardner to work with State governments so that compassionate safeguards are established to protect deserving mothers and needy children.

The welfare system in America is outmoded and in need of a major change.

COMMISSION ON INCOME MAINTENANCE PROGRAMS

I am announcing today the appointment of a Commission on Income Maintenance Programs to look into all aspects of existing welfare and related programs and to make just and equitable recommendations for constructive improvements, wherever needed and indicated. We must examine any and every plan, however unconventional, which could promise a constructive advance in meeting the income needs of all the American people.

That Commission of distinguished Americans will he chaired by Ben W. Heineman, chairman of the board, Chicago and Northwestern Railroads. Its membership will include Messrs. Thomas J. Watson, Jr., chairman of the board, IBM Corp.; Donald C. Burnham, president, Westinghouse Electric Corp; James W. Aston, president, Republic National Bank, Dallas, Texas; Asa T. Spaulding, recently retired president, North Carolina Mutual Life Co., Durham, N.C.; Henry S. Rowen, president, Rand Corp., Santa Monica, Calif.; George E. Reedy, Jr., president, Struthers Research and Development Corp., Washington, D.C.; Anna Rosenberg Hoffman, public and industrial relations consultant, New York City; Julian Samora, professor of sociology, University of Notre Dame; Robert M. Solow, professor of economics, MIT; Edmund G. "Pat" Brown, partner, law firm Bell, Hunt, Hart and Brown; and David Sullivan, general president, Building Service Employees International Union, New York.

Over the last third of a century in America we have proved that people who earn their living can make their lives better and more secure if they divert part of their incomes to protect themselves from the twists of fortune that face all men. Our challenge for the coming years is to see if we can extend that same human insurance and human dignity to persons who are not able to buy their own protection. Our challenge is to save children.

Lyndon B. Johnson