things, certain types of services, for example-obviously I am talking about legal services which will not be funded at the local level because local area agencies on aging or local politicians are afraid of possibly the result of funding a program at that local level which may well turn around and sue the county on behalf of senior citizens. So I would like to ask how that type of service will ever come about, will ever be responded to? The state of Vermont, when you ask people what are their priorities-or Rhode Island-what are their priorities, legal services will never come up because it is not the kind of thing that people recognize at the local level. Dr. BINSTOCK. Well, I appreciate what you are saying. It's almost a deja vu that brings us back to the days of OEO and legal services for the poor and representing the poor, and indeed Senator Eagleton's question went back to that notion of how do we get the proper representation. But here, again, I think, one, you are being pessimistic about how the question gets posed; and, two, about the role and this is where I think the people on Independence Avenue and in the regional offices-the role of the bureaucrats can be very positive. You see, if you pose the question about legal services in terms of do you think a problem, the No. 1 problem here, is seeing to it that everybody gets their entitlements under social security and under SSI and under Medicare-okay?-then you might get a positive answer. If you pose the question-do you think we ought to have legal services because our municipal government is very unresponsive to older persons, and our banks and all the other power brokers are terrible to older people-of course, you get your nega tive answer. I really think a lot of it lies with a consolidation period of leadership of this enormous network on aging that has been set up. Let me give one brief example. We had a regional office do a great job on a simple matter in Massachusetts. We had a former Secretary for Elderly Affairs wasn't using her Governor's advisory committee properly. The man in the regional office, who is reporting to AOA came in to the advisory committee and said: you people aren't being used right, and the secretary is not following the Federal regulations; you people should be reorganized; you should have a voice, you should meet more often, you should be structured in the following way. And it took somewhere between 8 and 10 monthsbut he brought it about. You wouldn't recognize that committee to day both in terms of who is represented, what its functions are. and so on. This is a good role for the bureaucracy, where its role can lie, and I think that's an important leadership phase we can move into now. Senator EAGLETON. Next the lady with the hat and then the lady without the hat. Ms. BRAVER. Ruth Braver, the Urban Elderly Coalition, an association of city offices on aging. I think even if you address 70 per cent of the funds in a local area to a one priority issue, I think based on our experience-and most of the people in this room would bear this out-that still would not, for instance, help fix up all the homes or provide all the homebound services. I would like to know what your thinking is about to whom you are going to address the service and what will the question of a means test be. Dr. BINSTOCK. Okay. I can't claim to have thought through all the answers to all these things in advance, okay? Ms. BRAVER. I know. Dr. BINSTOCK. I think I would not like to see a means test written into the Older Americans Act, as far as that goes. On the other hand, I don't feel that it is necessary for the staff to see to it that the Averell Harrimans are represented-that's all I am saying on that issue. I don't think we are going to solve every problem. I think there is a two-tiered job-and I believe the commissioner-designate has expressed this at some point, and I agree with him--there is a twotiered job to be done. One is to exercise moral leadership at the national level in pointing up the society's responsibilities to the elderlyand agism and a number of other issues of structure and image. Another job is to do well some concrete program that provides help to people, not to list in a Federal book the things that would be nice to do, but actually deliver some help to some people. And I think that's why Senator Eagleton likes the nutrition program, for example; he can go in there-and Senator Kennedy mentioned itand he can see, by God, those people are eating, and they are probably eating something they wouldn't be able to eat otherwise. And that is measurable. The only problem is the one I mentioned at the outset. If 250 million is meeting 1 percent of the job, is that 25 billion this year and how many billion next year for that job when we are paying out 100 billion in income transfers already before we even get into the nutrition program. Senator EAGLETON. Before getting to Senator Domenici-stay with us one minute, Doctor-the lady at the press table has raised her hand, and I would like to accommodate her. Would you give us your name and whom you represent, ma'am? Ms. SCHECHTER. I am Irma Schechter, editor of Supportive Services Newsletter. The proposal that you are making addresses a priority need of the community. What I wonder is, how are you going to address the priority needs of the individual who may not be in need of the particular service that you are offering? And also, how do you handle the situation where a community does not perceive yet what its need is and is in need of outreach programs, or is in need of some educational process? And I am a little shaky still on your representation of the homebound-in that category. Dr BINSTOCK. I'm a little shaky myself, but, as a brief answer, because I certainly don't want to keep a Senator waiting in the Senate-but I think the question of the individual's priority need goes back to this issue again of national platforms, national leadership, and so on. One of my greatest disappointments, for example, with a man I respected very much, Dr. Fleming, was that, for example, when the President waived his retirement, his forced retirement, and it was carried on CBS and NBC and ABC-he didn't get on there and say "and I think it should happen for everyone." Television is terribly powerful. One of the things I think is very important right now is this program "Over Easy," which can reach more and more people. It's pointing up those priorities, is telling people how to get Medicare, how they can get Medicaid, what it gives them, who to ask, and so on-what their benefits are, what they are entitled to, how to get legal services. I think it is through the mass media, through people who have the courage to speak out on national platforms, that we are going to start addressing those individual priority needs of people. It's not a full answer, but I hope it will do for the moment. Senator EAGLETON. Thank you, Doctor, very much. I would like to think we could call upon you, if we decide to go forward with this double-bill system-maybe it's a ridiculous thing to do-but if we decide to go forward, we would like to draw upon you for some advice. Dr. BINSTOCK. Certainly, any way I can. Senator EAGLETON. Maybe we will make it a triple bill-I'll have a traditional bill, my bill, and the administration's bill. I daresay the administration-Mr. Benedict-I think his bill will be somewhere in the middle between perhaps what I have sort of been hinting at and what we'll call the traditional approach. Thank you, Doctor, very much. Dr. BINSTOCK. Thank you. [The prepared statement of Dr. Binstock follows:] Statement by Binstock Mr. Chairman and Members of the Committee: -1 It is truly a privilege to be asked to present my views to you this morning. I do not say this in a spirit of perfunctory protocol, but rather because this Subcommittee has earned my respect. You are not simply interested in pushing along a conventional bill with a small new piece of window dressing. I am confident that your aim is to enact legislation that will have a substantial impact in helping older persons and their families who are concerned for them. With that confidence, my central message to you is that a drastic new approach to the Older Americans Act is essential. The current legislation and the pattern in which it has been implemented has many positive features. But the successes of this approach have brought it to a point of diminishing returns in which it is close to becoming a cruel hoax. If you reauthorize existing titles with more funds, and tack on one or two new program titles to the present roster, you will make happy the burgeoning industries in the field of aging. But you will do little to solve or to alleviate substantially many problems of disadvantaged older Americans. In order to have an impact on the lives of older persons, strong priorities will have to be set. - In short, a bold strategic departure is needed to move the Older Americans Act from an initial phase 12 years of agenda-setting and bureaucratic development to a second phase of problem-solving. Before making a suggestion for such a strategic departure, let me briefly review some of the major strengths and weaknesses of the Act during what I |