Senator PURTELL. I wonder, Senator Hill, if the Bureau of the Budget might have read that, the Journal of the American Hospital Association's issue of January 1954 in which they say:

In an opinion poll of the American Hospital Association house of delegates, members forecast A Road Ahead

the article is A Road Ahead and I am quoting from it. They said in part:

For the most part, members of the house of delegates were of the opinion that a shortage of beds in rural areas no longer exists. Many of them felt, however, that in rural areas where small hospitals are built it might have been more wise to have established a rural health center and to channel hospital patients to urban areas where more adequate diagnostic and treatment services were available and the respondents also frequently cited too low occupancy rate in smaller hospitals in rural areas.

The delegates of one Southwest Central State summarized the opinions of those who believe that there is no shortage of beds in rural areas by stating-and I quote:

Occupancy in hospitals in this State is reported to be extremely low, except in the larger cities. This would indicate that new beds provided by Hill-Burton funds should be added in the cities rather than in the outlying districts. There is no doubt that medical service has been improved in the outlying areas because of the Hill-Burton funds, and the activities brought about in the rural districts to obtain better facilities for the doctors in those areas. But it seems that this is perhaps the time when the saturation point should be considered and determined as nearly as possible.

There is another matter in the article but I thought those might be pertinent.

Senator HILL. I think that is pertinent, but I think that the various charts and figures that Mrs. Secretary has shown here today show the need for these other things. According to her figures you have a need now for 200,000 general hospital beds, 350,000 mental hospital beds, 40,000 TB beds, and 240,000 chronic disease beds.

On tomorrow, I understand, we will have the representative of the American Hospital Association here.

Senator PURTELL. Yes, Senator.

Senator HILL. I think you will find that if we ask him the question, he will very strongly advocate an increase in the $50 million. What I was seeking to do was to get this thing started now. Why wait! We can start now. We have the authority.

Mrs. HOBBY. I do not know exactly how you could get started when experience has been that the people have not made application for the chronically ill. And watching it develop, we thought the only way to get them to do it was to earmark the funds for it. It is perfectly true that under the law now, they could be built. But we believe they would not be built unless we earmark the funds.

Senator HILL. I think in view of the history that has happened here, this present bill and all this testimony and everything, that if you had additional funds, that you of the Public Health Service would be well justified in seeking more chronic hospital beds in your States. Then another thing about it, even with that, I want to say this, and I want to emphasize this, I put that emphasis that you did, my dear Mrs. Secretary, on the general hospital beds. In your own figures, your own figures

Mrs. HOBBY. We could not deny, Senator, that there is need for

Senator HILL. The chronic need today and when you talk about $50 million, knowing that so many of these communities have put burdens upon themselves, taken all kinds of steps to build these hospitals and then we get this little small sum of $50 million for that purpose. You see, your hospital beds, including your chronic disease beds, you have got approximately some 600,000 beds according to your own figures. So, I was hoping maybe you would go to President Eisenhower and ask him to tell Mr. Dodge to send up a budget estimate for a little more money.

Mrs. HOBBY. Thank you very much for your counsel.

Senator HILL. Would you think it over?

Mrs. HOBBY. Yes, sir, I will think it over.

I want to express my deep appreciation to the chairman for his great patience here and also to the other members of the committee. Senator HILL. Also I want to thank Mrs. Secretary and members of the Public Health Service who have been patient. I might say this, after getting this thing further, I may have some more questions, Mrs. Secretary.

Let me ask you one other question while you are here. I introduced a bill way last year and it was sent down to your Department for comment and in fact there were three of those bills, I believe. The bill I introduced was Senate 93, a bill dealing with health and health insurance, sent down on January 26, 1953, on which there has been no comment. Then I think, tomorrow, Mr. Chairman, I believe Senator Humphrey is coming on his bill, S. 1052. That bill went out on February 21, 1953, which is over a year ago. We have had no comment from your Department, I understand. Then the Flanders-Ives-Nixon bill-the Vice President was in the House and he introduced it in the House in 1953. I think we have had no comment on those bills. I wonder if we might not have some comment from your Department on those bills.

Mrs. HOBBY. Senator, I feel very badly that your committee has not. As a matter of fact, to be perfectly frank with you, I would just have to say that we have had so much work we could not get to all of it. And I apologize for my part of the staff because they work the clock around and, as you well know, there are limitations to the number of hours in the day and to physical endurance. We do hope to have shortly, I think it is in the process, a report on Senator Humphrey's bill, S. 1052, and the Ives-Flanders bill, which, as you know, is quite an extensive one requiring the greatest kind of care. We do get so many demands from the various committees in the Senate for immediate and almost deadline reports on bills they are hearing. This is just my apology to the committee, and a very sincere one, for not being able to keep up with all the bills on which we have been asked to report.

Senator HILL. Have you had your personnel reduced much, your staff?

Mrs. HOBBY. Legal counsel?

Senator HILL. I mean your whole staff.

Mrs. HOBBY. No, sir, we have not.

Senator HILL. I thought you might have had reductions in your budget, too.

Mrs. HOBBY. We were very fortunate, as you know. We were made a Department this time. I have forgotten-I would hate to put it in

the record-but I believe at one time we had over 900 bills for study. I would like to correct the figure, if it is wrong.

Senator HILL. Mr. Chairman, I imagine that Mrs. Secretary will want to give us some testimony sometime or some estimates sometime on the Humphrey bill because Senator Humphrey will be here tomorrow on that bill.

Senator PURTELL. I am advised that we have not been advised that he will be here tomorrow.

Senator HILL. Has he been advised to be here tomorrow?

Senator PURTELL. Yes.

Senator HILL. That means that if he does not come tomorrow, he will come in at a later time.

Senator PURTELL. That is correct.

Senator HILL. Of course we will have the bill before us and we will have to see it.

I would like to put in the record, Mr. Chairman, the budget estimates we have been talking about on health. I would like to put them in the record.

Senator PURTELL. So ordered.

Senator HILL. Thank you.

(The budget estimates referred to are as follows:)

ITEMIZED BUDGET CUTS

APPROPRIATIONS ASKED FOR 1955

1. The Department of Health, Education, and Welfare: A cut of $57 million. 1954, $1,863,000,000; 1955, $1,806,000,000 (budget, pp. A9 or 644).

2. Social security, welfare, and health: A cut of $62 million.

000,000; 1955, $1,857,000,000 (budget, p. M60).

3. Office of Education: A cut of $381⁄2 million.

$121,601,500 (budget, p. 646).

And as regards health:

1954, $1,919,

1954, $160,295,611; 1955,

4. Total funds for Public Health Service: A cut of $41 million. 1954, $232,830,950; 1955, $191,463,000 (budget, p. 647).

5. Funds for venereal disease control: A cut of $2.7 million (54 percent). 1954, $5,000,000; 1955, $2,300,000 (budget, p. 646). (Of course, we're conquering V. D.,

but not at a rate of 54 percent a year.)

6. Funds for tuberculosis control: A cut of $2% million (42 percent). $6,000,000; 1955, $3,500,000 (budget, p. 646). (Same comment.)

1954,

7. Funds for control of communicable disease: Cut more than half a million (though I haven't heard that the common cold has been licked yet). 1954, $5.009,000; 1955, $4,397,000 (budget, p. 646).

8. Funds for the going vocational-rehabilitation program: Cut $3.8 million. 1954, $23,658,100; 1955, $19,825,000 (budget, p. 646). (They say they will ask 8 million more if new legislation is passed.)

9. Funds for hospital construction: Cut $15 million. 1954, $65,000,000; 1955, $50,000,000 (budget, p. 646). (Here again they say they will ask 60 million more if legislation is passed. But since 150 million is already authorized, the President could have asked for 110 million instead of 50 million without new legislation.)

10. Funds for Medical Research: At first glance, the budget would seem to indicate that the administration is adding some $30,000 to funds for medical research under the National Institutes of Health. Upon examination, however, it becomes apparent that grants made by the Institute for general medical research, for detection and for special cancer control projects have actually been cut by more than $2 million. This does not show up readily in the budget because $2,365,000 have been added for direct operations at the new clinical center out in Bethesda. The fact is that when the Congress authorized the building of that center we knew it would cost over $2 million to operate after it was built. We intended that that $2 million be added to the funds being spent for research. We expected that the administration instead of cutting research grants by $2 million

would come before the Congress to ask for $2 million additional. Since they did not, we should have it clearly understood that a good deal of the money which at first glance would seem to be going for research is in fact going for housekeeping out at Bethesda. Specifically, almost half a million dollars of the $2 million I have referred to is charged to the housekeeping section of the National Institutes of Health. Over $400,000 is charged to service operations, and over $100,000 is to be spent for laundry. Now, I know that all of these services are essential to the operation of the fine new center we have built. But I don't want anyone to get the impression that funds for cleaning approximately 1 million square feet of floor space out there, or for washing 1,900 windows (and I don't know how often they wash them) are funds for medical research.

Conclusion: What on radio and television may sound like a "dynamic, progressive, forward-looking program" in the field of health, education, and welfare turns out, when we look at the hard facts as set forth in the budget, to be a dynamically, progressively, backward-moving program.

Senator PURTELL. Have you other questions, Senator?

Senator HILL. No, I want to thank you again, Senator, and I want to thank you, Mrs. Secretary, and all of those who have been very patient this morning.

Senator PURTELL. I want to thank you for helping us because the questions developed much what we will need in this record and I know it is going to be helpful to our colleagues on the committee and I want to thank you for the way in which information has been developed.

Mrs. Secretary, I want to thank you and your associates for coming up here and helping us and you have been a very great help to us and I want to compliment you again on the way in which your facts were presented. I want to tell you that your whole statement including the change made today and including the charts, and I would like to have that clear, the charts will become part of the record.

Mrs. HOBBY. Sir, may I ask that this chart that we introduced at the last minute which we did not use as a part of the chart talk be included in the record?

Senator PURTELL. Is it not in your prepared statement?

Mrs. HOBBY. No, sir.

Senator PURTELL. It will be included if you will supply us with something for the record.

(The statement and new chart referred to are as follows:)

STATEMENT BY GVETA CULP HOBBY, SECRETARY OF HEALTH, EDUCATION,

AND WELFARE

Mr. Chairman and members of the committee, I appreciate the privilege of appearing before you today in support of S. 2758, which was introduced by the chairman of your committee to implement one of President Eisenhower's principal recommendations for progressive health legislation. This bill relates to the construction of hospitals and related health facilities. Our testimony will also encompass the provisions of H. R. 8149, a bill passed by the House last week which is identical in most respects.

As your subcommittee chairman has indicated, the legislation you are considering this morning is part of an integrated health program proposed by the President in his special message to the Congress of January 18. The schedule of hearings arranged by your subcommittee will provide an excellent opportunity for thorough consideration of each proposal contained in the President's program. The recommendation that the Hospital Survey and Construction Act be broadened is the first of these proposals which you have selected for discussion. The hospital survey and construction program, generally known as the Hill-Burton program, is one of the most successful health programs ever undertaken by the Federal Government in cooperation with the States. A large measure of credit for its success belongs to your committee, which played such a prominent role in the enactment of the original Hospital Survey and Construction Act in 1946. The soundness of the program was reaffirmed by the Congress in 1949 when it

expanded the program and in 1953 when it extended its duration through the fiscal year 1957.

The essential features of the Hospital Survey and Construction Act are well known to your committee. Briefly, the law provides that each State and Territory, as a prerequisite to obtaining Federal aid, shall prepare and keep current a survey of its existing hospitals and public health centers and of its needs for additional facilities. On the basis of this survey, the State develops a plan, or program, for additional construction where it is most urgently needed.

Out of such sums as are appropriated annually by the Congress, allotments are made to the States and Territories to assist in the construction of hospitals in four major categories—general, mental, chronic disease, and tuberculosis— as well as for public health centers.

Progress under the program to date has indeed been very satisfying. We can now report that 2,200 projects have been approved, utilizing $600 million of Federal funds and a billion and a quarter dollars of State and local moneys. A total of 106,000 hospital beds, 446 public health centers, and many related health projects such as nurses' training facilities and laboratories-are being added to our health resources. Nevertheless, there still remains much to be done. Our greatest need today lies in the area of facilities for the chronically ill. By far the greatest percentage of construction under the program thus far has been in the general hospital category. As a consequence there has been a national net gain in the number of acceptable general hospital beds since 1948, when construction under the program commenced. During this same period, however, there has been a net loss in the number of acceptable hospital beds for the care of patients with chronic diseases, including cancer, arthritis, and heart disease. Thus as valuable as the present program is-it has not, to date, provided a balanced answer to our Nation's needs for hospital and health facilities. Before turning to the provisions of S. 2758, Mr. Chairman, I should like to ask Dr. Scheele to present some additional background information in graphic form.

BACKGROUND CHARTS

Chart A-Results of program to date; 1947-53

Chart A shows the accomplishment of the hospital survey and construction program from its beginning in 1947 to 1953. A total of 106,000 hospital beds have been built or are under construction with Federal support. These are divided among 4 categories as follows: General medical and surgical, 86,000 beds; mental, 11,000; chronic disease, 3,000; tuberculosis, 6,000.

In addition, 446 public health centers have been constructed, as well as many other supporting facilities such as diagnostic centers, State health department laboratories, premature nurseries, outpatient departments, and nurse-training facilities.

Chart B-Acceptable hospital beds, 1954

Chart B shows the actual number of acceptable beds in the United States today, as determined by State surveys, in the four categories. The chart also shows (by the light segment in the middle of each bar) the number of beds that have been added under the hospital survey and construction program; i. e., the same data as shown on chart A. The upper part of each bar shows the unmet need in each category. Overall needs in each category are based on formulae contained in the original Hospital Survey and Construction Act.

This chart shows that the greatest degree of unmet need for hospital beds is for patients with chronic illness.

Chart C-Existing and needed hospital facilities

Chart C is similar to chart B, but is in terms of percent of total needs rather than absolute number of beds. Taking the total number of beds needed in each of the 4 categories as 100 percent (the top of each bar), it shows, by percent, (1) the additional beds provided under the Hospital Survey and Construction Act, and (2) the remaining unmet need.

While there is a large remaining element of need in each of the four fields, the relative need in the area of chronic disease hospitals is by far the greatest88 percent.

Chart D-Increasing aged population

The need for more chronic beds is intensified by the aging character of our population. Chart D shows that in 1900, when the population of the United States was 76 million, the number of persons over 64 was only 3 million. In