understanding by one person of another. They are very deep, very pervasive, and no one Federal program, however honorably motí vated, is going to wipe it off by the printing of the statute and the gning of it by the President of the United States. It is too deep. It does not lend itself to any simple statute that just makes all the past

evaporate.

Dr. PEPPER. I truly believe that partnerships at the local level have to be part of the prescription for change.

Senator, I want to thank you again, and on behalf of our colleagues, thank you and the committee for all your work. We urge you to continue these kinds of hearings and, if possible at all in the future, to extend them to include not only professional groups but take the case to the people and talk to consumers as well.

Senator EAGLETON. That is a pretty good idea.

Thank you, Doctor.

Dr. Pepper's prepared statement may be found on p. 758.) Serator EAGLETON. Well, ladies and gentlemen, let me say in brief emmary, we have had eight and a half hours of hearings, 25 witnesses,

my reckoning. It is not the quantity that counts, it is the quality. Based on previous records that I have read and that I know my staff has read on this question of health manpower, this is the best testimony on the subject matter that I think has been assembled to date. We hope it is equally as good in Kansas City and, more importantly, this doesn't go for naught.

This isn't just for the purpose of compiling another printed book and putting it on somebody's shelf. The question of reorganization of health care, what to do with it, how to keep up with it, how to improve it, is an idea whose time has come, and it is no longer going to be just the debating topic at medical conventions or debating topic at political conventions for a plank to be put in the platform. The demands of the country are such that Congress, for better or for worse, properly or improperly, is going to have to take some action.

The purpose of these hearings is to try to find out which is the proper way to go. We are going to go, we are going to move, because we are being pushed that hard, that the system is about to break. Unless we have the advice of people such as the 25 witnesses today, we will undoubtedly make mistakes. Even with their advice we will probably make some. Maybe we will keep them to a level of tolerability and acceptability.

My thanks to all who have participated, and my special thanks to the officials and Mr. Jackson, who is still with us, and Father Drummond of St. Louis University, who have been so courteous to us, both for the facilities and for the fine lunch.

The subcommittee is adjourned.

(Whereupon, at 6:30 p.m., the hearing was adjourned, to reconvene September 4 in Kansas City, Mo.)

HEALTH MANPOWER, 1970

FRIDAY, SEPTEMBER 4, 1970

U.S. SENATE,

SUBCOMMITTEE ON HEALTH, OF THE

SENATE COMMITTEE ON LABOR AND PUBLIC WELFARE,

Kansas City, Mo.

The subcommittee met, pursuant to call, at 9:30 a.m., in the faculty lounge of the University of Missouri, Kansas City, School of Dentistry, Kansas City, Mo., Senator Thomas F. Eagleton of Miswr, presiding pro tempore.

Present: Senator Eagleton of Missouri.

Committee staff present: James J. Murphy, Committee counsel; and Loren Walters, research assistant for the subcommittee.

Senator EAGLETON. Good morning, ladies and gentlemen.

The Subcommittee on Health of the Senate Labor and Public Welfare Committee is now in session to continue its hearings with respect to health manpower.

This set of hearings began in St. Louis, Mo., on Wednesday of this week. This is the second installment of these hearings. Hearings will continue later on in perhaps the month of October in Washington ard, hopefully, thereafter in either New York City or Boston, dependg on which is the more propitious locale for witnesses we seek to hear.

First, I would like to dispose of some housekeeping chores and important ones at that.

We found in our St. Louis hearings that we had difficulty keeping on schedule. This is an important subject. It is at times a complicated one. We know it does not always lend itself to brevity. However, in fairness to all the witnesses who will be heard today, we have revised the witness list. If there are any witnesses in the audience, you can heck this list that appears as follows (indicating), and we are going to try to adhere to the schedule as spelled out on this list. We know we will lose a few minutes here and there, but, as best we can, we are going to try to adhere to this. These hearings must adjourn, so far as I am concerned and others who have other travel commitments, no ater than 3 o'clock this afternoon.

We will not recess for lunch other than maybe for a few minutes to grab a sandwich or something like that, so as to afford maximum t.me to the witnesses.

Finally, to my left is James J. Murphy, a staff member of the Senate Labor and Public Welfare Committee.

And another gentleman, who has momentarily left the room, is a rearch assistant for the committee, Mr. Loren Walters, who will be ated to my right during the process of the hearing.

I would like now to make an opening statement to set the tone or the backdrop for the hearings that we have been and are now conducting before calling our first witness, who will be Congressman William Randall.

Frequently we hear it said that there is a crisis in health care in this country. By definition, a crisis is a turning point, things are either going to improve or they will deteriorate. In short, it is a point at which change is inevitable.

The course of change in health care will be greatly affected by Federal legislation in this area. Many concerned individuals have voiced suggestions for the restructuring of existing Federal medical programs, Medicare, Medicaid, the Health Professions Education Assistance Act, and so forth. Most recently, Senator Edward Kennedy and 14 other Senators introduced a far-reaching proposal for a national health insurance system.

The Kennedy bill is one of the most sweeping, thoroughly researched programs for improving health care we have seen. It addresses itself not only to the question of financing adequate care for all of us, but also to correcting many of the inefficiencies which plague our present system for delivering health care.

The Kennedy proposal will undoubtedly be hotly debated in months and years to come. Its enactment is by no means a certainty. What is certain is that our health care system will not stand still while this bill is being considered.

It is equally certain that the most ingenious plan, the most elaborate mechanism, the most refined blueprint, will be of little value without an adequate supply of trained health manpower to implement it. There will be no significant improvement-indeed, deterioration is the more likely prospect-if we fail to increase the numbers of health personnel in the United States. This is doubly true if any existing educational institution for the health professions should be forced to close for lack of funds.

Today's hearings are designed to focus attention on the manpower problem and to obtain information relating to it.

Despite some differences among the experts, there is general agreement that we need something in the neighborhood of 50,000 doctors, 9,000 dentists, and 150,000 nurses. It is impossible to document the need for allied health personnel since, as yet, we have not even established the possible scope of their use.

How are we going to begin to meet these needs? How much Government assistance is going to be required and, perhaps of even greater importance, what kind of assistance should that be? What is the proper role for all levels of government, local and State as well as Federal? Will graduating more doctors, dentists, nurses, and other personnel answer the problem or must we also examine the manner in which their services will be employed? What should we do to alter the distribution of these trained people so that not only residents of the suburbs but also those in the inner city and in rural areas can receive the advantages of better health care?

What is the value to the community of a medical center, with all of its related institutions, and what should be the role of the medical center in promoting improvements in the delivery of health care?

How do we induce doctors to better utilize their time and talent by making use of the services of paramedical personnel to handle those procedures within the competence of subprofessionals that now consume so much of the doctor's time?

Health manpower-numbers, distribution, better utilization-that is our subject.

I repeat, this is a subject of national importance, the indispensable Prerequisite to any health care program, private or public.

Without any further ado, I would like to call for such remarks and -h presentation as he desires to make, the Honorable William Randall, Congressman, U.S. House of Representatives, from the Fourth Congressional District, Jackson County and adjacent counties thereto. Congressman Randall.

STATEMENT OF HON. WILLIAM RANDALL, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF MISSOURI

Congressman RANDALL. Thank you, Tom.

Let us make that 14 counties.

I appreciate the opportunity to make this very brief comment. We are going to try to pay our respects in a few minutes to a very distinguished citizen of this community, and I will ask to be excused after a few brief remarks.

I want to voice a thought that I know will be shared by all of you who are witnesses. There is a very distinguished list of witnesses, and I wish to express our appreciation and gratitude for the junior Senator of Missouri coming into the area and providing a forum for this kind of opportunity to present these facts.

I think before we proceed, also, there should be a special salute to two who will be witnesses, very distinguished witnesses, and I see them in the press section or just back of the press section, not only for what they have done and I refer to Nate Stark and to Homer Wadsworthbut for their plans which we know are in the offing so far as the new teaching hospital here, the new University of Missouri-Kansas City Hospital. I think, without reservation and without fear of being in error as time will go on, we will find that the new methods of this school, the innovations, will be, I say again without doubt, a trailblazer. It will set the pace nationwide for many new things. This is a very exciting point that we are here in terms of time for these hearings.

Tom, our side of the Congress, and we like to think there are two sides to the Congress, had quite considerable debate back in June and July while the other body was engaged in such things as some of our Supreme Court confrontations and sundry defense matters. In any event, there was quite a lengthy debate as to the need for medical manpower. I remember, those of you who have reason to want to corral these facts, you can find them in the debate on the House side, particularly in the Interstate and Foreign Commerce Committee.

Your purpose here, you are going to cover the Kansas City area and the Missouri area, and then you are going to New York, as you suggested.