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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 Missouri, 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 and, hopefully, thereafter in either New York City or Boston, depending 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 check 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 later 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 time 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 research assistant for the committee, Mr. Loren Walters, who will be seated 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 Govcrnment 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 such 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 who have reason to want to you 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.

I will point out for the information of all that the House has expended already for 3 years a total authorization of $370 million for the Allied Health Professions Training Act.

Also in July or in early August, the House passed the National Science Foundation Act, at another $537 million in new budget authority. Not all of that was the medical profession, but very likely, well, certainly 25 percent and probably as much as 35 percent was for health care.

At the end of June we were able to pass over the President's veto the $2.9 million Medical Facilities Construction and Modernization Act. That is Hill-Burton, in essence. I distinctly recall that when the time came for that vote, we got on what some of our colleagues call the horn-and talked with some who are interested in this program. We tried to reach Nate. We were able to reach Homer, and called our school over in the northeast part of town, Kansas City College of Osteopathy and Surgery. It is always a difficult decision when you come to the point of overriding a veto. There was no doubt but what it should have been overridden. We found at that time that Hill-Burton in its history has served almost 4,000 communities, and it has helped to a total of almost $12 billion, $11.6 billion in construction of hospital facilities over the years.

Also in early July, the House passed the HEW bill. We got by without a veto on that one, a $1.2 billion for general health services, mental health administration, and about $1.5 billion for other health, including NIH for the first time. Some of you may not have been knowledgeable, but we went into not only cancer, heart disease, stroke, dental problems, arthritic, and neurological, but the Institute at NIH was certainly an innovation for the first time.

Senator, and those who are on the distinguished list of witnesses, the really sorrowful and almost saddening aspect of overriding the veto, we had the votes to do it. The House has faced already this year four vetoes, the Senate faced up to at least two, have two in the offing, and have one left. After we were able to override the veto, we still did not have the votes as far as the Hill-Burton, that is, the medical facilities to fund the program, and that is what it is all about here this morning, whether we have the votes for the funding.

All of us have a list of priorities, and I am sure that for those two Members of the Congress who are here this morning, health care is at the very top of that list.

Senator, on our side, and not representing the inner city but the suburbs and the counties that go as far south nearly to Joplin, and out east to Sedalia and Marshall, a total of 14 counties in west central Missouri, as long as we happen to be a Member, we will continue to cast our vote for more money for the very important area that you are talking about here, because with all the brick and mortar and with all the other talks about insurance and the Kennedy bill, and on our side the Martha Griffith concept, it is going to be meaningless unless we have the manpower to fill the vacuum.

The startling thing about it all, and I am sure it will be developed, will be the almost unbelievable statistics that can be shown of the needs for medical manpower by the year 2000.

Thank you very much.

Senator EAGLETON. Thank you, Congressman Randall. We appreciate it. We know you are on a tight schedule. We are pleased you had the opportunity to be with us.

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