Dr. STEBBINS. I cannot answer that question. I do not know the official position of the Department on that.

Mr. WILLIAMS. Is it your feeling that the public health school legislation should be considered separate and apart from aid to other medical schools, or should it be considered with other medical schools? In other words, do you place your group in the same category as regular medical schools?

Dr. STEBBINS. We feel that we are somewhat unique in that 95 percent of our graduates go into public service.

Mr. WILLIAMS. You are training your people specifically and exclusively for public service, are you not?

Dr. STEBBINS. Yes; that is right.

Mr. WILLIAMs. And to that extent, at least, it is in a separate category from regular medical schools or medical colleges.

Dr. STEBBINS. Yes; that is right.

Mr. WILLIAMS. Thank you, sir.

Are there any questions?

Dr. Neal.

Mr. NEAL. What percentage of the trainees are postgraduate?

Dr. STEBBINS. In the majority of the schools, they are all postgraduate. In, I think, three of the State schools, there are relatively high numbers of undergraduate students.

Mr. NEAL. In other words, your schools of public health are only giving finishing touches to that particular preliminary training that has been carried on by the medical schools and various other institutions.

Dr. STEBBINS. This is a definitely postgraduate training program for the specialist in public health.

Mr. NEAL. Thank you.

Dr. DARLEY. Are there any questions, Mr. Chairman.

Mr. WILLIAMS. Do you have anyone representing the Public Health Service on the panel?

Dr. DARLEY. We do for tomorrow, sir. There are representatives of the Public Health Service here. Dr. Stebbins could not be here tomorrow, which is the reason he is covering so much ground today.

Mr. WILLIAMS. In view of the fact that the Health, Education, and Welfare Department has given a clean bill of health to providing this aid to public health schools, I trust that they will be prepared tomorrow to explain why they would oppose the granting of the earmarking of $1 million to the public health schools in one bill and then support the granting of several million dollars for construction purposes in another bill, in the absence of a report by this study commission.

Dr. DARLEY. The Surgeon General will be here tomorrow.
Mr. WILLIAMS. I trust he will be able to explain this.

Mr. DINGELL. I would like to hear an explanation from the representative of the American Medical Association who is present, Mr. Chairman, as to why the AMA has changed its position on the bill you were just referring to.

Mr. WILLIAMS. If he wants to explain that. I am at the point in the last few weeks where I wonder whether the AMA knows what it is doing, whether it has any set principles or whether its principles are flexible.

Mr. DINGELL. I want to say that I rather agree with the Chair at this point.

Dr. HUSSEY. Mr. Chairman, the principles with respect to the legislation that we are discussing this morning have been in existence, as I pointed out, since 1951, and have not changed.

Mr. WILLIAMS. Doctor, I do not want to argue this point, but with me, Federal aid to education is the same whether it is Federal aid to an elementary school or whether it is Federal aid to Harvard University. Apparently, the American Medical Association feels that the principle of Federal aid is flexible enough to take in those things which will benefit the AMA and yet exclude those things which will not benefit the AMA directly.

As I say, I do not want to argue the point, but I fail to understand the position that the AMA has taken with respect to Federal aid to medical schools, when the AMA has been so sound, in my opinion, with respect to keeping the Federal Government out of the practice of medicine in the past.

Of course, if the AMA wants to go ahead and contribute to the trend toward socializing medicine, that is their business. I do not intend to.

Mr. DINGELL. Mr. Chairman, I would like respectfully to remind the Chair that there are those of us who do not agree with the term "socialized medicine," and who happen to feel that there are certain changes in the practice of medicine today which would be very beneficial to the health of our constituents.

I think I can speak for my own, because my constituents thoroughly approve of what the AMA happens to disapprove of in using the term "socialized medicine." I would so like to remind the gentleman here from the AMA of that, too.

Mr. WILLIAMS. I would like to state to my colleague from Michigan that he was not here when the premise for that question was laid, by an expert testifying before this comittee, the chairman of the panel presently before us, who admitted under questioning that this legislation adds or gives impetus to the trend toward the nationalization or socialization of medicine itself.

I was basing that question on the premise laid by Dr. Darley himself.

Mr. DINGELL. Of course, I agree with respect to the Chair, but I would like to state also that I do not happen to agree with the term "socialized medicine." I would question anyone's wisdom who used the term. I would further go so far as to state that I happen to think that there are some things which are good for the health of the people of this country which the AMA does not happen to agree with.

Just to cite an instance, I would like to point to the expansion provisions of a couple of these bills that happen to provide for a little bit of expansion in the number of doctors which are being produced in this country today.

Mr. WILLIAMS. Proceed, Doctor.

Dr. DARLEY. Shall we go to the dental group?

Mr. WILLIAMS. Yes.

Dr. DARLEY. Dr. Herz will take over the chairmanship of the panel for the presentation of the dental picture.

STATEMENT OF DR. FRANCIS HERZ, MEMBER, COUNCIL ON LEGISLATION, AMERICAN DENTAL ASSOCIATION

Dr. HERZ. Thank you, Mr. Chairman.

I am Dr. Francis Herz of San Francisco, Calif., where I am engaged in the general practice of dentistry. I am a member of the council on legislation of the American Dental Association.

I might add that the American Dental Association supports in principle the legislation that is before you.

I have with me two distinguished dental school deans: Dr. Clement Rault of the Georgetown University, and Dr. Harry Lyons of Richmond, Va.'s, Medical College of Virginia. Dean Rault was the former head of the Dental Department of the United States Navy, and he retired as a rear admiral. He will speak for the American Association of Dental Schools. Dean Lyons will speak for the American Dental Association, as the association's immediate past president.

Dean Rault.

Dr. RAULT. Thank you, Mr. Chairman.

STATEMENT OF DR. CLEMENT V. RAULT, ON BEHALF OF THE AMERICAN ASSOCIATION OF DENTAL SCHOOLS

Dr. RAULT. Mr. Chairman, gentlemen, the health of our citizens is perhaps the most important of all our national resources. Dentistry has significantly contributed to our Nation's health. Good physical and mental health is the foundation of our national security. Yet, neraly 95 percent of our people suffer from dental diseases. The dental schools of the United States are the only source for the education and training of the Nation's dentists. For private practice, they supply all of the dentists in the United States.

Dentists as instruments in national defense: As Dr. Lyons has already stated, in World War II we had over 22,000 dentists who served in the defense forces. That is about one-third of the profession. That they were well prepared as dentists to aid in the health services is a historical fact.

The need for dentists and physicians in the Armed Forces has been so great that the Physicians and Dentists Draft Act was enacted. This act expires July 1959, and I am informed that reenactment will be recommended by the Department of Defense to insure the Army, Navy, and Air Force the necessary number of physicians and dentists.

In a recent survey made in the survices of 183,000 Marine and Navy recruits, it was found that 90 percent of the recruits, averaging 1812 years of age, needed dentistry, and that between 5 and 10 percent had so many teeth missing that they had to have artificial restorations to supply teeth.

The dental schools are the principal source of improving the efficiency of practice.

We know that 1 ancillary personnel assisting a dentist will increase the volume of his treatment 37 percent; and 2, by 68 percent. The dental schools had attempted to train hygienists, assistants, and technicians, but the cost has been beyond the ability of the schools to

continue in many cases. They have contributed, however, to the training of these auxiliaries to a large extent.

In closing, I would like to make one statement that I think would be of interest to the committee, particularly.

There are 47 dental schools in the United States and Puerto Rico. Nineteen of these are State schools, including the one in Puerto Rico. Fifty-seven percent of the students in dentistry are in privately supported schools this year. Last year, 66 percent were in privately supported schools.

Thank you.

Mr. WILLIAMS. Thank you, Doctor.

Is it your position that the need for this legislation is based on the need for additional dentists?

Dr. RAULT. Yes, sir.

Mr. WILLIAMS. And if this legislation is passed or is enacted, you feel that the number of qualified dentists in the United States will be considerably increased?

Dr. RAULT. We believe so.

Mr. WILLIAMS. Dr. Hussey, do you agree with that with respect to doctors?

Dr. HUSSEY. Yes; I think there will be a measurable increase, and that this will come about because the increased facilities will permit enrollment of more students.

Mr. WILLIAMS. Is that the underlying purpose of your support of the legislation, to try to increase the number of qualified physicians? Dr. HUSSEY. No, sir. The underlying purpose is to provide facilities to do the task that currently is being accomplished in inadequate facilities.

Mr. DINGELL. Will the Chair recognize me for one question?
Mr. WILLIAMS. Surely.

Mr. DINGELL. Dr. Hussey, would you say you are against an increase in the number of physicians in this country?

Dr. HUSSEY. No, sir.

Mr. DINGELL. But you would not favor a bill, then, which would increase the number of physicians in the country. Would that be a fair statement?

Dr. HUSSEY. I have already answered that, in part, sir.

Mr. DINGELL. I would like to have you answer it for me.

Dr. HUSSEY. The thought that I expressed earlier with regard to incentive features in some of the legislation that is under consideration is this, that an incentive to increase enrollment is not advisable simply because this puts a strain upon the school to do it, when in point of fact it may be the mission of that school not to increase the number of enrollments.

Mr. DINGELL. Would you say it was a general statment, then, that we should figure that it is not the mission of the medical schools in this country to turn out more doctors for the expanding population?

Dr. HUSSEY. No, sir. I think the accomplishment of that mission should be left to the free choice of the schools, and I contend that to some extent, at least, that free choice is hampered when an incentive feature is introduced into the legislation.

This will come about, I am confident, as a dividend, with the schools acting freely.

Mr. DINGELL. Are you not satisfied, Doctor, in your own mind, that this country does need more physicians and surgeons, doctors, and dentists?

Dr. HUSSEY. Yes, sir.

Mr. DINGELL. And our population is going to expand substantially in the next few years.

Dr. HUSSEY. Yes, sir.

Mr. DINGELL. And with each additional expansion, we are going to need more doctors and surgeons, physicians and dentists. Is that not a fair statement?

Dr. HUSSEY. I cannot foresee eventualities too far into the future. Mr. DINGELL. If I were to say that the census says that by 1965 we are going to have about 200 million people in this country, would that indicate to you that we are going to have an increase of about 12 percent, and we are going to need that many more doctors? Would that not be a fair statement?

Dr. HUSSEY. No, sir, for this reason: that if you had based a judgment of the need for farmers on farming practices of 3 or 4 decades ago, you would have foretold that we would need a great many more farmers than in point of fact actually turn out to be needed, because of changes in practices of farming.

Mr. DINGELL. There is a whole lot of difference between farming practices and medicine; is that not true?

Dr. HUSSEY. Yes, indeed.

Mr. DINGELL. And to grow more, you have only to plant the rows closer together and plough up another 40 acres and put on a little more fertilizer, and you produce more. Is that not right?

Dr. HUSSEY. The point I was making is

Mr. DINGELL. Is that not a fair statement, Doctor?

Dr. HUSSEY. The techniques of doing the plowing and the techniques of providing the fertilizer have changed.

Mr. DINGELL. And you buy a tractor instead of plowing with one jackass. Is that not right?

Dr. HUSSEY. Yes.

Mr. DINGELL. So there is a big difference between farming and the practice of medicine.

Dr. HUSSEY. Yes.

Mr. DINGELL. Or would you care to tell me that they are the same? Dr. HUSSEY. No.

Mr. NEAL. Would the gentleman yield there for a moment?

Mr. DINGELL. Doctor, I would be delighted to, but I just want to pursue my question a little more, if I may.

Doctor, I want to get down to H. R. 7841. You say we ought not to have any incentive feature in the bill that the committee reports out.

Would I be fair in assuming that that would be because your organizaton does not want any increase in the number of doctors? Dr. HUSSEY. No, sir.

Mr. DINGELL. Do you think an increase in the number of doctors in this country would be desirable?

Dr. HUSSEY. An increase in the number of doctors is inevitably needed. The extent of that increase in terms of