education incentive awards. These will help the schools of health professions introduce changes in curriculum, create area health education centers to help attract needed personnel to shortage areas, assist practicing doctors to keep abreast of the latest developments in medical practice, and insure a sound fiscal base for health education in this country. COMPREHENSIVE HEALTH PLANNING The budget includes an increase of $16 million to establish 100 new planning agencies for metropolitan areas and 20 new health planning councils for rural areas and to strengthen existing State-level planning agencies. These agencies are an integral part of the comprehensive nationwide health planning system envisioned in the partnership for health legislation. These new planning resources should help cities and towns make the optimum use of the health facilities, equipment, and manpower available to them. EMERGENCY SCHOOL ASSISTANCE While our choice of a strategy has had a very significant impact on our 1973 budget request, it has not governed all of our decisions. Preexisting initiatives and commitments have also been given appropriate recognition. In particular, we will carry out the emergency school assistance legislation and further expand biomedical research supported by the National Institutes of Health. We will move to implement the emergency school assistance legislation as soon as it is passed. We have included a supplemental of $500 million in 1972 and a budget request of $1 billion in 1973 for this purpose. This would carry out the President's commitment to spend $12 billion over a 2-year period to ease the problems of desegregation and reduce racial isolation in the public schools. Because of the delay in enacting the authorizing legislation, this program will have its first major impact in the school year beginning this fall. BIOMEDICAL RESEARCH We are requesting an appropriation of $1,573,000,000 for the biomedical research programs of the National Institutes of Health in 1973, an increase of $139 million over the appropriations made in 1972. The largest component in this increase is $92 million for cancer research, bringing the 1973 program level to $430 million. As subsequent witnesses will confirm, we are making what I believe is very satisfactory progress in carrying out the President's commitment to accelerate and expand the cancer research effort. The 1973 program will be nearly double the 1971 level. The appointment of Beno C. Schmidt as the chairman of the President's Cancer Research Advisory Committee is further evidence of this administration's commitment to provide the initiative in cancer research with a strong overview at the highest possible level in the executive branch. The 1973 program will press the attack against cancer on all fronts. including improved diagnosis, prevention, study of the basic causes of cancer, and improved therapy. Approximately $49 million will be allocated for the construction of cancer research facilities, including an addition to the clinical center at NIH. In addition, $20.5 million will be used for cancer research training awards to over 1,400 people throughout the United States, an increase of almost 300 over the number receiving training awards in fiscal year 1972. Significant program expansion beyond fiscal year 1973 necessarily depends on developing an adequate base of facilities and manpower. The budget for the Heart and Lung Institute is $22 million higher in 1973 than the 1972 appropriation. The greater part of this increase will be allocated to research on arteriosclerosis, the major cause of the heart attacks which result in 800,000 deaths each year. The increase for the Heart and Lung Institute includes $5 million for sickle cell disease research, bringing the total program level for this activity to $15 million in 1973. These funds will permit the Institute to pursue all worthwhile research leads and set up a number of clinical and education centers to screen and provide counseling to a statistically significant sample of the black population. It is our intention to test various experimental modes of therapy and determine the effectiveness of education and counseling as a method of preventing the disease. MAKING HEW PROGRAMS MORE RESPONSIVE Our objective of institutional reform goes beyond amounts budgeted for specific programs such as educational revenue sharing or career education. We are seeking to introduce integrated and flexible funding into our current operations and will seek legislation to enable States and localities to integrate the delivery of human services within their service areas. GRANTS PACKAGING We are planning to establish a new group in the Comptroller's office to facilitate access to grant funds. In advance of giving it an official name we have been calling it the switching station. Because many worthwhile projects deserving HEW support are too broad in scope to be wholly financed by one categorical grant-in-aid program, a prospective grantee is forced to divide his project into pieces which match the Federal categorical programs. He must then hunt separate funding for each piece. The switching station will change this. If a future grant applicant has a project requiring funding from several different HEW project grant programs, he will submit a single application to the switching station. This new organization will review his project as a single entity and, if it is approved, will arrange to combine funds from the applicable categorical programs into a single, integrated grant award. This is our most promising approach so far to establishing a grantpackaging capability in HEW. INTEGRATED DELIVERY OF SERVICES We will be submitting legislation to this session of Congress to permit States and local jurisdictions to integrate their human-service delivery systems. The current patchwork of overlapping and conflicting systems is often frustrating to the intended beneficiary and results in waste and inefficiency at all levels of government. The legislation would encourage States and localities to set up common intake and eligibility determination procedures, create comprehensive human service information systems, engage in joint planning and budgeting and begin to treat the individual in need as a whole person. TRANSFER AUTHORITY As a further effort to manage the discretionary funds available to the Department in a more flexible and efficient manner, we are requesting a general provision in the 1973 Appropriations Act which would permit the Secretary to transfer up to 5 percent of the appropriation for each discretionary program to another program, providing that the receiving appropriation is not increased by more than 10 percent. I believe that such a provision is necessary if we are to get the maximum payoff from the resources which Congress makes available to us. As new priorities emerge during the course of the year, we would be able to make limited reallocations among programs to recognize the new situation. In some cases, it would avoid our having to return to Congress to seek a supplemental appropriation. It would be a useful additional tool for making the Department more responsive. CONCLUSION I hope that my somewhat roundabout way of presenting the budget has given you an idea of the breadth of the Department's concerns and problems, and the efforts, underway or planned, to coordinate our programs better so that they add up to more than the sum of their parts. I believe that, working together, we can puncture the balloon of overpromise, and unfulfilled expectation. Mr. FLOOD. Thank you very much, Mr. Secretary, for a very interesting and very comprehensive statement. PROPOSED BUDGET REDUCTIONS You are proposing a number of decreases. Some of these are going to be very difficult for the Congress to swallow. I have before me a selected list of the cuts in this budget for which we are going to need some very, very strong arguments. (The list of selected items follows:) Program: Mental health training grants and fellowships__- Budget reduction -$15, 000, 000 -15, 000, 000 -112, 200, 000 -142, 385, 000 -19, 500, 000 -50, 000, 000 -180, 970, 000 -43, 000, 000 -3, 800, 000 -10, 000, 000 -12, 500, 000 -16, 479, 000 -9,500,000 -65, 136, 000 Mr. FLOOD. If you wish to discuss them briefly now, we will be glad to have you do so. We will, of course, go into more detail when we come to the individual items in the course of our hearings with the program administrators. For instance, on the program of mental health training grants and fellowships. The budget reduction is $15 million. Secretary RICHARDSON. I would be glad, Mr. Chairman, to go through these and comment on them asking my associates here to supplement what I say from time to time. Mr. FLOOD. You have before you a copy of what I hold in my hand here which lists a number of these programs and opposite them the budget reduction. Secretary RICHARDSON. Yes. MENTAL HEALTH TRAINING Starting then, Mr. Chairman, in the order in which these items are set forth on the sheet which you have already identified. In the case of mental health training grants and fellowships, this is the only program we have that earmarks funds for a particular type of health manpower training; and, since the Congress has just enacted new health manpower legislation and this committee has provided for a supplemental appropriation to fund it that provides substantially more funds for the education of various health professionals than we have ever had before, we thought we could therefore justify a reduction in this particular earmarked program. COMMUNITY MENTAL HEALTH CENTER CONSTRUCTION In the case of community mental health center construction grants, what we are trying to do here and in other areas is to get away from what seems to me to be called, aptly, the edifice complex. Mr. FLOOD. The Taj Mahal? Secretary RICHARDSON. Yes, sir. The Taj Mahal approach seems to reflect a notion that you can't provide a service unless you build a building in which to house it. Whereas in fact, the provision of community mental health services, more often than not what is really needed is the creation of a coalition of resources within the area to be served that may be comprised partly from the outpatient services of one hospital, the inpatient psychiatric services of a general hospital, a child guidance clinic and other community resources, which added together satisfy the standards of comprehensiveness in law. So when it comes to using dollars to move forward in the development of mental health services we think they can be used better to support the services and bring this kind of coalition into being than by focusing on construction. OTHER HEALTH CONSTRUCTION Much the same point centrally underlies the reduction for medical facilities construction, for health professions construction and nursing school construction. In the case of each we first believe that more effort should be devoted to using existing facilities, like, for example, in the case of medical schools, the use of the basic science buildings of the associated universities in the teaching of the scientific courses in the first 2 years. Or, the more effective use of community hospitals for teaching purposes rather than the creation of a brand new medical teaching center. The second point to be made with respect to the construction grant is the one I made earlier in my statement, which is, we believe more use can be made of subsidized guaranteed loans rather than the actual outright appropriation of construction costs. SCHOOL EQUIPMENT AND MINOR REMODELING The school equipment and minor remodeling is an authority that is a line item in the budget that is covered also by broader authorities in other parts of the Elementary and Secondary Education Act; and, we think that we are doing enough essentially in these areas without funding the separate line item. IMPACTED AREA AID Impacted area aid is reduced in order, as I testified earlier, to conform the program to its original purposes to provide for the education of children whose families live on Federal property and to provide for the education of Indian children who are going to school outside of a reservation. HIGHER EDUCATION CONSTRUCTION The higher education facilities construction grant reduction is justified on the same basis as the earlier one. We have here urged provision of subsidized loans. UNIVERSITY COMMUNITY SERVICES University community services I am not sure I know about. Mr. Cardwell, could you comment on that? Mr. CARDWEL. This is a case where the Commissioner of Education has concluded that we can achieve the same objective without working against a specific program. It is an area where he feels we have not had the payoff that we had expected; and we have treated it as a lower priority activity in the 1973 budget. Mr. MILLER. What the budget says is that we will continue ongoing activities but we are not proposing new starts. AID TO LAND-GRANT COLLEGES Secretary RICHARDSON. Aid to land-grant colleges is proposed for a further reduction primarily on the basis that it is a direct subsidy for only one type of institution; and, we have proposed a major expansion in student assistance under the President's higher education legislation, the creation of National Foundation for Higher Education, additional support for developing institutions, and we have said also that we would accept and keep funds for an institutional aid provision in the pending Higher Education Act, preferably along the lines of a cost of education grant. Mr. MILER. You may recall that about 2 years ago, I think, we proposed to eliminate this program and this committee said we agree with |