DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION AND RELATED AGENCIES APPROPRIATIONS FOR FISCAL YEAR 1991

FRIDAY, FEBRUARY 9, 1990

U.S. SENATE,

SUBCOMMITTEE OF THE COMMITTEE ON APPROPRIATIONS,

Washington, DC.

The subcommittee met at 10 a.m., in room SD-192, Dirksen Senate Office Building, Hon. Tom Harkin (chairman) presiding. Present: Senators Harkin, Bumpers, Reid, Adams, Specter, and Cochran.

DEPARTMENT OF HEALTH AND HUMAN SERVICES

OFFICE OF THE ASSISTANT SECRETARY FOR HEALTH

STATEMENT OF JAMES O. MASON, M.D., ASSISTANT SECRETARY FOR

HEALTH

ACCOMPANIED BY:

FREDERICK K. GOODWIN, M.D., ADMINISTRATOR, ALCOHOL, DRUG ABUSE, AND MENTAL HEALTH ADMINISTRATION

ROBERT HARMON, M.D., ADMINISTRATOR, HEALTH RESOURCES AND SERVICES ADMINISTRATION

WALTER DOWDLE, M.D., ACTING DIRECTOR, CENTERS FOR DISEASE CONTROL

J. JARRETT CLINTON, M.D., ACTING ADMINISTRATOR, AGENCY FOR HEALTH CARE POLICY AND RESEARCH

JAMES R. ALLEN, M.D., M.P.H., DIRECTOR, NATIONAL AIDS PROGRAM OFFICE

WILFORD J. FORBUSH, DEPUTY ASSISTANT SECRETARY FOR HEALTH OPERATIONS AND DIRECTOR, OFFICE OF MANAGEMENT

J. MICHAEL MCGINNIS, M.D., DEPUTY ASSISTANT SECRETARY FOR HEALTH (DISEASE PREVENTION AND HEALTH PROMOTION)

W. HARELL LITTLE, DIRECTOR, DIVISION OF PHS BUDGET

DENNIS P. WILLIAMS, DEPUTY ASSISTANT SECRETARY, BUDGET, DEPARTMENT OF HEALTH AND HUMAN SERVICES

BUDGET REQUEST

Senator HARKIN. Good morning. The Subcommittee on Labor, Health and Human Services, and Education, of the Appropriations Committee will come to order.

The hearing this morning will permit us to hear testimony first from Dr. James Mason concerning the fiscal year 1991 budget request for all the agencies included in the Public Health Service.

The fiscal year 1991 request for the several agencies within the jurisdiction of our subcommittee totals $14,991,157,000. Excluded from this total, but within the Public Health Service, are the budgets for the Food and Drug Administration and the Indian Health Service, which are under the jurisdiction of the Agriculture and Interior Subcommittees, respectively.

The committee is particularly pleased with the leadership that Dr. Mason has devoted to both the health objectives for 1990 and the newly released health objectives for the year 2000.

Collectively as a nation, we met only one-half of our health objectives for 1990. We partially met one-fourth and were uncertain with regard to the final fourth due to the lack of adequate data to evaluate our progress. Hopefully, we can do better in helping to meet the goals for the year 2000.

Because of my concern that we're not doing enough in the Nation to meet broad health prevention objectives, I introduced last week, along with a number of my colleagues, legislation to substantially increase the authorization for the principal health prevention vehicle, the prevention block grant within the Centers for Disease Control.

Another issue we would like to discuss with Dr. Mason this morning is the medical effectiveness research program, which is now included in the new Agency for Health Care Policy and Research. This morning the committee will receive a report from Dr. Mason on the progress to establish the new Agency.

Dr. Mason, we are pleased to have you with us this morning, and I leave the record open at this point for any opening statements which Senator Specter or other Senators might have.

I would also like to welcome Dr. Dowdle from the Centers for Disease Control, Dr. Goodwin from ADAMHA, Alcohol, Drug Abuse, and Mental Health Administration, and Dr. Harmon from HRSA.

What I propose that we do is, rather than questioning each individually, I would like to proceed in the following manner: hear testimony from Dr. Mason; then we will go to Dr. Dowdle, CDC, Dr. Goodwin, ADAMHA, and Dr. Harmon from HRSA.

That is not in any order of priority. That is just the way my book is arranged. [Laughter.]

PREPARED STATEMENT

So if we could do that, we will go on. And then after you have all had a chance to testify, then I think we will come back around for questioning. But I would like to get some idea of how these interrelate and everything, rather than just picking each person out specifically.

So again, Dr. Mason, welcome to the subcommittee. Your entire statement will be made a part of the record, and I would like to

ask you to summarize or at least make the high points. I would ask of all of you, what are the three, four, five-I am not going to put any limit on it, but what are the things that you really think are important for us to really know here today?

Dr. Mason, welcome back.

[The statement follows:]

The hearing this morning will permit us to hear testimony first from Dr. James Mason concerning the fiscal year 1991 budget request for all the agencies included in the Public Health Service.

The fiscal year 1991 request for the several agencies within the jurisdiction of our subcommittee totals $14,991,157,000. Excluded from this total, but within the Public Health Service, are the budgets for the Food and Drug Administration and the Indian Health Service, which are under the jurisdiction of the Agriculture and Interior Subcommittees, respectively.

The committee is particularly pleased with the leadership that Dr. Mason has devoted to both the health objectives for 1990 and the newly released health objectives for the year 2000.

Collectively as a nation, we met only one-half of our health objectives for 1990. We partially met one-fourth and were uncertain with regard to the final fourth due to the lack of adequate data to evaluate our progress. Hopefully, we can do better in helping to meet the goals for the year 2000.

Because of my concern that we're not doing enough in the Nation to meet broad health prevention objectives, I introduced last week, along with a number of my colleagues, legislation to substantially increase the authorization for the principal health prevention vehicle, the prevention block grant within the Centers for Disease Control.

Another issue we would like to discuss with Dr. Mason this morning is the medical effectiveness research program, which is now included in the new Agency for Health Care Policy and Research. This morning the committee will receive a report from Dr. Mason on the progress to establish the new Agency.

Dr. Mason, we are pleased to have you with us this morning, and I leave the record open at this point for any opening statements which Senator Specter or other Senators might have.

I would also like to welcome Dr. Dowdle from the Centers for Disease Control, Dr. Goodwin from ADAMHA, Alcohol, Drug Abuse, and Mental Health Administration, and Dr. Harmon from HRSA.

What I propose that we do is, rather than questioning each individually, I would like to proceed in the following manner: hear testimony from Dr. Mason; then we will go to Dr. Dowdle, CDC, Dr. Goodwin, ADAMHA, and Dr. Harmon from HRSA.

That is not in any order of priority. That is just the way my book is arranged. [Laughter.]

PREPARED STATEMENT

So if we could do that, we will go on. And then after you have all had a chance to testify, then I think we will come back around for questioning. But I would like to get some idea of how these interrelate and everything, rather than just picking each person out specifically.

So again, Dr. Mason, welcome to the subcommittee. Your entire statement will be made a part of the record, and I would like to