WEDNESDAY, SEPTEMBER 2, 1970 U.S. SENATE, SUBCOMMITTEE ON HEALTH OF THE LABOR AND PUBLIC WELFARE COMMITTEE, St. Louis, Mo. committee met, pursuant to call, at 10 a.m., in Miller Hall, Floge Hospital, Senator Thomas F. Eagleton of Missouri ...an) presiding. Pent: Senator Eagleton of Missouri. As present: Senator Symington and Congressman Symington. Staf Lembers present: James J. Murphy, subcommittee counsel; Waters, subcommittee research assistant; and Edward L. Filip stad asstant. ator EAGLETON. Good morning, ladies and gentlemen. I.. meeting of the Senate Subcommittee on Health of the Senate I want to introduce and have identified, for the record, those wow.l be assisting me in this hearing in St. Louis this morning, as one in Kansas City later this week. 1.. I my right, Mr. James J. Murphy, counsel to the subcommittee; xt to Mr. Murphy, Mr. Loren Walters, research assistant for the ...ttee; the other gentleman who was to my left a minute or 10 my assistant here in St. Louis, Mr. Edward Filippine. Aet me say at this juncture- and I will repeat it at the noon hour : at the conclusion of the hearing that any individuals who, ase of the limits of time or the inadequacy of the amount of notice for these hearings, wish to submit a statement to be put in as of the record may do so if they will submit such statement to us art within the next 2 weeks. Sed another way, the record of this hearing here in St. Louis will 1 open for supplemental statements, statistics, appendixes, and se for 2 weeks, I ad now like to make an opening statement to set the background day's hearing. Fretly we hear it said that there is a crisis in health care in ry. By definition a crisis is a turning point; things are either to prove or they will deteriorate. In short, it is a point at ange of some type is inevitable. Ie course of change in health care will be greatly affected by Fel 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 and 9,000 dentists. 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 reeds? 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 Clayton and Webster Groves, but also the inner city and rural Missouri 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 for today. I repeat, this is a subject of national importance-the indispensable prerequisite to any health care program, private or public. As our first witness this morning, I am pleased to call on my senior colleague in the U.S. Senate, a native of the St. Louis area and a man whas served with great distinction in the Senate for 18 years, the Hble Stewart Symington. ator SyMINGTON. Mr. Chairman, I have a prepared statement. May I read it ? Seator EAGLETON. Yes, sir; you may. We would be pleased to have STATEMENT OF HON. STUART SYMINGTON, A U.S. SENATOR FROM THE STATE OF MISSOURI Sator SYMINGTON. Mr. Chairman, I am very grateful for this et por inity to present my views on the subject of education for the ath professions. May I start by commending the wisdom and fegit of you, my distinguished colleague, in not only pointing up eportance of this subject but also searching earnestly for soluto the problems contained therein. It is typical of your deep interest in people. Ie Un ted States spends more than $63 billion a year on the health are industry. Nevertheless, more and more Americans question as to if her we are actually getting our money's worth. Even more critical are the problems which beset millions of our **zers who do not have any adequate medical care at all; namely the r and various minority groups, and those of our citizens who live 'sted and rural areas. I e a: nual national medical bill for each citizen averages out to 44 a person, more than double what it was 10 years ago. This is 6.7 tement of our gross national product which we are spending for health a higher percentage than that of any other country in the world. A year ago President Nixon and his principal health advisers coned that this country faces, and I quote, a "massive crisis" in care. The President added that "unless action is taken both atratively and legislatively to meet that crisis within the next 3 years, we will have a breakdown in our medical care system 4. could have consequences affecting millions of people throughout Sentry.” The evidence strongly supports that conclusion, and the clock con -to run. It is me that the achievements of American medicine have been erstanding, to the point where it is fair to say that this is the best we try in the world in which to have a serious illness, Health statistics, however, show that there is a broad gap between te best medical care this country can offer and the care actually re by a substantial portion of our population. Ispite the very large amounts of money being spent on that care country, not nearly enough funds are being allocated to correct the shortage of medical nianpower or to search for more effective ways tode ver treatment, with costs kept in bounds. Only 20 percent of the current Federal health budget of $20,600 on will be spent to provide more manpower and facilities, imeve the delivery of health services, and develop new knowledge. Most of the money will go for medicaid and medicare. The problem was clearly outlined by Dr. James A. Shannon, former Director of the National Institutes of Health and now professor and special assistant to the president of Rockefeller University. In a recent analysis made for the Subcommittee on Executive Reorganization and Government Research of the Senate Committee on Government Operations, Dr. Shannon stated in part: The critically important shortage of almost all types of health personnel is generally acknowledged. The program proposals contained in the 1971 budget will neither remedy these shortages nor provide for a more equitable distribution of health personnel in the middle range (5 to 10 years) future. Yet it is generally agreed that until the manpower shortages are remedied— Dr. Shannon continued it will be difficult to contain rising health costs and, at the same time, provide for the delivery of more effective health services *** If appropriate actions are not taken at this time and programs are not modified accordingly He concluded even further deterioration of the health care system will most surely and rapidly ensue. Mr. Chairman, at a time when there is an urgent need to expand our health manpower, we find that many of the medical schools in this country are already in serious financial straits. This is particularly true here in Missouri in the case of the St. Louis University School of Medicine. Dr. John Cooper, president of the Association of American Medical Colleges, told the Senate recently that the perilous financial structure of our medical schools has reached such a degree of instability that the whole structure was gravely threatened, particularly in the case of private schools. The latter constitute about half of all the medical schools in this country. So we see that at least one important part of the grave problem, Mr. Chairman, is being considered by you today, and is readily susceptible to analysis. The Government simply does not provide adequate funds to meet health manpower needs; and, judging by this administration's proposed budget, it does not intend to do so. A Federal grant was announced recently to help construct the proposed University of Missouri-Kansas City School of Medicine. This grant was aimed at correcting Missouri's deficit of 100 new doctors a year. No grant has been forthcoming to help build the teaching hospital, which would be vitally important to the effectiveness of any new school; and the medical school grant came out of a national backlog of more than $300 million in fund requests for new medical schools which have been recommended, but for which money has not been made available. More money is not only needed to pay for new teaching facilities; it is needed also to restore the financial health of existing facilities. Federal research grants make up a significant portion of the income of medical schools, and the low level of Federal grants in the past year, as well as in the proposed budget, combined with rising costs, has been a severe blow to many of these schools. More money for student support is also needed if medicine is not to become a profession that only the rich can afford to enter. Middleincome students are now having increasing trouble financing their education, and qualified low-income students need more support if we are to a leve any significantly greater representation of the various Forty groups in the health professions. 4 It is clear, therefore, that far greater financial support will be red if we are to make any progress in meeting the current shortof medical personnel. That shortage is now estimated at nearly physicians and several hundred thousand nurses and technicians. 1 other parts of this problem are less susceptible to quick analysis. example, it requires up to 10 years to train a doctor and, even if se enrollments now, we are faced with a continuing shortage most of the coming decade. sposes another question: How do we best cope with such a Perhaps one logical answer is to adopt more innovative d of increasing the efficiency of the doctors we have, making p--- ble for them to treat more people more effectively; in other ds, inprove the system through which medical care is delivered reasing physician productivity. Many of us in the Congress have worked and continue to work to e adequate funds to meet the health needs of the country, but obviously only part of the answer. The other part has to do ", the responsibility of the health professions themselves to develop shopt new methods so as to increase the efficiency and productivity e system. Iave, of course, to the able and distinguished doctors who are ed to testify before your subcommittee, Mr. Chairman, any etals about how the operation of present physicians could be more eftive, and would be interested in their views on such approaches a group practice, health care teams using paramedical personnel, 1'e use of new technques involving computers and other electronic Another aspect of the shortage of health personnel all around the 1ted States is the uneven geographical distribution of the people me tow have in those professions, a shortage most acute in urban end rural poverty areas. Some means must be found to motivate more »tors and dentists to practice in such areas. One proposal in the ste whch would certainly appear to have merit would provide for total cancellation of indebtedness on health professions loans after ars practice in such areas by the loan recipient. Inovations in curriculum are also proposed to help bridge this as obvious gap in medical personnel. To that end, for example, Murman, the new University of Missouri-Kansas City School Moscane plans to offer a full premedical and medical curriculum years instead of the usual eight by the method of operating on ger 4-week school year. 1.g. Mr. Chairman, the leadership role which medical schools I'd exercise in their communities is well illustrated by some of panning for the Kansas City school. That school intends to work with the Kansas City model cities program and the OEO borhood health center, as well as other local medical facilities, at students receive experience in the entire range of community Let me express confidence that Americans can and will meet the verge of providing adequate health care for all of our citizens, 1 a omplish that goal, however, will require the joint efforts of |