Page images
PDF
EPUB
[blocks in formation]

REVIEW OF ACHIEVEMENTS IN THE FIELDS OF HEALTH AND EDUCATION AND FURTHER RECOMMENDATIONS FOR ATTAINING GOALS

MARCH 1, 1966.-Referred to the Committee of the Whole House on the State of the Union and ordered to be printed

To the Congress of the United States:

A nation's greatness is measured by its concern for the health and welfare of its people. Throughout the history of our democracy, this commitment has grown and deepened.

The education of our people is a national investment. The health of our people is essential to the pursuit of happiness.

Today we can set ambitious goals for the future:

Full education for every citizen to the limits of his capacity to absorb it:

Good health for every citizen to the limits of our country's capacity to provide it.

The 88th and 89th Congresses have moved toward these goals. During the past three sessions, Congress has—

enacted 20 landmark measures in health and 19 in education; doubled the appropriations for health programs and increased the budget for our Office of Education more than fivefold. The achievements of the past 3 years promise a dramatic enrichment of American life. They already include in the field of health: 1. The medicare program which, on July 1, will make benefits available to more than 19 million older Americans.

2. Health services for more than 200,000 migrant workers in 34 States.

3. Maternal and infant care for mothers and children previously receiving inadequate services.

4. Expanded services for crippled children.

5. Thirty-two new clinics for retarded children.

6. Construction assistance for 1,300 hospital and health facilities. to add more than 56,000 new hospital beds.

7. Financial support for more than 16,000 medical research projects and advanced training for 25,000 scientists.

8. Construction starts for 62 institutions to enroll more than 2,400 additional students each year for training in the health professions. Our achievements in education are equally impressive. Among

them are:

1. Funds to improve educational opportunities for nearly 7.5 million underprivileged children in 20,000 school districts.

2. Summer Head Start programs for 560,000 preschool children in 13,350 community education projects and year-round programs for 120,000 children.

3. Textbooks and other learning materials for more than 40 million. children in every State.

4. College work-study programs for more than 110,000 needy college students.

5. Construction aid for 1,300 institutions of higher learning—including new classrooms, laboratories, and libraries.

6. Twelve million books to improve public libraries and training programs for more than 400 librarians.

HEALTH

With these programs and those I am recommending today, we can move closer to attainment of our goals

to bring every child the care he needs to develop his capacity to the fullest;

to reduce infant mortality, concentrating particularly on those minority groups whose death rate is highest;

to eradicate major communicable diseases as a threat to life. and health in the United States;

to reduce the burden of mental illness, and mental retardation; and

to cut the toll of the three great killers-heart disease, cancer, and stroke.

The health budget which I have proposed for fiscal year 1967 is $4.67 billion-an increase of almost $1 billion. In addition more than $3 billion in social security trust funds will be spent under medicare to assist our older citizens.

Funds for health manpower, facilities, and services are up $707 million. Funds for environmental activities and consumer protection are up $158 million. Funds for health research activities are up $78 million.

To insure continuing progress, we must

improve the administration of Federal health activities;

develop comprehensive health planning and services on the

State and community level;

strengthen our system of health care;

train needed health workers;

increase our research efforts; and

take additional steps to meet special health problems.

I. TO IMPROVE ADMINISTRATION OF FEDERAL HEALTH SERVICES

Our first concern must be the efficient and effective administration of the Federal health programs.

Over the last 12 years the budget of the Public Health Service for research, training, and services has grown almost tenfold-from $250 million to $2.4 billion. Yet major elements of the basic structure of the Public Health Service remain set by a law that is more than 20 years old.

The Secretary of Health, Education, and Welfare and the Surgeon General of the United States have consulted leading expertsphysicians, administrators, scientists, and public health specialistsin a thorough search for the best means to improve the administration of Federal health programs. They all agree that the need to modernize the administration of the Public Health Service is urgent.

To fulfill that need, I will shortly submit to Congress a proposed reorganization of the health functions of the Department of Health, Education, and Welfare.

The ultimate success of Federal health programs depends on the men and women who direct them. At present, the personnel system of the Public Health Service is inadequate to recruit and retain the talent needed for its rapidly changing and expanding role.

I will recommend legislation to improve the personnel system of the Public Health Service.

This legislation will

promote career development;

encourage more flexible use of health workers;
provide them with broader opportunities; and
stimulate higher standards of performance.

II. TO DEVELOP COMPREHENSIVE HEALTH PLANNING AND SERVICES ON THE STATE AND COMMUNITY LEVEL

The focus of our efforts is the individual and his family, living in their own community. To meet their health needs requires the cooperation of many agencies, institutions, and experts-of State and local government, of doctors, nurses, and paramedical personnel.

These are the frontline fighters in our battle against disease, disability, and death. As in military battle, a winning strategy demands wise and well planned use of manpower. It demands coordinated use of all the resources available.

I recommend to Congress a program of grants to enable States and communities to plan the better use of manpower, facilities, and financial resources for comprehensive health services.

At present, the Federal Government offers the States formula grants for categorical programs dealing with specific diseases. This leads to an unnecessarily rigid and compartmentalized approach to health problems.

Our purpose must be to help redirect and reform fragmented programs which encourage inefficiency and confusion and fail to meet the total health needs of our citizens.

I recommend a program to initiate new State formula grants for comprehensive public health services. This program would begin in fiscal 1968.

At the same time, we must recognize that special health problems occur in some parts of our Nation and not in others. Certain diseases, such as tuberculosis and venereal disease, are concentrated in metropolitan communities. Others, such as rabies and parasitic diseases, are prevalent in certain geographic areas.

Resources to serve health needs are not evenly distributed throughout the Nation. Special problems arise in remote rural areas and the city slums. We need greater flexibility to pinpoint our attack. To make certain we have that flexibility, I recommend a program, to commence in fiscal 1968, of grants to States, communities, medical schools, and hospitals to meet special health problems.

III. TO STRENGTHEN OUR SYSTEM OF HEALTH CARE

The Hill-Burton program for hospital construction is an outstanding example of creative federalism in action. Now in its 19th year, this Federal-State-local partnership has added more than 300,000 hospital and nursing home beds to our Nation and more than 2,000 other health facilities in areas of great need.

My budget requests the full authorization of $270 million for facilities construction under the Hill-Burton Act.

Medical advances demand new equipment and up-to-date laboratories. Intensive care units, as well as ambulatory and extended care facilities, require changes in the structure and function of aging hospitals, particularly in urban areas.

General hospitals containing 260,000 beds-one-third of our Nation's are now in obsolete condition.

When medicare becomes operative this July, the pressure on many hospitals will grow even more intense.

To begin to meet this urgent need, I recommend legislation to mobilize public and private resources to revitalize our obsolete hospitals. This will require a loan and grant program to assist in the long-term financing of hospital renewal projects.

The need for modernization goes beyond the bricks and mortar of construction. We must find new ways to lower the cost and raise the quality of health care, to organize health services more efficiently, to develop information systems. It will take the combined efforts of university, hospital, industry, group practice clinics, and many other organizations.

am directing the Secretary of Health, Education, and Welfare to conduct systems analyses and other studies to determine the most effective means of bringing high quality medical services to all the people at the lowest cost.

I also propose a 5-year program of grants for research and demonstration projects in the organization, financing, utilization, and delivery of health services.

As medical practice becomes more complex, specialization becomes more common. The number of general practitioners is declining66,000 today compared to 95,000 15 years ago. In 1950, there was 1 family physician for every 1,600 Americans. Today 2,900 Americans must depend on 1 family doctor.

Group practice benefits both physicians and patients. It makes expert health care more accessible for the patient. It enables the physician to draw on the combined talents of his colleagues.

High initial capital requirements and a shortage of long-term financing have restricted the development of this form of medical and dental practice.

I recommend that the Congress consider legislation now pending making mortgage insurance available for group practice facilities.

The first session of this Congress has liberated our citizens from the haunting fear of an inability to meet the cost of medical care in their later years. This landmark legislation assures that community hospitals, physicians, and others who provide for their health will be paid the reasonable cost and customary charges for such services. I propose that this same principle be extended to the care of patients in our own Federal hospitals and I recommend legislation to permit the reimbursement of these hospitals in the same manner.

IV. TO TRAIN NEEDED HEALTH WORKERS

Trained men and women continue to be in critically short supply in the field of health. Congress has already acted to help meet that need by enacting

the Health Professions Educational Assistance Act to provide assistance to both schools and students;

the Nurse Training Act to provide Federal aid to increase the supply of professional nurses; and

the Vocational Education Act to provide for training of practical nurses and other health workers.

But critical specialities remain dangerously understaffed-medical technologists, biomedical engineers, dental hygienists, and other college-trained health workers.

These personnel, allied with doctors, dentists, and nurses, constitute the modern health care team. They extend the reach and the scope of the physician.

I recommend a 3-year program to provide grants for training in allied health professions—

to construct and to improve needed educational facilities; to offer fellowships for students in advanced training; and

to stimulate institutions to develop new types of health personnel.

Last year, in the Higher Education Act of 1965, Congress enlisted the resources of our private banking community to make low-interest student loans. By this means, greatly increased financial assistance can be provided at minimal cost.

I recommend legislation to convert the health professions student loan program to privately financed and federally subsidized loans for students in the health professions.

V. TO ADVANCE RESEARCH

Over the past 10 years, Congress has increased the budget for health research thirteenfold. The dividends from this investment are incalculable. Miraculous progress in medical discovery is making possible

development of support devices for the failing heart-and even replacement of a human heart by an artificial organ;

advances toward the cure of cancers such as childhood leukemia and Hodgkin's disease;

« PreviousContinue »