sonnel with certain other training, it is our understanding that the justification calls for a $4 million reduction in that part of training which is for rehabilitation personnel. We have seen no justification for this reduction other than that it saves money. Rehabilitation programs, as well as other programs, are no better than the people who work in these programs, and the efficiency of their efforts depends upon the kind of training they can get. We think it is bad practice to try to reduce such appropriations. Additional funds for inservice training of vocational rehabilitation staffs are particularly needed.

(5) Mental retardation State facilities. We request an appropriation of $20 million for mental retardation hospital-facility-improvement grants. As members of this committee know, this is a fund that can be used an a very flexible basis to upgrade programs of State-operated mental retardation facilities throughout the country. Both the preceding and present administration are recommending $8,972,000 for this program, which we are informed actually represents a decrease in the program level for 1970.

(6) Mental retardation community facilities.—We recommend an appropriation of $30 million for mental retardation community facilities and the staffing of such facilities. Both the preceding and present administration recommended $20 million, which, again, we are informed includes certain funds which are being reappropriated. The $10 million extra we are recommending would be divided approximately equally between construction and staffing. This is a very important program which has made a substantial contribution to the welfare and rehabilitation of mentally retarded children, but it has a long way to go before consideration should be given to holding the line on this program.

(7) President's committee.-We request the committee to increase the amount appropriated for the President's Committee on the Employment of the Handicapped from the $531,000 which is the current level, to $600,000.

The 1968 Vocational Rehabilitation Amendments increased the appropriation authority for this program to $1 million per annum. The amount recommended in the budget presents no increase. It will actually be necessary to curtail the program if an increase in this appropriation is not forthcoming. It should be emphasized that this program is one, all of whose resources go to mobilize volunteer effort in support of rehabilitation and placement of handicapped individuals. It is no overstatement to say that the expenditure of this small sum on the President's Committee results in scores of millions of dollars of voluntary effort directed to rehabilitation and placement activities. 1969 section 2 appropriation

Let me return to the section 2 appropriation. First, a few statements about the 1969 appropriation. The appropriation authority for 1969 is $500 million, and allotments were made to the States on that basis. The Bureau of the Budget recommended an appropriation of $345 million, this being the Bureau's estimate of the amount needed to match State funds within the allotments. The subcommittee recommended and Congress appropriated the amount which had been requested. It turned out the States had more money available than had been anticipated, and the amount appropriated lacked $40 or $50 million being enough to do what Congress had anticipated would be done; that is, match the State money available.

I think it might be interesting to note here that for years this committee, and I think appropriately so, has been urging the States to move faster in this very important program, and progress has stepped up in the States, but this last year it was a little bit faster than the administration had anticipated.

By December it was evident that the appropriation would not be sufficient to meet the commitment the Secretary had made. The Bureau of the Budget indicated that it would not seek a supplemental appropriation, so it was necessary for the Secretary of HEW to inform the States of maximum grants that would be available, and these maximum grants were in all cases less than the State's allotment.

This situation caused quite a shock in the States, which had planned on the basis that all of their State money would be matched within the allotments which they had officially received. There being no certainty of the supplemental appropriation, it was necessary for program curtailments to begin at once. It is quite evident that one cannot wait until the end of the year when threatened by a lack of funds. There is no question but that this action set back the program quite a bit.

A supplemental appropriation of approximately $25 million would still be helpful for the 1969 year. Program curtailments already underway would probably mean that a supplemental of as much as $50 million, which is the amount actually needed for the year, could not be used. We understand that the committee is considering a supplemental appropriation for several HEW programs. This is not included among them so far as official recommendations are concerned. We think it might very well, on its own initiative, consider a supplemental for this program. To us, however, adequate appropriations for 1970 are more important than the supplemental for the remainder of this year, if a choice must be made.

The appropriation authority for 1970 is $600 million. The budget of the preceding administration anticipated this allotment base and recommended an appropriation of $524 million to match the money to be made available in the States. For some time we had thought that this amount was insufficient.

A survey of State needs in March of 1969, however, revealed that the current estimated need is $528 million, which is very close to the amount recommended by the preceding administration. So it appears the estimates are holding up pretty well.

The present administration has recommended lowering the appropriation authority to $500 million, which would have to be done by legislating in the appropriation bill. I understand that such language is being presented to the committee, although I have not seen the wording of such langauge. The current administration then recommends appropriating $471 million to match State funds available within the allotments. If the allotment is to be only $500 million, the $471 million will probably be sufficient, although a great deal of State money will remain unmatched by the Federal Government. The Federal Government will not be meeting its commitment in the legislation.

The position of the National Rehabilitation Association on this particular issue is as follows:

First, the allotment base should be $600 million as provided in the law. Even if the needed $528 million Federal appropriation cannot be

met in full, it would still be better to keep the $600 million allotment authority, and this is an important point I want to make. This would permit some growth in all of the States.

If the allotment remains at $500 million, a large number of States will find themselves stymied as far as growth for 1970 is concerned, and in some cases programs will have to be curtailed. It would be necessary, of course, in such a situation, that the Secretary of HEW find a way to limit grants to the amount of the appropriation, since the appropriation would not be enough to pay off all the allotments. This would be a difficult and thankless task, but it would be better to do this than to have the allotment base lowered to $500 million.

Second, we recommend that the appropriation under section 2 be $528 million, which is the amount that will be needed. We feel reasonably sure that an appropriation of this amount would prevent a situation such as occurred in December of 1968, which, we regret to say, has been quite detrimental to what I think all members of this committee agree to be one of the most constructive efforts the Federal Government undertakes in the field of human services.

Next, Mr. Chairman, we want to talk about a vocational evaluation and work adjustment program which was authorized in the 1968 legislation. This is, in the opinion of most people who have studied it, the most advanced legislation that this Congress has passed as related to a sensible, reasoned approach to the solutions of problems of unemployment and underemployment among the severely handicapped and otherwise disadvantaged citizens of this country. The vocational rehabilitation agencies have been far more successful than any other agencies in dealing with disadvantaged people. Some people do not seem to realize that the rehabilitation agencies are the original antipoverty agencies in this country as related to rehabilitation efforts. Seventy percent of the individuals rehabilitated by these agencies do not have any income at the time they make application; over 90 percent of them would meet the current test of poverty income. The success rate of vocational rehabilitation agencies in working with such individuals is far higher than that of any other agency working in this area and the per capita costs are much lower. Studies show it has the biggest ratio of cost effectiveness of any program with similar objectives.

We would call attention to the fact that recent HEW studies of cost effectiveness show that as far as the objectives of the program are concerned, that is to restore people to employment, a dollar spent in this program is far more effective than a dollar spent in any other program that relates to this general objective.

I do not know whether these figures and study have been made available to this subcommittee or not, but it is possible for you to get them.

Mr. MICHEL. What are you talking about exactly?

Mr. WHITTEN. A report made under the direction of Assistant Secretary Gorham and Dr. Rivilin, who succeeded him. They established certain criteria for determining success of programs measured in terms of objectives and then applied their mathematical formulas, which I do not understand, to try to determine which program produced most for the dollar. And this program was way ahead of any of the so-called manpower-welfare type of programs.

The reason for the greater success is, to a considerable extent, that Vocational rehabilitation agencies know better than most how to evaluate vocational potential, and hence, avoid long, expensive, and futile undertakings with no measurable practical results. The vocational evaluation and work adjustment program was initiated by Congress in order to meet this need for more effective evaluation of the rehabilitation potential of handicapped and other disadvantaged individuals. The services were to be available not only to the clients of the vocational rehabilitation agencies, but to the clients of manpower development and training programs, work incentive programs, and so forth. In many communities of the country, both the vocational rehabilitation agencies, manpower agencies, welfare agencies, and so forth, are waiting anxiously to see what Congress does about starting this program. They know that it offers a great deal of promise to make all of the manpower and welfare programs, as they relate to employment, more effective.

The appropriation authority in the legislation called for $50 million for 1969, $75 million for 1970, and $100 million for 1971. The regulations governing the act were not completed in time to make practical the beginning of a program in 1969. The regulations have been issued, many projects have been developed in the States, and there is no practical reason for not implementing the program on a broad scale way in 1970. Since the program did not get under way in 1969, however, we believe that the authorization of $50 million, intended for the first year, will be sufficient for 1970. The preceding administration recommended that $10 million be appropriated for this program, and suggested legislation in the appropriation bill that would change the program for the 1970 year from a formula grant program to a special project program which would be administered by the Secretary of HEW. The present administration cut this out of its budget with the simple comment that it would not begin the program in 1970.

I might add that in its comments the Administration spoke very favorably of vocational rehabilitation in general, but in this particular regard it stripped out all of the money with which this program would have been begun.

If the appropriation for the first year is to be less than $20 million, it probably would be better that it be a special project program, although we would certainly hope that the language in the appropriation bill would be written in such a way that it could not possibly apply to any year except the 1970 fiscal year. If the appropriation should be as much as $20 or $25 million, or higher a formula grant program, as is envisioned in the law, would be practical, and we would prefer that the special project language not be included in the bill.

At a time when we hear so much, and appropriately so, about the necessity to bring into the main stream of activity in this country the hundreds of thousands of individuals who somehow or other have not appeared to fit in anywhere, it would seem mandatory that a modest program, such as that evaluated in the vocational evaluation and work adjustment program, should be initiated without delay. It will be noted that this is a natural companion to the section 2 program. It will serve to make the vocational rehabilitation program more effective, at the same time providing service to the clients of other agencies, if they see fit to take advantage of it, and early indications

30-266-69-pt. 7-17

are that they are most anxious to do so. I say without hesitation that this program, administered along with the vocational rehabilitation program under section 2, will do more than any other programs now contemplated to reduce dependence in this country.

Mr. Chairman, I want to make one additional comment relative to the appropriation for the President's Committee on the Employment of the Handicapped, and this, incidentally, is in the Department of Labor bill, I believe in the Bureau of Standards section. This item is not identifiable in the bill itself, but I understand that the justifications indicate an appropriation of $531,000 for this organization for next year, the identical amount they have available for this year. I would strongly urge that you increase that $531,000 to $600,000. The appropriation authority is $1 million.

I just would remind the committee of something I know you have heard testimony about before, that this is an organization the entire focus of which is to involve the volunteer helping make employment possible for handicapped people, and every dollar spent in this program no doubt has resulted in the stimulation of numerous other dollars to serve these purposes. So a little appropriation of $50,000 or $60,000 additional for this program will certainly pay off in a tremendous way. I hope you will take that under careful consideration. Thank you.

Mr. NATCHER. Thank you very much. We appreciate your appearing before our committee.

FRIDAY, MAY 16, 1969.

PROPOSAL FOR A MECHANICAL HEART COMMISSION

WITNESS

DR. WOLCOTT E. STEWART, HUBRIS HEART RESEARCH

Mr. NATCHER. Our next witness is Dr. Wolcott E. Stewart. Dr. Stewart, it is a pleasure to have you appear before our committee and we will be pleased to hear from you at this time.

Dr. STEWART. Congressman, I will not read the complete text I have prepared but will summarize in the interest of time.

(Prepared statement follows:)

STATEMENT OF WOLCOTT E. STEWART, PH. D., PRESIDENT, HUBRIS
HEART RESEARCH, INC.

The U.S. Government needs a mechanical heart commission to lead an intragovernment research effort to the development of the total artificial heart. At the present time, it appears we do not have, within our Government, a single fulltime research doctor or scientist pursuing this goal. Yet, the mechanical heart promises to be a life-saving device for millions.

More than half of us face a cardiovascular death. There will be 11⁄21⁄2 million heart attacks this year. Forty percent will be fatal. Three hundred thousand victims will be under 65 years of age. Eighty thousand of these will be within the Nation's hospitals at the time of death. The medical community agrees that a high percentage of these victims could be treated with a total mechanical heart. Further, by using the artificial heart in advanced research projects we can make great strides in understanding circulation physiology and pathology. From this will evolve sounder medical practice and hopefully preventive medicine. A section of the intragovernment research team proposed for the mechanical heart