It maintained, however, that its basic orientation was "toward cooperative health programs with the States" and that it was "not oriented toward the broader problems associated with the conservation of waters for public water supplies, propagation of fish and aquatic life and wildlife, recreational purposes, agricultural, industrial and other uses." (Senate Report No. 556, 88th Congress, 1st Session) The Water Quality Act also establishes an additional position of Assistant Secretary to assist the Secretary in carrying out his responsibilities under the new law. This action was in recognition of the fact that the Department of Health, Education, and Welfare is second only to the Department of Defense in the complexity of its program responsibilities, and fifth in size in number of personnel. The Assistant Secretary designated to oversee the water pollution control program will have the assistance of an Administration head, to be appointed by the Secretary of the Department. Among other provisions, the Act directs that the Surgeon General shall be consulted by the Administration head on public health aspects of water pollution. The stated purpose of the Act is to enhance the quality and value of our water resources and to establish a national policy for the prevention, control, and abatement of water pollution. But this bill alone will not, as President Johnson said in signing it, "assure us of absolute success. Additional bolder legislation will be needed in the years ahead. But we have begun. And we have begun in the best American tradition--with a program of joint Federal, State, and local action...Much of the money, and some of the imagination, much of the effort, must be generated at the local level. Then, and really only then, will this blueprint for victory become victory in fact." Water pollution is in a very real sense a matter of national concern. The problem is of such magnitude that it can be dealt with effectively only if there is cooperative and coordinated effort at all three levels of government--Federal, State and local. This concept was given recognition in the Federal Water Pollution Control Act of 1961. The Water Quality Act of 1965 now provides the means to launch a national program to prevent water pollution at its source, as well as to halt the spread of pollution and clean up the Nation's rivers and waters. Wilbur J. Cohen THE HEART DISEASE, CANCER, AND STROKE AMENDMENTS OF 1965 (P.L. 89-239) Karl D. Yordy and Jane E. Fullarton Passage of the Heart Disease, Cancer, and Stroke Amendments of 1965 (P.L. 89-239) marks the launching of a major assault on the Nation's three major killing diseases: heart disease, cancer, and stroke. The Amendments, signed into law by President Johnson on October 6, 1965, implement the major recommendations of the 1964 Presidential Commission to study the problems and recommend means to achieve significant advances in the prevention, diagnosis, and treatment of these three disease groups which today exact such a staggering toll of human life and suffering. In 1963, heart disease, cancer, and stroke accounted for 71 percent of all deaths in the United States, causing nearly 14 million deaths in that year alone. The principal purpose of the new program is to provide the medical profession and medical institutions of the Nation greater opportunity to make available to their patients the latest advances in the diagnosis and treatment of heart disease, cancer, stroke, and related diseases. This is to be accomplished through the establishment of regional programs of cooperation in research, training, continuing education, and demonstration activities in patient care among medical schools, clinical research institutions, and hospitals. Provisions of the Bill To accomplish these goals, P.L. 89-239 authorizes a three-year, $340 million program of grants for the planning and establishment of regional medical programs. These grants would provide support for cooperative arrangements which would link major medical centers--usually consisting of a medical school and affiliated teaching hospitals--with clinical research centers, local community hospitals, and practicing physicians of the Nation. Grants will be made for planning and for feasibility studies, as well as for pilot projects to demonstrate the value of these cooperative regional arrangements and to provide a base of experience for further development of the program. The objectives of the legislation are to be carried out in cooperation with practicing physicians, medical center officials, hospital administrators, and representatives from appropriate voluntary health agencies, and without interference with patterns or the methods of financing of patient care, or Mr. Yordy is a Branch Chief and Miss Fullarton is a Legislative Analyst on his Staff, Office of Program Planning, National Institutes of Health, Public Health Service, U.S. Department of Health, Education, and Welfare. 31 Health, Education, and Welfare Indicators, Nov. 1965 REMARKS BY PRESIDENT JOHNSON UPON SIGNING THE HEART DISEASE, CANCER, AND STROKE AMENDMENTS OF 1965 October 6, 1965 Before this year is gone, over a million productive citizens will have been killed by three murderous diseases. Seven out of ten Americans who lose their lives this year will be the victims of heart disease or cancer or stroke. Now these are not dry statistics; these are deadly facts whose anguish touches every single family in this land of ours. This year, in this Nation at least twenty-five million people are going to be crippled by heart ailment. More than two million citizens are survivors of stroke. The economic cost of this death and disease is staggering beyond one's imagination; an estimated 45 billion dollars last year alone; more than $4 billion annually just in direct medical expenses. And the cost in human agony is far too great to ever tell. With these grim facts in mind I appointed a commission to recommend national action to reduce the toll of these killer diseases. ... One of the world's great surgeons and teachers, Dr. Michael Debakey of Houston, Texas, headed this commission. Their report last December set forth a series of extremely bold and daring proposals the seeds which will grow and flower into a much healthier America. And then the careful deliberation of both committees of both Houses produced this measure Heart Disease, Cancer and Stroke Measure of 1965. Its goal is simple: to speed the miracles of medical research from the laboratory to the bedside. Our method of reaching that goal is simple, too. Through grants to establish regional programs among our medical schools, clinical research institutes, we will unite our Nation's health resources. We will speed communication between the researcher and the student and the practicing physician. Our Nation desperately now needs more medical personnel. Under this Act, we will make the best use of existing medical personnel in these critical diseases, and then we will start improving the training of these specialists. Our Nation desperately needs better medical facilities and better equipment, and under this program we will get them and we will use them to help the victims of these killer diseases. - Our Nation desperately needs to help physicians and health personnel continue their education, and this Act will make that help possible. We cannot close the dark corridor of pain through which sufferers must pass. But we can do all that is humanly possible to increase the knowledge about these diseases to lessen the suffering and to reduce the waste of human lives. - It has been written: "Men who are occupied in the restoration of health to other men are above all the great of the earth. They even partake of divinity, since to preserve and renew is almost as noble as to create." professional practice, or with the administration of hospitals. this cooperation, the grant applicant must designate an advisory group to advise the applicant together with the participating institutions, in formulating and carrying out the plan for the establishment and operation of that regional medical program. The legislation authorizes appropriations for $50 million for FY 1966, $90 million for FY 1967, and $200 million for FY 1968, the funds for each fiscal year to remain available until the end of the following fiscal year as well. Grants may be made to pay all or part of the cost of the planning and other activities related to establishment of the regional medical programs. Funds for renovations and built-in equipment, however, may not exceed 90 percent of the cost. The National Advisory Council on Regional Medical Programs will be appointed to advise and assist the Surgeon General in the formulation of policy and regulations regarding the regional medical programs, and to make recommendations to him concerning approval of applications and amounts of grant awards. The Council will consist of the Surgeon General as Chairman, and twelve leaders in the fundamental sciences, the medical sciences, or public affairs. In particular, one of the twelve council members must be outstanding in the field of heart disease, one in cancer, and another in stroke, and two must be practicing physicians. To assist physicians and other interested persons, the Surgeon General must establish and maintain a current list of facilities in the United States equipped and staffed to provide the most advanced methods and techniques in the diagnosis and treatment of heart disease, cancer, and stroke. The Surgeon General may also maintain a record of the advanced specialty training available in these institutions, along with other information he deems necessary. In order to make this information as useful as possible, the legislation requires the Surgeon General to consult with interested national professional organizations. The Surgeon General is also required to make a report to the President and the Congress by June 30, 1967. In addition to recounting the activities carried out as a result of this legislation, the report must analyze the effectiveness of the activities in meeting the stated objective of the regional medical programs, as well as recommendations for extension and modification of this important program. Background In his Special Health Message to the Congress in February 1964, the President stated, "I am establishing a Commission on Heart Disease, Cancer, and Stroke to recommend steps to reduce the incidence of these diseases through new knowledge and more complete utilization of the medical knowledge we already have." When the Commission was convened at the White House in April, the President said, "Unless we do better, two-thirds of all Americans now living will suffer or die from cancer, heart disease, or stroke. I expect you to do something about it." With this mandate, the Commission set about to determine what could be done. The Commission heard testimony from scores of leaders in medicine and public affairs. Its overwhelming conclusion was that something could and must be done to reduce the deaths and disability caused by heart disease, cancer, and stroke. The Commission cited the many advances in diagnostic and therapeutic techniques made possible by the rapid progress of medical science. Further progress can be expected through exploitation of the results of the greatly expanded medical research effort. The testimony of leading medical experts convinced the Commission that the toll of these diseases could be reduced significantly if the latest medical advances already developed or developed in the future through extended research opportunities could be made more widely available to our citizens. They believed that there was danger of an increasing gap between the diagnostic and therapeutic capabilities found in the major medical centers--where an effective interplay between research, teaching, and patient care can bring rapid and effective application of new medical knowledge--and the medical capabilities available more widely in the communities. The Commission recognized that the complexities of modern techniques in the fields of heart disease, cancer, and stroke make more difficult the task of making these techniques available to more disease victims. Believing that the medical resources of this Nation were equal to this challenge if given the necessary assistance and encouragement, the Commission presented a series of recommendations aimed at reducing the toll of these diseases through the development of more effective means of bringing the latest medical advances to the benefit of more people and through the provision of additional opportunities for research. The major recommendations of the Commission are the basis for the proposed regional medical programs authorized by P.L. 89-239. Legislative History President Johnson's first legislative message to the 89th Congress sent on January 7, 1965, called for a broad health-care program, including regional medical complexes to combat heart disease, cancer, stroke, and other major illnesses. On January 19, companion administration bills-S. 596 and H.R. 3140--were introduced in the Senate by Senator Lester Hill and in the House by Representative Oren Harris, giving concrete, legislative form to the President's proposals. The bills were submitted to the Committee on Labor and Public Welfare in the Senate and the Committee on Interstate and Foreign Commerce in the House. After being reported with amendments by the respective committees, and further floor amendments in the House, the Senate passed the bill on June 28, 1965, and the House passed it on September 24, 1965. The Senate-passed bill stayed closer to the original Administration bill than did the House-passed bill. The House-passed version provided for appropriation of specific amounts for fiscal years 1966, 1967, and 1968. The Senate bill included funds for fiscal 1969. The House bill provided for planning, conducting feasibility studies, and operation of pilot projects for establishment of regional medical programs. A regional medical program was defined as a cooperative arrangement |