HEALTH CARE FOR DEPENDENTS OF SERVICEMEN FRIDAY, MARCH 14, 1952 UNITED STATES SENATE, SUBCOMMITTEE ON HEALTH OF THE COMMITTEE The subcommittee met, pursuant to recess, at 10 a. m., in the old Supreme Court room, the Capitol, Hon. Herbert H. Lehman (chairman) presiding. Present: Senator Lehman. Present also: Kenneth Meiklejohn, staff director; Melvin W. Sneed, assistant staff director; Nora K. Piore, research assistant. Senator LEHMAN. The hearing will come to order. We will hear first from the representative of the Secretary of Defense. Mr. Jackson, I believe you will be the first witness. Good morning. Mr. JACKSON. Good morning, sir. Senator LEHMAN. Will you identify yourself for the record, please. STATEMENT OF STEPHEN JACKSON, OFFICE OF COUNSEL, OFFICE OF THE SECRETARY OF DEFENSE Mr. JACKSON. My name is Stephen Jackson, Office of Counsel, Office of the Secretary of Defense. I have been designated to represent the Department of Defense in this matter at this hearing. The Department of Defense is pleased to accept the invitation of this committee to give its view on S. 2337 and S. 1245. The Department of Defense has a keen interest in the subject matter of these bills. The morale of the members of the Armed Forces is a matter of paramount importance to the Department of Defense. The normal concern, for instance, of the husband and prospective father who learns that his wife is expecting a child, heightened by his enforced absence while serving his country in the Armed Forces, becomes an acute source of worriment and anxiety when he knows of no way to meet the cost of maternity care and the care of his infant child. The serious effect of this on the morale of the absent serviceman is patent. From the standpoint of the individual it is a source of mental suffering from which he should be relieved as far as it is humanly possible. From the standpoint of the military it should be avoided because it is definitely deleterious to his effectiveness as a member of the Armed Forces. During World War II, the implications of this situation, both from the standpoint of the prospective mother and the child as well as the impact on the man in service, were recognized. The emergency maternity infant care program was adopted to meet this need. In gen 215 eral, the program was desirable and satisfactory to the armed services. As a new program it had certain limitations and weaknesses which the Lehman bill has remedied. The Department of Defense is strongly in favor of the emphasis, which is manifest in this bill, on the full utilization of community facilities, and in the discretion of the individual in the selection of those facilities. While requiring that certain standards be met, once the State agency has qualified, there should be this guaranty of freedom from governmental interference and domination of the program. The requirement of advisory groups at the State and Federal level, the utilization of duly qualified agencies, private as well as public, the right of the individual to appeal an adverse decision, and the access of a final appeal to the courts, are desirable guaranties of local independence which prompt the Department of Defense to favor S. 2337 over S. 1245 insofar as the latter establishes a program similar to that in title I of the Lehman bill. The Department of Defense professes no competency in and refrains from commenting on detailed features of administrative methods such as fee formulae for physicians and hospitals, but it does unequivocally endorse the over-all pattern reflected in S. 2337, for the maximum of emphasis on community participation, individual discretion, and the minimum governmental interference consistent with the assurance of proper standards of care. In an endeavor to assist the committee in its decision as to the present need for a program for maternity and infant care, the Department of Defense submits the following information. The established strength of the Military Establishment over fiscal year 1953 is set at 3,600,000. Approximately 3,200,000 of the active armed strength will be enlisted personnel; an estimated 28 percent of these will be married. Of this 28 percent, 13 percent will be in the lower four grades, and 15 percent in the upper three grades of enlisted personnel. From the experience in the military departments approximately 75,000 maternity cases of wives of enlisted men can, as a practical matter, be cared for through present military personnel and facilities. This number would decrease if the need for facilities for men in the Armed Forces were to increase materially. The Federal Security Administration estimates that over a year's period, a total of 200,000 children will be born to wives of enlisted men. On this basis there would be 125,000 for whom military facilities will be unavailable. A recent sample survey of enlisted Army personnel indicates that approximately 20 percent of the married men reported that their wives were pregnant at the time of the survey. Less than half of these expected that their baby would be born in a military hospital. More than one-third stated they would have to ask parents, relatives, friends, the Red Cross, or the Army Emergency Relief for help in paying for maternity care, or apply for a commercial loan. The Red Cross limits assistance to emergency needs, and medical care in relation to pregnancy is not regarded as an emergency need except in special cases. The Red Cross reports that it currently can expect to receive about 110,000 requests per year for help from families of servicemen in relation to maternity care and that only 10,000 will receive financial assistance. Surveys by the Red Cross and other social agencies indicate that the allotments to servicemen's wives are inadequate to provide for the costs of maternity care, in addition to the regular costs of support and maintenance of the family. In fact, it is the opinion of the Department of Defense that in the event such a law is passed, it would be desirable that these benefits be extended for the wives and children of members of the armed services up through the grade of company officer. As to title II of S. 2337 the Department of Defense endorses its similar pattern as to Federal and local participation in the program, as that set forth in title I. Again as to the determination of the need for such a program the Department of Defense defers to this committee and to Congress. We have no figures to submit with respect to need for hospital care of dependents of members of the Armed Forces; the military departments, as you know, are presently providing such care through military facilities on a permissive basis to the extent facilities are available. It is realized that this does not reach all military dependents; some implementation at the community level may be required. This statement has been submitted to the Bureau of the Budget, and it interposes no objection to it. With your permission, Mr. Chairman, I would like to make an oral addenda to this statement. Senator LEHMAN. I would very much like to hear it. Mr. JACKSON. That is relative to one point that was developed subsequent to the time this statement was approved. I should like to add the following comment, which is not a part of the formal statement as presented. When that statement was written and approved by the Department, it was on the assumption that the payment of Federal funds would be made on the traditional grants-inaid formula of matching the payments by the State. When it was pointed out that it was not intended in this bill to provide for a matching basis with the State, and that it was contemplated that the Federal Government would pay all of the money, I was directed to advise the committee that such a proposal, if it were enacted, would be less preferable to the Department of Defense, since it is felt that there would be a greater assurance in the States and at the local level that the program, and particularly the care afforded, would be better administered and more carefully supervised if the State were actually paying out its money for part of the care. Senator LEHMAN. That addendum which you have just read would not affect your feeling that such a program is very desirable? Mr. JACKSON. It does not radically affect our position; no, sir. It says less preferable. Senator LEHMAN. I do not quite follow your reasoning on this latter point. I do not think it is very significant, but I am not clear why you feel that there would be greater interest on the part of the States and more effective administration if their participation was on a matching basis. Do you mean that there would be more scrutiny with regard to the need, or that the States would be more interested in seeing that everybody was cared for who needed to be cared for? Mr. JACKSON. As I interpret the reason behind this-this point was discussed by the Chairman of the Armed Forces Medical Policy Council just recently—it is a very simple theory. I do not know in practice how much effect it would have. But it is on the theory that if a person is paying something out of his own pocket, he will be more anxious to see that he is getting his money's worth. And the State is on the ground, so to speak, it is on the spot, and if they had a stake in it, if they had a part of the payment, they would presumably be more interested to see that the care and the service was what it was supposed to be. That is the theory behind this position. Senator LEHMAN. I wonder whether you realize that under the bill the State would have very broad autonomy to act in accordance with a plan devised by the State, subject, of course, to approval by the Federal agency. From the time the plan and the standards set forth in the plan are approved by the Federal Government, the State has full authority to act. So it would seem to me that there would be no difficulties interposed by the Federal Government under any circumstances, regardless of the manner of payments, in the implementation of the plan. Mr. JACKSON. That feature of the local autonomy as we pointed out in the statement is a feature which we very strongly endorse. It was only as to the motivation as to how far the State might or might not be inclined to go if they had some financial interest in the program itself. Senator LEHMAN. You understand, of course, that under the World War II the emergency maternity and child care program, the Federal Government paid the entire expense, save some minor part of the administrative expenses. Mr. JACKSON. Yes, sir. Senator LEHMAN. The same situation would prevail in that respect under the bills now before us. As I interpret your testimony here, you feel that in the interest of humane treatment and in the interest of morale, in which you are particularly interested, a maternity and infant care program during the present emergency would be desirable? Mr. JACKSON. Yes, sir, particularly with regard to title I. Senator LEHMAN. Yes, for the moment I am considering title I. Mr. JACKSON. Yes, indeed. Senator LEHMAN. Can you tell me, when a man enlists or is drafted, whether any representations are made to him, formally or informally, with regard to what he might expect regarding the care of his dependents? Mr. JACKSON. I cannot tell you how formal it may be, sir, but certainly it is the current understanding that there will be provided care in military facilities for dependents of members of the armed services. I do not know how definitive it is with respect to the point of its availability. I think it would be pretty hard to apprase that in various recruiting offices, and how strongly it may be emphasized or otherwise. Officially, of course, with respect to the armed services, we are not indicating a guaranty to be made on an over-all coverage. It is on a space-available basis. How far in some instances it may be overemphasized, I do not know. Senator LEHMAN. Again confining my remarks to title I, is it a fair statement to say that when a man is drafted or enlists, and is taken away from his home and occupation in which his compensation may in many cases be substantially greater than the pay he receives in the Army, he is led to believe, and has a right to believe, that the cost of maternity and infant care for his wife and child will be taken care of, and that they will be given as good treatment as possible? Mr. JACKSON. I certainly feel he has a right to believe that, sir. How far he is led to believe it just on an informal basis in going over some of these matters, I was advised that there are many instances where the serviceman has no concept of the fact that even on the space-available basis, he has some of these rights. Whether he has been told or forgotten about it is something else again. But I certainly agree that he has the right to, and the Government should have, an adequate program where he would have the guarantee of that. Senator LEHMAN. Let me ask you, what is the procedure with regard to the wives of officers? Are they given any assurance or have they the right to demand hospital or other care in the event of approaching maternity? Mr. JACKSON. Under the present basis? Senator LEHMAN. Yes. Mr. JACKSON. As I understand it, there is no differentiation between officers and enlisted men. Senator LEHMAN. Have you any information with regard to the way that works out in practice? Do the wives of officers as a practical matter, regardless of statute, receive preference in respect to hospitalization or maternity care? What I am trying to establish is whether, given two cases, one the wife of an officer and one the wife of an enlisted man, and there is one bed available, the officer's wife would be likely to get the preference. Do you have any information as to that? Mr. JACKSON. As far as I know there is no such preference afforded to officers' wives. There is a representative of the Surgeon General of the Army present here who will testify later who can advise more authoritatively on this question. (At this point Colonel St. John arose and indicated that there was no such preference.) Senator LEHMAN. We have been hearing about 75,000 maternity cases that may be taken care of in existing military facilities. Would you say that is a maximum figure? Mr. JACKSON. Probably not, sir. I went over that question with the statistician, and probed it a little further, and they were of the opinion that if 5,000, say, more had come, that they would not have been turned away. It represents, as I said, in that apparently as far as availability and usability, that represents the number from the practical standpoint of the people getting there, and so on. As to the over-all facilities, they advised me that does not necessarily represent the maximum, and if more had come, they would not have been turned away. Senator LEHMAN. Have you any figures at all as to the number that are now being cared for in military installations? Mr. JACKSON. We have these figures, sir. From July 1951 through December 1951, of the number of deliveries in military hospitals, the number of out-patient treatments given to patients in military hospitals in the United States, and the number occupying hospitals in the United States. I would be glad to submit these or read them. Senator LEHMAN. Would you read them? 98358-52———15 |